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Tuesday, 28 August 2012

What Hinders Eating Disorder Recovery

Following from an earlier post about what helps. There are also things that don't work for recovery.

Having a label pinned to your chest.

Too many therapists label you as anorexic or bulimic, or an addict. Having a diagnosis doesn’t fully describe who you are or how you got the problem. We don’t call depressed people “depressives”. The ED is an illness, but you are not the disorder. Discovering the pathway into your disorder and what is keeping you stuck is better than a label for aiding your recovery.

Trivilialising your symptoms and experience.

Some support systems are not supportive, with family members ignoring the eating disorder altogether or not taking it seriously as a difficult issue that needs attention. Some people call it stupid or vain. They might say “Don’t you know better, you are an intelligent girl.” Or they say you are not fat or thin enough to warrant concern.
Families and friends need to understand what an eating disorder is. They may think that if you just eat more, the problem will be fixed. One girl said that if her parents had come and said lets all talk about this, how you are feeling, what is our role in this, it would have been awesome.

Too much focus on food or on weight.

I’ve heard it said, it’s not about food, it’s about feelings. It is both of course. Your weight might be important, but it is not the only thing we have to attend to. Many people say that the scales are too powerful. So many people don’t feel good enough because they are not thin enough according to their value system. So feedback about their weight can be hurtful.

Focus on health trumps focus on weight for sufferers and no-one must make a big deal of small changes in weight. Emma Woolf, writing in the Times said that focus on weight is crazy. Half the population is given brownie points for losing weight, while people with anorexia are told that to gain is good. How is it helpful to have one rule for some and one rule for others? Therapists must pay attention to overall health and wellbeing. Weight is part of that of course because you cannot be healthy too thin or morbidly obese. Moving focus away from weight and weighing fosters self acceptance. You can learn to stop using the scales as a way to gauge if you are OK, or not.

Being secretive.

Some therapists listen to what you have to say without giving you any feedback. They take notes about your story without helping you to make sense of it. Talking on its own isn’t helpful. Practical skills are helpful, like teaching someone how to eat healthfully and, significantly, how to reconnect to their natural appetite. (how many therapists know how to do Appetite Sensitivity Training?)

Isolation hinders recovery.

But I’m not sure if being in a group with other people with an eating disorder is the best company. There are times to stop thinking and talking about eating disorders and get on with life. Relationships suffer as a result with eating disorders and repairing these relationships is one reason why people decide to try and get better. Helping people to make these repairs and especially helping someone to forgive themselves for all the wasted time and family disruptions must be major part of treatment.

It also helps if we can teach our clients to eat with other people, and socialize without having to put on acts with other people. Learning to be comfortable with other people breaks the wall of isolation that can keep someone trapped in an eating problem.

Being stereotyped and stigmatized.

Feeling ashamed puts up a barrier between the sufferer and other people and we know that poor connection makes the disorder even worse. If someone had cancer, people would have been there for them, but people think that an eating disorder is self inflicted. If other people can’t always be kind, start being compassionate toward yourself.
Make sure that everyone around you learns what an eating disorder is and why some people fall ill, not others. Carers and friends all need to have this information so that they can be a source of help.

The wrong treatment.

While some people get good treatment, others get treatment from judgmental professionals who do not know how to work effectively with eating disorders. Being patronized and criticized destroys your confidence that therapy can work. Providers can inadvertently look down on someone who is struggling with food, and even make threats or hurtful comments rather than trying to understand. Working shoulder to shoulder together rather than face to face is how providers should behave.
Therapists who don’t even talk about food (it’s about feelings, not food) aren’t helpful. Patients express appreciation for learning how to start eating safe foods, and how to listen to their bodies for hunger cues. Getting in touch with hunger and satiety in recovery is important, as well as learning how to eat in front of other people, changing eating rules, and learning how to cook.

It’s really sad that very few people know what good treatment really is, they just have to take what they can get. If a sufferer is difficult, angry and combative, this is the disorder speaking. Good therapists should be able to work around this.

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