Eating Disorder Behaviors vs. Thoughts

Today's post is about the difference between eating disorder behaviors. Many people are under the impression that eating disorders are "simple" disorders with specific behavior and symptoms. Though eating disorders have criteria they must meet in order to be diagnosable, they are multidimensional like almost every other illness. As I already mentioned, the components of eating disorders can be broken into two different categories: behaviors and thoughts. First, I will talk about behaviors.

Behaviors include any act that someone does which encourages or fuels the disorder. The most common behaviors associated with eating disorders include:

• restricting (withholding food, decreasing intake)
• binging (eating excessive amounts of food in a short period of time)
• purging (getting rid of food by means of vomiting, laxatives, diuretics, or excessive exercise) 

Other behaviors may include chewing and spitting, constantly tapping one's foot in an attempt to burn calories,  guzzling water, etc. Many physicians and professionals place emphasis on the behaviors or compulsions because these are the components cause physical health problems. Restricting food can cause light-headedness, weight loss, fatigue, etc. Binging can lead to weight gain and hypertension amongst other things. And purging can cause dehydration, dizziness, and severe electrolyte imbalances which can lead to heart irregularities. Many treatment methods focus initially on trying to limit behaviors. Ceasing behaviors completely is a long term goal but it is very important to get them under control to make sure the patient is medically stable. When your body isn't working properly, neither is your mind.

Eating disorder thoughts make up the second part of the disorder. The important thing to understand about these thoughts is that they are different than everybody. Many people who suffer from an eating disorder will say these thoughts are coming from their "ED voice" and they will hear things like "you're too fat, don't eat", "you have to run x amount of miles before you can go to bed", "if you're thin, you're nothing" or the voices might tell you to binge because you're "worthless" and then to punish yourself and compensate you must throw up. So as you can see, ED thoughts are extremely complex. Some are subtle to the point where the person suffering may not even realize the thought is even disordered, while other thoughts are blatantly obvious. Though the thoughts are not necessarily causing direct bodily harm, they are the catalysts to the behaviors. Without the thoughts planted in the mind, one would not act out the compulsion or behavior. This is why during treatment, it is a very common exercise to write down your disordered thought on one side the paper and then write a thought that counteracts the disordered one. For example if you have "You don't deserve to eat" as your disordered thought, you could combat that with something like "I deserve to eat. I have to eat in order survive." The goal is to practice fighting the disordered thoughts so that over time it will become easier to ignore. Eventually, the ideal goal is to not have those thoughts at all.

Eating disorder thoughts and behaviors can go hand in hand. The goal of treatment is to minimize and eventually eliminate both. However, there is one thing I would like to point out: you can be behavior free and still struggle with the ED thoughts. Physical habits are easier to break than mental ones. It is VERY common for someone in treatment to have stopped using behaviors but still have ED thoughts going on in their mind. It doesn't mean you're doomed to struggle forever but it also doesn't mean you're completely eating disorder free. Through treatment, you will learn to become self-aware and identify your triggers. If your thoughts are occurring more frequently and are increasing in intensity, then it is recommended that you contact your treatment team. Just remember that it is normal to struggle with both thoughts and behaviors and it will take time, work, and consistency to stop them.

I hope you all now have a better understanding for the difference of eating disorder behaviors and eating disorder thoughts. If you have any questions please feel free to ask me. And if you or anyone you know is struggling, there are always resources available to you.

http://www.nationaleatingdisorders.org/
http://www.something-fishy.org/
http://www.nedc.com.au/helplines

But I'm Not "Sick" Enough For Recovery

I'm pretty sure that almost everybody with and eating disorder has said (or at least thought) this to themselves. We think that we aren't sick enough for recovery, as if there is some standardized test that will confirm you are sick enough to seek treatment. Let me tell you something right now: that's a load of crap. There is NO such thing as "sick" enough. It doesn't matter if you're 90 pounds or 190 pounds. If you have an eating disorder you are sick and you deserve help.

Your level of care needed may be different than someone else's. For example you may not need to go to a residential treatment facility. You may do better in a partial program or even outpatient. You may not have to have every meal monitored. You may not require medication. You may not be put on bed rest. Does that mean you're not sick? No. You know saying "All snowflakes are different?" Well, so are eating disorders. We develop them for different reasons, we use behaviors differently, and our RECOVERY and treatment will be different. The important thing is that you seek treatment.

Denial is usually our first response or defense mechanism. We think "I'm not skinny enough to get help" or "I only binge and purge x amount of times" or "I'll be the fattest one there." None of those statements are true. That is your eating disorder trying to convince you to stick with it. There is no criteria for being "sick enough." If you are sick then you are sick. Even look at the statistics: majority of those who suffer with Bulimia are either at a normal weight or are overweight. The DSM V also "no longer requires the patient’s weight for height to be less than 85% of that expected." Though weight is considered, it is not the only determinant for needed treatment.

I think that we use the excuse of not being "sick" enough because we are scared. The eating disorder has been a source of comfort. It's something we know how to do. It's something that is there for us to turn to when nothing or no one else is. So when you're thinking you're not sick enough, picture yourself in 1, 5, and 10 years if you continue to engage in your eating disorder. If you allow the eating disorder to control your mind and your life then you will never be "sick enough" for recovery. Don't let that faulty thinking control you.
Be brave. Advocate for yourself. And realize that you deserve recovery no matter what.