Eating disorders are classified as psychiatric illnesses for good reason. Although the physical symptoms are most obvious to the outside world, it's the inner psychological turmoil that causes the most pain.
The outward physical manifestations of eating disorders tends to overshadow the true nature of these illnesses. Starving or purging food distracts people from recognizing that beneath eating symptoms are far more insidious psychological symptoms. The medical effects of eating disorders often disturb clinicians and scare doctors away from treating these patients but also stops even the treaters from seeing the inner world of a sufferer. These illnesses cause chronic physical symptoms, and anorexia has the highest mortality rate of any psychiatric diagnosis. And the cure looks so simple as to be ludicrous, just eat.
To anyone watching a person in recovery, it's evident that eating isn't easy at all. Each bite is excruciating; each plate of food is an obstacle of epic proportion; each moment is dominated by fear of the next meal or snack. Eating a meal is a ritual that happens several times per day. Whether for pleasure, work, celebration or sustenance, food represents a mundane part of life to those who are well. The experience of terror around food mystifies even the most open-minded, compassionate person who doesn't have an eating disorder.
Understanding the true inner struggle of recovery necessitates a big step in logic. The eating disorder symptoms appear to be the biggest hurdle in treatment. Avoiding restriction or purging or over-exercise, a person in recovery starts to physically look better to the outside world. Normalized weight and energy makes concerned family and friends take a deep breath of relief.
The reality of recovery is much different. Once a patient starts to eat and avoid behaviors of the disease, things start to get really hard. Just when everyone stops worrying as much, the person in recovery needs a lot more comfort and support.
The easiest way to imagine the psychological symptoms of an eating disorder is to think of a repeating loop of thoughts in one's mind. The thoughts are an endless string of criticisms and punishments. These thoughts can attack every step the person takes: every comment, every decision, every opinion.
The result is to quash any meaningful aspect of this person's life. If ever an ounce of positive experience sneaks past the filter of these thoughts, the endless loop returns to the most effective punishment: food and body. Feeling guilty about eating food or ashamed of one's appearance will always stop any movement towards positivity and trap the person in the negative, critical loop of the illness.
There is only one way to calm the punishment: the eating disorder symptoms. Starving, binging or purging will make the thoughts stop for a moment and give a few minutes of peace. So the symptoms are the only thing that provides any relief to someone in the throes of an eating disorder, and eating is the only way to get better. The result is doing something many times per day that will get you well but makes you feel worse in the moment each time. Meanwhile, everyone who is supportive thinks things are better, yet the sick person just feels really bad. No wonder recovery gets so much harder.
Regular professional help will reinforce to the patient that this step in recovery is always very difficult. However, educating family and friends is crucial at this stage of treatment. While getting better, the person needs to reach out for support and work on building personal relationships. Those connections help loosen the grip of the eating disorder. It's critical for those close to the person in recovery to work hard to understand what makes eating so hard. The supporters need to regularly express love, compassion and understanding for the emotional struggle to try to live each day without engaging in the eating disorder symptoms. Doing so helps the person feel supported in the struggle to get well and comforted by the repeated recognition that even though eating each day is very, very hard, it's also the only way to get better.