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Watching The Crown’s Portrayal of Bulimia as a Sex Therapist

Princess Diana’s Bulimia Disorder

The Crown‘s latest season shows Princess Diana’s longtime cycle of Bulimia, an eating disorder involving binging on food then vomiting it up soon afterwards. The depiction of Diana’s patterned rituals is quite graphic in its detail.  In this period of social distancing, increased loneliness and upcoming meal-based holiday season, here are some psychological concepts  audiences can learn from the Netflix show.

After eating emotionally during a hearty holiday meal, it is all too easy for a person suffering from disordered eating and eating disorders to engage in a litany of self-criticism and potentially binging. The intensely negative self-talk often leads to internal negotiations around forms of restriction. Inevitably, the unforgiving rules imposed on oneself in moments of harsh guilt will reach a tipping point. At that moment, the person’s shame and rebellion lead to an overthrow of the restrictive policies leading to new overeating or binging. This is the cycle of eating disorders and disordered eating.

We see extreme cycles of Bulimia in the latest season of Netflix’s The Crown. The introduction of Lady Diana to the royal family was presented as a fairy tale romance in the press. Her public image, however, was somewhat a foil to her private life. In the television drama, we see Princess Diana in a secretive isolating cycle, experiencing years of intermittent bulimia. Starved of physical touch, kindness, sympathy, and sexual intimacy from Prince Charles, Diana sought control, expressing hurt, anger, loneliness  and possibly vengeance by binging on royal delicacies and then making herself throw up afterwards.

The Connection between Infidelity, Betrayal and Eating Disorders

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Eating disorders (like Bulimia and Anorexia) and disordered eating patterns are interpersonal as well as intra-personal disorders, meaning that they are triggered by feelings of betrayal or abandonment by others then turned inward as hatred or humiliation of oneself. What Diana experienced was an extreme sense of  isolation almost immediately after she first became engaged to Prince Charles. Soon after the engagement announcement was made public, she became aware that Prince Charles was still romantically involved with Camilla Parker-Bowles. In Diana, In Her Own Words, a documentary also on Netflix featuring secret recordings of Diana, she states that: “The bulimia started the week after we got engaged.”

After discovering that the whole engagement and courtship was totally fake and that the marriage was solely “a call to duty” and nothing more, Princess Diana experienced infidelity’s pang of betrayal as a deeply interpersonal wound. Turning Charles’ rejection against herself, she tried to be more of what she thought her husband wanted, hoping to win him back. As a sex therapist working with couples after the discovery of infidelity or an affair, the betrayed partner frequently takes out feelings like self-blame and anger at their partner out on their own bodies.  At times they begin behaviors of binging, purging or restrictive diets to lose weight in an effort to compete with their partner’s lover or a paid sex worker, who they assume are thinner than they are.

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In a BBC1 Panorama Radio Interview Diana gave in 1995, she described how after spending her days fulfilling her royal duties visiting charities which involved comforting others, she was left feeling emotionally depleted and rejected by Charles who was giving his emotional and sexual attention to Parker-Bowles.

“I’d come home feeling pretty empty, because my engagements at that time would be to do with people dying, people very sick, people’s marriage problems, and I’d come home and it would be very difficult to know how to comfort myself having been comforting lots of other people, so it would be a regular pattern to jump into the fridge.”

Eating Disorders in the Media

 

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While in reality, Diana’s eating disorder thrived in secrecy and shame for years, The Crown’s decision to portray bulimia in graphic scenes could be seen as glamorizing the disorder. Mary Anne Cohen LCSW, author of French Toast for Breakfast, says: “[Depictions of eating disorders in the media] can be a tremendous relief and, hopefully, become the first step to make the decision to get help and share one’s burden.”

Generally, eating disorders are treated by therapists who are specialists through individual and group therapy with a focus on healing a client’s attachment style, learning regulation skills, and mindfulness techniques while creating new habits.

Attachment Styles and Eating Disorder Treatment

Secure attachment to caretakers extends to one’s secure attachment to comfort in eating and feeling comfortable in one’s own skin. Insecure attachments, on the other hand, come from early unmet developmental needs. Diana revealed through her secret tapes In Diana in Her Own Words that she had been treated like “the virgin, the sacrificial lamb” by Prince Charles, the royal family and her own family.  “Isolation with pastry needs to be replaced by intimacy with people,” writes Cohen.

A crucial element of eating disorder treatment involves helping a client learn how to express their emotional needs directly to people they can rely on and to cognitively shift from a diet mindset to an anti-diet mindset. An anti-diet mindset is precisely what eating disorder specialist Alexis Conason Ph.D. recommends for those struggling with this punishing cycle.

A New Year’s Resolution Worth Trying: The Anti-Diet Mindset

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Dr. Conason suggests a sustainable and fundamental shift in mindset. “You haven’t failed your diet,” writes Dr. Conason, “Your diet has failed you.”

An anti-diet mindset is an agreement to eat in a way that honors your body’s needs, connecting to one’s body in a nurturing and peaceful way rather than a belittling, abusive one. Repairing this relationship with your own body is a way to repair the insecure attachment of childhood and the as outcome of infidelity.

People have traditionally created New Year’s resolutions to begin a diet after weeks of emotional holiday (Christmas, Chanukah, Kwanzaa) eating. However, given that 2020 saw an avalanche of COVID-19 weight-gain memes, with people feeling so guilty about their added pounds, we can logically expect  the 2021 New Year’s diet self-recriminations to be even more rigid and punishing.

Many times people who are dieting may feel too weak or less desirous of sexual intimacy. Whether they are waiting to show their body to a partner when their body is at the “perfect” size, or too ashamed to have their partner touch them for fear they will feel a part that has too much fat , many people with eating disorders deprive themselves of sexual pleasure.

Part of their healing is to understand that all emotions are human, including the desire for sexual intimacy and comfort. Helping them to turn toward a person instead of food or dieting to alleviate hurt and express anger is a critical step in their recovery.

The Trifecta: Sexuality, Eating Disorders and Body Dysmorphia

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Sexual disorders, Bulimia, Anorexia and Body Dysmorphia are interrelated issues. Researchers in an NCBI study “Sexual Functioning in Women with Eating Disorders” found that more women with eating disorders had:

  • loss of libido
  • prevalence of sexual anxiety, tension, frequent changes and higher frequency of detached relationships
  • relationships without intercourse and fewer with intercourse
  • avoided sexual relationships

In Diana: Her True Story – In Her Own Words, Andrew Morton quotes the Princess of Wales saying: “My husband [Prince Charles] put his hand on my waistline and said: ‘Oh, a bit chubby here, aren’t we?’ and that triggered off something in me.”

Some of our CLS clients verbally express body disgust for their own bodies in session to their therapist in addition to directly telling their partner their aversions. Most often their partner still feels quite attracted to them, continually trying to reassure them of their desire for them,  yet feeling helpless to have their compliments authentically received. If a comment about one’s weight is made unwittingly by a partner, the partner with the eating disorder catastrophizes and thinks their entire body is revolting.

Another important fact to consider is that Body Dysmorphia (BDD a persistent and intrusive preoccupation with an imagined or slight defect in one’s appearance) is not exclusively a women’s disease. In one American survey, for example, found that an estimated 2.2% for men and 2.5% of women suffered from Body Dysmorphia. Whether the focus is on weight, the thinness of hair or the longing for more muscles, men can be as secretive about their body shame and disordered eating as women. BDD interferes with male sexual desire and connection in similar ways as other eating disorders.

How to Approach the 2020 COVID Holiday Season as an Anti-Dieter

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Understanding the larger context of a meal is the first step to enjoying the holidays as an anti-dieter. With the additional stressors of the COVID-19 pandemic this year, I encourage more self-compassion and present-moment mindfulness. Make sure you have a buddy who you can call on when feeling triggered to binge, purge or withhold food. Give yourself permission to take a walk to ground yourself if feeling overwhelmed.

Coach yourself to receive sexual pleasure. Erotic intimacy should be considered a place to play and feel aroused rather than a space in which one needs to perform or pose. High Sex EsteemⓇ means that one accepts the notion that erotic behavior is a pleasurable, connecting place we go to experience comfort, fun, stress relief and passion, all basic human needs. Given that most Americans won’t be travelling long distances to gather with large groups of relatives this holiday season, use the extra time to have some mindful, sensual touching sessions with a partner who you can rely on, whether that be someone else or yourself.

If you are struggling with an eating disorder, a free resource in the U.S. is The National Eating Disorders Association. They offer extra chat hours over the holidays: https://www.nationaleatingdisorders.org/.

Trump Redux: 5 Lessons this Presidential Nominee Illustrates about Narcissism in Relationships

There could be a lot of lessons to be gleaned by this very unusual primary season thus far but nothing has baffled politicians, pundits and journalists as the immense popularity of Donald J.Trump. I thought I would use Trump as a good example of a person who exhibits many of the behaviors consistent with a person who a therapist would diagnosis with Narcissistic Personality Disorder. I write this blog to assist those people who feel like they might be involved with a person who may have similar tendencies with hopes they can begin to see the pattern of negative dynamics, the low self esteem that their behavior engenders in others and look to ways a person might change their relationship or leave to preserve their sense of self. In my years as a therapist, I have worked with many people who complain that their partner or spouse is berating them for a small behavior, or degrading them for not being attractive enough to have sex with, or throwing a tantrum when their partner finds fault with some of the narcissist’s behavior.

Donald Trump at a rally
Donald Trump at a rally

The symptomatic behavior of Narcissistic Personality Disorder are expressed when a person to is compelled to rely heavily on others’ adulation to maintain their own self esteem at a high level. Underneath all that self-aggrandizement is actually a very fragile ego. One can see Trump’s lack of empathy and bullying manner as efforts to be viewed consistently as a take-no-prisoners winner in the nominee race. He keeps talking to drown out any doubt about his abilities. People with this disorder can be at one time charming in order to get what they want from others and the next antagonistic, displaying feelings of entitlement, selfishness, and attention seeking. His frequent displays of lack of empathy and disdain are illustrated in his immigration policies and rhetoric on minorities and women, and his heightened sense of self-importance. Past tweets including one that reads “…my I.Q. is one of the highest -and you all know it! Please don’t feel so stupid or insecure,it’s not your fault” exemplify just this.

Clients of mine who tell me that their partner either yells when they try to address a conflict or retreats into a depressive state express the feeling that they often feel stifled to ask for what they authentically desire in the relationship for fear of their partner’s reaction. The “walking on eggshell” comment is a frequent description of how they feel. Although only about 0.5-1% of the general population is diagnosed with the disorder, about 50-75% of those diagnosed are men. There are also those who do not qualify for all criteria of a Personality Disorder by still display a few narcissistic trait. For example a man may feel his boyfriend is with him merely because he has great looks and is well built but when they begin to have sex the experience feels empty, as if he’s there only to make the narcissistic partner feel special enough to have won such a good looking partner. His boyfriend may begin that he is not fully seen as a 3 dimensional person nor that his needs are really met with authentic concern.Ill man sitting on his bed

Trump says whatever he wants with little remorse or concern for the feelings he may have engendered in others. He constantly works to be the loudest, most powerful, and authoritative figure in every room that he enters. From statements of “I will be the greatest jobs president that God ever created” to “(John McCain is) not a war hero…He’s a war hero because he was captured. I like people that weren’t captured” ,Trump has made it clear that he is a bulldozer, will to squash anyone in his path to his final destination: presidential nominee for the Republican party.

You may have already noticed these patterns in your relationship but I use this blog to outline more specifically five patterns of narcissists which we have seen in Trump’s behavior to enable you to figure out if your partner fits into these types of patterns.

1. Narcissists are only connected to those who mirror back greatness in looks, success, and greatness.
As their values are rooted in their thoughts of their own superiority and greatness, narcissists surround themselves with only those who they see as superior as well. This is used as a mirror of their own excellence. Their relationships are based on the reward they see in each person, judged by how well the person matches their description of power, control, dominance, and superiority.
Trump has claimed that “all of the women on The Apprentice flirted with [him]” illustrating that he thinks he is a kind of irresistible hunk that no woman could resist. Trump seeks out women who have superstar looks(according to this society’s beauty ideals) as a reflection of his own looks and to illustrate his power. While this behavior is not that unusual in our patriarchal society, Trump takes it a step further when he boasts of his sexual porwess: “And, he referred to my hands — ‘if they’re small, something else must be small.’ I guarantee you there’s no problem. I guarantee”, inferring that because his penis is large he is deserving and sexually appealing to Melania his current wife, who is several years younger than Donald, and a much photographed professional model. While there may be a lot more to his wife than we know, she is only brought out as arm candy to adorn his designer suits and upscale photo ops.
at the "NBC All-Star Party" in the Hollywood & Highland Complex, Hollywood, CA 01-14-04
2. They seemingly have thick skins but in fact are either covering up deep wounds from childhood or a feeling that they aren’t as smart or as capable as their parents may have expected them to be. They cover the narcissistic wound by putting down others to elevate their status.
Trump speaks with horrific insults of groups of people who he perceives as lesser in extremely hateful and derogatory ways. When he announced his run for the nomination he described undocumented Mexican immigrants as “… people that have lots of problems and they’re bringing those problems with us. They’re bringing drugs. They’re bringing crime. They’re rapists”
He constantly searches to put others down in order to establish his own dominance and to cover up his deeper sense of inadequacy. His motto could be hit him hard, non-stop and fast so they don’t know how to hit back. man in boxing gloves
One wonders what woman in his history would cause him to degrade and demean women in his many years in public life.

The realization that a narcissist may have been demeaned or abandoned by someone they loved or looked to for praise in their past cuts deep and in response, they often add to their bullying pattern externally, a set of extremely challenging goals as revenge for their experience of victimhood. For example was Donald driven to building a larger real estate empire to show his critical mother that he is more powerful than his father, or beat a brother who was favored for his warmer personality? We may never know what that chip on his shoulder is.
If your partner feels like he has to be a the best in every category and his pursuit of money, prestige and attention override his engagement with you, his partner, it may be that he considers you just another possession that he has won along his path to success. Research has shown a possible link between narcissists’ low self esteem and structural differences in their brains, with weaker links of the brain regions involved in self- esteem.with weaker links of the brain regions involved in self- esteem.(Citation). Narcissists have underlying beliefs that they are actually frauds and they are in constant panic of being exposed of perceived failure, leading them to overcompensate in many ways. You may see your partner being extremely self-blaming about their own mistakes and project this anger on you their partner as well as others, who are around them on a daily basis, like children, employees and parents. Man yelling at girlfriend not looking at him black and white

3. They also lash out with narcissistic rage when someone criticizes them so that they never have to be vulnerable or responsible, this can leave their partner emotionally abused.
Given that their superiority is simply a facade to accommodate past questioning and failure, narcissists will attack those who question their dominance or criticize their ego. This is quick, easy way to maintain the illusion of entitlement and selfishness, as those who show any sign of weakening them are quickly devalued and diminished

Trump exemplifies this pattern, seen when he attacked Fox News Anchor Megyn Kelly multiple times. In August 2015, Kelly asked Trump a question regarding his language use toward women, calling them ‘fat pigs’, ‘dogs, slobs and disgusting animals’. Trump responded by claiming that she had “blood coming out of her wherever” (some took this as Trump referring to her menstrual cycle, although he denies this) and then went to Twitter to post public tweets, in form of a rant, about Kelly, her personal life, her professional success, and more. This illustrates the pattern of rage, lack of empathy, and aggression in response to questioning of authority.
In an intimate relationship, this rage and blame can leaving the partner emotionally and/or physically hurt, while the abuser shows little to no remorse, never taking responsibility for their contribution to an argument or fight. Instead, the attack leaves the narcissist feeling even more in control, in the right and remarkably calm.
Young woman arguing with her boyfriend

4. They will cut you off if you don’t continually feed them positive feedback.
Months after his attack on Megyn Kelly, Trump announced that he would not attend the Republican Party debate that Kelly hosted in Iowa . Although he later denied that it was because of Kelly, I argue that this was his way of cutting her off and avoiding the chance of future criticism and lack of positive regard. By doing so, Trump asserted his presumed power and continued his cycle of dominance.
He also broke up his first two marriages and while we don’t know all the details, given his vicious attacks in public during this primary, one could guess that perhaps his wives challenged him and he wasn’t going to accept that kind of behavior from a woman or anyone for that matter. His current wife stated recently that she and Donald don’t try to change each other. Perhaps, this is another way of her saying she doesn’t challenge him too much.
You may experience your partner will cut off communication, positive regard or even financial support if you do not constantly focus, support, and reassure them of their power and greatness in order bolster their superiority facade. They may ignore your phone calls, block you from social media, and remain silent. This makes the person feel in control and proud of their imposed emotional distance while leaving you their partner feeling rejected, at fault and abandoned. It is their last resort in establishing dominance while distancing themselves from potential harm.

Sad couple having an argument sitting on bed

5. As a partner you’ll feel superficially connected during sex. You may feel like you have to perform in bed, and feel anxious if you’re not thoroughly turned on causing you to ‘fake’ your arousal and/or orgasm. You may feel like you have to appear perfect and/or spend a lot of time and/or money on your appearance. If you feel like a reflection of your partner who expects everyone and everything in his life to be of the highest quality, there may come a time when you start questioning your appearance and develop some body image disorders or disordered eating.
Your partner may make comments about the size of your breasts, your weight or your nose or compare you negatively to other women. This pattern of verbal abuse can lead a partner to seek out plastic surgery, go on extreme diets and lower their sense of self to an extremely low level leaving a partner feeling depressed and demoralized.

Do any of these descriptions sound like your partner? Have you remained quiet and cautious of complaining of their treatment of you or asking for your needs to be met? Lastly, If you have this feeling of never being enough to satisfy your partner’s visual and performative expectations, feel like you’re constantly walking on eggshells and can’t express yourself honestly, I encourage you to seek help from a licensed experienced AASECT-Certified sex therapist or a coach who can help you gain back your self esteem and your Sex Esteem®.

Latest Blog: Engagements & Weddings: 5 Topics to Cover

Dissatisfied wedding couple

It’s Spring again and a new crop of couples are preparing all the details for their upcoming nuptials.   Unfortunately, many people get caught up in the romance, erotic excitement, and wedding and dress plans of that first year to two years of their relationship that they neglect to talk about some critical elements that will help them safeguard their marriage and fidelity for the long haul.  Since June is one of the most popular months to marry and Americans are spending an average of $30,000 on a wedding according to theknot.com ,  I thought I would use this month’s blog to offer some sage advice to those out there that are getting ready to invest their hearts and money to wed.

Frequently in the media we have heard engagements and weddings called off by celebrities like  Bristol Palin and  Miley Cyrus . The actual statistic of cancelled weddings have been estimated at 20%,  and the issues can be about lies discovered, financial concerns or frequent arguments that never seem to get resolved.  I have done a lot of pre-marital counseling and have helped some couples who decide to delay their wedding until they are able to nail down some pretty challenging issues before they can say “I do” with the skills and confidence needed to fulfill their vows.

Wedding couple conflict, bad relationships. Woman bride and man groom looking at each other with angry expression. Isolated on white

Some of the issues couples come in to discuss before their weddings include: sexual incompatibility, concerns about cheating, alcohol or substance abuse, disagreements over financial habits, whether and/or when to have children, and differing religious beliefs.  After 20+ years of counseling couples who have been traumatized by infidelity, financial secrets, or constant arguing, I can state that EXPLICIT agreements are needed at the beginning of a marriage and need to be updated continually as situations change and people grow.

Relationship agreement? I know, some of you are scratching your heads and thinking: “ What agreement? We get married and we vow to honor, love and be faithful to one another, isn’t that all we need?”  The definitive answer is no, one needs to discuss these issues as seriously as where they want to hold the ceremony, reception and go for their honeymoon.  (As a note, I think the following tips could also be helpful to those committed couples that haven’t sat down in a while to discuss critical aspects of the marriage/relationship agreement).

Young couple finding out results of pregnancy test at home

  1. Make sure you share the same bottom line goals in life.

I am always surprised when couples have gotten engaged without discussing things like whether they both want or don’t want to have children, the religion in which they would raise their children, what city in which they would live. Make sure you and your fiancé(e) have a thorough discussion about these questions and make sure you’re agreed on the decisions. Leaving what I call deal-breaker decisions until after the honeymoon can frequently derail a marriage later on.

2. What do you consider cheating?

I know this sounds obvious but I have to reinforce the idea that couples frequently have different ideas about what they regard as broken commitments to their oath of fidelity.  Most people don’t have what I have termed Sex Esteem™, the confidence, education and skills to discuss sexual issues with one’s partner and yet sexual fidelity is a critical part of the agreement you’re creating with your partner.

Cheating his wife, young men chatting with his mistress while his wife sleeps

If this topic is too challenging to discuss on your own,  or you have already run into questionable situations of trusting your partner, seek out an experienced sex therapist to have some sessions on this topic before the wedding. It could save you a lot of heartache later on. An example of what partners might disagree on would be: a one-time kiss at a company party after having drunk too much, watching certain types of sexually explicit material, dancing all night with another man/woman, and a hook-up during a bachelor/bachelorette trip to Vegas.

3. How much time do you each want to spend on your own, with your friends/family and with one another?

It’s hard to judge what your baseline needs are when you are in the throes of a new relationship because all those hormones are making you want to spend every minute with one another. But once that stage settles down you each have your own sense of lifestyle that makes one feel balanced. Your partner may have a very different expectation about how much time you’ll spend as a couple going forward.   Make sure you’re clear about how many times a week and the amount of time you want to work out, how many times you like to speak to your parents/sister/brother, how many nights you want to have dinner together, and how frequently you want to have a date and/or sex etc. Mark-Zuckerberg-and-his-wife-Priscilla-ChanTake some inspiration from Priscilla Chan, wife of Mark Zuckerberg who asked her fiance to agree to 100 minutes of time each week, 1 dinner date a week and a 2-week trip abroad at the very minimum.

4. Commit to being your partner’s emissary to your parents

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Some of the most stressful times couples experience as they plan a wedding is with their soon-to-be in-laws. Remember you are creating a new family with your own beliefs and traditions from your family of origin. You each need to explain to your own parents why you and your fiancé(e) have made your decisions and that they need to support you both and not blame or criticize her/him because they’re disappointed. ( I think this role needs to last for the first 2-3 years of a relationship until the son/daughter-in-law can forge their own relationship with their in-laws)

5. Plan business meetings to discuss finances

coin couple

Marriages are about mutual love and support, fun and erotic connection in addition to being a financial partnership. I find that many couples discuss their financial goals and budgetary concerns as frequently as they discuss their sex life. Meaning, not as often as they should. I find those in long term partnerships or marriages need to carve out time (that is not designated for fun or sex) to discuss each of their goals, the steps they each are going to take to get them there and who is responsible for what aspect of their financial plan. Whether it’s how much to save for retirement, what each of you consider a reasonable rent, or how to plan for a vacation, preparing for a meeting and the considerations you each want to address can help keep underlying tension and anxiety from building. You can then move ahead to your fun time together more unified and eager to bond romantically.