Hopelessness as the Engine of an Eating Disorder

There is a distinct and important difference between depression and hopelessness in the experience of having an eating disorder.

Depression is a host of symptoms including low mood, decreased energy and motivation, lethargy, poor or too much sleep and sometimes thoughts of wanting to die. It is a disorder that comprises an entire experience of physical and psychological symptoms that consume daily life.

Hopelessness can be part of a larger depressive episode but often signifies something different in the context of an eating disorder. It is an intellectual understanding of one’s own life and, at its most intense, feels like an absolute truth.

Hopelessness represents the inability to see a future in one’s life. This thought makes it seem like nothing in life will change and that the current experience is the only experience. This sense of life and the world is how it is now and how it will be forever.

People often describe hopelessness as drowning in the misery of the moment with no escape. When combined with the reality of an eating disorder, hopelessness can make the eating disorder symptoms appear to be the only way out even if it is only temporary. The behaviors take up time and emotional energy that provide a respite from the relentless, hopeless feeling. The end result of the eating disorder behavioral cycle is to feel even more hopeless and unable to see any route to change one’s life.

From this perspective, hopelessness can be the engine of an eating disorder. If it is impossible to see any change in the future and if it feels like this misery is going to be what life entails, there is no reason to avoid the eating disorder symptoms. These behaviors almost always reinforce this sense of depression and low mood combined with hopelessness.

This vicious cycle can be the centerpiece that keeps an eating disorder alive. More importantly, the hopelessness can pervade every relationship in one’s life, including any clinical and therapeutic relationships. At some point, clinicians can start to feel as hopeless as the patient.

The key change for the person and clinician to consider is to question the hopelessness directly. If left to dominate, the hopelessness will derail treatment and someone’s life.

But there is no factual foundation to the hopelessness. There are always new ways to approach a problem, the hopeless thoughts or an eating disorder. How one feels never lasts forever. Given the new possibility of a direction for recovery can often be enough to break the hopeless cycle and start a new path.