How Eating Disorders Impact Relationships

When anorexia nervosa or bulimia nervosa patients are married or live together with a partner unmarried, the question arises as to what impact an eating disorder has on the relationship with a partner or, alternatively, how an intimate relationship with a partner influences the course of an eating disorder.

Despite valuable implications, the marital relationships of adult eating-disordered patients have not received much attention in the form of empirical research. One of the major impressions emphasized in clinical literature is that married eating disordered patients and their partners often report a significant degree of dissatisfaction with their relationships (Van den Broucke & Vandereycken, 1988).

Marital intimacy is one aspect of a relationship which may be conceived both as a process which includes empathy, (e.g., a characteristic way of relating of two partners), and as a state, (e.g., a relatively stable, structural quality of a relationship which emerges from this process) (Waring, 1988). Van den Broucke, Vandereycken, & Vertommen (1995) see intimacy as a quality of a personal relationship at a certain point in time primarily referring to a relational phenomenon, (e.g., the degree of connectedness or interdependence between two partners). As such it includes affective, cognitive and behavioral aspects. These three types of interdependence are reflected in the couples' emotional closeness, empathy and commitment, the validation of each other's ideas and values, and the implicit or explicit consensus about the rules which guide their interactions (Van den Broucke et al, 1988).

Additionally Van den Broucke, Vandereycken, & Vertommen (1995) suggest that there are two additional levels of intimacy, individual and situational. On an individual level, intimacy implies two aspects, one being authenticity, or the ability to be oneself in the relationship with the partner, and openness, or the readiness to share ideas and feelings with the partner. The situational level entails an aspect of exclusiveness: As the partners' individual privacy decreases with the enhancement of their intimacy, the dyadic privacy is likely to increase. Communication difficulties and the lack of openness in eating disordered patients' marriages were found and considered to be a serious relational deficiency, which may represent an important obstacle to the growth and enhancement of their marital intimacy. The intimacy deficiency of these patients' marriages does not necessarily imply that this deficiency is the cause of the eating disorder but probably more accurately is described as a circular enigma (Van den Broucke et al, 1995).

With empathy holding a key position in the construct of intimacy, Tangney's (1991) research discovering a positive correlation between proneness to guilt and empathetic responsiveness but inversely related to the tendency to experience shame, may provide some insight into the relational difficulties described by Van den Broucke, Vandereycken, & Vertommen (1995). Bateson (1990) defined empathy as including feelings of sympathy and concern, but distinguished empathy/sympathy from personal distress, the latter representing an observer's own feelings of distress in response to a distressed other. This other-oriented empathic concern, not self-oriented personal distress, has been linked to altruistic helping behavior (Bateson, 1988). Other-oriented empathy is generally viewed as the good moral affective capacity or experience because it is presumed to foster warm, close interpersonal relationships, to facilitate altruistic and prosocial behavior, and to inhibit interpersonal aggression (Bateson, 1990). Shame, an ugly feeling, draws the focus away from the distressed other, back to the self. This preoccupation with the self is inconsistent with the other-orientated nature of empathy. When faced with a distressed other, shame-prone individuals may be particularly likely to respond with a personal distress reaction, in lieu of a true empathetic response. The acute pain of shame may motivate a variety of intrapersonal and interpersonal processes that are incompatible with a continued empathic connection. Shame-prone individuals have a tendency to externalize cause or blame, as a defense maneuver against the overwhelming pain of the shame experience, in addition to making internal, global shame-type responses (Tangney, 1990; Tangney, 1991; Tangney, Wagner, Fletcher, & Gramzow, 1992).

While shame involves the self's negative evaluation of the entire self, guilt involves the self's negative evaluation of specific behaviors. Guilt's consequent motivation and behavior tends to be oriented toward reparative action. Guilt seems less likely to motivate the defensive maneuvers, antithetical to empathy, that are frequently associated with shame. Guilt-prone individuals are clearly not disposed to blame external factors or other people for negative events allowing room for empathetic responsiveness (Tangney, 1990, Tangney, 1991; Tangney et al, 1992). Tangney (1991) discovered that individuals who are generally empathic are also prone to feelings of guilt, exclusive of shame. The perspective-taking component of mature empathy requires the ability to make a clear differentiation between self and other. Guilt requires making a clear distinction between self and behavior, an ability to see behaviors as related but somewhat distinct from the self. Both guilt and empathy hinge on a capacity for differentiation, a more mature level of psychological development similar to such constructs as psychological differentiation, ego development, and cognitive complexity (Bateson, 1990; Tangney, 1991; Tangney et al, 1992). Shame-prone individuals may have difficulty maintaining an other-oriented empathic response, and instead may drift into a more self-focused personal distress reaction. They are likely to experience the resonant pain of personal distress as well as the pain of shame for "being the kind of person who would inflict such harm" (Bateson, 1990; Tangney, 1991). This wash of negative affect may be problematic as Berkowitz (1989) has demonstrated, negative affect in general can foster angry, hostile feelings and subsequent aggressive responses.

Consistent links have been found between proneness to shame and anger (Berkowitz, 1989; Tangney et al, 1992). Such anger may be fueled not only by the pain of shame itself, but also by the discomfort inherent in personal distress reaction to distressed others. The unpleasant interpersonal exchange may be so overwhelming that it may motivate a variety of defensive maneuvers that are fostered and reinforced by such anger. Finally, in the midst of a personal distress reaction the shamed individual may subsequently blame the distressed or injured party as a means of reducing their own pain. Thus shame-prone persons bring to their relationships a number of liabilities that may be particularly exacerbated during unpleasant interpersonal exchanges (Berkowitz, 1989; Tangney, 1991; Tangney et al, 1992).

Deborah J. Kuehnel, LCSW, © 1998

next: Myths and Misconceptions About Eating Disorders
~ eating disorders library
~ all articles on eating disorders