Judy Lightstone, clinician and researcher on eating disorders in the San Francisco Bay Area states, "The therapist must be aware of the role of dissociation in eating disorders." 1 I, too, believe the symptoms of eating disorders are a form of Dissociative Identity Disorder where the self splits into parts for emotional survival. People with eating disorders invariably have experienced significantly difficult or traumatic childhoods and teens.

I coined the term "Mild Multiplicity" to describe dissociation in eating disorders.3  "Mild" indicates that this type of dissociation is a less severe form of the condition.                                

Mild Multiplicity                                                                                      
Normally, we all have different parts of the self acting somewhat independently, depending on the situation. We dress, act, and feel differently at home and at work, with relatives or with strangers. The extreme form of Dissociative Identity Disorder is defined in the DSM IV: "Each personality state may be experienced as if it has a distinct personal history, self-image, and identity…”.4

Mild Multiplicity falls in between the bounds of normalcy and extreme dissociative disorder. On a scale from one to ten, a normal level of compartmentalization is a one. The DSM definition is a ten. Mild Multiplicity is from a six to an eight on the continuum.
 
With Mild Multiplicity, the dissociation is generally restricted to eating disorder behaviors; the person is unable to stop the parts of the self acting out by yo-yo dieting, fasting, bingeing, compulsive overeating, or purging.  Apart from the eating disorder beliefs and behaviors, an executive-self provides continuity of personality, behavior, and emotion, managing life’s tasks fairly well. Relationships are usually problematic.                                                                   

Freud and Eric Berne
The idea of separate aspects of the self is not new. Freud, in his formulation of Id, Ego, and Superego, established that the human psyche is multi-faceted. Erik Berne’s theory of Transactional Analysis adapted Freud's divisions of personality.5 The Id becomes the Inner Child, (Natural and Adapted) Ego is the Adult, and Superego is the Parent (Good or Critical). These systems of thought, feeling, and behavior are warring factions in the unconscious, especially in eating disorder patients.                                                                                                                        

The Parts in Mild Multiplicity
Although sometimes criticized as simplistic, Berne's formulation of the introjected Child, Adult and Parent Parts is a useful and easily accessible theoretical base to describe dissociation in eating disorders. This is incorporated into my definition of Mild Multiplicity.                                 

Child Parts in Mild Multiplicity
With an eating disorder, the Natural Child, expressive and joyful, hides away while the Adapted Child acts out with dysfunctional eating behaviors and negativity towards the body (Body Dysmorphic Disorder).

Adult Part in Mild Multiplicity
This is usually highly developed and extremely functional. People with eating disorders are typically intelligent and resourceful, and have unconsciously chosen the route of dissociation for survival. Injunctions from doctors and diet organizations are ineffectual long-term, however, since the well-disciplined and rational Adult has vanished, replaced by the emotionally hungry Adapted Child who rejects each diet.                      

Parent Parts in Mild Multiplicity                                                                       
The Critical Parent is a harshly negative self-concept. Self-hatred is projected onto the body. "Fat, fat, FAT! You're nothing but a fat pig," one patient constantly said to herself, even though she was no more than fifteen pounds above the norm for her height.

The Good Parent and Natural Child are undeveloped – often non-existent – in Mild Multiplicity                                                                                                        
The Hidden Ones                                                                                         
In working with eating disorders, I found far more hidden, unconscious Parts than the five Berne describes. They reflect:    
    Roles in the family of origin
    A difficult or traumatic childhood
    Unconscious ideas and beliefs
    Patterns of thought and behavior, especially around food and the body
    The emotional state at a certain age
    Reactions to experiences or people
    Various emotions, states of mind, or moods

The Parts are divided into the Challenging and the Affirmative Parts. Unfortunately, people suffering from eating disorders are governed by the Challenging Parts. The rational, nurturing, joyous, and creative Affirmative Parts can restore balance and health.

Naming a Part gives a handle to grab onto when it pops up unexpectedly and is followed by plunging into the knee-jerk, negative activity with food. Naming is the first step in allowing the disassociated Parts to emerge to conscious awareness.
    
Here are examples of named Parts that my patients and I have discovered and personalized  over the years: the Challenging Parts that cause dysfunctional eating, and the healing, encouraging Affirmative Parts.

Challenging Parts
Conditioned Children:Hungry Baby, Black Hole, War Zone Child, Goody Two Shoes, Pirate, Rebel, E.T., Child in the Well
Critical Parents: Slave Driver, Helpless Heap, Mad Monkey Mind, Daggers
Monsters: Binge Monster, Two-headed Green Dragon

Affirmative Parts
Adults: Rationalist, Mover and Shaker, Ms. Competence, Problem-solver, Natural Children, Explorer, Cuddles, Happy-go-lucky, Good Parents, Earth Mother, Wounded Healer, Warrior Knight, Higher Beings Angel Michaela, Yoda, White Light

The steps in managing the Parts are naming, accepting, and feeling compassion for them, dialoguing with them, strengthening the Affirmative Parts, and finally, integrating all the Parts.

Bringing the Parts to consciousness remedies the dissociation. This heals the alienation and inner hunger of an eating disorder, promoting a connection with passion, joy, and meaning in life.


Notes

1. Lightstone, Judy. (2005) Healing Intractable Eating Disorders. Home study course, p.23.

2. Something Fishy (2006) Website on eating disorders: Exploring the Role that Abuse Plays in the Development of an Eating Disorder.                                                                  

3. Kobrin, Shoshana. (2012) The Satisfied Soul: Transforming your Food and Weight Worries. Bloomington, IA: AuthorHouse.

4. American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, page 484. Washington D.C.

5. Berne, Erik. (1964) Games people play: The Basic Handbook of Transactional Analysis. New York: Ballantine Books.


Shoshana Kobrin LMFT, has a psychotherapy practice in Walnut Creek, specializing in eating disorders. She gives workshops, presentations, and trainings for professionals and the community. She’s the author of The Satisfied Soul GuideBook: Your Path to Transformation and The Satisfied Soul: Transforming Your Food and Weight Worries
To contact her: (925) 256-8503 shoshanakobrin@sbcglobal.net
www.shoshanakobrin.net  www.kobrinkreations.com


Shoshana will present a CEU Presentation with EBCAMFT on March 9 at Epworth United Methodist Church in Berkeley. Please check our Events section for more details.