The eating disorder voice explained…sort of

Over and over again, people with eating disorders and the clinicians who treat them refer to “the eating disorder voice.” You won’t find it described in the DSM or really anywhere but it is very real piece of the ED picture.  There are two different ways that “the voice” clinically manifests. The first is simply in beliefs and the second is in abusive self-talk.

Confused? You should be. It’s not easy to explain, but I am going to try!

Let’s start with beliefs. Sometimes in treatment, we attempt to differentiate between the beliefs of the person and the eating disorder. What is a thought based in the ED and what is a thought based in what we really value? These exercises are useful because sometimes, when we are in the middle of the eating disorder, the two are jumbled. It’s hard to tell the difference between what I really want and believe and what is simply a product of the eating disorder.

For example, a person with an eating disorder may say that no one has a right to be happy with a performance (work, school, whatever) unless it is perfect. Now, is this what the person really thinks or is this a function of an eating disorder? Occassionally, a person may truly believe that but often it has more to do with the perfectionism that plagues those with eating disorders. We strive (and fail) to be perfect at everything. Then we see other people, who are not even trying to be perfect, are happy and it makes us angry. “I try so hard and can’t be happy. They suck, Why are they happy?”

It’s not fair to other people but when the standards are set impossibly high for you, and no one else, it makes you a little angry. Thus, in treatment, we have to talk about why we are so angry about other people being happy and consider the possibility that the standards set us up to fail. We have to consider the idea that perfection is unattainable, that we are lovable, and that everything will be just fine if we are not perfect.

It’s a scary thing to face but the eating disorder beliefs have to be challenged and exposed for what they are. Only in removing the ED beliefs, can a person figure out what they really believe. Once the idea that perfectionism is not required to be happy or lovable, then we can start seeing that, for example, we might feel happiest when we are playing with a child or talking with a friend. The standards change and happiness is possible.

The second piece of the eating disorder voice is abusive self-talk. It might sound a little crazy but we all have self-talk all the time. Most of it relates to our ability handle the situation in front of us and most of the time, we are not aware of it.

Unfortunately, those with eating disorders are more aware of their self-talk and their self-talk tends to be more abusive. It is literally like someone is yelling at you all of the time, except in your head. It’s not psychotic. It’s not like someone with schizophrenia who hears a separate, distinct person. It’s still just you but you are very loudly yelling at yourself.

Have you ever made a really big mistake and been mad at yourself? You know how you say to yourself “Why did you do that? That was dumb? You need to fix this!” And then you regroup, shut down the yelling and start problem solving?

Well, that doesn’t happen in an eating disorder. You just yell at yourself…all the time…over everything. It’s unrelenting and cruel. It eventually tells you that you deserve to be punished and you have to punish yourself. It tell you that you do not deserve to eat, that you are worthless, and so on.

The worst part is that you believe it.

Obviously, the self-talk is much harder to treat. It’s like trying to fix a tape on repeat. (I just dated myself, I know.) It’s automatic, constant, repetitive, and loud. It basically meets all the criteria for sound torture.

So, what do you do? The best we know how to treat it is through mindfulness techniques. The person, usually with the help of the therapist, has to learn to nonjudgmentally identify when the self-talk is being abusive, and replace it with more positive self-talk. The goal is to systematically extend the amount of time that the self-talk is positive, until it is generally positive.

The eating disorder voice is very hard to describe but it’s very real. It’s real and devastating.

Have you ever experienced the ED voice? What was it like? How did you deal with it?

The Myth of Accountability

Accountability, in the general sense, means to be held responsible for your actions. It typically means that if you do not live up to goals, promises, or expectations there will be some sort of punishment.  Doesn’t sound very therapeutic, does it?

I frequently have discussion, both personally and professionally, about accountability. Clients find  that following a meal plan or not using behaviors is easier or more likely to happen at a higher level of care. That makes sense, right. There are nurses, nutritionists, techs, psychiatrists, therapists and other authority figures following you around all day, making sure you follow through.

What’s are the consequences if you don’t do what they say? Well, depending on how life threatening a behavior is, they can literally and physically force you to do something. They can kick you out of treatment. Or they can keep you in treatment. Or any number of other things. Usually, the simple presence of the authority figure is enough, but they do have their ways.

It certainly doesn’t sound appealing, but, it does mean that you have permission to eat. It does mean that someone else fights your eating disorder with you on a moment-by-moment basis. In many ways, it’s a relief.

Then, after all of this, something wonderful and terrible happens. You leave treatment. Suddenly, you’re back to being on your own and back in the same environment. You’re free…but so is your eating disorder. You’re free to do what you want but the eating disorder is free to do what it wants. It’s back to bossing your around and offering false relief.

Awesome…so what do you do now?

People often talk about having someone, be it a therapist or a family member or significant other, maintain accountability on an outpatient basis.”If I just had someone to keep me accountable, then I’d be able to do it.”

Unfortunately, this is a grand fallacy. It is a myth perpetuated by both well meaning individuals and the eating disorder alike. It seems to make sense at first.. “I’m accountable in an inpatient setting and can do it. So, if I was accountable out of the hospital, I could do it.”

Not how recovery works, unfortunately. The major problem is that the most someone else can do is know. They can know that you haven’t met your meal plan or know you have engaged in a behavior; But beyond that, what are they supposed to do? They cannot make you do anything, and any “punishment” runs the risk abusive or set up a counter productive power struggle. There is the added fact they they cannot monitor you forever. Accountability, in the traditional sense, does not produce the desired result of recovery.

Again, what do you do?

The real answer is to become “accountable” to yourself and use the support you have to help you fight the eating disorder. Instead of following a meal plan because you will get in trouble if you do not, you have to follow it because you want recovery.The people in your life, the therapist, significant other, family member are there to help you find why recovery is worth it, not shame you into it.

You can be accountable to yourself because there are very real consequences that you suffer when you continue to engage in eating disorder behaviors. Everything from heart problems to relationship difficulties. In all reality, the natural consequences hold us accountable.

There are also the positive aspects of recovery, those things that you can attain only if you live in recovery. Those things include improved relationships, fully experiencing emotions, loving yourself, being allowed to take care of yourself, relief from constant failure, and on and on. Being accountable to yourself also means being able to remember and be motivated by the positive things in life.

It’s certainly tough. Anyone who has recovered or has an eating disorder will tell you that we often do not know how to be motivated by good things. Shame and guilt have been there with us, for a very long time, and those are usually the things motivate us. It’s also tough because the eating disorder wants you to fail and has a lot of reasons why recovery isn’t worth it (All lies, btw.) There may even be people in your life who want you to keep the eating disorder.

Luckily, it’s worth it and there is support out there. Your therapist is there to help. Hopefully, your friends and family are there to help. And if they are not, there are communities out there who will help.

And most importantly, the reason to recover is reading this right now. You. You are the reason to recover. You  are the reason to follow a meal plan and use skills and stop using behaviors. You are worth it and you deserve it. Start believing that and you’ve started being accountable.


“Mommyrexia” and the value of motherhood

I am nearing the end of my second pregnancy and the nerves are starting to set in about the strangest things.

Of course, I’m nervous about having a second child. Having one already shook my life up quite a bit. What will two do? I’m nervous about lack of sleep again and being good enough and all of those other things moms, even not-so-new moms, worry about.

I’m also worried about the stupid ads that are going to start showing up on my Facebook and other social media accounts. Silly, right? It’s just an ad! But, honestly, I’m scared to see them again.

I don’t get how they knew the first time, but they sure knew when my son was born. It happened so quickly. Suddenly I was bombarded with ads about losing weight and getting my pre-baby body back. The onslaught was astounding in its intensity and ferocity. You would have thought I was in some sort of postpartum Hunger Games…that I was supposed to disappear into some arena for 6 weeks and emerge effortlessly and flawlessly victorious in a body that had never been touched by pregnancy or motherhood.

It was awful. I felt like I was being told that actually being a mother, ie nursing my son, holding him, letting my body heal, doing tummy time, etc., was worthless. The only thing that was supposed to matter was my body and if everyone else thought I was sexy. It’s hard thing to hear when I was already feeling so scared and unworthy of the job of being a mom.

Mommyrexia is a term that gets thrown around, and I’m not a big fan of it because it delegitimizes the very real struggles of those with eating disorders and the very real struggles of new moms. It makes “losing the baby weight” something about vanity.

However, the term Mommyrexia does point out that there is no actual media value in being the mother of an infant. The value is placed on your ability to distance yourself from that infant by having a body that shows no signs he was ever there. It’s sick, really.

Being a mom is really hard. It’s scary and isolating and emotional. It’s totally worth it, but like most worthwhile things, it pushed me into a world I had no idea existed. It was a world I had always wanted to live in but I felt ill-equipped and unworthy to be there.

It would have been nice, when I was alone, lost in all those fun postpartum thoughts, to see the outside world telling me how important my work was. It would have been nice to see in writing that this new world of motherhood was valuable; that feeding my son and bonding with him were more important than a number on a scale.

That’s not to say I didn’t have support. My husband and family were amazing. They helped me figure out how to be the mom I’ve always wanted to be. I valued being a mom and they valued what I was doing as a mother.

As I come to the end of this second pregnancy, I am even more grateful for the support I had. It would have been easy to buy into the world of Mommyrexia and just focus on losing weight. The world of motherhood is difficult in unimaginable ways. I don’t want to see the ads again; not because I believe them but because I just don’t want the negativity around me. I don’t want the media telling me that motherhood is worthless or that my insecurities are fair game for their marketers.

I just want to be able to love my new son and my first born and my husband in peace.



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