Sandra, a former patient of mine, was a clear example. At 5'2" and 195 pounds, she professed to be desperate to lose weight. Consciously, she hated her appearance and feared for her life, knowing she was at high risk for a heart attack or stroke. Yet despite repeated attempts at dieting, she would put the weight back on every time she got close to her goal. It was clear to me that Sandra was getting some kind of payoff for this self-sabotage. Somehow, someway, she unconsciously felt uncomfortable giving up her obesity. I began to dig deep, and it didn't take long to solve the mystery.
Starting at age 10, Sandra had begun to show signs of becoming a young woman—changes that did not go unnoticed by a sick and depraved uncle who molested her. The violation continued for years, and these were years marked by the shame and guilt of a confused little girl. Blaming herself and her body, Sandra discovered that as she inadvertently put on weight, the unwanted attention seemed to lessen. As she became more obese and her sexual characteristics were, in a sense, camouflaged, a feeling of safety came upon her.