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.