The most powerful component of an eating disorder is the thought process. Unlike most illnesses, the central part of an eating disorder feels as if it takes over our identity. The thoughts become our thoughts. The rules become our rules. The beliefs become our beliefs.
Deeply buried beneath a system that pushes someone to manipulate food in whatever way the eating disorder determines is the actual person. Those real and true thoughts and feelings are either very compartmentalized from the illness or simply ignored and not part of one's life.
Recovery initially entails normalizing food because improved nutrition and health are crucial for any steps towards wellness. However, from the start, successful treatment needs to incorporate the concept that the eating disorder thoughts are an alien experience that severely limit personal growth, satisfaction and the true nature of life.
It is a shock for people to realize how much they have been brainwashed by the illness. Our minds tend to be able to unconsciously accept a belief system, even if it's completely irrational or harmful, and find ways to function within that reality. Breaking through that wall to recognize the system is broken is a mainstay of recovery.
There are three main ways to accomplish this step.
The first is the food journal. This simple daily exercise exposes the insidious and constant nature of the eating disorder thoughts. The journal forces one to look many times per day at the painful but powerful eating disorder messages. Similarly, a small bit of perspective from this daily existence encourages the person to question if the food choices and thoughts really make sense.
Second, the therapy needs to try to separate eating disorder thoughts from personal thoughts. Some clinicians call this distinction the difference between healthy self and eating disorder. Although the terminology may seem artificial, it's critical to start to see the eating disorder as other rather than a necessary part of identity. Once the idea of a healthy self comes into view, those new thoughts consistently question the reality of living completely in an eating disorder world.
The last step is to use the journal and the healthy self to look more globally at life. As one begins to address a personal philosophy and overall goals, it becomes easier to see how the eating disorder will never allow anything to change in life. Other components of life, relationships, friends, work, must start to matter more and push out the eating disorder thoughts as the primary source of personal identity and accomplishment. As this process starts, it become harder to adhere to the disordered thoughts and philosophy.
These last two posts explain why eating disorders are psychological illnesses and why clinicians and loved ones need to try to understand the complexity of the illnesses in order to be loving and supportive. Nourishment and health are critical, yet psychological change is the hallmark of full recovery.