Giving ‘til it hurts’: Eating disorders and pathological altruism

When the willingness to place another’s perceived needs above one’s own in a way that causes self-harm, the normally positive and necessary characteristic of altruism can become unhealthy. “Pathological altruism�? has been the focus of a recent surge of theoretical, philosophical, clinical and empirical interest. This chapter explores its relevance to individuals suffering from eating disorders, who can be viewed as prototypical pathological altruists. Both genetic and environmental factors contribute to a poorly defined sense of self and the resulting adaptation to external expectations and devotion to others’ needs. A façade of self-sufficiency, all too often misinterpreted as a sign of health, belies the natural need to receive from others. A fear of losing relationships, a need for approval, and conscious or unconscious anger at self-sacrifice lend a flavor of martyrdom to the act of giving. The endorsement of the thin beauty ideal underlying eating disorders may be seen as a form of pathological altruism, since the biological need to eat is sacrificed to the “needs�? or dictates of society concerning body shape. Anecdotal, theoretical, clinical and empirical support for pathological altruism in eating disordered patients is presented, as well as implications for treatment, recovery and prevention.