During the recovery process, I believe it’s common, even normal that many of us feel some kind of nostalgia towards our eating disorder.
The times in recovery where our ED comes knocking and tries to lure us back, nostalgia is a tactic it uses.
I found this crazy, why would I ever want to return to something so destructive, yet I experienced a sense of wistfulness for it at times.
Your ED will not remind you of your darkest days in the depths of it, it will tell you mistruths, altered memories- such as, “it wasn’t that bad, you didn’t really have an eating disorder, not every day sucked, you still ate xyz, you didn’t miss” bla bla. But it will not be reminiscent of the rules you had to allow yourself to do that, the guilt and shame you felt and the resentment from others when their concern fell on deaf ears. No, it will not remind you of any of this.
It will recollect and romanticize the euphoria you felt on occasion, but not the crashing low points that always followed and were the majority. It is deceptive and the memories are modifications.
Your eating disorder has been a maladaptive coping strategy. It’s not surprising it tries to draw you in, at a point in your recovery where you are experiencing so many challenging emotions, new experiences, loosening of support, why wouldn’t your eating disorder try and lure you back, romanticize its role in your life?
It might be on a bad body image day; the voice whispers a reminder of old compliments you used to get. It will not remind you of the days where you missed out on happy events in order to follow the ED demands or how the compliments left you feeling conflicted and confused.
Nostalgia is natural in recovery, but do not dwell in it and do not believe the romanticized picture your ED paints, your ED was not a happy place.
On the days where your ED tries to convince you otherwise:
I find reminding myself of the many things I DO NOT miss about my eating disorder helps snap me out of it. Here are some of those things I do not miss…
My entire brain being consumed by nothing but thoughts of food and numbers.
Being “bone cold” all the damn time no matter what the temperature was.
The deception, the constant lies and shame that accompanied.
The isolation, the missed social events and memories
Not being able to eat with company, not being able to eat alone.
Not having a period
Feeling lightheaded most of the time
The pain, and many injuries through not allowing my body to rest.
The inability to laugh the inability to cry real tears.
The crippling fear when faced with a “fear food.”
The incapacitating supermarket, menu, choice “blindness.”
The brain fog and difficulty to concentrate and apply most of my brain.
The sore throat
The bloating and constipation
Never getting a full night’s sleep, sleep being haunted by fear foods.
Not being able to eat out without planning a year in advance.
Having to move 24/7. The unbearable discomfort of being still.
Being boring because I had nothing to talk about
Feeling like a constant failure no matter what. No number, image or achievement was ever enough.
Feeling like I wanted to crawl out of my skin all the time.
The list is not endless. I could continue.
However, I feel it is important to remember a few things:
Nostalgia towards your eating disorder is nothing to feel ashamed about, it makes a lot of sense in recovery. We should normalize it.
Nostalgia is natural in recovery, but do not dwell in it and do not believe the romanticized picture your ED paints. Bit by bit this nostalgia will dissipate and become replaced with the truth so long as you keep addressing it.
“Strength in vulnerability” Sound like opposites to you?
I have lived my entire life holding this belief. With the sense that showing vulnerability was demonstrating weakness. How incorrect this belief is.
From the wise words of Brenè Brown:
“Vulnerability is the birthplace of love, belonging, joy,courage, empathy, and creativity. It is the source of hope, empathy, accountability and authenticity. If we want greater clarity in our purpose or deeper more meaningful spiritual lives, vulnerability is the path.” (1)
This concept is a difficult one, when we have spent our entire lives believing weakness and vulnerability are one of the same.
But for me, I didn’t truly understand the meaning of vulnerability. Why is it such a difficult emotion for us to experience, why do we numb it?
Brenè Brown defines vulnerability as “uncertainty, risk and emotional exposure”.(1) I feel this depicts eating disorder recovery in one sentence, it’s beautiful; and it’s true.
People in recovery are anything but weak, I am yet to meet or speak to someone with an eating disorder who I consider weak. The people I have come across are some of the strongest, kindest, most resilient people I’ve encountered on all parts of my life.
Eating disorders are encompassed by guilt, shame and fear of being vulnerable. Feelings and emotions are viewed as weakness. During recovery, emotions that had been buried, lost or numbed are reclaimed and owned. Sometimes, all at once!! Some days in early recovery it’s a cluster fuck of emotions. Recovery is learning to tolerate these emotions and not numb out. This is embracing vulnerability.
Vulnerability for me has been, fear of being perceived as weak, judged, failure or a disappointment.
My eating disorder numbed everything,including these feelings but at the cost of all my positive emotions.
Exploring vulnerability has opened up my authentic self. I have never felt so vulnerable than these past 18 months, admitting my imperfections, my shadows.
I don’t see vulnerability as a negative now. It’s neither positive or negative, it’s just part of what makes us all human.
“Imperfections are not inadequacies; they are reminders that we’re all in this together.”(2)
Why shouldn’t we show vulnerability if it’s the foundations of how connections are made, creativity and passion is discovered? Connection can overshadow shame.
Yesterday I did something I would have never imagined myself doing, even a few months ago.
I shared my experience with anorexia publicly on my personal facebook account. It’s National Eating Disorder Awareness (NEDA) week in the US, which will be followed by the UK and Australasia next week. And So I decided, why not share my most “feared” secret with the hope of encouraging others to seek help, de-bunk myths and stigma and challenge attitudes.
I’m not going to pretend it was easy. It was more terrifying than either of the bungee jumps, sky dives I’ve done. Not nearly as scary as starting recovery, which is why I felt so compelled to do this . I know I am not alone but I am lucky, so lucky I have had help and support. It took nearly 2 decades to seek the help, which is sad, because this is not uncommon.
If my share changes one attitude, helps one person reach out for help then a little bit of fear is nothing. I’m fortunate I have found my voice. Many people remain struggling in silence. I’m not advising everyone to share their stories. It’s taken a long time for me to reach a place of acceptance and resilience. I know there will be some negativity from sharing such. It will come from ignorance. I feel equipped to deal with these because the majority of responses have been positive and most importantly I didn’t do it for the external validation. I am happy enough with who I am, I did it for those who are not. Those battling stigma and shame everyday.
There’s tons of ways to raise awareness for a subject, not everyone will comfortable with sharing personal accounts and that is ok. Have a look at some of the links below, NEDA and BEAT of how we can raise awareness and fight stigma.
For a deeper look at vulnerability, shame and guilt I recommend checking out:
Statistically people with eating disorders are more likely to experience co-morbid diagnoses, such as depression, obsessive compulsive disorder, anxiety, borderline personality disorder. There’s a lot of research investigating whether they are biologically, genetically connected.
When I was six it used to take me almost three hours to go to bed. I developed obsessive compulsive disorder (OCD). There are many overlapping features of OCD and eating disorders. I’m not sure that my OCD at times was separate from my eating disorder. I think it was like a shape shifter that adapted to fit my eating disorder.
The DSM-5 characterises OCD by negative repetitive thoughts that are intrusive and often result in compulsive behaviours to pacify the anxiety evoking obsessions. Common obsessions include ‘cleanliness, tidiness, numbers and many others.
My OCD was not your stereotypical “super clean and tidy” kinda picture. No it carried many similarities to my eating disorder compulsions but it did not relate to food. It began after several people close to me passed away before I was old enough to understand death or process emotions. I developed an intense fear of anyone else around me dying, or becoming sick. I began engaging in ritualistic behaviours. This involved counting, repeating certain phrases, running on the spot, avoiding certain numbers, turning light switches on and off and many more. I would perform these rituals or act out compulsions until I felt a sense of calm. The common denominator between my OCD and anorexia was the intense dread or fear of something happening if I did not perform X behaviour. (Fear in childhood death, fear from eating disorder weight gain). The only way I could silence my eating disorder voice was through compulsions and rituals.
It took a lot of child therapy to reduce these behaviours and challenge the thought patterns. Exposure therapy, similar to that in eating disorder recovery. I would cut a ritual a week until I was free. (A bit like reducing eating disorder behaviours). The exposures were ranked in order of fear and challenged with support.
But….. even though I was only six, I knew the thoughts were nuts. They were not ego-syntonic unlike the intrusive eating disorder thoughts where I believed my thoughts. For example, with an ED thought I truly believed my thoughts such as I “had to eat X number of calories or purge a chocolate bar” it wasn’t until these thoughts were challenged in therapy I could see they were disordered, I would not expect a friend to exist on the little I was eating, nor would I expect them to purge a chocolate bar. I could see after these challenges how distorted my thinking was around myself. I continue to use this, if I wouldn’t expect a friend to do something then why should I expect myself?
Another disparity between my ED and my OCD, I was far more resistant to giving up my eating disorder cognitions than I was my OCD thoughts and behaviours, even though I was just a child. I can make sense of this, neuroplasticity is much harder as an adult. But I do believe this is a distinction between my OCD and my eating disorder.
I feel it’s highly possible that having the predisposition and the appeasement provided to me by rituals definitely contributed to my developing of an eating disorder.
I believe they are both shape shifters. I can draw separations from the two disorders however there was some symbiosis within. For example, there were aspects to my anorexia that from the outside would be very difficult to draw a distinction from OCD. I had ritualistic cleaning behaviours “I had to engage in” to allow me to eat. I would clean the kitchen, from top to bottom prior to consuming anything. If I was interrupted I would start again. This may have been a part of my restriction, although I think more likely it was a separate entity to cope with the anxiety of eating. I don’t feel the thoughts surrounding this were related to the eating disorder.
Eating with very specific cutlery, is a completely different scenario. People with eating disorders often develop strange obsessions around cutlery. In my opinion (and I am only speaking from experience and talking to others who have had the same weird obsessions) this is very eating disorder driven. It serves several functions in the eating disorder. 1. Using a teaspoon (crazy) is a form of restriction. Small bowls, plates all the same. We have to stop. Using the same cutlery can feel “clean” this is an overlap.
My compulsive exercise is driven by my eating disorder. But personally I believe the compulsions and pathways were ignited and learned in my childhood. I would run on the spot or up and down the stairs for hours to feel my heart beating to feel alive. I imagine, my eating disorder reactivated this preformed pathway and used it. My drive to move when in the depths of my eating disorder was very different to when I was a six year old terrified of mortality but it still pacified my anxiety. The two disorders numb emotions that clearly I needed to find more constructive ways of coping with. My anxiety from my eating disorder was fear of weight gain, I was not afraid of this when I was six. The result of movement however, was the same, it appeased the discomfort short-term and clearly I had learnt this subconsciously as a child. This is just my simpleton thought and explanation. They both distract my brain, when I’m worrying about food or washing my hands, clearly I’m not worrying about the thing my disorders are protecting me from. But neither are healthy.
For me, overcoming my eating disorder has been so much harder than OCD. Again some of this will have been my easier to sculpt paediatric neural pathways, rather than my years of entrenched adult pathways. But I also feel it’s the eating disorder itself. We don’t want to recover, not initially from an eating disorder. This is very unlikely to be the case with someone suffering from OCD. I doubt there’s few people who decide that they want to keep their OCD, or that it’s a ‘friend’.
Cognitive behavioural therapy, has helped me with both. I guess that’s the good news about the two coinciding disorders, they are sometimes treated together. But I think it’s been more beneficial from an eating disorder perspective, because those of us with eating disorders have very distorted cognitions that can take some convincing. Whereas, I know that no one is going to die if I don’t wash my hands 37 times, I know it’s a ridiculous thought even though it causes similar anxiety. But I would have argued until I had no more breath that some of my eating disorder perceptions were not unhealthy. For the previous, it was more a case of changing my relationship with the thought- for example, when I get the thought “everyone is going to die if I don’t wash my hands 37 times” I have confronted not participating in the behaviour and “urge surfing, delaying or distracting” so many times now that I don’t feel the same anxiety and I am committed to not performing the action of washing my hands 37 times. No one has died. My brain knows this. For the latter, I have had to develop an extensive toolkit that is ever growing. When I experience a disordered thought, like; a food is “good or bad” and resultant anxiety I challenge the cognition, food does not carry moral value. And to avoid the behaviour I use a skill from the toolkit, self compassion, opposite actions.
Same same but different….
My eating disorder meant I had to eat the same things, same time, I would chew everything a specific amount of times (this was not OCD). It could easily have looked that way. I would eat in the same order. But these all served the eating disorder and were part of restriction.
I was extremely rigid with my rituals and compulsions. These were common to both.
My OCD did not cause my eating disorder but I strongly believe there is a connection, that is biological, genetic and psychiatric. I do not feel that my OCD diagnosis was important in my recovery from anorexia. I’m not sure I even really discussed it with my therapist but I think it is useful to understand the possible connection as not addressing co-existing disorders may make recovery more difficult. The treatments are similar but with variances. We are all complex individuals and so it’s possible for some not drawing a distinction may be ok in recovery but for others it may require addressing them together and with focus on specific aspects.
One thing I know for sure, the anxiety is never about the donut or the heart beating.
“8 Keys to Recovery from an Eating Disorder” WORKBOOK by Carolyn Costin, this is so helpful it has lots of exercises, to challenge healthy self vs eating disorder self. https://www.carolyn-costin.com/books
I recently shared a post on instagram after hearing a person with an eating disorder referred to as their disorder. “They’re bulimic”
It infuriated me. I wanted to remind that individual “they are not their eating disorder” It’s hard enough for the person to seperate themselves from this idea without it being fuelled externally. It continues the shame and stigma attached to these complex disorders.
I see this identity as the sufferer playing underdog to their eating disorder, but that does not mean they are that disorder. Most times the underdog prevails eventually.
This notion was something really important for me to hear when I first started the recovery process. From day one my therapist repeated this mantra, that I was not my eating disorder. Even when I didn’t see it or believe it.
We often attach our identities to the the eating disorder, because we have lost touch with who we truly are. That does not make the identity true or real.
Still not convinced? Picture this. You would not call a person suffering from cancer, “cancer”. The principle is the same for us experiencing an eating disorder. A person is not “cancer” anymore than a person is “anorexia, bulimia or Binge eating disorder” You have an eating disorder, it is not you.
When we embark on recovery, there maybe times where it is easier for the person to hold on to that identity whilst discovering who they are without that disorder. REGARDLESS, It is still helpful to be reminded that they are not their disorder. The disorder is acting as their safety blanket. Of course, early in recovery you will return to the safety of that blanket. But it’s a blanket, it is not part of you. Eventually you don’t need the warmth the blanket offers.
During recovery I think it’s important to explore who you want to become? Who is that identity?
Picturing who I want to be, what I want my life to look like helps me stay in recovery from anorexia. It helped me to see myself separately to the disorder I was fighting. Our values are completely incongruous. I don’t have all the answers and I’m still learning. That’s recovery and growth.
When we are amidst the throws of an eating disorder, for most of us our world becomes very small. There’s very little room for anything beyond- food, exercise and concerns with these. It’s all consuming and incredibly isolating. But- it’s not really what most people want from life.
Eating disorders restrict EVERYTHING.
Who wants to be 80 years old and look back on their life, and all it’s filled with is fear and anxiety over eating, body image, exercise. None of it matters. If we are lucky to reach an old age I want to look back on what my life was filled with, not an eating disorder. It is never too late to make this change. I don’t care if you have been the underdog to your eating disorder for 50 years, there is always hope you can recover.
My journal has been my haven for my recovery but also exploring who this recovered person is, what her goals, aspirations, values and worth are.
I promise you, my recovered self is not fixated on dietary restraint, exercise or control over shape. My recovered self is loud, doesn’t care for other people’s judgements, grateful for the process of getting from A-B and not just being at B.
That brings me onto my next point. G. R. A. T. I. T. U. D. E…
It is easy when we are having a tough time to focus on the negatives. But one thing I have learnt from recovery is there is always something to be grateful for. Even in the darkest of times when you don’t feel there is anything to be grateful about. There will be. Start small on those days. Gratitude, has really helped me ground myself and shift from the “all or nothing” thinking we so often experience with eating disorders. Black and white thinking is a prominent trait we share. I promise you, if you give gratitude practice a go, it’s very hard to stay in a negative space. I make it a daily practice now. I get it, you think I’m full of crap. I thought the person who suggested it to me was too. I thought it was hippy bull crap and I’d be making daisy chains. No.
Everyday for a week, think of at least 2 things you are grateful for. It can be as big as you want or small as you want. Aim to build up to more than 2. Some days this will feel harder than others. It’s these days you need to find things. The way you see yourself and the world around you will improve.
You will discover your life beyond they eating disorder even if you don’t see it now.
But for those who need to hear it again… “You are not your eating disorder”
Giving less f*cks has been very important in my recovery. I feel giving less f*cks is liberating.
I do not mean, I don’t care about anything. Far from. I have learned that giving too many f*cks is part of my problem. So learning what to get rid of in my giving a f*ck bucket has been energy freeing. Freeing up the genuine give a “f*cks” like my family, friends, career, running, sketching, my cat, helping others.
I care a lot about my job, my career and everything it represents. However my profession is a breeding ground for perfectionism and comparison. Both things I have had to work very hard at challenging for my eating disorder recovery. Right now recovering from my eating disorder is priority so that my future self can be my best version in all areas of my life including my career. That has meant some things I have given too many f*cks about previously I simply cannot afford to anymore.
As part of my core values and self worth it is important to me to work hard, be good at what I do. But how that’s defined does not have to rely on single peer comments or being aware of every statistic from every journal ever. It comes from so much more holistically.
Another thing I have found to help me in recovery is to “let go of comparison”
There is a popular phrase, “compare and despair” which I believe is very relatable.
I believe it is innate in us all to compare ourselves to our peers. But what we compare is what I believe causes us harm and dis-regulation. It can come at a huge detriment in recovery.
Body comparison is common and meaningless. For instance, I recall early on in my recovery my therapist at the time challenging this very process. I used to compare my body to other people’s bodies all the time. She explained, that we carry biases. We tend to only see what our brain filters and we have a very selective attention. Therefore I remember one of my challenges was to walk through a crowded street, take notice of the diversity. Sure enough we all come in many shapes and sizes and our appearance is irrelevant.
This exercise made this particular comparison easier to stop. Knowing the bias I harboured meant I could be accountable and when I found myself comparing, I could call myself out on it. Additionally challenging why I was trying to compare. Realising that what you see externally does not translate to what’s beneath the surface and so we are comparing to a false ideal we have created. How do we know the richer, slimmer person is any happier than ourselves.
Your eating disorder will never tell you you are as good as the person you are comparing to. Importantly, why would we want to be anyone other than ourselves?
Getting out of other people’s business..
I had a massive problem with comparing what I was eating to what everyone else was eating. I was in everyone’s business. But just as what I am eating is no body else’s business, it is of no relevance to me what anyone else is eating. I no longer could tell you what every single person at a social gathering did or didn’t eat because it doesn’t matter!!!
Comparing your eating disorder to someone else’s, completely futile and not comparable even within the same diagnostic label. Comparing others’ recovery and feeling you’re doing it wrong or not as deserving or vice versa. Just stop it, this is the eating disorder. Your recovery is your own. Your body is your own with it’s own requirements. Letting go of this has made recovery much more free.
There are many situations we can find ourselves drawing comparisons, status, aesthetics, character traits, possessions, families, sporting prowess, holidays, weddings, education, careers the list is endless when you think about it. It’s problematic when it’s black and white and impacts upon our thinking style. I’m not saying you will never compare yourself to someone again, I believe it’s ingrained in us all from an evolutional perspective, where historically it would have been a survival advantage. However there are ways I have learnt to lessen the unhelpful comparisons.
We live in a competitive society
We are told on a daily basis on many platforms to be the “healthiest’, richest, most successful. Women are made to compare themselves to other women constantly. It’s all external measures and rewards. Competition can be healthy, but recognising when it’s a problem is important.
For me, as long as I know am performing at my best, whether it’s at work or any other aspect of my life, I do not need to compare myself to my peers.
I know when I’m doing ok in this, because I don’t feel like I’m constantly striving and never achieving, I can feel grateful in little wins. This is not the case when perfectionism is in the foreground and unhealthy competition, then I never feel satisfied or recognise achievements big or small.
Practising daily gratitude has really helped with this mindset shift. Seeing celebrations in the small things, there is something to be grateful every day, even on days where it’s hard to feel gratitude. This helps me filter my ‘Give a f*ck bucket”.
In my profession, I am yet to meet someone who in their final moments, talks about how much money they made, or how gorgeous they were in their youth. No they always talk about what matters, family, friendships and experiences.
Stop basing how you see yourself by comparing yourself to others. One thing is guaranteed is there will ALWAYS be someone who appears to be ranking better than you on some standard. You are good enough just as you.
Iv’e been in recovery some time now, I can’t have a bad day right? Sound like a familiar thought? Bad days happen, shit happens.
Today, I was caught off guard. So I wanted to share for anyone else who had found themselves, feeling they “should be further than they are in recovery or should not have a bad day”
It was at a colleague’s farewell lunch which was a buffet to celebrate and wish her well.
But as I sat amongst my peers, the familiar thoughts and noise returned to, how am I back here again? How can it be so hard to put a piece of damn food in my mouth.
Panic swept over me, as the noise got louder and louder. The harder it became for me to pick up the single piece of sushi I had put in front of myself. Why couldn’t I just eat? “Seriously are we really back here after all this time? You should not be finding it this hard.”
Willing myself to pick it up and take a freaking bite. It became a battle. A battle I was all too familiar with but had felt very distant. I had almost forgotten what this absolute feeling of being overwhelmed and petrified of food was like. It was a battle.
The thoughts, “how are you suddenly paralyzed by a simple buffet? You look crazy, people are going to notice, you can’t eat that now it will look even weirder, pick something up, hide something”. JUST NOISE.
Everyone else had finished.
I realized if I was going to win this battle I needed to find and-listen to my healthy voice, the kind voice that was thinking about our future, where my life won’t be defined by moments like these, but what I will gain from listening to this voice. Not this “HH”.
Through the time in recovery, my voice is much stronger now than the noise of “HH” and can be found if I listen.
Another thing that has helped me move through today has been, accepting ok, I’m here today. It’s not where I want to be but it’s not where I was either. Before that I was criticizing myself for having “a moment of weakness”, feeling overwhelmed, but I realised, that’s not helpful or what got me moving forward and in tune with my healthy voice. This has taken practice and perseverance but it’s why I am here, now.
Finally, as we were clearing up I took some deep soothing breaths and I shoved the piece of sushi into my mouth. I picked up another piece and I repeated.
Beating myself up blaming myself for “not being further than I should” in recovery, is not serving my recovery. Some of life’s greatest lessons come from experiences and slips like this. So I am grateful for constant learning and growth.
Struggling is a standard part of recovery. I felt crushed when I was in that moment, it felt too acute and raw. I was terrified I was back to square one. Experiencing challenging moments doesn’t mean my recovery is “failing”. When we look past a particularly difficult experience, we can see actually how far we have come. We tend to focus on the negatives, what we do “wrong” and often get swept away in our unrealistic expectations. But if we take a step back and show ourselves kindness there’s something positive to be taken from every experience good or bad.
I have felt like I have been running along, but when we are running we often trip/ stumble at some point and that is normal. Recovery is no different.
I am grateful for this reminder how far I have come, but also that recovery really is a process of ups and downs.
So for anyone feeling they are failing at recovery for having a bad day, or should be further along, give yourself a break and see how far you have come. It’s ok to not be where you want to be yet.
Not playing the blame game is a game changer.
It’s been a shit day. I haven’t failed because tomorrow I get back up and carry on with recovery having gotten through a bad day, that much stronger.
Being unproductive is productive in eating disorder recovery
“I have achieved nothing this weekend”
This would have been completely unacceptable to me a few months ago. But learning being unproductive is actually productive to our mental health and recovery. This nuance has been a huge step forwards for me.
I still found it uncomfortable i’m not going to lie, the idea of sitting and literally doing nothing but listening to a podcast or watching a video is not something that has ever come easy to me.
In the depths of my anorexia I had to be “constantly productive”, driving my perfectionism to extremes. Often it led me to my becoming more unproductive because I couldn’t focus on a single task and the thoughts were constant and in conflict. Which led to exhaustion and frustration.
But, this weekend, I felt a bit off. I tried to do some work, I attempted to write a blog, but I just couldn’t. I felt so tired and I ended up doing, nothing. The ‘HH’ thoughts were there in the background, “this is so lazy, such a waste of time” However, I ignored them and did what my body was telling me to do and that was, nap and eat! I realized after I stopped fighting myself, that this is actually another recovery lesson. This is productive for recovery. And the most productive thing I can do for my future is to recover fully.
Being “unproductive or lazy and doing things without an end result, is near impossible and like torture for some of us with eating disorders, especially with a strong perfectionism component.
What do I mean by this?
When I was in my eating disorder, everything I did had to have a purpose, an end result, a target. If it didn’t it wasn’t worth expenditure of time or energy (even if it was something I wanted to do) I just couldn’t give myself permission. Things like reading a non work related book, or watching a movie etc
Now, sure the voice was there muttering away that I’m lazy bla bla but I don’t have to engage. I don’t ignore it, but I choose to not participate and try to reframe my thoughts.
This is where self compassion comes in.
Self compassion is integral to our mental health.
I like to think of it as, treating ourselves how we would treat a friend if they were suffering.
Why is it relevant in eating disorder recovery?
People with a history of eating disorders or living in it, tend to be very self critical and self compassion is not something that comes easily. I have always been hyper-critical of myself. Often we are very compassionate people, but when it comes to ourselves the thought of treating ourselves with a kindness is just simply alien and something that has to be practiced or learned. This is certainly the case for myself, when my therapist introduced the idea of trying to be more self compassionate I scoffed initially. Many times in fact before I became curious and open to exploring.
So what is self compassion really?
It’s a practice, with a ton of research behind showing that treating ourselves and others with kindness allows us to make positive changes in our lives. Pretty important for someone with lots of negative thoughts, distortions and behaviours associated with an ED. Also important in general.
I like to know things are evidence based, that’s my science brain. Kristen Neff is one of the frontline researchers of this movement and she has essentially outlined 3 major components of self compassion. I’ve linked her YouTube video summarizing below.
1. Self kindness. ( this one is probably the most obvious but also the most difficult for those of us who are very self critical) This is where the friend analogy comes in to play. On a difficult day, it’s listening to ourselves and soothing oneself, recognising difficult feelings or emotions and allowing ourselves what we need in that moment. Whether it’s just acknowledging the feeling, or doing something that we enjoy or is comforting. (This does not include using eating disorder behaviours for comfort because this is not self care).
We can become our own best friend, number one supporter.
2. I am only human. Recognizing common humanity is the second component. Accepting our faults, shortcomings and knowing it is not unique to just ourselves, rather we all suffer, we all have imperfections and that’s what makes us human.
3. Mindfulness: not suppressing or numbing unwanted thoughts or emotions. Listening to thoughts without judgement. In the depths of ED I tended to focus on the negative thoughts, rather than meeting them without judgment and often it led to escalating or destructive thoughts. I’m still working on this, for instance- I find it very difficult to call in sick from work even if I’m really unwell because I criticize myself, judge myself rather than experiencing the discomfort of the thoughts. But this is not how I would treat a friend if they were in the same situation. We all have areas we can work on.
Self compassion is not, judgmental, self indulgent or selfish. It is an important aspect of our well being. Sometimes doing something for the hell of it or enjoyment is good for us. Recovering is the most productive thing we can do and that involves learning to be “unproductive” at times.
Yesterday, I had a strange realisation. It’s taken me almost 30 years to get to it, but yesterday I realised food is not just fuel. Food has no rules, no moral value and no foods can be ‘good’ or ‘bad’.
Whilst reflecting about my relationship with food, I craved a chocolate Hobnob. I heard ‘HH’ stipulate, ‘but you’re not hungry’. It was this thought, I rewound and re-framed my life-time’s thinking. Food, although important for fuel and nutrition is also part of connection and ENJOYMENT. It’s always blown my mind that people have just been able to easily eat something, just because. But yesterday, I understood food can be eaten whenever. Whether we are hungry or not. If we want to eat something we can, without judgement, without compensating, because it’s just food.
I was feeling particularly reflective yesterday, because I felt really fucking sad. The fact the I felt sad, set off a whole chain of thoughts. But what made me grateful amongst it all, the fact I could acknowledge and identify that emotion. For years I have numbed my emotions, to the extent when I started to feel again, it took me a while to recognise what I felt. That’s pretty common I think amongst us who have eating disorders. I no longer associate with the nickname I have had for years and use to value, ‘the ice queen’. This is not me now. Nor do I want it to be. The fact it became at one with my identity is quite disturbing to me now, as I am a compassionate person. But in the depths of ‘HH’s grips I was an emotional void. I’d get angry, anxious & irritable if my routine was disturbed, or challenged but these were pretty much the extent of my emotions. Instead of returning to my old behaviours yesterday, exercising to the point of exhaustion, pain or restricting to the point of false euphoria, to numb out the events. Instead I went for a walk out in nature listening to a podcast and then had a cup of tea with a Hobnob.
I felt grateful. Grateful I have reached a point of mental freedom to enable me to feel. Being numb is not living. I was grateful I could feel sadness and sit with it. Feelings pass and are not permanent. But eating disorders are. Recovery although hard, is also temporary.
The next thing I’m working hard to reach, is body neutrality. There is so much talk about ‘body positivity’ at present. I believe the premise of this is great, but I also feel it’s a double edged sword. It’s general concept to love and accept your body, sure. Promoting acceptance by society of shape, size, gender or race is the main aim. But, I feel there’s pressure with ‘body positivity’ as a concept. It over values of the body image itself, rather than appreciation of the body’s functions. For me, I don’t know if I’ll ever ‘love my body’ but I love the things my body enables me to do. I think very few people eating disorder or no eating disorder love their bodies. So for me, getting to a point where I do not care, or have any value from my appearance will be sufficient, beyond that a bonus. But I feel it’s healthier to see our bodies as a vessel, a vessel that allows us to do what we desire. It does not matter what that vessel looks like. That’s what I believe the social media message should be, that’s what body positivity should be.
Interestingly my ‘negative body image’ didn’t truly start until I was in the depths of my eating disorder. Sure there were things I had insecurities with, but I think most people on this planet do have hang ups. But I can say, the negative body image spiralled and it took so much value. This value is incongruent with my own true values, i’m not a shallow person, I couldn’t give a rat’s arse what someone looks like if they are a good human being. But the world becomes so small, consuming and out of alignment with our own beliefs. I really struggle with this aspect of my eating disorder, because on a bad ‘body image’ day it still has far too much space. Space that’s not relevant or part of me. However this is part of the divorce from diet culture and unlearning so many untruths that are so engrained in society. Most days now fortunately I am neutral towards my body, but i’m not where I want to be yet. I’m not where I want the whole of society to be, where body image is as relevant as yesterday’s weather. But rejecting diet culture and accepting ourselves is a start towards remodelling society’s beliefs . Ultimately change starts with yourself.
I say normal, loosely. Because the majority of the population has some form of low grade restriction going on. Whether they realize it or not, any diet behavior is restriction. This is not normal eating. But it is ‘societies normal’ This is not an option for us.
When we restrict, our body adapts, by lowering metabolism and a whole heap of other changes like disrupting hunger cues. (This is partly why diets don’t work, restriction leads to a response known as ‘hyperphagia’ (increased hunger) to counteract this unnatural behaviour. Our bodies function in equilibrium and so will adapt or correct the perceived famine. For anyone who is interested like me, in evidence or scientific explanations, the ‘Minnesota Starvation experiment, led by Ancel Keys’ is the closest we will ever get to depicting what happens to humans when starved, both physiologically and psychologically. It would never pass an ethics committee today but the evidence still stands. This was a practice changing study from the forties that still helps to shape nutritional rehabilitation. It provides explanation for experiences such as hyperphagia.
In early recovery most of us experience “extreme hunger”, hyperphagia. For me this wasn’t so much physical hunger, for the most part, but it translated more as mental hunger or feeling off. Regardless it’s still hunger, if we are obsessing about food it’s because our bodies are needing fuel. I was constantly thinking about food, when I was next going to eat, what I could eat, worrying about whether it was ok/ not enough, even dreaming about food, obsessing about food, reading recipes the list goes on. It felt relentless and really intrusive. It was hard to think about anything else. During this period, I would also find it hard to leave food on my plate, even if I felt full, I guess it was my brain freaking out, fearing that I was going to return to a state of famine again. I’d feel almost a compulsion to finish everything. I never felt satisfied early on, I would be painfully full but still thinking about food. This has gotten better with time. I don’t feel the need to finish everything in front of me. This obsession with food was different to that in the depths of my eating disorder, where I would obsess over food then. When under the grip of ‘HH’ I would control everything around it, I’d cook for others, but never eat what I’d made. I’d bake a lot at this point, now I bake if it’s someone’s birthday, I’m just not interested or obsessed like I was. This is common I think, now we have a rule in my house if I make it, I eat it. Some days, if I haven’t eaten quite enough, I find my extreme hunger can return the next day, but this is getting less and less.
This is terrifying when it first happens. If it is happening to you, or someone you know, extreme hunger is normal, it’s a healthy response to energy deficit and reintroducing nutrition. It showed up for me months later in recovery, after I got back on track from a relapse. I didn’t experience it prior. Bingeing is normal in this setting. It’s distressing, it feels it’s going against everything the eating disorder believes. But the only way I found it improved was to listen and respond to it. Restriction remains the enemy for this.
Some-thing I still find difficult, is what’s normal. I also think, there probably isn’t actually a normal, because what’s normal for one person is not for another. However serving sizes is a tricky one, I can under-eat some times because I have done so for so long and my perception of what a ‘normal portion’ is warped.
I have found asking for help with this, although humiliating as an adult and at time unbearably uncomfortable, I often run my lunches past my husband and if he tells me it’s not enough, I don’t argue, I add more. I am trying to re-learn normal eating.
Another thing that helped me, although at the time I hated it and argued until I was blue in the face was relinquishing control around food. By this I mean, I was lucky my partner took complete control of what I ate, when I could not make healthy decisions geared towards recovery without ‘HH’ sabotaging. I was not allowed to cook, prepare meals, or enter the kitchen when meals were being prepared. It was one of the most humiliating experiences of my life and there were times when I would argue, shout, cry, throw, he would force me to eat what was in front of me. I was like a child. But worse, I was an adult having a meltdown. But this role was necessary for a short time, because if left alone, I would skip ingredients, make smaller meals, substitute ingredients ‘for healthier’ alternatives etc.
But it was important for me to regain independence quickly (for me and my partner) and the only way I could was to suck it up.
I cannot express the grattitude I have for my partner, I think people who support a person through eating disorder recovery are saints, they see the worst side of a person imaginable, because a caged animal will always lash out. I have apologised more times than I wish I’d ever have to in a life time. I think this is where it’s useful to seperate the person from their eating disorder. We are not our eating disorders, and the non-negotiations are with the eating disorder, not the person being over shadowed by it. This does not give a free pass to be a dick, it’s just to help understand why you have to keep fighting for recovery. Thankfully this wasn’t needed for long.
For a short while, I followed the principles from Gwyneth Olwyns, homeodynamic recovery. I like evidence and this is evidence based. I will link this below. I do not count calories and find doing so to be detrimental, however this principle sets minimums and it helped me for a short period when trying to become independent again.
One thing I’ve accepted is, comparing what we need to eat in recovery to someone who has not just waged war on there body is never going to be helpful. We need more than most people to heal. Healing doesn’t end at ‘weight restoration’, we still have a nutritional rehabilitation, inner repair, mental healing beyond this. Who knows how long this will take. This, Is hard for someone with a restrictive eating disorder, but I believe it’s true and giving yourself permission to eat whatever, whenever and often ‘more’ than people around you is an important step. Letting go of the judgment. I’ve only recently gotten to this point, I used to find it really really hard to eat in front of, or with others. That’s isolating and something a lot of us have to overcome. So ignoring comments about food is important, hard but totally achievable.
Recovery doesn’t have to be complicated. But I think it can be made easier.
Yesterday I got my haircut. ( I know lucky, in non lockdown) But I didn’t appreciate HOW LONG it was going to take! 4.5 hours, Two things firstly, I was able to sit an do nothing for this period. Something I have found really hard to do before, giving myself permission to be still, not fidgeting, standing, on the go or doing something productive. Because our ED’s tell us this is the worst thing a human could do, and it’s lazy. So that’s a victory that this was easy, outside of the boredom of being in the hairdressers on one of my only days off!
But…..today is harder. Why? Because I didn’t plan ahead very well. I always make an effort to eat 3 meals, and normally 2-3 snacks between, because I don’t have hunger signals yet so I eat regularly.
Second…I thought I’d be out in time for lunch yesterday. I wasn’t. I took a few crisps with me * also a win, would have never eaten anything before and I used to envy the people who would sit and snack care free. But I ended up missing lunch. Doing this feeds ‘HH’. I normally plan to have stuff with me at all times. Because missing a meal whether it’s intentional or not leads to energy deficit, which opens up pathways to old thoughts, behaviours. I cannot afford to do this. I expect with time, the odd unintentional meal miss won’t be an issue but early in recovery when there are neural pathways that are so brittle and easy to ignite it’s not a good idea.
I can feel when I haven’t eaten enough, or have allowed myself to get into energy deficit. I don’t have to be hungry to get this, it’s a feeling, and I am grateful I can now recognise it because I avoid it like the plague (or COVID to be more to relevant) But life happens. Like yesterday.
I ate as soon as I left, but I could already feel I felt out of gear. I made an extra effort to have a ‘big’ dinner and a snack before bed. I was not going to let ‘HH’ in. But just to explain how brittle recovery is in the early parts. I went to bed. I woke at 2:00 wired, with a feeling of what I guess was hunger. I felt empty. A feeling I was way to familiar with and “HH’ was there, ‘I remember this feeling it feels clean, now we need to do something, move, we don’t need to sleep’
Insomnia was a huge issue for me when I was sick, possibly the worst part, that and being bone cold all the time. Now for the most part I sleep like a baby, except if i’ve got the balance wrong. So its a warning for me. I got up and had a biscuit, because ‘HH’ thoughts were creeping in and demonising anything. So I ate my hobnob and slept through.
I knew today would likely be a bit harder, this morning questions of ‘ isn’t that too many oats, too much almond butter’ were there. So I added extra. But this is the thing, this is how we can either carry on moving forward, or a slip can happen after a simple innocent incident. Something that someone who has never had an eating disorder never has to think about, or likely understand. But for us, it’s something we cannot be complacent with it’s a tightrope. But again, the rope becomes more like a bridge than a rope with time, because now although the thoughts are louder today, I’m not acting on them. Before I would have and that’s all it would have taken to knock me off my rope. But through repeatedly getting back on the rope, it’s wider, stronger.
I know for next time, I will take my lunch, just in case. Recovery is learning, growth. Prepping like a boss for all the things that knock you off that rope is key. But getting back on the rope is vital no matter how many times you fall.
I’ve been journaling for a long time. I was re-reading an old journal, one I started in early recovery. I found there was a theme to the language I used to describe how I was feeling, or when journalling about behaviours.
It was all self critical. Extremely negative.
Common words I used: ASHAMED, DISGUSTED, LONELY, ANGRY, FAT. This was even when I’d documented small positive steps to change.
“I feel ashamed, I want to crawl out of my skin, I feel trapped, consumed & powerless. I’m disgusted I’ve allowed myself to get into this predicament. I don’t feel I deserve the help. It’s a spell I cannot break no matter how hard I try I’m stuck”
This was an entry I made a few weeks into recovery.
Comparing this to more recent entries, there’s none of the negative language. It’s incredible how consuming our eating disorders are, they overshadow us, they thrive on secrecy and feed the feelings of isolation and shame grows and grows.
Now that I’m much further into recovery, I can seperate this unkind voice from my own, kinder, compassionate in built healthy self voice. I do not allow myself to use language such as ashamed, disgusted, instead I reframe them and ask myself what I’m needing. Why the ‘HH’ voice is spouting these terms. If I have a thought that sounds hypercritical I know it’s coming from ‘HH’ and not me, and serves no purpose in driving my recovery.
Self compassion is difficult in early recovery because we are listening to the negative thoughts. But as we grow stronger in recovery it’s easier to be kinder to ourselves. Something we have to re-learn to do. After being the opposite for so long. It feels uncomfortable. But anything in recovery that’s uncomfortable is good.
I found it hard to do NOTHING. Or pause have a cup of tea when I felt tired, or allow myself to feel emotions. But with time, one of my favourite pass times is to sit and literally do nothing with a cup of tea ( and most often a chocolate hobnob) Yes I am English and do believe this solves everything. I never thought that weekend early in recovery I would be able to to do that. I thought ‘HH’ would berate me for sitting for a second. Sure, there are days where I do hear the negative utterances. But the difference is now I don’t turn against myself, I don’t tell myself I’m ashamed of myself, not deserving etc. I tell myself I am worthy, I can live however I want and I don’t have to listen to the thoughts. I am not those thoughts. What thoughts do you need to re-frame?
This time last year, I was getting both excited and off the chart anxious about surprising my family in the UK for Christmas, with a holiday on the way via New York.
So much has happened over the past 12 months. We couldn’t go and do this now even if we wanted to. COVID-19 has changed everything for everyone.
We were lucky we could make this trip last year. However I think we become increasingly reflective in our recovery. We have to I believe, to make sure we don’t become complacent and let the foot slip off the gas of progress and allow ourselves to slip backwards. SO naturally this means we reflect on where things lie. I have been thinking about last year’s trip a lot these past few weeks, partly because my family bring it up at every zoom chat and partly because we are making plans for this Christmas.
I can see how far I have come during this time. I felt more dread and fear around the whole trip than I did excitement. How fucked up is that?! I have always loved Christmas and a massive dream was to visit New York at Christmas time. My family Christmases have always been epic and I hadn’t spent Christmas with my family for 8 years so it was going to be special.
Uptight and not present…
Seeing the Rockerfeller tree, snow in Central Park, Macy’s displays was magical. But something still felt missing. ME. I wasn’t really present. It was like I was observing someone else experiencing what I’d always dreamed of. I sat feeling the coldest I had ever felt at a Soccer game, worrying about what we’d eat, how I’d compensate. Fixating on what my families reactions would be having not seen me for ages. Worrying about the Christmas dinners, socials it went on and on.
Then the Christmas itself- I felt numb and empty and so sad. It was not the reunion, surprise I envisioned. I was stressed the whole time, controlling everything. I wanted nothing more than to make last Christmas special, happy. But I hadn’t really committed to recovery at this point, so I had set myself up for a difficult time. Which was unnecessary.
Reflecting on progress…Now fast forward 12 months- I don’t act on ED behaviours, we are spending Xmas with friends this year. I have worked hard to be here, I have so much more freedom with each day. I’m not worrying about this Christmas, I’m looking forward to it. Looking forward to being present, being relaxed and not a controlling freak who has to micromanage everything. But this brings me sadness too. I cannot share this with my family. I cannot show them how things have changed. I hate that, the memory that should have been really special I allowed my ED, yet again to dominate, dictate and taint.
This brings me on to my next point, I know in order to get here, to keep moving forward so that I will be able to share happy holidays with my family again, I have to make a conceited effort every day to make positive steps. If you had have asked me 12 months ago, what does recovery mean, I didn’t really have a clue. I remember my therapist asked me to write down what recovery meant. However, I think at the beginning of recovery we don’t know because we are still overshadowed by our ED personality. Not so much our healthy self. I think it’s important to think about this early on, but I’m not surprised my list is different now. For starters 1 thing that is on my list of full recovery means, being able to spend time with family without any ED anxiety, complete freedom. Being able to travel without any compensation, anxiety about eating a different routine. Not being bothered by other peoples comments pertaining to my food, appearance, diets bla bla. So many more.
But in the early days it was two dimensional and clearly written by “HH”: I.e I don’t want to be cold, develop healthy relationship with exercise etc.
I think we grow in every sense as we recover. I have a far better understanding of who I am now. So in short reflection helps us to continue forward.
Phases of clothes shopping through recovery is Like “the origins of man” demonstrated by this spongebob gif!
I went clothes shopping last week. No one tells you how hard this experience is in recovery.
I decided to charity shop my “skinny” clothes. I will never need them again. It’s almost like a grieving process. I never liked how I looked at my lowest weight. I was self conscious. But buying small clothes was something my ED used as targets. Although I never felt better when I met them. I actually felt worse and worse, especially when nothing actually fit. When I started gaining weight, “HH” freaked out. Suddenly nothing fit and I felt self conscious all over again.
EDs will try and make you hold on to old behaviors or reminders of it. For me it was keeping these clothes “just in case” but they were holding me back. How can you recover with the thought you might one day fit in the clothes that fit when you are nowhere near your natural body shape or size. You can’t stay there. Not healthily anyway.
Buying clothes throughout the “weight restoration phase” is traumatic. I would recommend if you’re going through it, you don’t do it alone. It’s triggering no matter how far in you are or how committed. I would say this corresponds to the third picture in the gif. You are in no mans land. You’re not in the emaciated shell, you have fat in weird places so it’s hard to find things that fit and feel comfortable.
I went with a friend I could trust and my husband. I asked them to ask me questions like, how I felt in the clothes rather than making comments about appearance or fit. I looked for clothes I’d feel comfortable in at this stage in my recovery where my weight isn’t evenly distributed. Clothes that would accentuate other features that I’m less insecure with. For me this was flowy dresses. I have spent a long time in clothes hiding my weight for the other reason. I don’t want to hide my shape at all now, but I do want to feel comfortable. ‘HH’ longs for the old clothes but healthy me sees it a triumph of how far I’ve come.
You don’t have to like your body, I have become relatively neutral towards it. However uneven distribution, clothes shopping with size tags, mirrors is not fun. I also only bought a few things I really needed rather than a whole new wardrobe.
I didn’t do it all at once and checked in regularly. I talked through my HH thoughts with my psychologist.
Last week I went shopping on my own. It wasn’t that hard. It doesn’t need to be hard. Plan what you need, check in with your support and look after yourself.
Reckon this stage 4th sponge bob on the gif. Powering through, accepting the changes. Grateful for what you can do in your body and with your recovered body. Don’t think it’s necessary to love your body but if you do that’s a win and definitely the last sponge bob on the gif.
Eating disorders affect any age, gender, body size, ethnicity and socioeconomic background
One of my main motivations for starting this blog was to contribute from the ground up in informing misconceptions surrounding eating disorders.
Look at the person to your right, look at the person to your left and in front of you. (If you’re currently alone try this next time you’re in a room full of people). Chances are one of those people has had some form of struggle at some point in their life with relationship with food/ body image.
If you’re like me, you had possibly never thought about what a person with an eating disorder looked like before you had one or supported a person suffering with one. Eating disorders affect ANYONE. The sad truth is, society has helped create an image of what an eating disorder should look like. Typically a white, emaciated, teenage girl with anorexia nervosa. Although I fitted this demographic, this is actually the rarity. I want to help change people’s understanding of this. I want treatment to be available to everyone, this happens with awareness of what an eating disorder really looks like.
A person in a “larger” body may be as unwell as the stereotypical emaciated person. Anorexia, can affect any size, weight and BMI cannot identify this. A person in a larger body is less likely to seek help when they are significantly impaired by disordered thoughts or physiological consequences of eating disorder. They can be as malnourished as a person who appears emaciated. Seeking help is harder, why? Because when a person in a larger body loses weight they are often rewarded by society, health professionals. Making it impossible for them to find help or feel like they need help. Health professionals carry their own biases and this needs to change.
Additionally anorexia although the most portrayed eating disorder, is the least common eating disorder. Binge eating disorder, Bulimia, OFSED are more common but talked about less. Why? Because often they are not the stereotypical image.
Globally eating disorders affect close to 1 in 10 people (10% roughly)
Eating disorders have the highest mortality than any other psychiatric illness. Startling.
Before I started recovery, I used to get angry with myself. I questioned how as a doctor I could possibly be having this struggle. I have seen first hand the consequences of eating disorders. Even in the thick of my disorder I treated patients medically, this makes me feel sad now. There was a constant dissonance within. It was like a DVD playing on repeat in my brain, you should know better, you’re a doctor, why don’t you stop? This highlights beautifully the grip an ED can have on someone. It is a mental illness. I could not stop. It was not a choice. It was not a diet “gone wrong” I didn’t like being thin, although I couldn’t stop. So how can we expect others to understand when we don’t understand ourselves.
Not only was I a doctor, I was an adult and in healthcare there is a stigma towards anything other than being 100% all the time, let alone suffering from a mental health problem. Not only did I question myself, how could I be so irresponsible as a doctor. I received the same judgement, confusion from those I chose to share my struggle with. They could not understand how a healthcare professional could behave this way. That made the inner disgust and struggle that the ED likes to feed on so much more powerful. This was not their fault, this is society’s lack of understanding of mental health full stop.
This, I hope highlights how EDs sink their ugly claws in, and become an unwanted hitchhiker. The sufferer may think they have control, but when challenged to stop behaviours, thoughts they cannot. It adds to shame when people describe eating disorders as a choice. Some EDs may have started from “good intentions” like a special diet for health reasons etc, but once the disorder develops, takes hold it is crippling. My ED was a perfect storm, I had the “perfectionism traits” genetic vulnerability and I dieted. I wanted to stop, I did know better, I couldn’t stop until I sought help. But once I knew it was an illness, even if others didn’t understand (they don’t have to) I could use it to my advantage and make choices towards recovery. EATING DISORDERS are not a choice, or a lifestyle. They are a mental illness.
The earlier someone seeks intervention for an eating disorder the better the outcome. That’s not to say that someone who has had an ED for many years cannot recover, because ANYONE can recover. But recognising signs you or someone has an eating disorder is the first step towards recovery. Understanding the diversity within eating disorders is fundamental to change.