Beneath the Surface: The Role of Splitting in Eating Disorders and How It Unfolds in Therapy

In the world of eating disorders, patients often struggle with internal chaos, feelings of worthlessness, and a deep sense of emotional fragmentation. One psychological defense mechanism that frequently appears in these individuals is splitting—a defense that divides the world, and often themselves, into extremes: all good or all bad, with no middle ground. In therapy, this can present as sudden shifts in perception, an inability to see shades of gray in relationships, or an overwhelming sense of self-loathing interspersed with moments of inflated self-worth. Splitting, although an unconscious defense, is a key emotional barrier that therapists must navigate carefully in order to guide their patients toward healthier ways of processing and relating to their emotions.

But what does splitting actually look like in the context of an eating disorder? How does this defense manifest in therapy? To better understand this, let’s explore a case example of a patient dealing with both an eating disorder and a tendency to split, and how this dynamic might play out during the therapeutic process.

The Mechanism of Splitting: A Defense Against Emotional Conflict
Splitting is often viewed through the lens of object relations theory, which focuses on how early relationships with caregivers shape the internalized emotional world of the individual. When a child experiences inconsistent or emotionally chaotic caregiving, they may struggle to integrate conflicting feelings into a cohesive sense of self. The result can be a fragmented, black-and-white view of people, experiences, and themselves. In cases of eating disorders, this fragmentation can be projected onto their relationship with food, body image, and self-worth.

Splitting serves as a way of protecting the individual from overwhelming emotional pain by simplifying their internal world into extreme categories. This defense mechanism provides a temporary sense of relief, but it also makes it difficult for the person to cope with the complexities of their emotions. For someone with an eating disorder, splitting might manifest as sudden shifts between feeling „perfectly in control“ or „completely out of control“ when it comes to food. These extreme shifts can also show up in their relationships—such as seeing the therapist as either an all-good, idealized figure or a source of rejection and frustration.

Case Example: „Anna“
Let’s consider the case of Anna, a 25-year-old woman diagnosed with anorexia nervosa. Anna began therapy after years of struggling with intense body image issues, extreme dieting, and a sense of worthlessness that she couldn’t shake. Her early relationships, particularly with her mother, had been emotionally inconsistent—her mother could be warm and loving one moment, but cold and critical the next. This inconsistency led Anna to develop a profound fear of rejection, along with an internalized need for perfectionism.

In therapy, Anna initially idealized the therapist, viewing them as a perfect, almost omnipotent figure capable of understanding her deepest pain and saving her from the emotional torment she felt every day. During these early sessions, Anna would express her belief that the therapist would help her gain control over her eating, that with their support, she could finally „fix“ herself.

However, after a few weeks of treatment, Anna began to shift her perception. When the therapist gently challenged her unrealistic expectations or offered a difficult reflection, Anna’s idealized view of the therapist crumbled. She felt betrayed, misunderstood, and dismissed, and she began to view the therapist as someone who didn’t truly care about her or her struggles. This shift marked the classic defense of splitting—Anna went from seeing the therapist as all-good to all-bad, unable to integrate the complexity of the therapeutic relationship or accept that the therapist could both support her and challenge her at the same time.

Splitting and Eating Disorders: A Cycle of Extremes
In Anna’s case, the eating disorder mirrored her tendency to split. On days when she felt „in control“ of her eating—when she successfully restricted her food intake or exercised excessively—she would feel a sense of superiority, believing that her self-worth was tied to her ability to maintain control. But on other days, when she faltered and gave in to cravings or deviated from her rigid eating rules, Anna would spiral into overwhelming guilt, shame, and self-loathing. She would describe herself as „weak“ or „disgusting,“ unable to tolerate any middle ground between her idealized self and the person she perceived as a failure.

In therapy, Anna’s emotional swings were evident. One week she would express feelings of hope, believing that therapy could lead her to „perfection,“ and the next week she would question the point of therapy altogether, convinced that nothing could help her, and that she would never be good enough.

Splitting in Therapy: Navigating the Polarities
Therapists working with patients like Anna must be attuned to these emotional swings and the defense of splitting. Understanding this pattern allows the therapist to gently challenge the patient’s all-or-nothing thinking without invalidating their emotional experience. Here’s how splitting might unfold in a therapeutic setting:

The Idealization Phase: At the beginning of therapy, Anna might idealize the therapist, placing them on a pedestal as a perfect figure capable of offering salvation. She might share that she’s confident this treatment will finally help her „become perfect“ or „become someone worthy.“ The therapist must acknowledge this fantasy, while still offering a grounded perspective on the realities of the therapeutic journey.
The Devaluation Phase: As therapy progresses, Anna might experience a moment where the therapist reflects on her idealized self-image or offers a more realistic suggestion, which triggers feelings of abandonment or betrayal. She may suddenly devalue the therapist, feeling misunderstood or disappointed. Here, the therapist’s role is to hold space for Anna’s anger or pain, while also helping her recognize that relationships—both personal and therapeutic—are complicated, and that the therapist is both supportive and challenging.
Exploring the Fear of Abandonment: Through these phases, the therapist can help Anna unpack the root of her fear of abandonment. In Anna’s case, this likely stems from her early attachment experiences, where emotional support was inconsistent. The therapist can gradually work with Anna to help her see the middle ground between the extremes of idealization and devaluation, encouraging her to develop more integrated, realistic views of herself and her relationships.
Building Tolerance for Ambiguity: Over time, the therapist’s task is to guide Anna toward greater tolerance of emotional complexity. This involves working through the defense of splitting and teaching Anna to see that life—like therapy—is not all good or all bad. Through this process, Anna can begin to understand that she is not defined by her eating disorder or her perfectionism, but rather by her ability to hold space for imperfection and growth.
The Healing Journey: From Splitting to Integration
The therapeutic process for individuals like Anna involves helping them move from a world of extremes to one of greater emotional integration. As Anna learns to tolerate the gray areas in her relationships, both with food and with people, she can start to dismantle the all-or-nothing thinking that drives her eating disorder. Over time, she will begin to build a more cohesive sense of self—one that allows for imperfection, vulnerability, and the integration of both strengths and weaknesses.

By working through the splitting defense, the therapist helps Anna learn that she is not defined by her rigid patterns or her fluctuating self-worth. Instead, she can begin to embrace her complexity, allowing her to heal both emotionally and physically, step by step.

Conclusion: The Power of Integration
In summary, splitting is a common defense mechanism in individuals with eating disorders, driven by early attachment wounds and the need to protect the self from emotional fragmentation. In therapy, this manifests as sudden shifts in perception, particularly within the therapeutic relationship. By carefully navigating these swings, therapists can help patients like Anna move from black-and-white thinking to a more integrated, balanced understanding of themselves and their emotional experiences. With time, patience, and insight, the patient can begin to heal, gradually breaking free from the extremes of perfectionism and self-loathing that sustain the eating disorder.