How Indecisiveness can Derail Eating Disorder Recovery

A common symptom of ADD and some learning disorders is indecisiveness. For a number of reasons, the process of making decisions, even seemingly inconsequential ones, can be very difficult. The issue is not in the actual decision itself but instead the process of choosing one and committing to it.

Often therapists try to work through the internal emotional struggle around decision making and instead attribute the issue to perfectionism or ambivalence about recovery. More often, the difficulty is related to organization, processing and prioritizing.

Symptoms of ADD lead a person to get stuck on one task for too long and to struggle to prioritize tasks in a timely manner to be able to accomplish them. Medication and CBT (cognitive behavioral therapy) are very effective in managing many ADD symptoms.

The same can be said about decision making. The most important initial step is to recognize that making the decision is much more important than the actual decision that is made. If the goal is to assess the options, make a decision and move forward, it becomes clear that the focus of the learning process is to make the decision and not worry about which decision is correct. 

In eating disorder recovery, decision making is imperative. Patients who struggle to make decisions find choosing food to eat six times per day in their meal plan to be onerous. Often decisions become so difficult that it becomes easier to avoid the decisions and not eat. Despite the desire to recover, decision making can derail recovery.

For people in this situation, a few steps can make a big difference in success with eating.

First, a much more specific and clear meal plan makes a very big difference. That means a plan with exact times to eat and exact amounts of food to eat. By taking decision making out of the equation at first, the goal is simply to follow the plan. 

The transition to creating a new plan not set completely by the team needs to involve only a few decisions per day with a few options. The goal is to practice meal planning and recognize that making a decision matters and the actual decision is less critical.

The biggest worry is that the team mistakes difficulty making decisions with the lack of motivation to get well. This incorrect assessment can be very demoralizing and also can miss the actual obstacle to getting better.