The Relevance of Pathological Altruism to Eating Disorders

Much anecdotal, clinical, and research evidence highlights the tendency of individuals with eating disorders to deprive themselves while satisfying others' needs. A combination of and interaction between genetic and environmental factors contribute to a poorly defined sense of self and the resulting adaptation to external expectations and devotion to others' needs described in Heinz Kohut's theory of self-psychology. A façade of selfsufficiency, 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. Paradoxically, a high level of narcissism is also expressed in an eating disorder. Whereas altruism and narcissism may seem contradictory, they may in fact represent two sides of the same coin. The implications of pathological altruism for treatment, recovery, and prevention are discussed.