The Discovery of Self-Worth

Much has been written by acclaimed clinicians who treat people with eating disorders about the desire to disappear. One central wish for many people who suffer from these illnesses is to fade away and simply vanish from the world. The mere act of starvation is the process of wasting away in order to take up less physical space, but the wish to be gone represents more than that concrete manifestation.

The underlying tenet of this fantasy is the concept of not having personal value as a human being. For most people, a sense of self-worth pervades the way everyone goes through the world. Waking up and living each day implies a sense of meaning and value. Meaningful relationships or even simple, human interaction give a sense of purpose to our days. There are many more ways people see their increased value but I  am trying to point out the most basic self-worth we have as human beings. 

There are more subtle ways people express how they value themselves. Speaking up for your own wishes or rights is a way of expressing self-worth. Emphasizing self-care can send a message to yourself and others of valuing yourself. Talking about one's life day to day implies value in the quotidian tasks. Even the basic concerns like sleeping and eating show a sense of value in ensuring one's body is prepared for the day. 

People with eating disorders can have trouble with all of these things: speaking up, self-care, taking about oneself and ensuring basic needs are met. 

The result of struggling to prioritize these concerns represents the figurative process of disappearing. Even if the eating disorder does not cause a literal disappearance or diminishing, the psychological underpinning of these illnesses is one's own disappearance. 

In terms of support and treatment, the implications for these truths are very clear. Therapy, but also support from friends and family, needs to emphasize self-worth in the world.

Personal characteristics and positive traits that may be obvious to most people are almost impossible for someone with an eating disorder to see. That person may need their own positive attributes repeated dozens of times before they start to process the information. Self-deprecating comments need to be contained and questioned again and again. It's critical to identify these thoughts as untrue and caused directly by the eating disorder. 

Although the actual causes for the intense self-negation for someone with an eating disorder are varied, figuring out that cause is not always necessary or central to treatment. It maybe useful for some people, but the important idea is to undermine those thoughts and help the person to find their own voice and learn to see themselves clearly in the world.


Regret has no Place in Eating Disorder Recovery

A confusing part of treatment for an eating disorder is the need to avoid certain feelings. That is not the usual method therapy applies and seems counterintuitive for a set of illnesses that enable people to avoid feelings. The underlying reality is that certain feelings reinforce a sense of hopelessness which can sabotage any real attempt at recovery. 

The most insidious of these feelings is regret. In the safe confines of the eating disorder mindset, all decisions about food are paramount and, accordingly, everything becomes secondary to the primary goals laid out by the illness. It's problematic that many of those other concerns are much more important when it comes to daily living than the short-sighted, fruitless tasks of an eating disorder. 

But understanding the power of an eating disorder means making sense of this powerful driving force. The thoughts feel incredibly meaningful and give order and structure to the scary emotions, relationships and decisions that are a part of every day life. 

Even a small step away from the eating disorder can open a person's eyes quickly. That immediate awareness, like a screen suddenly lifting, illuminates the emptiness of life run by an eating disorder and the missed opportunities that abound during the years lost in illness. 

It's tempting to follow that path of regret both for the patient but also in therapy. Mourning and a sense of loss are often critical parts of adult life and are very hard for even people who are emotionally healthy. The pain and struggle are easily avoided in the daily routine so any therapist would feel compelled to explore these emotions. 

For people with eating disorders, regret is a bottomless pit of shame, a detour right back into the self-loathing that can start a full relapse. Recovery takes so much attention and focus on current emotions and on each meal and snack. Sometimes, hope can be hard to find in the daily slog but a sense of purpose or at least delayed promise can serve as enough drive just to get through each day. 

That amount of resolve cannot withstand a period of dwelling on loss. That time has passed and reviewing the pain wrought by the eating disorder leads to a strong urge to rely on the illness to cope with the emotions. 

Once the person is ready to face the sense of loss, life has already taken over. Moments of regret might pop up at times, but the pressing moments of life instead take center stage. 


Ownership of Eating Disorder Recovery

The eating disorder thoughts, as I have written many times in this blog, are incredibly powerful and often just feel like thoughts. Distinguishing eating disorder thoughts from one's own is critical for recovery, but the process is not linear. It takes time and practice to learn how to do so reliably. That interim can be a risky time for relapse despite the real desire the person has to get well. 

This transition also marks a shift in the personal ownership for the recovery process. Before this time, the therapist, family or friends stand firmly for health while the person suffering can only blindly follow the eating disorder. The thoughts are too internalized and strong to resist.

The ability to have a moment of perspective about the eating disorder thoughts creates a new situation. All of a sudden, there is a choice whether or not to follow the thoughts. Having the moment does not mean the power to choose differently right away, but it does mean the path out of the illness is possible for the first time. 

During this time, the person with an eating disorder starts to take ownership of the recovery process. It truly becomes their own, and it's crucial to start to take on that mantle. Because distinguishing the two thought patterns is so new, it's a risky proposition. Owning the process opens the door for worsening symptoms and a fall into relapse with much less oversight. 

The hardest part for others to accept is that the risk is worth it. True recovery must mean the person not only takes ownership for her health but for her life. Successful treatment cannot leave that person unable to function in the world as an independent adult.