How to Make Recovery From Anorexia More Enjoyable

Part 1: Making recovery from anorexia less unpleasant.

Posted May 13, 2020

What are you saying yes to, when you say yes to recovery? 

You are initiating a process whose outcome is uncertain; embarking on a journey whose destination is unknowable. You are weighing up probabilities, and throwing in your hat for the chance of something better than this. 

The trouble is, you’re also committing to near-certainty that some things will feel worse than they do now for some time to come. Recovery done right involves great delights and the recognition of grand near-forgotten liberties. But the unpleasantness of the recovery process is manifold and often unavoidable. From digestive discomfort to cognitive turmoil, from oscillations between extreme hunger and its opposite to the ultimate cultural rebellion of doing all you can to make yourself fatter, many things are likely to conspire to make you hate and doubt the whole thing at times.

You will probably never invest more effort or emotional resources into personal change than you do in recovery: reconstructing a body and a mind is exhausting. With the profound uncertainty of the outcome (not just “will I ever get fully better?” but “what will being fully better mean for me?”) comes fear.

And that fear is compounded by the association between anorexia and intolerance of uncertainty (Kesby et al., 2019Konstantellou et al., 2019Sternheim et al., 2011): if anorexic behaviours function in part as responses to intolerance of uncertainty, they also systematically ratchet up the intolerance by allowing less and less of it into everyday life, thus removing opportunities to confront it and learn that it is confrontable.

So, you end up with a severely atrophied capacity for uncertainty tolerance plus the requirement to commit to profound uncertainty for an uncertain but probably long period. (Throw in a global pandemic, and saying yes to recovery may become less likely because uncertainty cubed is too much to bear; or more likely because COVID makes clear what an appalling coping strategy anorexia is.) 

Layered uncertainties are inevitable in recovery, then, and they generate fear. Fear, in turn, generates exhaustion. Fear and exhaustion plus all the other banes of the recovering life make for a wicked mixture. So, how to keep yourself going regardless?

There are several approaches open to you, probably best used in combination, with varying emphases at different points in the process. They are:

  1. Holding the goal firmly in mind
  2. Making the process non-negotiable 
  3. Making the process less unpleasant

The first is crucial: If you have no idea why you’re doing this, there’s no way you’ll see it through. It’s also complicated by the intrinsic unknowability of the recovered state: You may know what you want and never attain it, and you may think you know what you want and realise that when it comes to it, you don’t anymore.

Refusing the possibility that your definition of "recovered" might change will probably scupper the process. So the balancing act between insisting on the potential for your dreams to be realised and accepting that you must be prepared for your dreams to strike you suddenly as outdated, or unattainable — that is one you must somehow master.

The second strategy is a little simpler: It’s about having a plan and sticking to it until you experience the change you desire. The plan must centre on a plan for eating (and maybe exercise or its absence), and it must be upheld until you get what you want — or until you realise that you want something different now. So, of course, it ultimately gets folded into the first strategy, but at a day-to-day level, it’s more about just getting on with the prosaic necessities of rebuilding a body blighted by a lack of food. 

The third is about the process, but rather than the simple, ruthless, life-giving imperatives (eat, rest, eat more, sleep, keep eating). It’s about the more creative side of making this thing not a total slog from start to end — which would seem to matter quite a bit, given start and end will probably be separated by many months, if not a number of years. I’ll suggest, though, that we should also ask the question, “should we necessarily make recovery less of a slog?”.

These thoughts were inspired by this question from a reader, Lauren:

"If the weight restoration portion of recovery already feels so difficult, and if my hunger and fatigue continue to consume so much energy, what can I do to ensure weight restoration in ways that don’t preclude lightheartedness and joy? (This is complicated, of course, by the ongoing COVID-19 pandemic; most people are likely feeling significantly more confined and restricted.)"

How can we avoid precluding lightheartedness and joy in recovery? Let me first offer a direct answer, in the form of some ideas:

  • Setting short-, medium-, and long-term recovery goals, and celebrating their achievement. (This is about incentivising the process via extrinsic rewards.)
  • Practising attentiveness to the improvements (physical, cognitive, emotional, behavioural) that are already happening. (This involves appreciating the process via intrinsic rewards.)
  • Reminding yourself that the pain, whether digestive or emotional or anything in between, is not forever. 
  • Sitting with the pain and the fear sometimes, rather than pushing it away.
  • Distracting yourself, sometimes, from the discomfort of eating by watching/reading/listening to things that engage you.
  • Reminding yourself that the intensity of the pain correlates with the severity of the damage being healed.
  • Reminding yourself that this was bound to be hard and demoralising sometimes, maybe a lot of the time, and that it’s magnificent that you’re keeping going regardless.
  • Treating failures as great chances to learn.
  • Allowing this to be easy. Allowing yourself to laugh at the sheer triviality of doing this thing you’ve been bizarrely treating for years as impossible.
  • Making things playful (especially things directly related to eating and drinking and moving).
  • Making sure the rest of life doesn’t diminish to a pinprick. You don’t start to find out who you are without anorexia unless you press yourself, now and then, to expand your definition of recovering.
  • Letting other people in.
  • Laughing at yourself.
  • Laughing at anorexia.
  • Changing the metaphors.
  • Allowing food to taste nice, when the fear is stripped back.

In my own recovery, some of the most helpful things I learned from other people were how not to take it all too seriously. One kind friend helped me be playful with food and drink. The evening when he helped me decide to start eating more tomorrow, he offered to accompany me in the strangeness by ordering steak-frites at a restaurant, even though he’d been a vegetarian for years. In the months that followed, he brought me pretty tins of doughnuts and nostalgic childhood ice creams, and we chose the most over-the-top cocktails we could find on menus, and we did foody dares together, like eating leftover bits of fishy garlic with said ice cream or attempting a rendition of the cultural icon that is the deep-fried Mars Bar.

In their different ways, all the other things on this list were part of my recovery too, some of them not as fully as they probably should have been, many of them thanks to the involvements of other people: their minds, their bodies, their willingness to meet me where I was and show me something different. I recommend all of them as starting points for cultivating the kind of process that opens out into the kind of life you want to be leading.

But then there’s the question that wasn’t quite asked: “Is enhancing lightheartedness and joy in recovery necessarily a good idea?” I’ll address this in the second part of this post.

To find a therapist, please visit the Psychology Today Therapy Directory

References

Kesby, A., Maguire, S., Vartanian, L. R., & Grisham, J. R. (2019). Intolerance of uncertainty and eating disorder behaviour: Piloting a consumption task in a non-clinical sample. Journal of Behavior Therapy and Experimental Psychiatry65, 101492. Direct PDF download here.

Konstantellou, A., Hale, L., Sternheim, L., Simic, M., & Eisler, I. (2019). The experience of intolerance of uncertainty for young people with a restrictive eating disorder: a pilot study. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 24(3), 533-540. Paywall-protected journal record here.

Sternheim, L. C., Fisher, M., Harrison, A., & Watling, R. (2017). Predicting intolerance of uncertainty in individuals with eating disorder symptoms. Journal of Eating Disorders5(1), 26. Open-access full text here.