The concept of ambiguous loss helps us understand what gets in the way of patients receiving the support they need to recover from an eating disorder. Ambiguous loss is categorized into two types. Type one describes a loss in which a person is not physically present, however remains present psychologically. This would apply, for example, to a soldier deployed overseas who is physically separated from their family. Type two is just the opposite: the person is still physically with their family and friends, however is psychologically absent. Despite being present physically, they are not in the same mind space. This is the case with many eating disorders patients. The mind space that used to include hobbies, relationships, and ambitions becomes replaced with obsessive and anxiety-ridden thoughts about food, weight and body image.
On the road to recovery, family members often report moments when they “see” their loved one again, alternating with moments of painfully wondering where that person is underneath their psychological battle. As providers we often use the metaphor of an eclipse: moments when the eating disorder appears to fully occupy that person’s mind space (full eclipse); moments when both the person and the eating disorder seem present (partial eclipse); and moments when the person’s mind space appears to be where it was prior to their struggle with an ED. It’s confusing. It’s ambiguous. For family members it is sometimes that ambiguous loss that blocks the ability to cope with the situation. Do you grieve a loss or hold on for hope? The answer is unclear. It creates chaos for the family. One day the ability and motivation to support the patient is higher than ever. The next day, it crashes along with the belief in recovery. For the most part, we know more about how to grieve and cope when a loss is clear. When it’s not, we need to learn to navigate tolerance of that ambiguity in order to remain resilient and prevent losing hope. The acknowledgement of this struggle of family members is a powerful player in the patient’s and family’s recovery process. Family therapy alongside individual therapy increases a person’s resources to work towards that long-term goal of regaining control of their mind space from the eating disorder.
About the author:
Renee Bazinet Nelson, Psy.D. is the Director of the Adolescent Intensive Outpatient Program at Walden Behavioral Care. She earned her doctoral degree in Clinical Psychology with a concentration in health psychology from the Massachusetts School of Professional Psychology. Dr. Nelson enjoys almost any outdoor adventure and spending time with family and friends. Dr. Nelson is passionate about her work with patients of all ages and families coping with a range of health issues.