Is "Eating Disorder Projection" Real?

The New York Times Consults blog answers an odd question today — whether someone with an eating disorder will sometimes try to keep a spouse fat.

Actually, it’s not exactly a question. “Erik” writes,

Back 40 years ago I was married to a woman who secretly threw up after almost every dinner. (I didn’t know to call it bulimia back then, but I knew about it.) Oddly, she insisted that I eat heaping meals with her even though I was not bulimic. […]

[T]he curious thing was, back then, that while my wife was trying to get or stay thin by vomiting, she was trying to keep me fat. As she would tell me, “Don’t worry about your weight. I’ve got it under control.” That was the issue.

Consults’s Dr. Katherine Zerbe answers,

I imagine that your wife wanted to be the thin one in the relationship and disavow any chance of becoming overweight. You were indeed compensating for your wife’s unconscious wishes to eat and yet stay thin at the same time by being the one who ate. In comparison to you, she could feel even better about herself for being the “thin one.”

Though Zerbe did note that “This is just an educated guess, though. A therapist could figure this out only in an in-depth couples or individual therapy process,” her response still rubbed me the wrong way. Why did she choose to answer a question she could only provide a guess on — and one that, for that matter, seemed more like a bit of ex-bashing than an actual inquiry? Why did Erik decide to talk about this 40 years after the fact? And most of all, why didn’t Zerbe challenge his assumption that his wife’s eating disorder was all about control? She had a better response last summer to another armchair psychiatrist who claimed to have discovered that people with bulimia “have such a high sense of competitiveness that if a friend experiences something good or neutral, the bulimic suffers, what looks like, physical pain.” Zerbe wrote,

Eating disorders are tough illnesses to treat because there are genetic, biochemical, cultural and individual psychological factors involved in getting them started and keeping them going. […] However, it is also important for some people to listen to the struggles of others who have had the problem and see how the role of culture, family and individual conflict and loss impact the problem.

This response is more nuanced and holistic than what Zerbe told Erik, but just because his letter is somewhat distasteful doesn’t mean his experience is entirely false. Some people with eating disorders do become obsessed with cooking for others, and it’s possible that someone could project aspects of bulimia by trying to “keep a spouse fat.” There’s actually surprisingly little information available online for the spouses of eating disorder sufferers — at least in my limited research, I came across some book excerpts, a study finding no benefit from spousal involvement in cognitive-behavioral therapy for binge eating, and another advice column, this one telling a woman with an eating-disordered husband that she’d probably have to divorce him. Erik’s not-so-sensitive letter reveals that spouses as well as sufferers may need help in dealing with eating disorders — whether they’re feeling pressured to overeat or taking fallout in other ways. What they don’t need is what today’s Consults offers: a combination of sour grapes and speculation.