Q & A with Dr. Johnston

You state that disordered eating often begins in adolescence at the onset of menstruation. What is the relationship between the two?
Becoming a woman also involves recognizing and trusting her sexual instincts. Unfortunately, as you state, woman get so many mixed messages about their sexuality these instincts can become the hidden causes of disordered eating. What does sex have to do with eating compulsions?
Every year there are countless new books and theories on how to deal with disordered eating. As part of your therapeutic approach you use storytelling to help rid woman of their eating compulsion. How does this work?
You emphasize the need for woman to bring masculine and feminine qualities into balance to recover from disordered eating. What does that mean?
Women often discover that they have the most trouble with disordered eating when they are premenstrual and are going through extreme mood swings – a condition we may have mislabeled as PMS. If women are attuned to their body rhythms, can the mood swings and the compulsive eating be eliminated?
Why don’t diets work?
You point out that there are significant differences between substance addictions and eating addictions and that people who treat their eating disorders like alcohol addictions may fail in their determination to “kick the habit”. What are the dangers in equating the two?
Since, obviously, we can’t be deprived of food, is there a cure for food obsessions?
You advise women to keep a journal of their eating behavior and what they were thinking and feeling just before eating. What is the point of this exercise?

Q: You state that disordered eating often begins in adolescence at the onset of menstruation. What is the relationship between the two?

A: The onset of menstruation coincides with rather dramatic physical changes in a girl’s body. Because of our society’s emphasis on flat bellies, thin thighs, and narrow hips as the ideal shape for a female body, and because we have no rituals in our culture to honor the transition from girl to woman, these changes can be rather alarming for a young girl. Disordered eating can develop out of her efforts to control her body and feelings about becoming a woman.

Q: Becoming a woman also involves recognizing and trusting her sexual instincts. Unfortunately, as you state, woman get so many mixed messages about their sexuality these instincts can become the hidden causes of disordered eating. What does sex have to do with eating compulsions?

A: Most women have internalized our society’s tendency to focus on their sexual desirability rather than on their sexual desires. Consequently, they may not even recognize their desires and instead turn to food in order to fulfill a vague hunger they can’t quite identify. Many woman experience a great deal of pain over feeling sexually undesirable (because they don’t meet the standards set forth by the media of what a sexual woman is supposed to look like), so they eat compulsively in an attempt to quell their frustration and pain. Also, some woman unconsciously gain weight in an attempt to ward off sexual advances they don’t feel equipped to handle.

Q: Every year there are countless new books and theories on how to deal with disordered eating. As part of your therapeutic approach you use storytelling to help rid woman of their eating compulsion. How does this work.

A: Through ancient myths and stories we learn the language of symbol and metaphor. When a woman wants to understand the deeper issues underlying her struggle with food she needs to learn how to look at her obsession with food as a metaphor or as indication that there is a lack of nourishment in some aspect of her life. Storytelling can help her learn to read between the lines and find the real problems that need to be solved.

Q: You emphasize the need for woman to bring masculine and feminine qualities into balance to recover from disordered eating. What does that mean?

A: I am referring not to men and woman, but to the masculine (logical, linear, action and goal oriented, outwardly focused) and feminine (emotional, intuitive, inner, relationship-oriented) aspects of ourselves and our culture. Eastern philosophies refer to this polarity as yang and yin. If there is an imbalance where, for example, the masculine qualities are valued over the feminine, this can lean to an emptiness that a woman tries to fill with food.

Q: Women often discover that they have the most trouble with disordered eating when they are premenstrual and are going through extreme mood swings – a condition we may have mislabeled as PMS. If women are attuned to their body rhythms, can the mood swings and the compulsive eating be eliminated?

A: If a woman is accustomed to eating compulsively when confronted with strong feelings, she may find herself eating more when she is premenstrual because this is the time when emotional sensitivity is the greatest. Once she learns to respond to her feelings by acknowledging, accepting, and expressing them assertively throughout the month, they will no longer overwhelm her and the urge to eat excessively when she’s premenstrual will diminish.

Q: Why don’t diets work?

A: Diets don’t work because they are based on restriction and “will power”. Most of us have a part of ourselves that will eventually rebel against the deprivation created by dieting.

Q: You point out that there are significant differences between substance addictions and eating addictions and that people who treat their eating disorders like alcohol addictions may fail in their determination to “kick the habit”. What are the dangers in equating the two?

A: A woman who is struggling with disordered eating is addicted to the process of eating, not to the food itself. An alcoholic is addicted to the substance of alcohol. With alcoholism, the first step in the recovery process is to remove the substance and explore the underlying issues. An alcoholic remains an alcoholic because she can never again drink alcohol. It is impossible to remove food from one’s life and attempts at abstinence place too much emphasis on the food itself instead of the underlying issues that cause eating addictions.

Q: Since, obviously, we can’t be deprived of food, is there a cure for food obsessions?

A: It is certainly possible to recover completely from food obsessions. There are usually only a handful of issues that need to be resolved or skills that need to be developed. Once we develop the body awareness needed to discern the difference between physical and emotional hungers, and we learn the skills for responding appropriately to our deeper hungers, then our relationship with our bodies improves. Food becomes just food. We eat only when we are physically hungry and stop when we are full.

Q: You advise women to keep a journal of their eating behavior and what they were thinking and feeling just before eating. What is the point of this exercise?

A: It’s not enough to understand in theory that repression of feelings can lead to overeating. We must be able to identify which feelings act as triggers and to identify them the moment they surface before any changes in eating behavior can occur. The journal helps women to become fully conscious, to tune in to their feelings moment to moment so they can respond appropriately.