As a therapist who has dedicated my career to eating disorder recovery, I have encountered many misconceptions about eating disorders and treatment. I feel that they are important to address because these statements often create unnecessary obstacles for people seeking help. Recovery is hard enough on it’s own! We don’t need these ideas getting in the way of anyone working towards a better life. We have a great opportunity here to start a more productive dialogue about these complex disorders.
“People choose eating disorders just to get attention”
This one is a painful misconception that I see expressed often on social media. This short statement is loaded with misinformation and I could write volumes about it. The short version is; eating disorders are not a black and white “choice”, they are legitimate disorders. Eating disorders usually start off with good intentions. A person is in some kind of emotional pain or trying to cope with trauma and they decide to try and help themselves through it either with a diet or eating as a way to comfort themselves. Nobody starts with the idea, “Hey, I think I’ll try having an eating disorder!”. During this process of using either weight loss or food as a coping mechanism, a structural change happens in the brain. The brain begins a developing a dysfunctional attachment the idea that these coping mechanisms are necessary and then it begins to reinforce these behaviors, strengthening them over time (this is where it becomes a mental illness). Hunger becomes a source of satisfying comfort and often feels like the only way to have any relief from painful emotions. Binging and purging can feel like a necessary ritual in order to feel okay. Next, the behaviors start fusing with a person’s personal identity. The number on the scale becomes an indicator of being a “good” or “bad” person” and the weight loss behaviors start feeling like the only thing he/she is good at. It starts to become all-consuming and pushes out other interests, personality traits and relationships. Life becomes centered around preserving the eating disorder. It doesn’t happen overnight, it develops over time.
Most of this experience happens internally. The idea that it is “for attention” is not a fair assessment. Even if the eating disorder is visible to others, the person usually works very hard to keep the behaviors secret. The idea of being found out feels scary and very risky. Many people with eating disorders want to go unnoticed or “become invisible”. Eating disorders are not used as a tool for attention, that explanation is too simplistic to describe this complex condition.
“If you stop your eating disorder, you’ll feel better, right?”
This idea usually comes up when a person starts seeking out treatment. They have made the courageous step to get help and people around them are trying to be supportive, pointing out all the ways they’ll feel “healthier” and “happier” after they let go of their eating disorders. Again, the intentions here are good, but there needs to be more understanding of the process of eating disorder treatment. In the early stages of treatment, the idea of letting go of the eating disorder is terrifying. These behaviors have been a source of comfort for months or years, a part of the persons identity and the eating disorder has promised big things. If you follow the rules of the eating disorder, you’ll be happy! You’ll be successful! People will love you! It takes time and a strong, healthy relationship with a therapist and dietitian to challenge this. It often feels worse before it gets better. That is a normal part of the recovery process. If a person doesn’t know this, it could discourage them from continuing treatment. If weight gain is a part of a persons’ recovery, that is another level of adjustment that loved ones should be sensitive to. It’s not until the mid or late stages of treatment when the person starts to feel more positively about living life without his or her eating disorder. It often takes more time than parents/spouses/friends think that it will, I think our expectations need to be adjusted to reflect this. If we push that idea that recovery should equal happiness every step of the way, then I believe we are setting up an unrealistic expectation that will become an obstacle in recovery.
“If I accept my body, I will go out of control, gain weight and it won’t ever stop”
This is a common fear for people in eating disorder recovery. We talk a lot about body acceptance, but the idea of eating intuitively and accepting our bodies is often a scary one. If a person has lived for years with strict “rules” about food and weight, the idea of letting them go can feel like a direct connection to being “out of control” and gaining weight with no stopping point. The body’s metabolism needs time without restricting, binging or purging in order to regulate itself and get back to a fully functional place. This is where a relationship with a Registered Dietitian can make all the difference in recovery. Having a trained professional help guide you from your eating disorder rules to a place of eating intuitively is a tremendous burden off of your shoulders. A dietitian can help explain what kinds of things are happening with your metabolism and how to maintain a healthy weight without obsessing over a number on a scale. It is best practice to set up a treatment team that involves a mental health professional and a registered dietitian, this way the psychological/emotional facets of the eating disorder as well as the physical ones. Medical doctors are needed to keep tabs on the physical effects of the eating disorder, but they can not provide the specialized and ongoing guidance that a dietitian can offer.
“I can recover from this on my own”
This idea is the biggest one that I want to address. The most important thing a person can do for his or her recovery is to establish a relationship with a therapist. In order to fully replace the eating disorder behaviors and thrive, a person needs to build a healthy relationship with someone who can help guide them through the process. This relationship creates an atmosphere where a person can be challenged but in a safe and empathetic way. Books are great, reading articles like this are great, but they really are just primers for the real work. Gaining insight is a starting point, but it’s not the entire process. Recovery can not be achieved in a classroom setting, where a person is just absorbing knowledge but not going through the emotional side of the process. Eating disorder recovery is about finding ways to cope with difficult emotions and building positive connections with others, it isn’t a skill that can be taught through a book or a blog post. It is an experience that must be lived through. There is a community of experts out there who have years of experience with this journey, utilizing this rich resource can only benefit a person who is struggling with an eating disorder. Since the therapeutic relationship is a personal one, experience is not the only factor in choosing the right therapist. Feeling safe with a therapist, feeling like you are being genuinely listened to, and an overall comfortable feeling in the room with that person is vital for recovery. You can find eating disorder professionals through the website www.EDReferral.com.