Can I recover from my eating disorder and control my size?
It’s a fair question. For many of my clients, their body feels like the root of the problem and the source of their discomfort / anxiety. For many clients, they believe that to feel better, they simply need to “get the right body.” “If only it were different, then I wouldn’t feel so bad about my body and have so much anxiety.” It seems logical that undesirable changes will only cause more discomfort and anxiety. Who would want to feel that?
So… is it possible to stop obsessing about food / movement, eat socially / flexibly, and be present while controlling your size?
Great question. Let’s explore.
What’s an eating disorder all about?
I’ll be the first to say that I don’t have a crystal ball. And I haven’t met every person in the world. But I do have extensive experience supporting folks in healing their relationship with food and body. In order to really answer this question, we have to understand what an eating disorder is.
Eating disorders are mental health conditions. They are not a “choice.” There are psychological, social, genetic, and biological factors that contribute to the development of an eating disorder.
Ultimately in an eating disorder, a person finds it increasingly difficult to engage with food in a flexible, reasonable, and social way. While eating disorders may result in physical health issues, the real severity of an eating disorder is the extent to which the fear impacts a person’s ability to function.
At the root of an eating disorder, there is often a strong fear. For many, the fear is the body changing in undesirable ways and in turn, impacting how much others accept them and how they internalize their own self-worth.
What is “undesirable” can vary and often connects back to social, culture, and gender norms. It may show up as a fear of being “too big,” “too small,” or “too much body fat.”
Other times, the fear can be about physical safety – a fear about getting sick, choking, or experiencing unpleasant / intolerable sensory experiences.
Still other times, the fear is more ambiguous – things won’t feel right, moral imperative, and/or connected to trauma (and safety) within the body.
No matter how you break it down, eating disorders ultimately connect back to deep rooted fears and a desire for safety. What the fear is about can vary person to person. It’s worth reiterating that the fear really isn’t about appearance. While that’s the narrative around it, when you dig beneath the surface, it’s the beliefs people have about what appearance means that are the core fear.
For example, someone might be afraid of gaining weight. But when you ask what might happen if they gain weight, that starts to drill down into the core drivers. Often clients will respond with things like….if I gain weight, no one will like me… if no one likes me, I’ll be alone.”
Very often (but not always), there is a core fear of rejection and isolation and a belief that having “the right” body is a sure path to connection and acceptance. A cruel irony given how much eating disorders ultimately result in isolation.
Where the behaviors fit in…
The eating disorder “behaviors” we see on the surface are the ways people try to avoid the uncertainty that their fear might be realized OR reassure themselves the fear won’t happen.
For example, to protect themselves from uncertainty around body changes, folks may engage in disordered behaviors –
- Calorie (or macro) counting
- Eating very particular nutrient combinations
- Rigid rules around textures or brands
- Avoiding certain ingredients or nutrients
- Avoiding / delaying hunger
- Avoiding fullness
- Eating with particular plates / utensils
- Rigid rules around when to eat
- Rigid rules around how much to eat
- Rules around food order
- Eating at particular times
- Rigid rules around how much to move
- Rigid rules around what types of foods to eat
- And more…
If someone feels like these protective rules have been violated (whether because of circumstance or “losing control”), they ultimately feel threatened that their fear(s) may come true. That can lead folks to engage in behaviors to get rid of the emotional discomfort –
- Planning to / actually restricting at later meals and/or compensating with movement
- Body checking (looking / analyzing parts of the body using their eyes / hands, trying on clothes)
- Trying to get rid of food (purging, laxative abuse)
- Recounting calories/ macros
- Extensive thinking (rumination) trying to rationalize deviations
- Comparing their eating to past experience or to people around them
- Comparing bodies
- Excessively analyzing sensations
- Vocalizing their distress / rationalizing their eating to others (eg, “I’ve been good…” “I earned this…” “I’ll pay for it later…” “I’m so bad.”)
- And more…
The whole point is, folks feel trapped by their behaviors. They are either always trying to avoid their fear OR responding to their fear. The fear is what ultimately drives the thoughts / behaviors / preoccupation in the first place. It’s hard to imagine a world in which you can stop engaging in behaviors while actively trying to get over your fear.
For most clients, the “behaviors” are the thing they want to get rid of. They don’t want to think about food / body so much. They don’t want to feel out of control with food. They want to be able to be with their friends, be flexible with food, be present in their lives. They want to take rest days.
But they don’t want to risk their body changing.
Don’t Forget About Biology…
While much of this post has centered around the psychological influences of recovery, there are biological factors that also play a role. There is long standing research that the action of undereating can fuel anxiety around food and fear of weight gain (https://doi.org/10.1016/j.jad.2024.07.065 ; https://doi.org/10.1007/s00737-017-0761-6 ; https://doi.org/10.1016/j.appet.2022.106019 )
Moreover, both biological and psychological restriction can fuel obsession and impulsivity in eating that contribute to binge eating behaviors (https://doi.org/10.1016/j.eatbeh.2023.101791 ; https://doi.org/10.1017/S0033291721002786; https://doi.org/10.1017/S0033291724003337 ; https://doi.org/10.1016/j.brat.2011.06.006 ) .
A parallel example…
Let’s look at this with another example.
Imagine you were terrified of dogs. Perhaps there was a negative past experience, maybe it’s because of stories you heard, or perhaps for no reason at all….you’ve just always been afraid of dogs. When we are afraid of something, the natural, normal, and intuitive thing to do is avoid the thing you’re scared of. And thank goodness for that! To an extent, fear is nature’s way of keeping us safe – we “should” be afraid of and not engage with threats to our safety – like lions and tigers.
But not every fear we have is rooted in actual, immediate threat. Yet, our minds go to great lengths to try to find evidence that the thing we are afraid of is indeed a threat and will often ignore / dismiss evidence to the contrary. I know…so confusing.
Back to dogs. If you are scared of dogs, you may find your mind going to great lengths to find and maintain evidence that dogs are scary / should be avoided.
Folks who are afraid of dogs often label them gross, disgusting, smelly. They limit their interactions with dogs – avoiding places where dogs are, getting angry with dog owners, they don’t look at dogs, and may panic (run away, hide, scream) if a dog gets too close.
Certainly, you can live your life that way. But the reality is that dogs are part of our world and creating a life in which you cannot tolerate interacting with dogs can inhibit where you go in life and who you spend time with.
To actually work through a fear of dogs, you can’t just “change your mind” or tell yourself, “I like dogs now” while continuing to avoid them. Because the moment you’re in their presence, you likely will not be ok.
To actually work through that fear, you have to experience your way out of it. To understand what it’s like to be with dogs and tolerate the uncomfortable emotions / urges that come up when you see them, hear them, or are around them. Then over time, your mind and your nervous system learn that hey….this isn’t the threat we thought it was. We may not love dogs, but they don’t have to dictate how we live our life.
Now, working through these fears isn’t about just petting every dog you see or even loving dogs. You have to work to understand them – how they communicate, what their boundaries are, and how they interact with humans. While having some willingness to unlearn the stories you’ve told yourself along the way.
Back to eating disorder recovery…
Much of this is also true for eating disorder recovery. Recovery isn’t as simple as “just gain weight” or “eat the food.” It’s about learning to navigate the fear and discomfort that come up from doing it differently. And changing your relationship to the thoughts and urges that arise (and control you).
So “can” you control your size while pursuing recovery? Again, I don’t want to be the person to tell you what you can and cannot do. But it’s really important to be honest with yourself about whether fixating on that is allowing you to actually work through and let go of the fears that drive the behaviors in the first place.
No one gets through recovery by simply telling themself they’re not scared (gosh I wish that was how it worked). Instead, we have to experience our way through it – challenging ourselves to step outside of the walls that keep us safe and towards the space of living more.
It’s a slow process that we master through experience, not just knowledge. We all “know” what to do, but the work is learning to trust that we are more than our body, food, or movement.