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Nancy Matsumoto
Eating Disorders

Therapist Carolyn Costin on the Eight Keys to Eating Disorder Recovery

An upcoming book distills eating disorders recovery to eight key steps.

One of our most insightful eating disorders experts, Carolyn Costin, has a new book coming out in November called 8 Keys to Recovery From an Eating Disorder (W.W. Norton & Company). Costin is a therapist, author, and founder of the residential treatment facility Monte Nido in Malibu, CA. She and co-author Gwen Schubert Grabb have both recovered from an eating disorder; Grabb is a former patient of Costin's who is now a therapist herself.

This accessible self-help guide actively engages readers with writing assignments (examples include describing your worst eating-disordered day, visualizing in detail a day in your future life when you are recovered, and "talking back" to your eating disorder self) that challenge them to look within and fashion their own recovery.

It's worth noting that just as Marcia described her own belief in the possibility of full recovery from an eating disorder in our book, and Aimee Liu does the same in her latest book, Costin and Grabb are also firm believers in total recovery. Here's Costin's description:

"Being recovered is when a person can accept his or her natural body size and shape and no longer has a self-destructive relationship with food or exercise. When you are recovered, food and weight take a proper perspective in your life, and what you weigh is not more important than who you are; in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size, or reach a certain number on a scale. When you are recovered you do not use eating disorder behaviors to deal with, distract from, or cope with other problems."

The eight keys are:

  1. Motivation, patience, and hope
  2. Your healthy self will heal your eating-disordered self
  3. It's not about the food
  4. Feel your feelings, challenge your thoughts
  5. It is about the food
  6. Changing your behaviors
  7. Reach out to people rather than your eating disorder
  8. Finding meaning and purpose

In the second key, the authors write about the "eating disorder self," explaining, "the goal is not to get rid of your eating disorder self, but to learn from it, discover what it is doing for you, and then strengthen your healthy self to take over its job." Throughout, the authors share stories from their own recoveries to help guide readers through the difficult twists and turns on their own road back to health.

On the divisive subject of food addiction, the authors write, "There is no proof that binge-eating disorder, bulimia, or anorexia, which is essentially food refusal, are illnesses caused by any certain food or food addiction. They note that 12-step approaches were first applied to help compulsive overeaters (now referred to as binge eaters) abstain from binge foods, then later adapted to anorexia and bulimia. Costin and Grabb like many of the support mechanisms that such groups provide. But they believe that rather than trying to abstain from certain foods, readers' time would be better spent working on improving behaviors such as bingeing or restricting. They offer a well-reasoned set of guidelines on how to adapt the 12-step model to eating disorders recovery.

I especially liked Costin and Grabb's description of how eating-disordered behavior can start as a way to numb certain feelings or enhance others, and then eventually become an end unto themselves. By stopping these automatic behaviors, they explain, you can begin to feel actual feelings again and work on developing better ways to experience, process, learn from and cope with them. In Key 5, the authors acknowledge that recovery means changing your relationship to food, whether it is too rigid or overly chaotic. By Key 7, readers are likely to be ready to engage in reaching out to others rather than their eating disorder in times of stress or need. "Getting better feels bad," at least at first, Coston and Grabb explain, so "You need support." The last key focuses on moving beyond superficial concerns over how flat your belly is to more spiritually nourishing activities, and advises "bringing meaning to your life through feeding your soul," whether it is through "telling truth without judgment," mindfulness, meditation, or building an altar.

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent's Guide to Eating Disorders, Gūrze Books. Marcia is also author of Nutrition Counseling in the Treatment of Eating Disorders.

About the Author

Nancy Matsumoto is a freelance journalist who has written numerous stories on health, eating disorders, and body image.