How the Therapy Relationship Helps People Leave Ed

Unlike any other psychiatric disorder, eating disorders are often personified. They are referred to by name, Ed, as a friend or as a partner.

The concept of having a relationship with one’s eating disorder is not just a turn of phrase or a therapy tool. Eating disorder thoughts and behaviors replace the many ways one might turn to family, a partner or friends for support, solace, guidance or comfort.

Eating disorders provide reliable, consistent and predictable answers to difficult situations. They provide rules and structure around food and body when life becomes challenging. They can be strict but caring when events in life get frightening. They can be calm and soothing for periods of enormous stress. And they can be punishing if one’s actions feel like too much to bear.

Ultimately, eating disorders aren’t just about the food, as the saying goes. The disorder provides a stable, steady relationship to help navigate the emotional and psychological challenges life brings.

Once anyone has that kind of support, no matter the associated burdens and pain, it’s very hard to give it up.

After recovery begins, one has to learn how to handle all the emotions and confusion that would automatically be buried under eating disorder thoughts and behaviors. These emotional steps are one of the hardest parts of recovery. Every emotion feels unbearable. The pressure of experiencing these feelings and not acting on them makes the emotions feel too large and overwhelming.

Trying to manage these feelings without any coping mechanisms is extremely challenging at first. Regular relationships in life often are not equipped to handle the initial bursts of emotion in recovery.

The therapy relationship is well equipped to handle all these emotions and thoughts. Recovery almost always needs a therapy relationship able to withstand, process and move through the intensity of emotion that bubbles up when someone chooses to face the feelings and not suppress them with the eating disorder.

The therapy relationship becomes a beacon of hope and promise towards a new way of living without the eating disorder.

The path of treatment is often complicated and intense. The feelings at times are very positive and warm and other times very angry and painful. If the therapy relationship can withstand all these feelings, the person has the opportunity to learn how to identify, express and manage their emotions in positive ways to foster relationships in their lives.

Therapy serves as a vehicle to help people safely learn how to see their emotions as part of their human experience, not something to avoid through the eating disorder. Doing so means the possibility of true recovery.

Metabolic Dysfunction in Eating Disorders

The term metabolism means different things in different settings, but a clear medical description is essential to understand eating disorder recovery.

The biological definition is the process through which the body utilitizes the food we eat both through energy expenditure and storage.

There are many factors that influence a person’s metabolism: genetics, age, lifestyle and exercise to name a few. Metabolism also can change in hours, say after a meal, over days to weeks like with increased exercise or over years through aging.

Metabolism regulation occurs largely through the gastrointestinal hormonal system that adjusts how energy is used. Other hormonal systems alter metabolism over longer periods of time as well.

Eating consistently regulates metabolism so that the body can rely on sufficient energy through food and then adjust metabolism as needed for external factors that change in the short-term.

Eating inconsistently, often irrespective of the body’s typical needs, stresses overall metabolism greatly. The body will to attempt to adjust the hormonal signals that affect metabolism due to these changes but struggles to do so effectively when eating is erratic, intermittent and completely unrelated to hunger.

The first step in eating disorder recovery involves consistent meals and snacks at fairly regular times through the day. The reason a meal plan is so important is to help the body return to stable metabolic function. Doing so helps re-establish homeostasis (overall stable biological functioning of the body) which is much less balanced during period of disordered eating.

The biological underpinnings of an eating disorder helps explain how disruptive these symptoms are. In this blog, I have written at length about the psychological and emotional effects of an eating disorder. Unlike other psychiatric disorders, eating disorders cause biological symptoms, specially metabolic, which stress the body immensely. It takes an enormous amount of effort for the body to maintain stability during long periods of disordered eating. Normal lab results during these times belies the truth of how much damage an eating disorder causes.

Metabolism is not a contest about whose is fast and slow. That definition reflects the weight bias in our culture and the ignorance about metabolic function. Instead, metabolism describes how our body manages energy intake and needs.

Understanding how eating disorders cause metabolic dysfunction is necessary to know how these disorders affect our health. Recovery needs to prioritize normalizing metabolism as a first step through regular eating.

The Rebuttal to “Why Can’t You Just Eat?”

People who don’t understand eating disorders always ask someone struggling with one a simple question: why can’t you just eat?

To people versed in these illnesses, let alone those who are struggling with one, the question is frustrating, upsetting and ignorant. Being asked the same question time and again becomes truly demoralizing.

However, the question comes from a simple and logical place. People without eating disorders just eat. Even if they worry about what they eat, when they eat or their body in general, the premise of whether or not to eat is never really relevant.

The biological imperative to eat is just too powerful.

Eating disorders, by definition, indicate a strong urge to eat or not eat by other factors then hunger and fullness. These behaviors become full-fledged eating disorders when disruptive enough to interfere greatly with daily functioning in life.

Many people think a lot about their food and body. Our culture continues to greatly magnify the importance of food and weight. Capitalism and the media prey on these communal fears, with Ozempic and the GLP-1 agonists being the latest corporate cash cow for our collective obsession with weight.

And the ever present drive towards thinness means no decrease in people developing eating disorders.

The answer to the question “why don’t you just eat” is both simple and complex.

The simple answer is that you have an eating disorder which means that you have other thoughts and urges that dictate when and how you eat. And so “just eating” isn’t possible.

The complex answer is connected to what treatment means. Recovery aims to regulate eating into a pattern based on hunger and fullness and less on the psychological and emotional drives of the eating disorder. The best step for most people is to eat according to a meal plan created by a professional and to relearn hunger and fullness cues. In time the goal is to “just eat” again but that comment isn’t helpful or kind with respect to eating disorders.

A more thoughtful and education about that overused question hopefully will lead to more understanding, and perhaps even more support, going forward.