Eating Disorder Thoughts

Most of the focus on eating disorder treatment is on the eating behaviors themselves. They are a concrete representation of complex mental and physical illnesses and present a facile way to explain the complex recovery process. It remains clear that powerful psychological barriers make the practical changes extremely difficult.

This obstacle stems largely from the conflation of personal identity and the eating disorder. Two facts about eating disorders make this condition likely. First, since eating disorders emerge at the same time as identity growth during adolescence, the objectives and thought patterns of the eating disorder feel like a personal philosophy. Second, the eating disorder rules boost self-esteem and help buoy internal confidence, and are called in psychological terms ego syntonic. 

Thus, an important part of recovery is the separation of one's own individual thoughts and identity from the eating disorder thoughts. Since these two thought processes grow together, the person has a lot of difficulty distinguishing them. Thus, the separation is a tall order. 

The concept of eating disorder thoughts is very abstract to people without eating disorders. In fact, the range in quality, strength and tenacity of these thoughts is broad. For some, the thoughts are a construct to conceptually separate identity from the eating disorder, yet the thoughts have no real mental manifestation other than arbitrary rules. For others, the thoughts feel like an entity unto themselves. When disobeyed, these thoughts turn into screaming, critical accusations and punishment in one's mind.  In these cases, the thoughts aren't just rules to follow; they feel like an actual mental presence determined to destroy any sense of peace if not followed completely. 

The eating disorder thoughts run along a spectrum between these extremes. For people with less powerful thoughts, treatment and nourishment can be sufficient to weaken the thoughts and lead to recovery. The stronger the thoughts, the increased difficulty of fighting and questioning the thoughts, even after periods of normal eating, and the longer and more painful the recovery. 

Little has been written about eating disorder thoughts through the process of recovery. Certainly, starvation and malnourishment worsen the thoughts considerably. Also these thoughts tend to be insidious and find ways to adapt to changes in recovery. They also are always very categorical, absolute and punitive. The process of questioning the thoughts is exquisitely painful for anyone in recovery. It means enduring long stretches of internal screaming each day, every day for an extended period of time. When following the thoughts, that person feels calm and soothed. Without these thoughts, it feels like there is no other way to feel a sense of calmness, so the internal punishment is accompanied by an inability to find calm in any other way. 

Over time, recovery will lead someone to new ways to find internal peace and open up exponentially more opportunity for fulfillment in daily life. However, even with that knowledge, the long and painful transformation from comfort in the eating disorder to knowledge and experience of a healthy life is excruciating and can be terribly difficult to navigate.

Hearing about others' road to health can be inspiring, yet recovery involves a leap of faith in facing down the thoughts day after day without immediate benefits. The end result is very different from life with an eating disorder. But it's worth it.


The Primal Nature of Hunger and Fullness in Eating Disorder Recovery

Clinicians in the eating disorder world frequently refer to hunger and satiety as basic survival mechanisms gone awry as a primary effect of these illnesses. Normalization of eating patterns through meal plans and portioning can retrain one's internal clock to reset.

But for many people in recovery, attempting to reprogram eating patterns feels more like a stroke patient learning how to walk again than approaching a new skill like yoga or knitting. In other words, it's much more challenging to change ingrained, automatic behavior patterns than to pick up new abilities. 

The reason behind this difference lies in levels of brain function. Some brain activity is basic and primal. It's shared by most mammals, which means that it developed millions of years ago, long before the differentiation of mammal species. These include sleep patterns, walking, fear response and hunger and fullness. 

Humans, however, have a significant percentage of the brain, mostly in the frontal cortex, that is vastly different and more complex than other mammals. This part of the brain coordinates planning and a variety of abstract functions lumped together into something called higher order functions, basically only actions humans can accomplish. These activities and behaviors can vary from technology to agriculture, literature to fine arts, or knitting to yoga. They are consciously learned activities that take practice and attention to master, clearly different from the automatic, ingrained actions of the more basic parts of the brain. 

This newer part of the brain is much more adaptable. We can use these abilities to learn and grow throughout our lives. Changing behaviors that are higher order functions take time, attention and practice. Any alteration in the more primal, basic functions can feel almost impossible. These actions are so ingrained, so automatic that we almost begin to conflate them with our actual selves. How we walk, sleep and eat simply defines the foundation of daily life. 

So, with a primer in different types of brain function, the recovery adage of retraining hunger and fullness seems inadequate to describe the enormity of the task. Any alteration in such a basic function demands constant attention. Any lapse opens the door for the automaticity of old disordered behaviors and a return to what that person knows and has long been comfortable with. It's no wonder recovery makes the other daily chores of life so difficult. There's no room to let up without slipping back into old patterns. Resetting years of established routines in one of the most basic human functions demands an extended period of making these new thought patterns and actions automatic. 

This functional explanation of the obstacles encountered in eating disorder recovery gives another reason to explain why recovery feels like an identity transformation. If we define ourselves in part by how we go about our daily routine, then such a massive change in routine will feel completely disorienting. Anyone who has experienced a significant change knows how off-kilter it feels to lose the foundation of knowing the ins and outs of daily life. Changing jobs, moving to a new city or even just a new home leads to months of disorientation. Transforming one's daily interaction with food, one that has defined much of life, is like stepping into a new world. 

This explanation for the difficulty of recovery can also help patients understand why recovery must be life's top priority for a period of time in order for that person to get fully well. Since it takes full concentration and attention to change basic functions, such as eating patterns, other distractions will by definition allow the old disordered patterns to continue. However, an extended period of time focused on making these new patterns the default way to eat will give that person the time to normalize the new eating behaviors. Then, upon returning to normal life already practiced in recovery, it's possible to enter a new daily routine with regular eating.