Not Moving Forward With Eating Disorder Behaviors

By December 14, 2012

I was diagnosed with anorexia many years back. Have gone inpatient once and PHP twice but have not had that intense of treatment in the past three years. I relocated to another state three years ago and about 6 months ago kind of slipped up a bit and started seeing a therapist again. I was also seeing a dietitian as well but have stopped going recently because I was feeling as though there is nothing new I can learn from it. I know what I’m supposed to do and have a meal plan. So my question is… my therapist says I’ve been doing very well. I guess with the psychological stuff I’ve been making headway but feel as though I’m still stuck and not moving forward with ED behaviors. We don’t discuss ED behaviors that much and focus on other things instead. So I feel stuck; although I’m making headway with other stuff, the ED thoughts and behaviors are still in control and I’m starting to feel like it will always be that way. I don’t really work on any ED behaviors and am still struggling with restricting. Is fixing the other drama in my life going to eventually make the ED behaviors disappear? I’m just confused and feeling really stuck at the moment. Any advise would be greatly appreciated. – D.

Dear D,

You are definitely asking the right questions and taking the right steps. The fact that you sought out a treatment team when you “slipped up” is a great sign of your awareness and commitment. I’m guessing that these are some of the reasons your therapist says you are doing great. Of course, that is assuming you are being completely honest with your therapist about your behaviors.

The fact that you are not always discussing your behaviors with your therapist doesn’t surprise me. In my experience (and the research of many professionals) the behaviors of an eating disorder act as a coping mechanism. In other words they are, in part, a reaction to the other “psychological stuff” in your life. So, your therapist is right to help you process the other things going on in your life. Having said that, if you are concerned that your therapist is not addressing the issues that concern you then you should bring that up in your next session. This will help you explore these issues, as well as giving your therapist an opportunity to explain his/her approach.

As for your continued struggles with urges and behaviors, fixing the drama in your life won’t make them the just go away. Learning to handle the drama in your life differently will reduce the power those behaviors have in controlling you. But to really make progress in changing the way you act you will need to learn ways to break the cycle of addiction that you have practiced again and again over the years. One way of breaking the cycle is having a consistent accountability relationship with someone. This doesn’t mean you have to “confess” every struggle or wayward thought, but rather that you have regular conversations in which you are honest about your actual behaviors and talk about what led up to those actions. The other major way of breaking a pattern is to understand what those patterns are and then find skills and methods to interrupt the patterns that result in ED behaviors.

Consider a chain, for example. Each link in the chain represents a thought, feeling, circumstance or behavior and each link is connected to the one before and after. So, you have a stressful day at work (link 1) which leads you to the thought, “I better do better or I may lose my job” (link 2) which results in feelings anxious (link 3) which you manage by skipping lunch (link 4) which results in you feeling more self-disciplined (link 5) but also results in you feeling guilt and shame (link 6) which adds to the stress and distracts you at work (back to link 1).

At any point along the way you could have caught yourself and broken the chain. For example you could have recognized the stress at work and stopped to ask yourself how you were feeling. At that point you could have recognized the anxiety and likely come to the conclusion that you know that you often handle stress by restricting. Now, knowing that you were feeling tempted to restrict you could have called a friend and said, “Hey, I’m concerned that I’m going to skip lunch. Will you go to lunch with me?” Doing this will do several things; first it breaks the chain between links 2 and 3 because you interrupted your thinking patterns. Secondly, it will take away some of the power of the temptation to restrict because you are talking to someone about it (just try it, it really works). And thirdly, you learn other skills to cope with stress outside of your eating disorder.

This won’t come all at once. This type of behavior is a life skill learned over time. But as you have success (not perfection, but growth) you will grow in confidence and find yourself thinking less and less about your ED.

Keep up the fight. You are not your eating disorder.


Travis Stewart, LPC