As I have been reflecting on what to write for this month, I have returned over and over to the topic of discomfort. I am both a survivor of an eating disorder and an eating disorder provider, which can offer me a unique perspective in not only the journeys my clients are on when it comes to their recoveries, but also the challenges they face that can leave them feeling stuck in the early phases of recovery, with no idea of how to push forward toward more food freedom, healing, and peace.
Currently, I work primarily with young girls in a residential treatment center for eating disorders. Upon entering care, many of my clients are not interested in recovery, either feeling unwilling or unable, uninterested or afraid, of engaging in the recovery process, let alone eating one of the six daily plates of food put in front of them daily.
There is no shame or judgment about being in this place. I was there once, too. Truthfully, it was the decision of my therapist at the time to pursue entering me into care that finally made me break, so to speak, and begin forcing myself to eat, as the fear of treatment was very significant in my life. There are so many reasons that someone may not feel ready or able to engage in recovery; I find it imperative to respond to all of them with compassion instead of fear mongering, guilt, or shame, and make myself available for the hard work in front of them.
The goal is to help clients experience movement when it comes to these fears. This movement can and should not be accomplished through shame, guilt, and fear. So, what does this look like?
I wanted to share my thoughts on this process, as well as the one I cling to the most and that this post is titled after: embracing discomfort, otherwise known as doing it afraid.
Before we jump into my clinical thoughts, I wanted to touch base further on my personal experience, as it can illustrate a look into the reality of living with an eating disorder. I have never experienced something as devastating, all-consuming, and heartbreaking as living with anorexia, outside of an additional, non-eating disorder category mental health diagnosis that has taken years of work (and continues to).
To do that, I need to set you up with a brief timeline.
I developed my eating disorder before my senior year of high school. Previously, I had never struggled with body image, self-esteem, etc. I had never thought of calories or what I was eating. I just ate when I was hungry and stopped when I was full. I did have several risk factors for the development of an eating disorder, I see now, but I was very blessed to have years of an eating disorder free life to miss and desire when I was in the depths of my disorder. I wanted to recover, especially as my disorder became more severe and life altering.
I didn’t realize I had an eating disorder until the wintertime, but my family and friends knew far before I did. I did not consider it something that needed to be fixed or changed until college as my eating disorder was my main coping skill that year for large amounts of distress and pain. I mostly experienced confusion with the anger or concern people showed toward me.
Then, college, where I began to realize how much was being taken from me, and I realized how powerless I felt about my eating disorder. I could not eat, even if I wanted to. I became desperate and afraid, and I began therapy willingly twice a week, with a group treatment modality once a week additionally. I willingly went to a physician to talk about my eating struggles, beginning weekly weigh-ins and medication to help with the obsessive thoughts, anxiety, and depression. I began working the 12 steps of EDA with a sponsor.
I did this for two years, learning so much about myself and cultivating a better relationship with myself, but I still could not eat.
I could not do it. I physically could not understand how I was supposed to be able to eat again. It felt impossible. I would sit with food in front of me for hours unable to eat it. I couldn’t even touch it, the repulsion so strong in my body, and I could not stop exercising, as I felt compulsively compelled to exercise constantly. Even in the rain and snow, even when my body began to break down. Even when all the bad stuff happened. I could not do it. Even when people begged me to eat: I could not do it.
I would get on my knees, lay flat on the ground and pray for hours for God to help me eat. I would beg. I spent hours in prayer. I was deeply religious at the time, so my faith was a huge part of my worldview and support system.
I want to pause to identify that I was still changing, just in ways I could not see. I was kinder to myself. I believed I deserved to live a life. I began to believe I deserved life and that I deserved to be treated well, cared for, nourished. I had laid the foundation for self-esteem and self-care, for self-compassion, trauma-identification, creating and using a support system, distress tolerance techniques, and valuing myself as a living being. I began to feel emotions instead of suppressing them, and I let myself talk and be heard for the first time in my life. I was healing, even if the eating was not happening. Do not lose faith if you or someone you love is “stuck” in an aspect of recovery. Their life and work still matters during this time. Do not lose hope. These years of my life spent in restriction still matter in my life, and they were not lost, wasted, or stolen from me.
I deeply reject the idea that the years in our illness were wasted. They had to happen for me. Now, with space and time, I use them every day. Every time I eat a Reese's peanut butter cup with the girls I care for, I am proud of myself. Every time I love and feed my body, I am thankful for the version of me - that scared, hurting young woman - that survived and lived through that suffering.
Anyway - I was waiting for something to happen to allow me to begin to eat: divine intervention, something to give, a readiness to start to eat. What I did not realize was this: I was going to have to make myself. I would never feel ready. I would not feel able. Food was not going to just feel easy until I started making myself eat.
So one day, laying on the floor of my therapist’s office mid-panic attack while she called the treatment center to arrange for me entering into care, I felt something snap inside me. After my therapist got off the phone, I told her to give me a chance. I had never said before that I would eat, as I had never felt ready. So she believed me, trusted me, and gave me a chance when I asked for it.
I left her office, went to the grocery store, picked out things that had been my favorite pre-eating disorder, and I started to eat them.
It was unbelievably hard. But I did it: goldfish by goldfish cracker. Slice of pizza, bites of ice cream. Slowly but surely, I began to eat enough to meet my needs and then some, and I began to gain weight.
Second note: I did this without a nutritionist, as I had no knowledge of an RD’s role in recovery. My team was very new to eating disorders, as was my physician, and I did my entire recovery journey in a state with a very poor, under equipped healthcare system, but I had an amazing team of individuals who read books, took trainings, and did so much research in an area they had not encountered before.
Please, if you are in treatment or struggling, know that you deserve a comprehensive treatment team, including a registered dietitian, therapist, medical physician or nurse practitioner, and psychiatrist. I was very lucky I did not get refeeding syndrome or suffer any ill effects from my sudden refeeding.
The weight gain was difficult, and my self-hatred sharply increased. However, I did not stop, especially because I was letting myself eat and I was so hungry. I had year’s worth of hunger in my body, and I was ravenous. In the first year of eating enough to meet my needs, my eating disorder’s presence in my head increased more, which I had no idea was possible. But I did not stop, and even as I gained weight and felt horrified by my body, I did not stop.
After about a year and a half, I began to feel neutral about my body. Slowly but surely after that, my self-love for my physical being began to increase. I still have hard days, seven years into this process, but I also have days where I think I am so cute, and so beautiful, and I am so thankful for my body I could fall to my knees and weep in gratitude for keeping me alive.
Full circle: you may never feel ready for recovery or eating; you may have to begin if it feels impossible. You can still do it, even if every bite is a fight.
So, back to now. When my clients come to me saying that they cannot eat, I say I understand. How can I help you? What this looks like on a day to day basis: snack sessions where I eat and drink with them, even if I am the only one eating and drinking. I sit with them and eat with them at dinners, offering them 1:1 processing for the ED thoughts coming up for them. I remind them that they deserve to eat, that they are kicking ass by trying, and that I believe in them. I ask them to take 1 sip of water, one bite of food with me. We pick something that feels safe for this meal, with a bigger goal for the next one. I process with them after fear foods, challenging the guilt and shame after eating with compassion and the knowledge that they deserve to eat and be nourished. I teach them distress management skills and sit with them in intense distress. We use frozen rags, affirmations, and loving kindness at our disposal. I remind them frequently and often that they do not deserve to starve. That, by starving ourselves, our lives become starved as well. We have to help them believe that they deserve to eat. That they deserve to be well, that being happy, healthy, and safe is possible for them.
We talk and we talk and we talk about the same food, the same fears, the guilt and shame, over and over, as many times as we need to at a meal, during the week, during their stay. I tell them how proud I am, regardless if they finish or not.
I ask them to make themselves uncomfortable: that when they feel afraid to eat something, or when they feel discomfort about a food, that this is an opportunity to remind their eating disorder that they are learning something new, and that they can do it afraid, even if it’s just a bite.
It is slow, steady work. But it is the work I was made for. It is deeply brave. To eat when it is the thing that terrifies you - to eat when the voice in your head is screaming that it will kill you, unwind your process - to eat and the voice gets louder and the self-hatred gets louder: how immensely, deeply brave.
We eat and allow ourselves to be distressed.
We eat even if it is uncomfortable.
We eat even if it is terrifying.
We eat even when it feels impossible.
Every bite we take is creating a new muscle, a strengthening of our resolve. It is proof that the disorder cannot control every single thing that enters your body. It grows the courage, the hope. It restores life. The discomfort is a sign that we are doing exactly what we need to do.
We thank it for existing, and ask it: how can I help you today?
Then we work to give it what it needs - building something new and better for the part of us that is in pain, and establishing more helpful patterns that lead to nourishment: a nourished life, a nourished self.