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When You Don’t Want to Recover from Your Eating Disorder

Why won’t you just eat?”

“You’re beautiful just as you are.”

“Why are you doing this to yourself?”

“This can kill you!”

Eating disorder recovery, while often life-saving, can feel grueling in its depths.  For those who may not understand this pain first-hand, it can be disillusioning to watch a loved one engage in eating disorder behaviors at the expense of their well-being.  Questions and statements, like those listed above, though typically well-intentioned, do little more than frustrate someone who – if they could – would just eat

If you have ever pursued a major life change, you likely experienced some second thoughts despite your reasons for wanting to make such a change.  If I’m unhappy with my job, for example, I can imagine that I might be happier in a new position.  In order to be happier in this way, though, I have to do a bunch of unpleasant tasks like updating my resume, browsing job postings, writing cover letters, going to interviews, and taking time and effort out of my already busy schedule to do more mundane tasks.  I’ll probably feel good once I land a new position I feel passionate about, and – even knowing that – the process of getting there is still unpleasant and it might be easier for me to just stay at my current job.

In addition to the typical discomforts of life changes, eating disorder recovery poses unique challenges above and beyond that of applying for a new job.  Among its many challenges, the need for weight gain in recovery from some eating disorders is particularly onerous.  For anyone, regardless of whether they have an eating disorder, major changes to your body come with an adjustment.  This is partially due to our internal catching up with our external; think of a clumsy teenager unaware of their new height, banging their knees and hunching awkwardly – their brain hasn’t yet caught up with their body.  A well-studied example of this phenomenon has been observed in people with amputated limbs.  Around 80% of people with an amputated limb report experiencing sensations where their limb once was, commonly referred to as “phantom limb syndrome.”  Likewise, when someone gains a significant amount of weight, their brains take some time to adjust to their newfound body shape and size.  There are also physical discomforts associated with reintroducing foods, eating more regularly and/or in greater volume, gaining weight, and/or reducing or eliminating engagement in inappropriate compensatory methods.  During the earlier phases of recovery, the body is working hard to replenish nutrient levels – a process that can sometimes even result in dangerous medical complications.  Around 30-40% of people in recovery from anorexia or bulimia experience edema, a condition where excess fluid is trapped in the body’s tissues, and 98% experience at least one functional gut disorder, such as gastroparesis or irritable bowel syndrome.

Weight gain is uncomfortable for more reasons than the physical adjustments that occur in our brains and bodies during recovery, though.  At the core of anorexia, bulimia, and most other eating disorder presentations, is a preoccupation with weight or shape.  For someone with an eating disorder who is preoccupied with their body weight/shape, there is an extreme fear of weight gain.  Though this may not seem logical from an outsider’s perspective, this fear is ingrained in the very essence of the disorder, much like a fever and sore throat are ingrained in the flu.

In Western cultures, weight gain is also highly stigmatized and equated with poor health, immorality, laziness, and a lack of self-restraint, among other negative characteristics.  For many Americans, particularly for women, the pursuit of weight loss is so normalized that 75% endorse engaging in disordered eating behaviors (e.g., skipping meals, taking diet pills, smoking cigarettes, etc. in an attempt to lose weight) at some point in their lives, and around 45% whose weight is classified as either “underweight” or “normal weight” report actively attempting to lose weight.  To attempt to eat more or gain weight in eating disorder recovery, thus, can be countercultural.  In a qualitative study on recovery experiences, one participant described this experience, stating, “[r]ecovery is like a mandate to do what everyone else is working not to do.”

The recovery process can feel especially countercultural for people whose bodies are already stigmatized by society.  Those with disabilities, people of color, transgender and nonbinary people, and multiple other marginalized groups, already embody traits that do not fit into narrow beauty ideals. People in larger bodies are often encouraged to engage in extreme attempts at weight loss, and their eating disorder behaviors are fueled, minimized, and untreated, by those meant to help them.  For people with eating disorders holding one or more of these identities, recovery is likely to look significantly different – and be significantly harder – than for someone whose body is not a source of oppression.  

Eating disorder behaviors can also be functional, making recovery even more disorienting.  The cause of one’s eating disorder is highly individual and multi-faceted, with biological, psychological, and social components.  Aside from desired weight loss, which may be part of the reason a person is engaging in disordered eating behaviors, a common theme in the maintenance of these behaviors is their functionality.  While people don’t generally wake up one morning and decide to begin binging and purging to cope, over time these behaviors can begin to feel helpful, affirming, and even soothing.  For people who experience traumatic stress, engaging in disordered eating behaviors can serve as a powerful means of suppressing intrusive thoughts, memories, or flashbacks.  Eating disorders also sometimes provide a sense of control for people who feel that their lives are otherwise uncontrollable.  For trans and nonbinary folks, restriction or extreme weight loss attempts may help them to reduce the appearance of secondary sex characteristics like breasts, hips, or facial hair, due to the effect of malnourishment on hormone regulation.  Moreover, weight loss might provide privileges for those in marginalized bodies, morphing their size and shape into the unrealistic standards that they can’t achieve healthily.

One client I worked with, who had both an eating disorder and Posttraumatic Stress Disorder (PTSD) as a result of years of childhood abuse, once described feeling as if her eating disorder “saved her”, noting that she wasn’t sure how she could have survived the abuse she endured without the emotional numbing her eating disorder provided.  As a child, she was in a situation in which she was powerless to an abuser and turned to eating disorder behaviors to cope.  As a child, she didn’t have the knowledge or resources necessary to cope and so she developed a pattern of unhealthy, yet functional, behaviors.  While I worked with her toward recovery, and we both acknowledged that her eating disorder was no longer serving her, I believe she was only able to make this progress because we acknowledged the function of her behaviors. 

Though functional at times, eating disorders themselves can become even more disillusioning than trying to give them up.  It can be horrifying to watch yourself engage in behaviors that you know can be deadly, yet feel powerless to stop.  To know that if you continue down the path you are on, your career, relationships, family, health, and more, might suffer.  In treatment, clients are often encouraged to think of their eating disorder as a separate entity from themselves; you are not the disorder that has overtaken you, but a victim of its wrath.  Sometimes the eating disorder is given a name like “Ed” or is imagined to be a well-intentioned, yet harmful, voice in our heads.  For example, someone in recovery might suggest that “the eating disorder” wants them to lose more weight and that their “healthy thoughts” want them to be able to eat without fear again.  This strategy can be highly effective in examining and challenging thoughts and urges to engage in disordered eating behaviors, while also allowing for an understanding of the function of these thoughts/urges.  

In one type of psychotherapy, Dialectical Behavioral Therapy (DBT), this separation of “the eating disorder” from the “self” is done through dialectical thinking.  Dialectical thinking refers to the act of holding two seemingly opposing thoughts at the same time, with the goal being acceptance and change.  An important part of dialectical thinking is holding these seemingly opposing thoughts as both true, which allows for acceptance.  Through dialectics, we see that opposites can be true simultaneously.  Dialectics are often framed by swapping the word “but” for the word “and.”  For example, instead of saying “I understand your point but I disagree” we say “I understand your point and I disagree”; the first example using “but” negates the first half of the sentence, whereas the example using “and” holds both as true.

In eating disorder recovery, dialectical thinking might help a person accept that their disordered behaviors are functional, while helping them work to change them.  Part of recovery, especially in its early stages, is ambivalence.  It is common, and even expected, for someone to be unsure if they want to give up their eating disorder.  In fact, part of the criteria for diagnosing anorexia is a “persistent lack of recognition of [the disorder’s] seriousness”. That’s why dialectical thinking can be so helpful, as it affirms this ambivalence while also building hope for change and insight into the seriousness of the disorder.  Below are some examples of dialectics that come up frequently in eating disorder recovery, that may serve as helpful reframes for moments of ambivalence.

  • I hate my body and
    • I still need to eat
    • I still deserve to eat 
    • I know that I can’t healthily change my body
    • I am more than my body
    • I hated my body when I was thinner, too
  • Treatment is uncomfortable and
    • My body is healing 
    • This discomfort is temporary 
  • My eating disorder helps me cope and
    • If I keep this up I could die 
    • It’s interfering with so much of my life 
    • I don’t know if it’s worth it
    • I can learn new coping skills 
  • I’m not sure I want to recover and
    • I’m not sure I want to keep my eating disorder, either
    • I don’t have to commit to long-term recovery
    • I don’t have to commit to a “full” recovery
    • I can give recovery a try
  • I miss my eating disorder and 
    • My life is so much fuller without it 
    • I have new and healthier ways to cope now
    • That doesn’t mean I have to go back to it

If you think you might benefit from improving your relationship with food/body image, click here to learn more about working with me.  Check out my social media below for free resources and updated information on my services!

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