This blog is a collection of things that people have told me — unedited — in the last couple of weeks. This collection circles around what I see to be one of the primary problems with eating disorder treatment: Professionals reinforcing the very fears that the eating disorder brain holds. That is rather like your skydive instructor telling you to jump out of the plane, but also reminding you that the last person do did so wrapped themselves around a telegraph pole and died on the way down.
In respect to eating disorder recovery, these fears are primarily:
- Fear of weight gain
- Mistrust of one’s own body to be able to manage establishing an optimum bodyweight
- The idea that dietary restriction is a normal
- The idea that one has to suppress one’s natural bodyweight
- The idea that weight gain has to be micromanaged and that there is an “optimal” rate of weight gain
One of the biggest and most healing tests for me in recovery was the challenge of unconditionally accepting that my body knows how to optimise it’s own weight, and that it doesn’t need me to micromanage it. Furthermore, I learnt, that whenever I did try and micromanage by bodyweight or my rate of weight gain via dietary restriction or exercise, by body justifiably reacted with a huge and unsatisfiable hunger.
I often use the analogy of healing a cut. If I cut myself I don’t micromanage the healing process. I shove a plaster on it and forget about it. I don’t accuse my body of healing “too fast.” I don’t pick the scab off because I think that I know better and that my body is healing at a rate that is unsafe. I leave it the fuck alone. And guess what happens? My body takes care of it and sorts it all out for me. Basically if I stay out the way and don’t fuck it up, my body does all the work.
That is how it is supposed to be. There is a reason we have automated processes that we don’t have to and aren’t supposed to manually oversee in our bodies. Micromanaging your own body is not a good use of your intelligence. Common sense should tell you that in order to heal from malnutrition you have to eat a load of food and your body will take care of it. Yet, an eating disorder brain (which is neither partial to common sense nor logic) will tell you that you have to control every bite of food that you take otherwise “bad things” will happen.
Which is nuts. That’s okay. You are excused for being nuts because you have an eating disorder and that screws your logic.
That’s your excuse. What is the professionals’ excuse then? Because over and over and time and time again it seems it is the treatment community that is the worst at reinforcing beliefs that the human body can’t take care of itself and we need to jump in with our judgement and tell it what to do.
Please. Do you think that humans would have ever got to the moon if they really had to obsessively manage every calorie of food that they eat? There is a reason we have automatic processes to do this for us! When we start putting our noses into things that really our none of our business — such as trying to decide whether or not a hunger signal is valid or not — we get stupider. And less healthy.
And the sad thing? The amount of damage a professional can do to a person in recovery with a comment such as “Well, are you sure you are hungry, it might just be emotional eating …” is devastating. I have clients in their fifties who still are stuck on a comment like that someone made to them twenty years ago.
Rather than take it from me. Here are the voices of a small slither of people in recovery who have had such experiences:
“They were more scared of recovery than I was. I wanted to eat. I was allowing myself to eat. I was gaining weight. And I was scared but also not scared. But they were scared of my hunger more than I was. They were scared of my weight gain more than I was.” -Said by a 19 year old in recovery about her NHS treatment team
Once when I was inpatient as soon as I got to BMI 18.5 my meal plan was stripped to the minimum (3 meals a day). And I was fucking starving. My set point has never been 18.5 and never will be. (Fair to say I was hungry). I remember saying to a psychologist there ‘I really want to try and get to a bmi of 20’ . Her response ‘oh that’s insulation, most people with anorexia wouldn’t normally want to get to that point’ (bloody hell, no wonder it’s difficult)
Thought these point although frustrating are quite funny. I guess you’ve got to laugh, ignore, and carry on Ey!The most disconcerting thing about recovery for me is believing that I am doing it ‘wrong’ by going against traditional methods. Finally, I have chosen to nutritionally rehabilitate by following mental hunger signals and eating in a totally unrestricted way having spent years being told that I should eat according to a strict diet plan, micro-manage my activity levels and look for underlying reasons as to why I developed anorexia. I now have to try and forget that the medical profession told me I was ‘binging’ when I ate over my minuscule meal plan. I have to try and forget that they told me that I gained weight too quickly when my starved body first started to eat. I have to try and forget that when I reached a BMI of 19 they told me I should maintain my weight and not gain any more. I have to trust that eating according to my body is the right thing rather than eating to the micro-managed treatment plan that the doctors prescribed.
All my body wants to do is eat a lot of food a lot of the time. Simple. But the traditional anorexia treatment reinforced the idea that I needed to carefully control my food and activity; that I can’t trust my body to do this for me. This makes absolutely no sense. Ignoring bodily signals by using a diet plan? Controlled weight gain? Recovery from a restrictive eating disorder using restriction? Total codswallop. As far as my own recovery goes, I only ever needed to know two things: firstly, I can eat whatever the heck I want and secondly, I can trust my body. Instead, I became dependent on a treatment team and was made to feel hopeless for not being able to recover in the way that they wanted me to. Signing off from the CBT-E therapy was the best decision I made. I now have the freedom to recover by listening to my body rather than to other people who are trying to speak for my body.
Of course this process is still scary. My body is in control and I don’t know where it is going or when it is going to stop wanting to eat everything in it’s path but at least I have confidence in myself again. I know that I have all the answers to heal myself. I know what I need to do to survive. I still have to speak to people about my worries – infinite weight gain and never-ending mental hunger – but I trust that it will settle down if I stick with it and accept.I do whole-heartedly believe that the first step in treatment from an eating disorder is allowing yourself to eat in a non-disordered way: no meal plans, no timing rules, no food that you can or can’t eat. Whatever you want, whenever you want, totally unrestricted.
I have quite a few stories. English is not my native language, I live in Germany and my treatment is here as well. Please excuse any weird mistakes regarding English I make. Also, I’m typing on my phone. Now the stories, 4 that pop right into my mind: 1.) I was told on more than one occasion when I was eating lunch after being upset about something else that I should not force food into myself like a horse and they fear I was punishing myself. I wasn’t. 2.) Also, I had to finish dinner within 30 minutes. That is not the problem and even though I never had problems with slow eating, it makes sense. Since I was a general ward and I ate as fast or slow as the others without EDs, it took us about 10 to 15 minutes. I had one nurse tell me that I should eat quickly, and another nurse who was in the same shift scold me for finishing before the end of the 30 minute time span, because it was clearly what my contract said…so she believed. She actually said I broke the contract when I ate too quickly and that 30 mins was not a maximum, but should be the exact time over which I should evenly distribute my eating. as my therapist in the clinic (I got one after signing the contract, yay!…even though I wasn’t allowed to switch to the one I liked more because of the threat of manipulation or idk, while at the same time being told I shouldn’t do it as an outpatient because it would take to long to meet with several therapists until finding a fitting one…:/ ) clearly pointed it out to her afterwards. I understand that the nurse was scared for me and interpreted the contract differently, thinking exactly 30 minutes meant a therapeutic approach to a healthy eating behavior. I was scared nonetheless because a break would mean being put into the locked ward. I didn’t have visitor rights back then and I was scared of being even more alone. 3.) Another incident: On the first couple of days while I was on the contract and had to eat everything (which I did, after I commited to eating, there was not one meal I did not finish, in spite of eating extra as soon as I was allowed to 🙂 ), I still got delivered a breakfast tray from before the contract that had snacks for throughout the day on it and a variety of vegetable spreads to choose from, because I had talked to a dietitian before. It’s a complicated story. 😉 I ate it all including the spreads, and snacks, for breakfast because I was hungry, I was commited to gaining weight, and because that’s what the contract said (my boyfriend calculated the calories afterwards, and yes, it was more than what most people eat in 2 days 😀 ). And because I could. I felt fine, it was early recovery, breakfast and I was hungry. My stomach could handle. One nurse made tea for me, told me how bad my brain must be (it wasn’t), and how I was sure hating myself now for the amount of food (I didn’t, I wanted to get my life back), and next morning, I had to show her my tray. She actually removed the snacks (notthe spreads, though) because she said she has worked in ED clinics and that breakfast should be way less. It all turned out okay after my dietitian adjusted the meal plan a couple of days later (to actually even less breakfast because she said I should learn what normal people eat…). But the gaslightning about how I was supposed to hate myself for the calories got me furious, because I really didn’t. I understand she wanted to be empathic and that with an ED you’re prone to hating yourself irrationally for eating to gain. But still, I think, if someone is vulnerable, maybe a side note of how the hate (which for me wasn’t there) was not necessary would maybe be helpful for some. 4.) And – this has nothing directly to do with restricting, sorry – I had often accidentally delivered low-fat, sugarfree products even though I had convinced my dietitation to get me full-fat milk and yoghurt. I totally understand that missunderstanding happen and the kitchen cannot always pay special attention to every patient, especially in a non-ED-treatment setting. But what was not helpful was the team not being sure whether I (or my ED) was to be punished if I ate it, or if I didn’t because my contract said I wasn’t allowed to eat artificial sweeteners.
When I was working with a CBT therapist, she told me that she didn’t want to push weight gain because I would likely just want to revolt and push back. Her goal was to make me “happy,” and if I thought I would be happier ten pounds lighter, then she would support that. The larger context was that she was asking me to look at my history, and if I would ever be happy at a lower weight. But all I heard was ok! Yay green light to lose weight. Mind you, I was already in a severely underweight body. It was irresponsible and unethical to further my emaciation. It also furthered my body dysmorphia, because I believed I didn’t look sick at the time. Fast forward a year and I’m diagnosed with osteoporosis. She also told me it was ok to fast a day after binging the night before, as long as I was listening to my body. In her own words, she was apparently “really good at treating eating disorders.”
I was also given a weight loss meal plan by my first nutritionist. She was trying to get me to eat more than I had been, but in no way was that what to prescribe someone with a restrictive eating disorder.
Since starting my treatment in the UK under the NHS my therapist has constantly tried to ‘reassure’ me that they only need me to get up to a ‘healthy BMI of 19’ to be considered as ready for discharge. It was only after asking her two weeks ago (a year into recovery) that I asked her to stop saying this as I didn’t believe this to actually be a healthy weight for me to aim for without having to continue restricting
My current therapist is very nice and I do like him a lot, but one thing has really given me a battle. He has accepted that before my ED I was in a larger body, and a higher weight, and has told me that I will be aiming for a higher than usual BMI – as in, higher than the ‘normal’ range – to achieve happiness and health. Thats a really great thing and I do feel lucky to get that much.
However he has also told me that it is unhealthy to be as big as I was before. That I can KIND OF get on board with… just before my ED, I had another illness that completely and utterly sent my body doolally and I think I was completely off balance anyway, which may have contributed to my body being pushed past even its own healthy set point (I could barely walk, etc). Still, it did put fear in me..
The worst thing though, was that he said that he believes I will ‘never be someone who can eat freely’ (i.e, will always have to restrict my intake to some degree/ignore hunger/calculate etc) to avoid gaining too much. He has told me that whilst he is monitoring my weight to make sure I don’t lose and that I steadily gain to the target they have in mind, he will also be monitoring my weight to make sure I don’t end up gaining TOO much.
He told me all this very early on in my treatment. I almost stopped going completely because I thought, what was the point then. If I always have to restrict, why am I going to treatment for anorexia? What are we actually trying to fix here? Is the aim to just restrict a little LESS? Whats the point of that… still miserable, still living a half life, yet now my ED is always mad at me too because I am just a bit fatter and eating just a bit too much. That situation is even worse…
I said that to him actually. quite bluntly… I said to him ‘Whats the point of still having to restrict, yet not being skinny to make up for it? I’d rather restrict and be thin than restrict and always be upset that I am still staying too fat’. He just went quiet and went ‘Hmmmm yes…’. He still hasnt answered that question.
I kept going though because I didn’t know what else to do. He hasnt said anything similar recently, but I think thats because I am still a way off the target weight he has in mind for me.
I’ve also had experience with an NHS dietician who restricted me to max 500kcals for a day to start because she didn’t believe I was already eating well but was overexerting myself. I was sooooo hungry and felt ashamed for wanting more than a professional told me I could have. I then found a private nutritionist who aimed to help people lose weight but told me to follow the same plan&recipes ‘just add whatevr you want to it’&take protein powders.An inpatient ‘specialist nurse’ removed yogurts and a blooming digestive from me because it was not on her plan.The leading nutritionist in NI didn’t know what I meant when I mentioned HAES or intuitive eating. My old GP insisted I gain 2kgs per week,no less or else I was doing sthg wrong. When I kickstarted refeeding on my own and are unrestrictedly,I lost weight and it fluctuated by about 6kgs both ways.Dr totally doubted&derided me. X
I remember my very first therapist before going in-patient. I have been underweight and an obsessiv exercise addict
I have been so afraid of gaining weight or stop exercising.
I never ever forget her words….
“I totally understand your fear, because bring obese is so disgusting, don’t you think?”
No… I never thought so…..
She highly recommended me to continue going jogging, since it’s a mood lifter for depressive people like me.
Every time I saw her she constantly was swearing about “those fat ones on the street eating double cheese burgers” and told me that she herself just eats fruits and veggies in order to stay thin.
Absolutely helpful……… NOT!
The first clinic I was in called me before, that I need to lose xxkg in order to be sick enough for the treatment there.
During my time there, we had to gain weight on schedule. Every Thursday we need to gain exactly xxkg.
My body didn’t give a damn about schedules and I gained much more in one week, but didn’t hit the jackpot the week after. That happened twice and eventually I was kicked out
Even though I gained a good amount, but not how there schedule expected me to
I was told to “stay the same until we can get you an appointment with the psychologist” by my eating disorders consultant psychiatrist, when I was first referred to her. At the time, my bmi was dangerously low and I had openly told her I was severely restricting and overexercsing. I waited 6 months for a psychologis (during which I kept seeing the consultant for monitoring and the message remained the same) and needless to say I lost more weight during this time so by the time I started seeing the psychologist I couldn’t even think straight.
my therapist told me two weeks ago, to better restrict again, when I told him that I was struggeling with my bodyimage.. He suggested to just eat the average food and to make sure to not allow myself too much ‚junkfood‘! bc this would be not good for my body, and if I would eat ‚too much‘ than I would not be able to resist my compulsiv behavior (exercise)
nooot really helpful at all..
In addition when I was IP last year, I was very malnourished, and I wanted to eat more bc I was hungry they told me that I can‘t, this woudn‘t be in the mealplan.. So I acutally asked for another fruit for dessert and they said no.. this would be to much..
One therapist which I used to go, told me to look up my fridge or freezer so I can‘t go to eat during the night or keep it looked between the meals so I‘m not able to eat more then my mealplan sais..
just so stupid..
I went to the GP aged 21 when I knew I was relapsing. Despite my history (severe AN aged 12-17), I was told my BMI was 0.3 units too high to qualify for referral and to come back in a week when it had dropped.
So let’s get this straight: We have people suffering from deadly restrictive eating disorders who are still very underweight being told to be careful they don’t overeat and gain too much weight by the professionals who are treating them. Can’t make this shit up, can you?
Time to wake up! If you are a professional treating people with eating disorders you have to recognize the damage that you could be doing when you advocate for restriction and “weight management.” Can can literally kill a person with a restrictive eating disorder with these comments. That, or you set them up to live a half-life of fear.
Please, professionals, therapists, dietitians, treatment providers, doctors … if you cannot trust yourself to be an advocate for the intelligence and brilliance of the human body, if you are going to tell a person that they need to dedicate their life to micromanaging their food consumption and their weight, do the responsible thing and do not treat people with eating disorders.
Do you have a similar story? Feel free to share it in the comments of this blog. Others will read it, and it is by sharing these stories of people in recovery that we can spread the understanding that we — people with eating disorders — cannot trust our bodies if the very people who are supposed to be helping us don’t.