Many people with eating disorders start out completely unsure if they even want help. The people who come to get therapy are often pressured in to attending by loved ones or by some life circumstance, rather than coming in because they themselves want to change.
At the stage where someone would be researching a website like this one, the prospect of getting better can sound simultaneously fantastic and frightening.
When starting therapy, it is always important take in to account
that you may have not made your mind up about recovering -
and that is OK!
Half or more of the therapeutic process is about YOU deciding how far you want to go. Many people need time to think through their options, take small steps, and reassess their commitment throughout their experience. Below, you will find some brief descriptions of the approaches used in therapy so you can get a general sense of what your process would look like.
8 Keys To Recovery From an Eating Disorder
A great place to begin eating disorder therapy is in the “8 Keys To Recovery From an Eating Disorder” by Carolyn Costin and Gwen Schubert Grabb. Both Carolyn and Gwen are fully trained therapists who completely recovered (i.e. they no longer have disordered thoughts, urges, or behaviors) from their own eating disorders. They then went on to help others who suffer.
Their treatment philosophy focuses therapy on the battle between the conflicting voices in the minds of people with eating disorders: the Eating Disorder Self and Healthy Self. By helping individuals find and strengthen their healthy voices, the supportive parts of eating disorder symptoms are understood. Then, if the person chooses, those unhealthy coping behaviors are gradually replaced with other ways of managing emotional problems.
The job of a good eating disorder therapist is to help you develop your own interest in recovering, and then help you to strengthen your Healthy Self so that it can take over whatever role is being played by your Eating Disorder Self.
Cognitive Behavioral Therapy (CBT)
CBT focuses on helping people change how they feel by challenging their thoughts, and creating realistic plans to overcome ineffective behaviors. To adjust repetitive patterns of thinking, there are exercises used in CBT that bring out your underlying beliefs and then help you change them. On the behavioral side of things, you will learn to reevaluate how you spend time on a daily basis. From there, you can begin tweaking small choices that introduce positive emotions into your life. From those successes, you can build new skills to tackle larger problems and take bigger and bigger steps towards your goals. CBT is well researched, and for many mental health problems, it is considered the "gold standard" of care.
Exposure Therapy (ET)
ET guides people through a process of desensitizing themselves to situations that would typically make them feel very uncomfortable. For someone with an eating disorder, this could mean overcoming certain "trigger" foods, dining situations, or discomfort that comes from their body image. ET can help you build confidence in your ability to tolerate difficult feelings and teach you how to make those difficult feelings smaller, smaller, and smaller. ET is especially known for being an excellent treatment for anxiety problems, which often happen alongside eating disorders.
Family and Supporter Therapy
With your permission, we can meet with the people who are most important to you: parents, spouses, partners, siblings, coaches, clergy - anyone that you feel would be helpful to talk to. Involving loved ones can help someone boost their motivation for recovery by addressing important relationship dynamics, explaining the basics of how eating disorders work, or just communicating about what feels supportive. Having an informed community of helpers around you can make the difference when you feel like giving up.
What Healing Can Look Like
Over time if you choose to stick with therapy and ride the ups-and-downs of being in recovery, you will find that your life gets better. You will choose to use your eating disorder behaviors less frequently, think about your body less often, and experience fewer urges to reengage in symptomatic behaviors.
How much you care about your appearance will shift from your #1 concern to something more like 'a human average' - you still care, but its not an obsession. You'll also notice that you can solve problems real-life problems in ways that don't hurt you and make you feel worse. You will develop a sense of growing peace that may start out as tiny moments of relief, but as your recovery progresses, it begins to become your new normal.
People in stable recovery also talk about their eating disorder voice becoming quieter, and quieter, and quieter as it becomes less and less relied upon. As time continues to move forward and you keep strengthening your healthy voice, you'll find that you start thinking of your eating disorder as a 'thing you used to have', rather than something you currently struggle with.
If this goes on long enough, and someone really abstains from symptom behaviors while they keep working on their underlying emotional issues, they can reach a place where they feel "recovered".
What Does It Mean To Be "Recovered"?
Being recovered (sometimes also referred to as “having a full recovery”) is the complete end to eating disorder thoughts, urges, and behaviors. Anyone can be 100% recovered from an eating disorder.
Regardless of how long you’ve been sick, how many previous treatments you’ve had, what other professionals told you, or how hopeless you may feel about yourself – you can be recovered too. Carolyn Costin's book "100 Questions & Answers About Eating Disorders" gives this definition of "recovered" on page 164:
Being recovered is when the person can accept his or her natural body size and shape and no longer has a self-destructive relationship with food or exercise. When you are recovered, food and weight take a proper perspective in your life, and what you weigh is not more important than who you are; in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size, or reach a certain number on the scale. When you are recovered, you do not use eating disorder behaviors to deal with, distract from, or cope with other problems.
Sources:
- NEDA.org - What are Eating Disorders?
- Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry, 13(2), 153-160
