Stop gaslighting eating disorder patients (and parents)

Gaslighting = manipulate (someone) by psychological means into questioning their own sanity.

Gaslighting is usually thought of in a domestic abuse setting but also happens in many other settings — including therapy. This sort of behaviour is not limited to eating disorder patients. It’s the story of therapists using their authority, and professional status to convince patients that their opinion is correct and, … basically win arguments — which is unfair, and unprofessional. Gaslighting is psychological abuse..

I have to admit that before I started writing this post I didn’t know that gaslighting was so common among therapists in general. If you Google it, there are whole books on the subject!

Theodore Dorpat defines gaslighting as a situation in which one individual “attempts to exert control over the feelings, thoughts or activities of another.” He writes: “In order to be effective, gaslighting depends on first convincing the victim that his thinking is distorted and secondly persuading him that the victimizer’s ideas are the correct and true ones.”


Here’s an example of institutional gaslighting from someone I know. Not a client, but an acquaintance:

A few years ago I was hospitalised due to electrolyte imbalance. I was very ill. But ‘totally fine’ I thought. I honestly had no idea I had an ed (until recently…). Anyway, my severely ill state, understandably triggered a mandatory process of having to see mental health team. I live rurally and was put into a regional hospital. Consultant and dietitian were brill on reflection, despite the lack of real ed talk. They focused, importantly, on getting me stabilised.

The MH team had no idea at all. They forced me to take antidepressants. They were bullying and accused me of waterloading, making myself sick, hiding food etc. They shouted at me, made me have a monitor person in my room 24/7, yes even when sleeping, someone had to sit by my bed in case I made self sick etc. I have never made myself sick, or waterloaded or any other of the things they accused me of. I’d never heard of waterloading. I was totally honest and wanted to get well.

I was so isolated (hubby traveled two hours daily to visit me). I was stuck in single room with a random person staring at me 24/7. I started believing I was making myself sick I started doubting if I was seeing myself as thin when I was actually bigger, I started thinking I was hiding food. I believed I was going insane. they really really fucked my head and when I considered discharging myself they threatened to section me… They gave me a lot of issues. I remember thinking at the time it was like Milgrams experiment (how nurses and monitors became towards me) and a bit like Rosenhan type experiments where they see what they expect. It disturbed me how compliant I became and I just got so scared and intimidated of them all. I stopped challenging or questioning them. Even when home, for a while, I felt watched and kept reporting to my hubby. I kept thinking they were coming to section me. I know ed can trigger paranoia, but this was totally generated by hospital experience. Being intimidated and obedient to others is not me, if something is wrong I’m usually the first to challenge! They really screwed me up.

 

Making assumptions t0 fit the therapeutic model

Having an eating disorder doesn’t mean that you should be treated like a criminal. It doesn’t mean that all the stereotypical eating disorder behaviours apply either. It most certainly doesn’t mean that the assumption should be made that you were abused as a child. This was the one I got that really vexed me. Those prodding questions, and “knowing looks.” The worst part is that if you try and argue that the child abuse isn’t true they probably assume that you are in denial, or severely repressed. It’s like you can’t argue without being diagnosed with something else. I haven’t been to a therapist, but I did have GPs probing me for potential child abuse, and I felt like my denials that I had never been abused in any way were not listened to. Not properly. I would still be given that “it’s okay, we’ll get the truth out of you soon enough” look that would make me want to scream. And you can bet that had I screamed, that would have been taken as further proof that I had deep repressed trauma. So I didn’t scream, I just skulked out of the doctors office silently fuming and didn’t go back.

I had one client who told me that early on in her illness, when she was 16, a therapist convinced her that she had been abused as a child and that is what caused her eating disorder. She said initially she denied suffering any abuse, but after weeks of prodding she really began to doubt her own memory and the therapist was so insistent that there was something to be found in the past that she began to wonder if she had indeed been abused and it was repressed. She says for a while there she thought she was going nuts, and it caused family tension as her therapist advised her to not discuss with her parents. Thankfully, she says the doubt only stuck with her a week or so before she was able to pull herself back to what she knows to be true: she has a loving family who have never tried to hurt her.

That’s a classic example of a therapist having an idea of what anorexia is, and trying to fit the client into a box. Never mind how psychologically damaging doing so could be for the client and the client’s entire family. Never mind that there is zero evidence or account of abuse of any kind. Never mind that doing so isn’t going to help the client get out of malnutrition or in fact have any positive impact on their illness whatsoever. Never mind any of that, because so long as you find repressed memories you are doing your job, even if you invent them and place them in your clients mind.

That’s really … fucked up.

Alright, so what about using a person’s hunger against them to make them think that they are crazy? A person in malnutrition. A person with a history of restriction. But, rather than encourage this person to eat as their body was requesting, this therapist decided to turn it into a power struggle:

“I asked my therapist if it was okay to eat more if I was hungry and she said that I need to be careful not to binge eat. I tried to start explaining why I didn’t think that I should be made to restrict and she basically sat there, listened, then when I was done took a big deep breath and said in a condescending tone that this was another example of me resisting and rebelling.”

 

One of my clients just described to me this week a conversation she had with a medical professional in the UK. The long and the short was that she was trying to advocate for her right NOT weigh herself in the process of recovery. She’s been through treatment enough times to have experience around what works for her and what doesn’t, and I was actually bloody proud of her for being brave enough to admit that weighing herself becomes an obstacle to weight gain. Power to her! She is acting on what she knows from experience is right for her at the present time — this is what I call taking control and responsibility for ones own recovery. (Just to be clear I my opinion on the subject of knowing one’s weight or not in recovery is that it should be dependent on what is best for the individual.)

The mental health professional, however, disagreed. Perhaps not weighing oneself in recovery is not advised in her textbook. Whatever. My client stood up for herself and stood her ground by insisting that she wanted to try not being weighed because she truly believed it would help her to continue to eat more at this point. The therapist replied with a patronising “would you say this is one of those relationship dynamics you get into?” 

That is a form of gaslighting. The mental health practitioner is using the fact that somebody is a mental health patient as a reason that their opinion should not be considered or listened to. It happens to people with eating disorders all the time. As soon as they disagree with a professional or have an opinion, it’s “the eating disorder talking.” And while in recovery we do need to have our disordered thought and bahaviours challenged, it doesn’t mean that is an excuse to shut people down and not listen.

… being told that I couldn’t be using the behaviors I was reporting because my body was reacting differently to them than the clinicians thought it should – ie reporting that I was binging and purging constantly and being told that that wasn’t possible because I was losing weight and everyone knows that when you purge you only get rid of 1/2 the calories. I literally had to sit down with a team of therapists to discuss why I was lying about my behaviors. And conversely at a different time not being believed about levels of restriction/exercise because my weight was low but stable and similarly being told that I was exaggerating because I wanted more attention. Both instances definitely made me question whether my perception of my behaviors was distorted (spoiler alert: it wasn’t).

I hear many reports of people with eating disorders being told that they are guilty of certain behaviours because “that’s what people with eating disorders do,” and told they are lying when they claim that they are not. This frequently happens with people who are experiencing hypermetabolism, and not gaining weight on the amount of food they have been allotted. They get accused of not eating or purging, even when there is no evidence that is happening. Turns out a lot of the time the problem is that the bloody meal plan is too low.

 

And what about people with eating disorders in larger bodies?

I expect that consistently being told by medical professionals that you don’t actually have an eating disorder at all because your body isn’t statistically underweight is enough to make you think that you are crazy. I imagine that when you are looked at in disbelief and told that you must be eating more than you claim, or told that you actually need to increase your disordered behaviors of restriction, you may begin to question your own sanity.

“Every doctor I have been to has told me to lose weight by eating less and exercising more. Even when I have told them that I heavily restrict the majority of the time and how unhealthy this has made my brain.”

This is from someone talking about a therapist she briefly saw:

I told her that I was no longer willing to engage in disordered behaviors of restriction. She then questioned why and I told her I have an eating disorder. She asked if I had been diagnosed, and what made me think I had an eating disorder. Even after a lengthy explanation from me, she told me that my self-reported symptoms were not valid, and then asked me questions about my childhood and insinuated that my attention seeking via phantom diagnosis was a result of having not been listened to.

 

Parents get gaslighted too

“Our daughter was diagnosed with anorexia at 10 years old. When we went to see a therapist, I handed her the book on FBT, she handed it back and said “ I don’t need to read a book to know you are a bad parent.” The psychiatrist also questioned my husband on the fact that she thought it was strange a ten year old would let her father carry her naked into the shower .( she was too weak to walk and we took turns with the night shift in the hospital.”

Are you fucking kidding me? Firstly, who do you think that you are to judge a parent based on their child having a genetically based illness. Second, a ten year old in hospital and you are going to insinuate child abuse because her father tried to help the nurses bathe her? But I imagine that had her father stayed out of the picture, that would have been construed as obvious neglect? How the heck do parents win with this sort of shit? You’re damned if you do and your damned if you don’t.

There are a plethora of parent stories where a parent of a child with an eating disorder has been gaslighted by a therapist. Called a “helicopter parent” just because they show concern that their child is not eating enough. Been told that their dysfunctional family is what caused the eating disorder. Been rendered so confused and distressed that they start to doubt their parenting skills.

“The family therapist implied that my husband and I argue a lot in front of our daughter and that this could have contributed to her anorexia (I don’t think that we argue a lot at all really) which really confused the both of us, so we kinda didn’t say anything at all for the rest of the session for fear of looking like we were arguing.”

Of course, this does nothing to actually help the child recover. And at worst, can break families.

So we meet the inpatient family therapist
She was highly experienced, we were told, especially  with a lot of years experience with families & patients with mental health issues…

Well,firstly she asked us what had happened to our child, basically,what abuse or trauma had been endured to have brought on this illness. We told her – none, no abuse, no trauma. She told us the illness is about control. Its about eating is the only control the child has, due to being so deeply unhappy according to her.

So she cross questioned us about everything, & I mean everything trying to find something on us.
At this point husband and I were devastated that we “ caused this” , but both of us agreed that all we wanted was our kid to get better,& we would take any abuse and blame from her, just to get through this.

Eventually she came up with really silly stuff, like the rule to save some of the pocket money in the bank, instead of spending it all. She told us we were obviously completely over controlling parents. Our child was made sit in on these sessions with us, as well as having separate sessions with her.

So after 2 or 3 sessions my kid said that enough was enough, that we were being blamed on something that we did not cause ,& on that basis refused to enter a room with her again.

The therapist answer to that, was that our kid was the most difficult kid she ever dealt with.

The woman did nothing but turn my husband and I on each other to blame each other.

Roll on the  clock…That was 3 years ago now.
Luckily, I had already started to EDucate myself.
We have now supported our child ever since discharge,through this illness with FBT at home.
Our kid is in strong recovery, and is doing great at home with our support.
That is with thanks to FEAST / Around The Dinner Table,and also a different  Family therapist & His new Psychologist that we had after discharge.
They were great, a breath of fresh air, they were much more up to date & empowered us.

Unfortunately We are still traumatized from the way we were treated by the family thearpist in the hospital.
We are doing our best to heal, but she really made us question and put cracks in our marriage that are slowly healing. We are working hard on it.
She did much more damage to our family than good.

Yes to disagreeing. Yes to challenging. No to shutting down

Am I saying therapists should not challenge their patients. Hell no!

Challenging someone is one thing. Using their mental health diagnosis against them to close a conversation with a you’re the crazy one so you’re obviously wrong and I’m the therapist so I’m always right is quite another. This is not challenging someone; it is shutting them down. It’s also a pretty nauseating power card that is being played. Not okay. When you shut someone down, that doesn’t mean they are in agreement with you, that means that they have stopped communicating their opinion. And when you gaslight a child’s parents, you are lighting a fire under their entire support system and potentially causing long term damage to that whole family. How can that possibly be helping?

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What do you think?

  1. Not long after my daughter’s diagnosis, that time period where she couldn’t think straight, was weak, suicidal and had newly begun to purge via making herself vomit we went to the only php option in Maine. Her therapist, psychiatrist and I all agreed she needed at least php. We cancelled appts thinking if she wasn’t accepted it would be because she was placed into inpatient, instead. After four hours, when I finally was called in to sit with her and the head dr/psych everything was tossed out. She told my d that her purge count wasn’t much yet and that she was really just dabbling in an eating disorder (the child that had been going through periods of extreme restriction ending them after days in binges, or more recently in the past year or two was over exercising. She thought she was safe, as long as she didn’t vomit it wasn’t ED… once dx’d the vomiting began. She was already so sick we were scared for her life. This psych went ahead and told my child that she wasn’t really that sick or she would be purging more. She told her if she can’t turn it around in a few weeks to come back. When I asked her what exactly was I supposed to do upon taking home my very suicidal child. She said, “You need to learn to trust your gut. You have a mom instinct you’re not using. She isn’t going to kill her self. She then turned to my d and said, “Are you going to kill yourself?” At this point, I thought my d was going to faint between the ed and the full blown anxiety I saw running through her. It took myself and her ‘team’ a lot to get her to see that she had a full blown eating disorder. This one trip invalidated everything Everything we helped her see, everything she felt. Imagine how terrified she was to get up at the wee hours of the morning and not know if she’d be coming home nor for how long only to be told “You’re fine” Unfortunately, my daughter doesn’t fit the BMI guidelines. Her eating disorder caused weight gain. She didn’t fit the picture therefore, we were both crazy, my d was ‘dabbling’ and I needed to learn how to be a mom. (I have a difficult time typing this without using superlatives) As we stood up to leave she went to hand me her card, leaned in and had it almost in my grasp and she pulled it back and said, “No, I’m going to give this to you.” and she handed it to my d (then 16) We got to the elevator, my d handed me the card… I tore it up and home we went.

      • Exactly, gaslighting is manipulation to gain power and it’s too effective of a way to do so. Just this short experience had a damaging effect on our forward motion, because it had us both questioning all we thought we knew.

  2. My experience is similar to your first person’s story. When I went into hospital that time, I didn’t go in with an eating disorder but I sure as hell came out with one, partly driven by the “treatment” I had from the psych team. And I know my parents had experience similar to the last when I was hospitalised then too, accused of all sorts. I’m sad that others have also had this experience too.

  3. I just finished a 2 month day program with a 5 month step down process. I have had some form of eating disorder, generally restricting type, for almost 30 years but this was the first time I’d experienced an intensive treatment program specifically for eating disorders. Due to the long waiting list to start the program (yay Canadian health care) I had already put on some weight with the help of private therapy. ie. my weight was at a “normal” BMI. After my first week, the team lowered my meal plan below what any of the other patients were on. My designated individual counselor had apparently not read my file as she was surprised when my husband told her how frightened of how skeletal I had been earlier in the year. My weight continued to rise much to my horror. The staff clearly assumed I was lying about following my meal plan – they assumed I was bingeing. The protocol for dealing with symptoms of restriction was to make up missed items in program. They never asked me to despite repeated restrictions. Now I’m finished the program. I’ve never felt so ashamed of my weight in my life. I’ve learned skills or strategies to help me stabilize my weight. The policy is every patient gets sent for a bone density test. Even though I’m a peri menopausal women with a decades long history of missing periods, I was not sent for this test. I feel completely invalidated. Clearly I was truly “not sick enough” as I originally thought. And my symptoms and suffering were all manufactured for… attention?

  4. I recently finished a 2 month day program with a 5 month step down program. Despite an almost 30 year history of eating disorders (mostly restrictive) this was my first time in an intensive eating disorder program. Due to the long waiting list to start treatment (yay Canadian health care) I had already gained some weight back with the help of a private therapist. So by the time I started, my weight was “normal”. After the first week, my meal plan was decreased lower than any of the other patients. My appointed individual counselor clearly had not read my file as she was surprised when my husband told her how concerned he was by my skeletal appearance earlier in the year. The protocol for addressing restrictive symptoms was to make up missed food during program hours. I was never asked to do so despite repeated missed meals. As my weight continued to rise, the staff accused me of lying about following my meal plan (assumed I was bingeing). All patients were to be sent for bone density testing. Even though I’m a peri menopausal woman with a decades long eating disorder and years of missed periods, I was not sent for testing. Now I’m finished the program. I’ve never been so ashamed of my weight in my life. I have not learned any skills or strategies to figure out how to stabilize my weight. I feel like I was right all along – I wasn’t “sick enough” to deserve help. I was exaggerating my symptoms and wasn’t really suffering apparently.

  5. I was told repeatedly by a therapist that I was suicidal and that my mother killed herself (she died from repatory failure die to an illness and this was in one session) she told me that I wanted people to feel bad fpr me and that I was doing all of this to kill myself. She also told me not to stop exercising because it was not healthy to stop and was very rude. After two sessions I became very upset and wanted to give up therapy with her. I am curently seeing a new therapist and I’m much happier.

  6. Gaslighting is deliberate manipulation; ignorance is not. A good therapist/clinician would not, by default, assume abuse or trauma. But neither would they dismiss it outright. Sadly there are some ignorant clinicians and therapists, but there are also some very good ones.

    Furthermore, when you state that AN is a genetic based illness, remember the recent GWAS study which demonstrates genetic relations between AN and other psychiatric conditions, including major depression and schizophrenia. These findings suggest that AN is indeed a psychiatric illness – at least in a significant number of people.

    Also remember that you have written posts on ‘anosognosia’ – implying that people with AN don’t know they are ill. So if that’s really the case, it is perhaps not surprising that some clinicians/therapists may make assumptions, that may be erroneous?

  7. I don’t agree with everything you write, but I’m glad you took on this topic and could relate deeply to most of the stories you included – the first woman’s in particular. I shared my own story of a particularly terrifying and psychologically damaging involuntary hospital stay with Carrie Wick a few years ago for a magazine story she wrote on the topic of “defiant patients.” I was sectioned directly from a voluntary ED program for not finishing a meal, and put in an IP psych ward 1000 miles from home with a 24-hour watcher (and threatened with up to a 21-day commitment), denied access to human rights reps and social workers, and forcibly drugged and and restrained because I was “out of control” while sitting quietly and reading a book. Like the woman in your article, I also had a very hard time adjusting to life after this experience and it took many months and years to approach trusting my own judgement again.

    While I was on the unit, I actually asked at one point for a nurse to check the placement of an NG tube they were using to forcibly feed me, as it had not been assessed in days, and was told that I had been given a chest X-ray the day before. I said that I had not received an X-ray, and was told repeatedly that I was wrong, and that my memory was faulty. I asked them multiple times to check the records, but in the moment, I actually started to question whether I had gone so crazy that I *could* block out an experience of people performing a procedure on me 24 hours before. (In the end, they did check the EMR and found that no X-ray was ever done.)

    I was also told repeatedly that despite flying from Boston to MO less than a week earlier on my own, electively, for treatment, they could not discharge me because “I would die on the plane.” I assured the doctors that I had good providers and hospital access (in Boston of all places!), but was told that these providers obviously must not care about me very much, because they allowed me to get so sick.

    The biggest blow came two years later when I changed insurance providers, and sorted through my records from my old plan. That was when I discovered that I had been admitted and committed to this IP unit under the diagnoses of Psychosis and Somatoform Disorder. Essentially – I was given two wildly inaccurate labels that both served to undermine the credibility of virtually anything I said about my own mental, emotional or physical experience while in custody. I was not diagnosed with anorexia or any other ED. In hindsight, learning this makes it much clearer why all of my requests to see a patient advocate were denied, and why all of my claims that I had been restrained brutally and inappropriately were literally laughed-at by staff. If my chart said I was actively psychotic, I supposed the nurses assumed that I hallucinated the whole thing. But, as you point out in your blog – malnourished and sick with an ED is not the same as frankly crazy across the board.

    I could go on with the other examples – other treatment providers, the insurance companies. But I assume it’s all par for the course. The best luck I ever had was finding a treatment program and a highly specialized therapist to help me with my ED *and* help me heal from the mind-fuckery imposed by all of the other “professionals” I’ve had the misfortune of meeting along the way.

    We may not all agree on the contributory role of lifetime trauma in the development of EDs, but I’m sure we can find common ground in agreeing that there is zero room for professionals to actively discredit and psychologically manipulate patients or their families in the ways described, and that there are potentially very serious ramifications when this (all too commonly) does occur.