But the truth is far more complicated. At that point, I’d regained some of the weight I’d lost after I was discharged from the hospital, but I was binge eating and vomiting, and my recovery from my eating disorder was still a ways off. I didn’t know it at the time, but sorting out our marital difficulties would take a lot of hard work. Looking back, I can understand why Darren wrote that letter; he felt that my eating disorder had changed my personality, taken over my life, and pushed him away. Since I was barely talking to him, he wasn’t sure what was left of our relationship, and his letter was an attempt to find out. But when I first read the letter, I wasn’t able to see his point of view. Instead, I felt like I’d been hit by a tidal wave of criticism. I sensed ‘I’m bad’ coming from so many different directions that I could barely keep my head above water. That’s where individual therapy helped. I was afraid that my therapists were mad at me for starting to binge, so I didn’t want to tell them much about what was going on. But as it turned out, they were not angry and just seemed to want to get to know me better as a person. I liked that. Soon, my treatment team adjusted the dose of my antidepressant medication [a selective serotonin reuptake inhibitor], which began to take the edge off my dark thoughts, making it easier to get through the day.

“When I mentioned the tension between me and Darren to my therapists, they viewed my recognition of this problem as a sign of progress and encouraged me to elaborate. A few weeks later, they suggested that Darren and I consider couples counseling, which would offer us an opportunity to work on our relationship together under the guidance of a therapist. At first, I didn’t like the idea because I was afraid the couples sessions would focus on how I was ruining our marriage. But when I told Darren about the recommendation, he was surprisingly receptive, even mentioning that our problems were no one’s fault and that he couldn’t imagine how we could fix our marriage without professional help.

Deep inside, I sensed Darren’s openness to couples counseling was right, so we signed on, attending sessions every week for more than a year. This work proved invaluable in a number of ways.

First, we hadn’t shared our feelings openly for so long that we’d almost forgotten how. The counseling helped us break the ice so that we could communicate more effectively. In addition, the joint sessions helped each of us see where the other was coming from and-as Darren had requested in his letter-explore how my eating disorder had affected our relationship and vice versa.”

In discussing the impact of an illness on a marriage, it is important not to overgeneralize or oversimplify. Every interpersonal relationship is different and complex. Like Sybil, many people with eating disorders are so engrossed in their food and exercise routines that they cannot communicate in ways that are necessary to develop and sustain healthy relationships. Darren began to feel angry at Sybil, rejected by her, and sad to have lost the woman he had loved. Such feelings are not unusual among the significant others of people who suffer from eating disorders. Under such circumstances, couples therapy can prove very productive.

Looking back, Sybil tried to put couples counseling in perspective. “It wasn’t a magic bullet,” she explains. “It couldn’t undo the pain of the last several years or get back the idealism and bliss that we enjoyed during our first year of marriage. But couples sessions did make a positive difference in our lives, not only by addressing the past but also by helping us look ahead. I was 29 years old. Four long years after my eating disorder had developed, my nutrition had improved, and my body was healthy. Darren and I began to think about starting a family.

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David B. Herzog, M.D., Debra L. Franko, Ph.D., Pat Cable, RN

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David B. Herzog, M.D., is the Harvard Medical School Endowed Professor of psychiatry in the field of eating disorders at Massachusetts General Hospital and the director of the Harris Center at Massachusetts General Hospital.
Debra L. Franko, Ph.D., is a professor in the Department of Counseling and Applied Educational Psychology at Northeastern University and the associate director of the Harris Center at Massachusetts General Hospital
Pat Cable, RN, is the director of publications at the Harris Center.