3 Reasons Why Eating Disorder Recovery Is Hard Work
By Jessica Slatus, LCSW
Reaching out for help for an eating disorder is an important and brave first step towards healing. Recovery itself can be a long process and requires great commitment, persistence, and openness to moments of discomfort, internal turmoil, and growth. Day by day, meal by meal, sometimes minute by minute, it is a challenge that requires faith in yourself, curiosity about how your life could be different, and trust in your capacity to heal, grow, and recover from your eating disorder. 
If you’re struggling with the recovery process, you are not alone. Here are a few reasons that eating disorder recovery can be so challenging:
You Experience Your Emotions
By the time most people enter recovery, they are well aware of the physical and emotional tolls of the eating disorder. They have seen, firsthand, the downsides of the behaviors, how dangerous they can be, and how difficult they are to get out of alone. The costs of the eating disorder are many.
Yet, eating disorders are also compelling. For many, one of the reasons that eating disorders are so powerful is that they are self-protective in nature. Your eating disorder, in spite of its dangers, can have an adaptive function. It can offer a way to help you manage your emotions and deal with life’s experiences. Remember that awkward dinner with your dad? Focusing on the calories in your meal gave you a bit of space from having to be present with him. Remember that pang of hurt you felt when you found out what your friend had said behind your back? Purging that night made you forget all about it, at least for a bit.
When you begin to let go of your symptoms and release the tight hold that the eating disorder has had, you begin to make more contact with your core emotions. Core emotions (Hendel, 2018), also called basic emotions (Ekman, 1992), or categorical emotions (Fosha, 2000) are universal, wired-in feelings that we all have, such as sadness, anger, disgust, fear, joy, excitement, and sexual excitement. Core emotions give us information about our experience and help our nervous systems figure out what action to take in response to what we are feeling. They make us human and help us to connect with others.
Sometimes, you may not be sure what to do with these emotions. They can be overwhelming or frightening, especially when you have to deal with them alone. Often anxiety or shame gets in the way of tuning into the emotion underneath, and we develop defenses – or ways of coping that help us to avoid or distract from what we are feeling (Fosha, 2000). Eating disorders do this job well. In the past, you may have turned to your eating disorder to cope with how you feel. Now that you are practicing doing things differently, you are making more contact with your emotions and you may need some new tools.
In my psychotherapy practice, I help people to reconnect with their emotional experiences and begin to feel enlivened by them. I use a kind of therapy called Accelerated Experiential Dynamic Psychotherapy (AEDP) (Fosha, 2000). AEDP is focused on feeling and processing core emotions within a safe and secure relationship with your therapist. Together, we appreciate all that the eating disorder has done for you, and help you to deepen and expand your emotional world. Without the fear or burden of having to manage your feelings all alone, you can begin to be nourished by your emotions once again, and the eating disorder will become a less viable option.
What you can do: To begin to tune into your emotional experience, practice noticing how an emotion sits in your body. Where do you feel it? What is the physical sensation? Try to observe the information that it is giving you without judging it. Remind yourself that we all have emotions and that having an emotion is not the same as acting on it. Imagine that you are stretching this emotional “muscle” within you. Being more emotionally limber will give you more resources for managing difficult situations without turning to your eating disorder for help. Practice being kind to yourself as you do this work. Reach out to a therapist if you need some help or support.
Learning to trust your body
When all goes well, we grow up learning to be in sync with our bodies and to recognize signs of hunger, fullness, fatigue, and discomfort, and to respond in kind. For someone with an eating disorder, this innate ability to tune into physical cues can be muddled by thoughts and beliefs about what or when you should eat. Recovery is not just about restoring weight or reducing symptoms. It involves re-learning how to trust your body and the signals it is giving you. Just as the work of recovery involves listening to the emotional information your body is offering, so does it involve listening and responding to its physical cues.
This sounds easier in theory than it is in practice. It is one thing to follow a meal plan and another to let your body’s signals lead the way. Clients in recovery are often scared that if they eat what they want, in accordance with their hunger, their bodies will spiral out of control. They equate attuned eating with “getting fat,” and this terrifies them. This doesn’t give your body very much credit! As humans, we are oriented towards growth and healing (Fosha, 2008), and our bodies are amazingly resilient. Think of what happens when you get a cut or a scrape. Your body quickly forms a scab to protect the injury. Similarly, in spite of months or sometimes years of mistreating your body using your eating disorder, with enough time and attention, you can hear your body’s cues once again. Remember that your body has taken care of you. It has gotten you this far.
What you can do: When you are feeling hungry or it is mealtime, close your eyes and let yourself imagine what you might eat. Let yourself envision the food and how it feels in your mouth and as it digests in your body. See if your head, which may have other ideas about which foods are safe or acceptable, can step to the side as you do this. Know that your head is working hard to “protect” you and thank it for doing so. Remind yourself that you and your body are on a journey together. Acknowledge how hard it must have been on your body to have been ignored or overridden for so long. Thank your body for how hard it is working and practice bringing some compassion to yourself. Seek out a nutritionist who specializes in eating disorders to help you as you navigate this journey.
You may continue to be symptomatic
Being in recovery from an eating disorder does not mean that you never experience symptoms or have the impulse to act on them. In fact, learning to tolerate urges is part and parcel of the recovery process. But what about when you act on your symptoms? Can you be in recovery and sometimes be symptomatic? I think so.
I realize that this may sound a bit controversial, so I will explain what I mean using a vignette from my practice:
Recently, I was talking with a client who I have known for a number of years. When we first began our work together, he was purging daily, sometimes multiple times a day. In the past eight years, he has been generally symptom-free. We have done a lot of work around understanding the role of his bulimia, gaining access to his emotional experience, and finding other ways to cope with stressors in his life. In our recent conversation, he shared that he had thrown up twice since our last session. This is still recovery.
Here’s why: In our conversation, there was no hiding, shame, or minimizing the behavior. He had a sense, in hindsight at least, of what was creating so much stress and anxiety in the moment that he chose this as his outlet. It didn’t become a pattern. He threw up twice, he experienced his feelings about it, and he moved on. He didn’t blame himself or drown in shame about it. He shared it with me, and he told his girlfriend. In our conversation, he expressed compassion towards himself about what was going on. He wasn’t proud of his choice to act on his symptoms, but he was lucid, curious, insightful, and open to tenderhearted connection with himself. This is recovery. Being imperfect and loving yourself—not in spite of, but for—your imperfections, is part of recovery.
What you can do: If you are in recovery and find yourself returning to your symptoms, you may feel disappointed, confused, or scared. There may be a part of you that is still deeply connected to the eating disorder and feels “good” about using it. This is all normal. Rather than scolding yourself, try to be gently curious about this experience. Imagine that you are a detective and closely track as much as you can about what you were feeling before, during, and after you were symptomatic. Remember that the eating disorder was stepping in to “take care” of you, but that you have other tools now. Reach out to your support community. Tomorrow is a new day.
The road to recovery is not easy and it is often not linear. It changes you and it can change your relationships with others, as well. Trust the process, bumps and all. If you stick with it, you will grow and change in ways that you could not have imagined.
About the author:
Jessica Slatus, LCSW is a psychotherapist and eating disorder specialist in Boulder, Colorado. She has a Master in Social Work from New York University, and received her training in eating disorders at the Center for the Study of Anorexia & Bulimia (CSAB) in New York City, where she later worked as a staff therapist. She is a Certified Supervisor at the Accelerated Experiential Dynamic Psychotherapy (AEDP) Institute, and is the author of two publications on working with eating disorders using AEDP. For more information about her practice please visit www.jessicaslatus.com.
References:
Eckman, P. (1992). An argument for basic emotions. Cognition and Emotion. 6 (3/4), 169-200.
Fosha, D. (2000). The transforming power of affect: A model for accelerated change. New York, NY: Basic Books.
Fosha, D. (2008). Transformance, recognition of self by self, and effective action. In K.J.
Schneider (Ed.) Existential-Integrative Psychotherapy: Guideposts to the Core of Pratice, pp. 290-320. New York, NY: Routledge.
Hendel, H. J. (2018). It’s not always depression: working the change triangle to listen to the body, discover core emotions, and connect with your authentic self. New York, NY: Random House.