What is treatment like?

Some aspects of treatment and recovery differ for each person, though some aspects are common to many people, males and females alike. Some people (a male and several females) who went through treatment offered some perspectives about their experiences.

Female experiences

Mealtimes can be difficult not only during recovery, but for a long time—and even throughout the rest of a patient’s life. Family members often aren’t sure how to act—should they congratulate the patient for eating food and encourage more eating? Should they take the focus completely off food and talk about something else? One family found meal planning helpful. They decided with their recovering daughter which foods to eat and when. This was their only focus on food. They would “eat what was healthy and forget about it.”

Staying busy after meals was important to get their daughter’s mind off what she had just consumed. The family would take walks or go shopping. Therapy helped this family work out how best to relate to their daughter. Although the mother said it was “not easy to sit with counselors and realize your faults as parents,” she felt that confronting her own role in the family was important to her daughter’s recovery.

Another patient said it took two years of intermittent treatment before she was truly comfortable at dinners. Mealtimes were tough during those two years; the family wasn’t sure how to address the food issue. The patient’s feelings towards food changed over time—from wanting to ignore it completely at meals to feeling comfortable talking about it.

The family had difficulty keeping up with the changes, and this caused tension. The patient described it this way. “You’re trying not to think about [food], and you’re feeling scrutinized about it.” The family didn’t go to therapy, although the patient felt it would have been helpful. Therapy can help the family and patient “figure out where you are on that continuum” of focusing on food or avoiding it, she said.

Another patient went in and out of treatment centers for five years and met a lot of other people in her situation. She observed that most of the patients, including her, had alienated or lost touch with old friends and bonded with each other in the center. This proved to be a double-edged sword. For this patient, the new-found friends were initially a life line to recovery because they understood each other. But, some relationships eventually became a breeding ground for competition on weight loss or who would be the first to relapse and return to the treatment center. “The intense bonding is just what you need in the moment, but later it can just hold you back,” she said.

She felt that staying friends with people who had not progressed as far in recovery as she had was holding back her own treatment. She also noted that because many people with eating disorders have abandonment issues, separating from friends made in treatment centers can be especially difficult. She maintains few relationships made during her recovery and said that therapy was key to her ability to rebuild most of the friendships she had before starting treatment.

Treatment is a difficult process physically and emotionally. For one patient, the hardest part came after the treatment had started and her symptoms began to subside. She explained that for her, the disorder was about control—controlling her eating that later developed into controlling her emotions. She developed a “numb” feeling that “felt good” as her disorder progressed. However, as her treatment progressed and symptoms disappeared, her emotions returned and the numbness was gone. In her case, she noted, “the hardest thing was feeling the feelings.”

A male’s experience

A male in recovery who experienced both bulimia nervosa and anorexia shared his experiences at different stages of treatment and recovery. He began disordered eating behaviors in his mid-twenties and several years later sought help. Now, nearly twenty years later, he reflected on those times and how he now feels.

“I eventually reached a point where I felt spiritually and physically exhausted from an all-consuming life of exercise, over-planning meals, and purging. These feelings eventually started me on a path that led to disclosure, treatment, and ultimately a process of recovery. I began by looking up information about eating disorders. I was confused in the beginning, because I realized that I had behaviors found in both anorexia AND bulimia. I eventually learned that many persons diagnosed with an eating disorder have both. Eventually, I was diagnosed as an anorectic with bulimic tendencies. Over time, I learned what that diagnosis really meant. The person that everyone else saw was confident, strong, capable, and content…but inside, I was dangerously insecure and I used food to deal with it. I had become fully dependent on the control and behaviors associated with my eating disorder and they provided a sense of accomplishment. However, in the end, they were a poor substitute for the sense of self-worth and confidence I craved. Eventually I came to see my eating disorder as something else – an affliction resulting from an almost fatal lack of self-worth.”

He described having the following feelings and thoughts as he considered how, when, and to whom to disclose his eating disorder. He had been very overweight and had decided to lose weight and begin physically working out.

“The first step towards treatment for my eating disorder that I took began with… a series of disclosures… admitting it to myself, then to those closest to me, and eventually to persons who could help me address it. While admitting and disclosing that I had an eating disorder was necessary, it also made things worse, especially in the beginning. When I told people that I had an eating disorder, I felt as if the world turned, but left me behind. People who once encouraged my weight loss and who were proud of my accomplishments now saw it as a bad thing. Once the secret was out, it was not always easy to see where that “bad thing” ended and I, as a person, began.”

“Disclosure also had a direct affect in regards to my bulimia. For years, bulimia helped me to hide my eating disorder from those around me. I could appear to eat a normal meal, but purging – whether making myself get sick and excessive exercising – allowed me to help control the effects and feelings associated with eating. Once I disclosed, my secrecy was gone and I felt watched or judged every time I went into a bathroom after a meal or went to the gym or for run.”

He emphasized that recovery is not a linear progression—there are steps forward as well as relapses, and it’s a process, not an event. It’s important not to be discouraged when a relapse happens. He also points out that treatment and recovery are two different things.

“Things did not magically get better in my life because I acknowledged that I had an eating disorder or when I began treatment, which included years of regular visits to my therapist. I had to learn that treatment did not automatically equate to recovery. In my case, treatment went on for about two years, before recovery really started. Actually, there were times during those first two years I did not really want to recover. The thought of life without an eating disorder to depend on scared me, and I needed to face those fears as well.”

He also described challenges regarding being a male with an eating disorder—the challenges included clinicians who were unaware that eating disorders affect males, too. Those challenges posed some barriers on his recovery journey.

“As a male with an eating disorder, it seemed that my healthcare providers were not always sure what to do with a ‘thirty-something male anorectic.’ When I first told my primary care physician, it almost seemed as if he did not believe me, suggesting that perhaps I just got ‘carried away.’ As a result, I made a fateful and intentional decision to lose even more weight. I thought if I did not look sick, people would not believe that there was something wrong with me.”

“During recovery, I had to learn that it is a process, not an event. Recovery was not about simply deciding to stop my eating disorder; it was about breaking my dependency and the feelings of insecurity that drove my need for control. I started to consider how unrealistic expectations, especially ones that equated success with an ‘all-or-nothing’ proposition, could be just as damaging as not trying to recover at all. I needed to have realistic expectations and let my recovery be ‘imperfect’ in terms of my behaviors. If I purged, skipped a meal, or exercised twice a day, it didn’t matter as long as I was making progress. I did not need to be perfect in my recovery; rather, I only needed to recover.”

“At times during treatment and recovery, I felt the need to prove I was committed to getting better. I put this pressure on myself. I once questioned my therapist about whether he let spouses or family members attend sessions. He told me ‘only on very rare occasions.’ He even said he would not allow parents of younger persons with an eating disorder be present during sessions. I told him this confused me.”

“He explained that he saw preserving the security and trust he builds with his patients as his greatest responsibility. By letting others attend, it opened the possibility of jeopardizing that trust while also discouraging open discussion about certain issues. As I considered this, I knew that I would have been much more hesitant discuss my feelings or certain life events if my parents, wife, or someone else had been present. He told me that he tended to get another therapist or counselor involved to conduct group or family sessions to address specific relationship issues. His response impressed me…and told me that I worked with someone who really understood the nuances of eating disorders, especially trust and control issues.”

“During treatment, I learned about many theories about reasons that eating disorders develop. These included environmental factors, family problems, relationship issues, abuse, societal expectations, and genetics. It might have been easier if I could blame one or two external factors for my eating disorder. However, the fact remained that I was ultimately accountable for my routines and behaviors, including bulimia. Ultimately, recovery came down to a question of responsibility rather than a reason. If I made something or someone else accountable, it validated the feelings that drove my eating disorder, but not without giving away control over my life. My eating disorder was my coping method. It was how I responded to my feelings and fears. I was the only person who could bear responsibility for what I did to my body and the consequences. While not everything in life was my fault, I had an undeniable accountability for how I reacted to things and the power to change my actions.”

Recovery can look and feel different to different people, but also people with an eating disorder have some experiences and thoughts in common. Being in recovery for nearly 20 years, he described what recovery has meant to him.

“Recovery meant trusting people with the real me. Supporting me in recovery meant helping me to find a sense of self and to find worth in me. I suspect I will never forget the experiences of my eating disorder and the lessons it taught me. If I don’t remember them, I will probably run the risk of relapse. After nearly twenty years, the temptations and tendencies remain. However – now I choose not to employ them. As I have talked to others with an eating disorder, I have found that my feelings and experiences are not unique.”