The Responsibility of Eating Disorder Recovery

One tenet of early treatment for an eating disorder is that it is not the person’s fault for getting sick. Falling into an eating disorder is terrifying, and realizing how trapped one is even more so. As hard as it can be to see that not eating normally is an illness, it’s crucial in order to start the road to recovery.

Education about eating disorders and treatment involves a lot of education. Someone must understand how the thought process of an eating disorder works in order to learn how to circumvent it. This involves difficult components such as identifying one’s own thoughts as eating disorder thoughts or challenging the idea that hunger and fullness may not be an accurate assessment of the body’s needs. Making changes involves questioning daily experiences most people can take for granted and trust.

However, some people, even after having significant treatment and education about their illness, still struggle to get well. Although all people can recover, everyone doesn’t recover, even those who have seemingly taken all the appropriate steps.

There comes a point when someone needs to find a way to implement everything they have learned about recovery into their daily lives. This means following a meal plan, accepting accountability for their daily choices, tolerating the enormous emotional and psychological discomfort of those decisions and committing to difficult changes for the long haul until they see the rewards for their actions.

Clearly this is a difficult road.

For people who struggle to make changes for years, it’s easy to see how the initial phase of not blaming the patient may turn falsely back to blame. Again they are not responsible for having gotten sick. That always remains true. However, after receiving the available treatment, any further changes has to come from the person struggling. No one can feed them. No one can walk in their shoes. No one else can endure that pain and suffering.

At that point the person needs to bear responsibility for the steps they need to take for recovery. It’s not about blame and it certainly isn’t fair. It only highlights the limitations of eating disorder treatment.

Although there is so much more help than there was twenty years ago, the reality is that the final steps to get well still lie squarely on the shoulders of the person suffering. I wish wholeheartedly that treatment could offer more, but these realities mean that responsibility, not blame, still lie with the person who is ill.

Satiety Dysfunction: a Novel Eating Disorder?

Binge eating disorder is discussed less frequently than most eating disorders. There is a specific subtype of binge eating disorder that has even more limited exposure. It involves people who have obsessive thoughts about food all day, intense cravings for various foods and who compulsively eat all day. Many if not most days, they eat until they are in pain and can hardly move or breathe. However, they never binge in the typical sense by eating a much larger than normal meal in a short period of time. Instead they eat constantly without cease all day.

For most eating disorders there is a clear emotional connection to the eating, but in this circumstance, it is often difficult to find immediate connections between behaviors and emotional or psychological needs. Eating is almost a constant, physiological need.

In treatment or circumstances without access to food, these people can refrain from binging. With any access, the thoughts and urges are almost impossible to resist.

Unlike many eating disorders, I have wondered if this type of eating disorder may turn out to have clear biological underpinnings. We all have cravings to eat food and then are satisfied once the meal is done. These people don’t seem to have the mechanism of satiety which leads to feeling satisfied, both physically and mentally, followed by the decreased desire to continue eating. As we learn more about the gastrointestinal hormonal system, it is possible these people have an abnormality in this system which inhibits their ability to respond to satiety appropriately.

The reality of this kind of eating disorder is constant physical discomfort and often pain. Endless binging leads to chronic gastrointestinal pain and stretching out of the stomach. Sometimes people can get so full that it takes hours if not a full day to digest the food. The energy needed to digest and process this amount of food takes away from energy for the rest of life, and functioning in school or work can suffer. The effects can be debilitating.

In my experience, many of these patients try a sufficient round of therapy and treatment to no avail. Medications such as Topamax, Vyvanse and even an old medication no longer available in he United States called Meridia can be effective. When a medication helps, it is as if a light is switched off. People suddenly feel able to withstand mental cravings for food and can heed satiety cues. The result feels miraculous to them. It’s very rare for people with eating disorders to have such an immediate and potent response to medications.

These symptoms seem to function as a different kind of eating disorder. I consider the symptoms as a problem with satiety more than anything else. Recognizing this illness as a distinct entity in the eating disorder treatment community would help these people get care tailored to their specific issues.

The First Steps in Finding Treatment for an Eating Disorder

When a family first hears that their child has been diagnosed with an eating disorder, the sense of shock quickly morphs into action. An online search leads to a dizzying array of options all presented in glossy format on newly designed websites. It feels like picking out a spa for vacation more than clinical care.

Even five years ago, the initial search for help was very different. It was a lot harder to find ways to navigate the eating disorder treatment world back then. The handful of programs were the backdrop for other types of outpatient care. Now the programs compete for eyes marketing their programs as much as they do health and recovery.

I have always told families or individuals looking for help that the most important step is to find a clinician who can organize a structure and plan for treatment. With a trusted person focusing solely on health and wellness of the person with the eating disorder, the other forces that dominate the eating disorder treatment community can’t take over.

Ultimately, the course of care needs to be individualized. Even though eating disorder symptoms are fairly similar person to person, each individual needs different care after the first few months. The larger programs are designed to give standardized care for a brief amount of time, rarely more than six months. Since recovery is a longer road, there needs to be someone thinking over the full spectrum of the path to getting well.

For families or individuals, the best course is to research clinicians in their area and even to broaden the search to less convenient locations in order to find the right person. That person needs to have experience treating people with eating disorders and connections to a larger community of clinicians who do the same work. The most important factor is a sense of trust in this person’s desire to help and to care. Getting well isn’t based on the fancy new program but on finding the right person to coordinate care.

The Politics of Body Image

The eating disorder treatment community typically treats body image struggles as a type of disordered thought without any context. The cognitive behavioral model identifies it as a false idea that needs to be contradicted and then will be best treated through distraction techniques.

Although this form of support and guidance can be helpful, the clinical approach to body image also ignores the larger context of women’s body image in our society and the physical self as a means of societally condoned self-loathing.

I am certainly no expert in women’s studies or the objectification of women, but the rise of eating disorders starting in the late 60’s also coincided with the media saturation of images of women that instigated a deep sense of inadequacy for women and their appearance. In fact, there is clear evidence that the introduction of western culture quickly triggers eating disorders in societies without any bias for thinness. The best example of this change is in Fiji in the late 90’s where American television created an eating disorder culture within a few years.

However, the clinical community cannot also function as a philosophical guardian for our culture. We as clinicians may be able to treat symptoms, but we cannot police a culture gone awry that has, through powerful, pervasive messages touting body inadequacy, disempowered women at a time when their power and strength has finally risen.

Where should clinicians then draw the line about accepting eating disorders as a reality in our world? Should part of eating disorder advocacy also involve recognizing the need for a fundamental shift in how we view women’s bodies? Is the correlation between eating disorders and addiction a way of normalizing these illnesses and not facing their societal ramifications?

As a man in a women’s universe of eating disorders, I may have some perspective but also by definition am outside this daily reality of inhabiting a woman’s body in today’s world. Yet I think it behooves the eating disorder clinical community to recognize the events that have brought up a brand new set of illnesses in recent decades. Sanctioned starvation combined with culturally acceptable self-loathing of women’s bodies have made eating disorders a new fact of modern life. These realities need to be more clearly expressed and called out by the activist organizations.