Eating Makes Recovery so much Harder

Eating disorders are classified as psychiatric illnesses for good reason. Although the physical symptoms are most obvious to the outside world, it's the inner psychological turmoil that causes the most pain.

The outward physical manifestations of eating disorders tends to overshadow the true nature of these illnesses. Starving or purging food distracts people from recognizing that beneath eating symptoms are far more insidious psychological symptoms. The medical effects of eating disorders often disturb clinicians and scare doctors away from treating these patients but also stops even the treaters from seeing the inner world of a sufferer. These illnesses cause chronic physical symptoms, and anorexia has the highest mortality rate of any psychiatric diagnosis. And the cure looks so simple as to be ludicrous, just eat.

To anyone watching a person in recovery, it's evident that eating isn't easy at all. Each bite is excruciating; each plate of food is an obstacle of epic proportion; each moment is dominated by fear of the next meal or snack. Eating a meal is a ritual that happens several times per day. Whether for pleasure, work, celebration or sustenance, food represents a mundane part of life to those who are well. The experience of terror around food mystifies even the most open-minded, compassionate person who doesn't have an eating disorder.

Understanding the true inner struggle of recovery necessitates a big step in logic. The eating disorder symptoms appear to be the biggest hurdle in treatment. Avoiding restriction or purging or over-exercise, a person in recovery starts to physically look better to the outside world. Normalized weight and energy makes concerned family and friends take a deep breath of relief.

The reality of recovery is much different. Once a patient starts to eat and avoid behaviors of the disease, things start to get really hard. Just when everyone stops worrying as much, the person in recovery needs a lot more comfort and support.

The easiest way to imagine the psychological symptoms of an eating disorder is to think of a repeating loop of thoughts in one's mind. The thoughts are an endless string of criticisms and punishments. These thoughts can attack every step the person takes: every comment, every decision, every opinion.

The result is to quash any meaningful aspect of this person's life. If ever an ounce of positive experience sneaks past the filter of these thoughts, the endless loop returns to the most effective punishment: food and body. Feeling guilty about eating food or ashamed of one's appearance will always stop any movement towards positivity and trap the person in the negative, critical loop of the illness.

There is only one way to calm the punishment: the eating disorder symptoms. Starving, binging or purging will make the thoughts stop for a moment and give a few minutes of peace. So the symptoms are the only thing that provides any relief to someone in the throes of an eating disorder, and eating is the only way to get better. The result is doing something many times per day that will get you well but makes you feel worse in the moment each time. Meanwhile, everyone who is supportive thinks things are better, yet the sick person just feels really bad. No wonder recovery gets so much harder.

Regular professional help will reinforce to the patient that this step in recovery is always very difficult. However, educating family and friends is crucial at this stage of treatment. While getting better, the person needs to reach out for support and work on building personal relationships. Those connections help loosen the grip of the eating disorder. It's critical for those close to the person in recovery to work hard to understand what makes eating so hard. The supporters need to regularly express love, compassion and understanding for the emotional struggle to try to live each day without engaging in the eating disorder symptoms. Doing so helps the person feel supported in the struggle to get well and comforted by the repeated recognition that even though eating each day is very, very hard, it's also the only way to get better.

The Challenge of Compliments for a Person in Eating Disorder Recovery

Compliments generally have a universal effect on people. They smile, feel better about themselves or feel more connected in the moment. Families and friends, recognizing the challenges in recovery from an eating disorder, want to acknowledge small successes and encourage their loved ones through the process. Yet compliments to a person in recovery usually backfire. The patient tends to feel worse afterwards and pull away from the relationship, a confusing response to a gesture of love and caring and, in light of my recent posts about relationships and intimacy in recovery, somewhat paradoxical. But a more careful understanding of the social dynamics of a compliment explain the situation more clearly.

In order for a compliment to be helpful, the receiver has to be able to do several things. First, she has to believe the statement comes from someone being genuine. Second, she has to understand that the statement might very well be true. Third, she must allow the closeness that comes with accepting the statement and must allow herself to express the vulnerability of gratitude. In other words, the seemingly automatic and easy responses to a compliment don't come naturally to someone with an eating disorder.

Wary of relationships, the person in recovery isn't facile at believing a positive statement from someone else can be authentic. It's hard to imagine a compliment is real when one's internal thoughts are constantly negative and critical. If a positive comment doesn't represent true caring, the next alternative is to assume the other person has an agenda. The internal criticism can cook up many stories to explain the comment from wanting something in return to veiled competition. Sizing up another's motivation for a compliment will only reinforce the negative thoughts associated with the eating disorder and confirm the world is just as harsh and cruel as the disease itself.

Even more difficult for a patient in recovery is to assume the opposite of the critical thoughts, that a compliment may in fact be true. A lot of work in recovery is explicitly geared towards imagining a positive statement about oneself is true. At the core of the illness is the absolute belief that one is a horrible person. Although the patient can live in the world and fake being "normal," a word frequently used by people with a chronic eating disorder, the underlying identity is a complete negative self-image. There are almost no positive thoughts to find in someone with longstanding illness. And so it takes time, patience and a lot of repetition to begin to replace those critical, automatic negative thoughts. Positive comments from others seem irrelevant, not connected at all to the identity of the sick person, and learning how to accept and believe these statements is a central part of recovery.

The last step in accepting a compliment is the hardest. The social norm in responding to a positive statement is a subtle but powerful engagement. The complimenter is extending a hand and showing some personal vulnerability with the praise. Compliments generally come with eye contact and an expectation of a response. The complimentee is likely surprised and will smile and be gracious. That response necessitates returning the eye contact, a smile and an extension of the vulnerability by allowing a moment of connection, likely leading to a sense of emotional closeness. For many reasons, this short, subtle exchange taxes the patient's ability to engage in the intimacy of relationships, something that generally terrifies someone in recovery from an eating disorder.

Left without the natural response to help a loved one in recovery, family and friends can feel powerless to say anything. A compliment pushes the person away and any even subtly critical comment certainly hurts. Yet not saying anything at all will send the message that one doesn't care. Often, emotional distance in all relationships precedes the step into recovery so these once close relationships are already strained and much more distant than in the past, a fact that puts significant pressure on making communication work. Confusion and tentativeness are the most common response for loved ones close to the person in recovery. 

The best approach is to continue to compliment the loved one while also recognizing how difficult that interaction might be. It's best to preface the statement by saying a compliment is on its way or that this statement might not be so easy to hear. This will give the person a moment to prepare for the emotions that follow. Even commenting that it might be hard to believe the statement will help the person feel understood. Steps forward in recovery can be challenging and the process of improvement leads to mixed feelings, as I have written often in this blog. Sensitivity to the challenges in recovery, even in something as hard to understand as taking a compliment, will only help the person in recovery continue down that path and feel supported and loved.

The Role of Weight Loss in the Treatment of Binge Eating Disorder

Binge eating disorder (BED) is a newly accepted diagnosis in the DSM-V, the most recent update to the guidebook for mental health. Accordingly, the clinical approach to BED is under increased scrutiny. Treatment using food journals and cognitive behavioral techniques to break the cycle of binges remains the gold standard, but the official diagnosis will generate increased attention and funding to investigate the differences between BED and other eating disorders. It's a relief for clinicians that the committee revising the manual acknowledged the reality and prevalence of BED and put the spotlight on improving care for these patients.

With that controversy in the past, another debate is in the forefront of BED treatment: weight. Patients with anorexia are clearly underweight, whereas those with bulimia range between underweight and normal weight. Treatment of these two illnesses include weight restoration and improved health and nutrition. Binge Eating Disorder is the first eating disorder diagnosis likely to cause weight gain. Eating disorder clinicians, thrust into the obesity debate, are unsure how to respond. The greatest risk is that the overarching societal focus on weight overrides the best clinical approach for these patients.

People with BED are just as focused on feeling overweight as those with other eating disorders and erroneously view weight loss as the solution to all their problems. The problem is that clinicians may agree because these patients usually are overweight and not focus on eating disorder treatment.

The result of weight obsession in BED patients is serial dieting followed by worsening relapses of binging and, ironically, subsequent weight gain. The pattern isn't all that different from all serial dieters except for the two things that make BED an eating disorder: binging rather than overeating in response to dieting, and the internal punishing dialogue, discussed at length in this blog, present in all eating disorders.

In anorexia and bulimia, much of the focus in therapy stems from feeling fat even when normal weight or very underweight. Accordingly, treatment involves challenging the obviously distorted thoughts about body and weight and linking these thoughts with the self-loathing associated with the eating disorder. Countering the distorted thoughts is easier when it's clear the patient isn't overweight at all: the fat thoughts are a distortion, the punishment meted out by the eating disorder.

In a patient with BED, the practical thoughts about being overweight are often true, and the societal focus on obesity reaffirms these same punishing eating disorder thoughts as occur in anorexia and bulimia. It's much harder to convince a patient with BED that the fat thoughts are distortions if the person is overweight. Being overweight, to the sick person, confirms that the person is truly horrific and that weight loss is the only way to recover. This scenario complicates treatment greatly, namely forcing the therapist to confront the thoughts about weight not as a distortion but as a tool the eating disorder uses to worsen the cycle of symptoms.

When weight loss is central to BED therapy, the course of treatment quickly goes awry. The message received by the patient is that weight is the only real problem and the most shameful part of the illness. Immediately, everything else will be secondary, and the punishing thoughts become more true. The practical result inevitably is more hateful feelings that trigger more binging and continued weight gain. Just as in other eating disorders, if weight and body image are taken seriously, rather than as distortions of the disease, treatment won't work. Effective treatment includes normalizing eating with a meal plan while focusing on avoiding triggers for binges and countering the punitive thoughts of the eating disorder.

But any patient with BED will quickly point out the obvious: obesity has serious long term health consequences. No clinician can refute this statement, so it's too easy to find the conversation steered to weight loss as a primary goal of treatment. Unlike any other eating disorder, even drastic measures like Bariatric surgery often enter the discussion. At this point, the underlying emotional and physiological reasons for the binge eating, a core aspect of treatment, are secondary. The eating disorder has hijacked the conversation. As with every quick fix, the scenario will fail and trigger another slip into worsening binging. 

Early on, the clinician needs to point out that BED is another eating disorder with the same eating patterns and same punishing thoughts of all eating disorders. Even if BED leads to weight gain, the goal of treatment has to be eating disorder recovery to make any headway. Focusing on weight, which certainly is affected by these illnesses, reaffirms a central tenet of the disorder and always worsens symptoms. When the patient tries to explain the health concerns of being overweight, it's important to acknowledge these statements are true but also to point treatment in a direction that can lead to improvement in the patient's quality of life.

Normalizing eating while stopping binges will lead to weight loss. Addressing the emotional triggers for binges while encouraging compassionate thoughts about oneself are central to effective therapy. To help patients with BED, clinicians need to ignore to obesity epidemic swirling in society and focus instead on what's best for this cohort of patients: treatment for their eating disorder.

The Importance of Relationships and Closeness in Eating Disorder Recovery

One difficult part of recovery from an eating disorder is letting people close again. It's hard to tell which comes first: the illness or the lack of intimacy. Being so sick at a young age with an obsessive disease completely eliminates any ability for closeness, but, for some, the eating disorder replaces the need for relationships by providing reliable comfort and solace. The food, or starvation, has a powerful calming effect that for the time replaces the need for others in life. No matter the type of eating disorder, recovery necessitates finding close relationships again in order to help the person both find connection, a vital part of being human, and remember what the illness has taken away.

The transition from isolation to intimacy is rough and rocky. The eating disorder may be punishing, treacherous and dangerous but, above all, it's reliable, and that's very hard to give up. Starving or binging and purging or overeating all lead to predictable comfort and effectively numb any feelings from day to day life. The calm may be brief and followed by guilt and anger, but in the moment the symptoms feel worth it. Life stops for a moment. The escalating swirl of emotions and frustrations of daily life, which overwhelms someone with an eating disorder, temporarily fades. All that's left are the simple rules of an eating disorder and the powerful chemical brain effects created by the symptoms around food.

But no one recovers alone in a bubble. Without relationships and support, the internal urge to return to the eating disorder is too strong, and a slip or relapse is all but inevitable. What confuses many people, both those recovering and friends and family, is why relationships feel so hard.

It's not obvious why an illness focused on food and weight has anything to do with closeness and intimacy. The confusion can easily trigger disputes and arguments. Often people accuse those in recovery of being too sensitive and needing to develop a tougher skin. Another common complaint is that the person isn't being honest or forthright. Even if these comments are meant to be helpful advice, anyone in recovery would interpret the statement as, "You're too much of a bother for me."

Although the solace from the eating disorder symptoms are short-lived and ultimately unsatisfying, it's very consistent. This known quantity helped eliminate two dangers of being close to others: dependence and disappointment. Most people in recovery find those feelings unbearable, largely from a lack of experience. Years of isolation limited their ability to learn how to navigate these normal parts of relationships. Similarly, people in recovery haven't had any practice expressing their emotions or frustrations to others. And so family and friends try to engage with the person in recovery as if they haven't been sick. Expecting someone with a broken leg to run five miles the day after the cast comes off is completely unrealistic. Similarly, it takes time to understand and handle the ups and downs of close relationships. Finding comfort in closeness with others is something to get used to, not an automatic experience. Expressing emotions or needs clearly in a relationship takes practice. Patience, kindness and understanding go a long way to expedite the process.

The caring from another person feels terrifying and miraculous to someone in recovery. Having been so alone, hopeless and lost, the person has gotten used to loneliness and feeling misunderstood. The illness has consumed their mind and taken even the closest people away. The fear of getting close and then losing the intimacy back to the illness is overpowering. Every misstep feels like the end of the relationship. Any trust feels like it will be instantly taken away. Every moment of caring feels fleeting. Any disappointment seems to foreshadow the end of this brief respite from the disease. It's easy to minimize the magnitude of each moment. Building relationships over time will gradually ease these fears and allow stability of community to replace the shaky foundation of the eating disorder.

The best advice both for the person in recovery and friends and family is patience. Starting to eat means feeling less numb to the world. Every moment of daily life is raw and intense. Each interaction in a relationship feels fraught and fragile. The urge to go back to the familiarity of the illness is ever present. Sustained patience and and understanding of the process of relearning how to live and love without the eating disorder is what the person in recovery needs. That room to learn, grow and get better is often the difference between aborted treatment and full recovery.

The Facts about Food, Hunger and Weight: Why so much food makes us so sick

While the only solution to the growing public health issue of obesity and disordered eating remains willpower and healthy eating, the problem grows unabated. Shifting responsibility from agribusiness, food conglomerates and regulatory agencies to the individual strengthens the foundation of our collective struggle and leaves us nothing to grasp onto for relief. Doctors recommend ineffective solutions; experts blame the lack of willpower; and science searches for the biological or genetic cause. But it seems as if the answer to facing this world of food is right under our noses.

We have created a world of paradoxes and just sit back and watch how our population goes haywire. The first world is inundated with food, much more than we could ever consume. Food companies exploit scientific and psychological knowledge of food preference to create treats we are programmed to desire. Meanwhile, cultural touchstones present slim figures as the panacea for our woes, a body shape most of the population cannot attain without starvation. We all stand by while experts sanction severe diets as if this is normal behavior.

And our minds and bodies pay the price. We are plagued with guilt and shame, tricked into thinking willpower can override hunger, as we indulge in treats unaware that we are powerless to do otherwise. We chronically starve under the pretense of a sanctioned diet, supposedly doing the right thing, and wonder why we are always so hungry and unable to stop eating. The hunger triggers food obsession and slowed metabolism, and we are shocked when we keep gaining weight and develop diabetes. The system is rigged but no one seems to understand.

There is no one piece of the puzzle to vilify. The whole system is broken. The fix lies in changing the conversation enough for people and society to listen and start to shift our priorities.

From the start, that means education. Without the basic knowledge, we are so easily duped that we sit around blaming ourselves for the disastrous scenario. The basic knowledge will help us understand why we can't accept the current food situation and, in our own small way, will help us understand how to change our own perspective and behavior around food.

The three critical components of education are the biology of food and weight, the myth of willpower and the nonsensical media chatter about food which leads us to blame ourselves.

The biology is simple. Although there is plenty of complex and fascinating science, the layperson only needs to know the basics. Food is necessary for human survival. Our instincts tell us to eat to survive and to eat more when there is surplus and to eat even more when we have been hungry. Historically, the periods of abundance of food have been scarce, and there has never before been a time of endless supply. Even though times have changed, our innate response to food hasn't. Believing we can control all food intake is patently false. Our biological instinct to eat can't be changed. It's a fact of being human we need to respect and not expect to magically override.

Similarly, weight is not a variable we have ultimate control over. The number can shift with fluid changes, hormones and even external factors like seasonal changes. Our bodies allow this value to move to maintain our health, not at our whim. It is one of many components that our bodies adjust for our well-being. The idea that we are solely responsible for the number on the scale based on food intake and exercise is absurd. Basing one's self-image on the number on a scale is a losing battle that ignores the reality of how our bodies function.

The concept of willpower is only effective for a population ignorant of how our body manages hunger and weight. The industries that rely on our ignorance reinforce the false hypothesis. The myth of willpower states that we have the mental ability to restrict what we eat, avoid mouthwatering treats and maintain a too low body weight. The biology of hunger and weight clearly prove otherwise. No perfect diet, newly identified nutrition culprit or Bariatric surgery will overcome our biology.

If biology trumps willpower and our society sets us up for failure, then none of the media information makes sense. Self-help books, supposedly proven diets, medical recommendations and government-sponsored programs encourage behavior that relies solely on willpower. The information is false and leaves us flailing purely focused on our own sense of failure because even the mentally strongest person cant seem to override biology. The only way to manage the media message about food and weight is to ignore it and remember how our bodies truly respond to food.

The basic information about the human response to food and hunger is humbling. The expectation that we all have ultimate control over eating and weight, although pure myth, has a profound effect on our sense of ourselves. It's comforting to believe the answer is within our grasp but ultimately demoralizing to realize we have been duped. Accepting our need for regular meals through the day, a variety of food and a weight range that may be higher than the social norm is a significant first step. The belief that food and weight can't be our top priority may be disorienting at first. It's a leap of faith to know that, with all the advances in modern life, we have it completely wrong when it comes to food and weight. Culture and tradition planned for regular, hearty meals through the day. That pattern stabilized hunger and weight and also trained our minds and bodies to expect food and to learn regulate hunger and fullness accordingly. Modern life has tried to phase out hunger and been wholly ineffective. If we respect our human nature around food and weight and work to incorporate regular meals throughout the day and listen to hunger, we will have much more success in the world of plentiful food than we do now. Knowledge, including debunking all the current false beliefs, followed by new eating behaviors will help us all avoid the pitfalls around so much food.

A Full Assessment of the Hard-Line Approach to Eating Disorder Treatment

The frustration and confusion in treating people with eating disorders allows clinicians to adopt a wide range of therapeutic approaches. Yes, patients do get better and recover, but there is little consensus or evidence of a reliable and effective treatment to get them there. Instead, therapists cobble together a mixture of available options to find a personal style that works. The lack of effective standard guidelines and an accredited subspecialty leaves patients at a loss to find expert clinicians and to assess their competence.

One resulting dilemma among treaters is the theoretical difference between compassion and even love as a source of recovery versus the hard line, best described as "eat or else." These two theories hold sway in the clinical community and often divide a treatment team and limit effective care.

The philosophy of compassion is one I have written about extensively in this blog. The psychological thought process of an eating disorder relies heavily on an internal, critical monologue. The thoughts berate the patient in every aspect of life and curtail any pleasure from even small parts of daily existence. The criticism focuses primarily on food and weight but can encompass most of one's day and cause endless misery. The theory behind compassion is that kindness, forgiveness and caring counters the psychological underpinnings of the eating disorder and presents the patient with an alternate mindset of how to live. At first confused or even angry at the compassion, the patient gradually begins to accept the connectedness and positivity and to recognize the critical thoughts, once confused with identity, as a core symptom of the illness.

The hard line philosophy originated with the clinical application of theories used to treat people with drug addiction and alcoholism. Viewing eating disorders as a subset of substance abuse, therapists insist on regular meals and a weight goal as a mandatory part of treatment. If a patent cannot reach the goal, the team sets a deadline to either eat meals and stop purging behaviors or reach a specific weight. The punishment of not doing so is termination of treatment until the patient is ready to comply with the recommendations.

There are two important points to support this model. First, outpatient treatment with a patient who is malnourished has significant limitations. When someone remains so sick, the brain cannot function well, and therapy cannot be nearly

as effective, and for some completely useless. The body also physically continues to deteriorate, and many clinicians believe that treating a patient under these conditions is akin to enabling a chronic and often fatal illness.

Second, this line of reasoning implies that recovery and eating will be very hard, and there is no point waiting for an epiphany, in or out of therapy. In order to fully recover and get well, every patient must go through the emotionally and physically painful process of eating again and reacquainting the body with regular meals and snacks every day. Learning to face the food and the feelings and experiences that come with eating will always be hard. The hard line approach emphasizes that recovery must come with nourishment, and there is no better time to start than now.

The difference between these two philosophies, in my opinion, is not related to the course of recovery. Patients who find a treatment team with either approach can get well. However, the message underlying that process leads to two diverging ways to live afterwards.

The hard-line approach certainly encourages autonomy, self-determination and the critical importance of eating. A patient who responds to this thought process will bring to many components of life the urgency just to push through, an admirable trait but one that still condones or at least tolerates the critical thoughts of the eating disorder. What this approach ignores is the patient's need to look inward not for guts and determination, something many eating disorder patients have in spades, but for love and kindness.

The goal of treatment is a full recovery and a full life, but the hard line approach neglects to address what a full life means. It means a generosity of spirit, a desire to help others as well as yourself and an ability to take pleasure in the small things around us every day. It must embrace a positive outlook on the identity of the recovered person and the ability to receive and truly feel compliments and care from others. It must allow the person to depend on others and not feel alone in the world anymore, no longer isolated by the punishing thoughts of a horrible illness.

The compassionate philosophy of treatment of eating disorders remains more murky and thus more complicated. Tolerating the severity of symptoms and the medical and psychological sequelae of chronic illness is no easy feat for patients, families or clinicians. At times, it feels like delay or just treading water for long periods of time. However, staying the course with unlimited caring reinforces the concept that only a turnaround in how the person views oneself will lead to a true recovery. Identifying and healing from the eating disorder thoughts must accompany eating and physical well-being in order to attain a full life. Even though the hard-line can get the job of nourishment and weight restoration done, that just isn't enough to get people well.

The Isolation of an Eating Disorder

Much has been written about the isolation created by chronic illness. Healthy people have the luxury to live as they please, or believe they will one day, and to dream about the future. Being sick takes away those gifts in a moment, destroying the pleasure of each day and allowing only the hope for survival. Although sickness highlights how precious each day is, that's no solace for the loss of personal freedom.

This pain is magnified when the sick person is young, and eating disorders are afflictions of youth. Adolescence and early adulthood, the typical time of onset of eating disorders, are typified by idealism, hope and brazenness. Even if the reality of these stages feels much harder to the individual, society idealizes the freedom of this age and cherishes the passage from childhood to responsibility and seeks to delay the transition as long as possible.

It's a bit easier when the young have diseases that instantly trigger sympathy and understanding, but for people with eating disorders, the loss is magnified further by the confusion surrounding these illnesses. Not sympathized with like cancer or dramatized like addiction, painful and destructive though they both are, eating disorders are the strange diseases when someone cannot eat. The general misunderstanding of eating disorders makes it easy for family and friends to ascribe blame to the sick person. The psychological and emotional torment makes little sense to the uneducated, and the refrain "just have a milkshake!" seems as likely a fix as intensive, and usually expensive, treatment.

Crossing the line from well to ill, early age of onset and limited public knowledge quickly isolate someone with an eating disorder. For a time, many people can hide their symptoms and suffering while acting as if they are fine, just like everyone else. There's a time, around the mid-twenties, when it becomes much more difficult to stay connected with the truly well. As social events typically revolve around food and as other people's lives progress in the way a sick person's can't, it becomes too hard to continue unfazed by daily life. The isolation, once internal, largely about feeling different, becomes external and much more real. The time spent alone burdened by the years of sickness, the years gone by and the hours still lost to the eating disorder symptoms become even more painful and isolating. The years of feeling so different from everyone else truly takes its toll.

Much is made of the medical and psychological treatment of eating disorders, but the isolation created by these illnesses brings an even greater need for people to get well: community. Fostering the growth of connectedness, of not feeling alone and of others who have tread the same path opens up a long sick mind to the hope of getting well. The shame that is a bedrock of eating disorders furthers the notion that these people cannot connect. The misguided fears of clinicians that patients will only egg each other on and worsen their symptoms limits potential friendships and bonds. The rules of some programs to curtail personal connections among clients serves to heighten the isolation. But connection and dependence on others strengthens each individual's belief that full recovery is possible. It's crucial the clinical field and national organizations not only support awareness but support building community.

There are several ways to build community and give hope to

the chronically ill with eating disorders. Probably the most common option is group therapy. The opportunity to engage with other ill people and therapists is often eye opening for people who've been so isolated by their illness. Seeing the similarities between themselves and others also afflicted makes it clear that an eating disorder is not a personal failure but an illness. 

Many programs hire therapists who have recovered from eating disorders themselves. Becoming close to someone who found a way to health is a powerful experience and makes true recovery tangible. It also helps people so alone in the disease see the larger picture of relapse, recovery and wellness right in front of their eyes. Encouraging people to stay in touch with therapists and clients after discharge solidifies the reality that a bonded community fosters healing and isolation encourages sickness.

The organizations and opportunities already exist to encourage togetherness to help people get well. The more clinicians help patients and families connect to community from the start, the more the message of true recovery will spread. A therapy team is a critical first step in treatment, but community is a lifeline that ought to be part of that first line of help. Knowing full recovery is an option within your grasp, and that there is a group of people behind that imperative, must be part of any initial steps to get help.