image of psychiatrist holding hands of her patient

As may be the case for many people with an eating disorder, my first therapist was imposed on me at a time of medical crisis. It was far from a match made in heaven.

He was a busy intern with scant understanding of anorexia and even less empathy. His questions were superficial and often insulting, and it felt like he saw me as a set of symptoms, not a person.

But to be fair, anyone in the grip of an eating disorder can be a difficult patient, and I was no exception. My illness had turned me from a compliant, communicative adolescent into a hostile and openly defiant patient. And my ability to engage in meaningful therapy was compromised by the confusion my starvation had caused.

By its very nature, this was an adversarial relationship — one side advocating weight gain and one resisting. As a result, I cycled through petulance, defiance and despair during his daily visits, and we got nowhere.

Over the course of several hospitalizations, I encountered countless psychologists, psychiatrists and counselors, all of whom treated me with disrespect and contempt. After my last hospitalization, I decided the best thing I could do for myself was to try to reestablish a “normal” life, which meant a break from my medical team. They saw this as an attempt to go back to my “bad old ways” and in the most patronizing of ways said they would wait until I needed them again.

I never went back. I worked hard to create a new life and was proud of what I achieved. But in moments of honesty, I admitted to myself the causes of my anorexia had not been dealt with, despite my much healthier weight.

So after many years, I found a new therapist, and while she was a vast improvement on those I had encountered during my hospitalizations, I was still defensive, and we made limited progress. When she retired, I made no effort to replace her — it seemed like so much trouble to start again with someone new.

Fast-forward another few years, and my general practitioner suggested I see yet another therapist. Finding a doctor I trusted had been a major achievement for me, and when she said she knew a psychologist who specialized in eating disorders, I understood my doctor really believed this would help me heal.

I remember her exact words: “I think you will like her, Clare.”

“Like”? Could I really like a therapist?

Yes, I did like her, and this time I have come to understand the power of a positive therapeutic relationship. I have come to believe you do need to like your therapist, because this is hard work, and you need a sense that your therapist is your partner, not someone to be outsmarted.

I don’t mean “like” as in someone you want to hang out with — although I do think if I met my therapist at a party we would hit it off.

By “like,” I mean someone you value, respect, and maybe even want to please.

Unlike my previous therapist who was a lot older than me, this time I have someone whose life experiences are similar to mine. And our communication is not one way — she shares little parts of herself with me, which is very brave I think.

And perhaps most surprising of all, we are able to laugh together. If you strip away everything, I feel there is something quite absurd about an eating disorder, and it is amazing to me that it was a therapist who showed me this.

None of the progress I have been able to make would have been possible without a truly nonjudgmental environment, and this was the crucial flaw in the approach of my early therapists. Now, I have a safe place where I can reveal the worst parts of myself without fear.

Many people may blindly accept a therapist just because they don’t want to create trouble. I now believe this never ends well.

To be clear, I am not talking about rejecting everyone because you are not ready to do the hard work (and it is hard!). That shortchanges everyone.

But if you are ready to commit to recovery, find someone who feels right. Even then, understand there will likely be times when your therapist will challenge you, and you may feel rejected. This relationship is a confronting one, but in my case, I have never felt like running away when things got tough. I know how blessed I am to have found my therapist, and I encourage everyone to fight to find the support they deserve.

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If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

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I live with anorexia nervosa and struggle daily to choose recovery. The longer an eating disorder goes untreated, the more difficult it is to reverse not only the physical effects, but also the beliefs and behaviors associated with it. Early intervention is crucial, but eating disorders often go unnoticed.

When we think of someone with anorexia, it’s likely that we picture an individual whose bones protrude from their skin, their bodies composed of sharp angles. In essence, they “look” sick. This is all too often the point at which treatment begins. We must change what we think someone with an eating disorder looks like because too many struggle until they develop complications.

For so long, too long, I flew under the radar while I struggled with anorexia. No one thought I could possibly be dealing with disordered eating because I didn’t look like the stereotypical person with anorexia. I was a “healthy” size, a “healthy” weight and had a “healthy” diet. Yet, at some point this was no longer true, and my illness began to show. I began to experience many of the physical complications that come with anorexia.

Physicians monitored me closely with weekly appointments because I had a low heart rate. (If it had fallen any lower, then they would have no choice but to hospitalize me.) Though I hid my eating disorder fairly well, its effects were became increasingly noticeable to those around me. All my energy was devoted to keeping my mental calculator running, keeping track of the numbers that haunted me. My eating rituals and behaviors drew more and more attention as I became a shell of the person I once was. It was then that people began to question whether or not I was truly healthy.

The truth is most of us who live with an eating disorder do not look like what you would imagine. Though some do fit the description of “skin and bones,” many are overweight or within the bounds of what is considered a healthy weight. The thing is, you “look” healthy until you don’t. We don’t start out “looking sick,” but that “ideal” body is often our goal.

We have ultimate goal weights. We count, we restrict and we compensate. We can do all these disordered eating behaviors and still maintain the appearance that we are healthy. This allows us to struggle in silence and continue to suppress our emotional pain. While the manifestation of an eating disorder is a focus on food, that attention only masks what is truly going on. Eating disorders are both about food and entirely not about food.

The more time that passes without recognizing the signs of disordered eating, the more adept we become at hiding our behaviors until it becomes all too obvious that we have moved from “healthy” to sick. This does not occur overnight. Developing an eating disorder is a process, and it is possible to intervene early on if we are educated.

If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

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Dear R,

I’ve have been seeing you for over a year and a half, but some things you say to me hurt. They hurt more than I let on. I have been trying to find my place in life. I have tried to differentiate myself from my anorexia, but you still make me feel like I am my anorexia. Although you said I was,“the typical 17-year old-anorexic,” I am here to say I’m not. I am not a statistic! I am an individual who had the misfortune of having an eating disorder. I do not associate myself as my anorexia. I try not to define myself as it, but when you tell me things like that it hurts.

R, we used to have sessions twice a week, then once, then twice, and now once again. I feel as if you do not care. I feel as if you want to bring me down at times just to see what I’ll do. You know me, you know what pushes my buttons, yet you still say hurtful things. You told me I should change my goal of becoming a psychologist. You told me I was not equipped for that goal. You have turned my misfortunes into weaknesses about me as an individual. You never let me live it down. Although you do not let me forget my mistakes, I have people who do.

I am here to tell anyone who has been put in a category due to their mental illness that you need to fight. You need to tell the individual you are not a statistic because you are unique. You are different, every eating disorder was triggered by some different event. You may not have the same recovery pathway as the next person who walks in your therapist’s door, but that is OK! Life would be boring if everyone was the same. You are not typical, you are beautiful in your own way.

So, thank you R. Thank you for all the times you have brought me down and at times brought me up. Thank you for making me realize the only one who knows what upsets them is the person being told the upsetting information. Thank you for calling me “a typical 17-year-old anorexic” because maybe if you kept that to yourself, I would not fight so hard to gain the weight back. Without your help, I would not be able to fight for the life I so desperately want, instead of the life I may get with my eating disorder.


The patient

If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

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At this point in my eating disorder recovery, I often find myself consulting a friend who has been sober for five years. She gets it. She’s experienced addiction. It tore her life apart. She worked hard, and now, she is on the other side. Her insights have been invaluable, and I owe her more recognition than words.

As a special educator, I study human behavior at length. The cyclical patterns of behavior present in anorexia have been a long-standing interest of mine. It’s exciting to see research is beginning to focus on new methods to change the thought patterns and behaviors of individuals living with anorexia.

Psychology Today defines an addiction as a condition that results when a person ingests a substance or engages in an activity that can be pleasurable, but the continued use or act (of the substance or activity) becomes compulsive and interferes with ordinary life responsibilities. While anorexia is not clinically recognized as an addictive disorder, one could argue the symptomology and the level of impairment of people with anorexia equate to a clinically significant obsession or addiction.

The behavioral change process is a growing phenomenon in our society. A common misconception is all behavior change is aimed at decreasing or eliminating a behavior. Cutting out foods, spending less money and reducing bad habits are all examples of decreasing behaviors. Unsurprisingly, the behaviors of people with addictions, alcoholism and bulimia all fall into this category. With each of these addictions, one must eliminate or reduce a targeted behavior.

This is what separates anorexia recovery from recovery of similar illnesses. For individuals with anorexia, rather than focus on the elimination of a behavior, an individual must significantly increase his or her energy. This not only includes consuming a greater quantity, but also a larger variety of foods and nutrients. Herein lies the dichotomy of this mental illness. No other addiction-based illness requires an individual to actively increase a single aversive behavior.

One could argue individuals with anxiety and depressive disorders must engage in non-preferred behaviors to manage their illnesses, too. For example, someone with depression may need to increase his amount of time out of bed, while someone with an anxiety disorder must increase her socialization. While these disorders require the individuals affected to engage in new behaviors, symptomologies associated with these disorders present in various ways with no single solution. No other mental illness requires those in recovery to increase a single, specific behavior without alternative options.

So, what does all this mean? Why does this matter? The treatment of anorexia is different. Individuals impacted must constantly come in contact with their addiction every day. While people recovering from alcoholism, drug use and bulimia can go “cold-turkey” and avoid their addiction, someone with anorexia must actively engage in a non-preferred behavior to cure their illness. This is not to say treating anorexia is easier or more challenging than treating substance abuse or other mental illnesses. It is just different.

In my opinion, this makes anorexia recovery exhausting. Every day, several times a day, I must make an active choice to eat. I must engage in a behavior I despise. I cannot avoid my fear or numb it; I must face it head on. I must learn to tolerate and then accept eating meals and gaining weight.

While it can become easier, the demand never fully goes away. This is an unbelievably terrifying realization. There are no days off or breaks. There is no finish line. I must continue to eat three meals a day for the rest of my life. In these moments when doubt and uncertainty creep in, I look to my sober friend and think: If you can eliminate liquor completely, I can choose to keep eating completely, too.

If you or a loved one is affected by addiction and need help, you can call SAMHSA’s hotline at 1-800-662-4357.

 If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

We want to hear your story. Become a Mighty contributor here.

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When scrolling through the #edrecovery tag on Instagram, it’s common to see transformation photos juxtaposing an emaciated and healthy body. I understand the purpose of these photos: they document the impressive achievement of weight restoration, and even I admit to posting one of these before and after pictures. But I now fear these images are largely unhealthy to both those who have eating disorders and the general public.

When I posted my transformation photo, I was not in a good place. I examined that before photo constantly, looking for differences and idolizing my most extreme features. The eating disorder loved these photos; they acted as a reminder that I had this body before, and I could get it again. These sick photos were images that I deleted once I began true recovery, for I didn’t want to give myself the opportunity to trigger myself in a moment of weakness. Holding onto these photos, even for a transformation picture, seems risky to me.

For others struggling with eating disorders, these images are also problematic. Eating disorders love to compare, and the proliferation of sick photos acts as a direct means of comparisons. I remember looking at before photos of other individuals at my worst, critiquing myself and using them as a motivation to restrict and exercise more. These photos provide similar ammunition to eating disordered individuals that got the #proana and #promia tags reported.

Even though these photos will likely not act as a trigger to the general public, they do perpetuate the oversimplification of eating disorders in society. Eating disorders are mental illnesses and are rooted in issues beyond weight, but these transformation pictures only acknowledge the physical aspects of eating disorders that are already overemphasized in society. In addition, they suggest that weight restoration is the only requirement for eating disorder recovery, which we know is not true. Some may be struggling the most at a healthy weight, and others may not even have to undergo weight restoration in order to recover, but this does not make their struggle less valid.

Instead of physical transformation photos, I want to see the joys of recovery captured on camera. Eating disorder recovery is more about gaining freedom and happiness rather than weight, and I want to see that on Instagram.

If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

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I always thought people were lying to me when they said the words “It gets better.” I thought I would wake up and fear the food I would have to eat for every single day of the rest of my life. Yet, I woke up this morning after having a three-course meal with some friends and never felt more joy.

The last few years, anorexia clouded my perception of what the world had to offer me. My life was consumed by thoughts associated with food, weight and calories. I had no enthusiasm for recovery; I felt purely controlled by fear of food. Listening to anorexia led to me being unable to support myself, yet now I am sitting here a year later about to make myself pancakes for breakfast. Everything has changed.

Accepting recovery is one of the greatest choices I have ever made. At first, it felt unnatural and painful. It would involve crying and refusing food, yet five minutes later, picking the fork up and completing the meal. It would involve planning relapse, yet waking up and doing the opposite. And it involved powering through the hardest moments in my journey. Slowly, it got easier. It got easier to say yes to the piece of pizza or the slice of cake, but it wasn’t just food that got better; my gratitude towards life improved. I began to smile more, laugh more, dance more, I started to accept myself and my imperfections more. Since starting my recovery, I have done things I never thought I would have the opportunity to do; I started to live, I opened up more, I went out for meals, I went on holidays, I helped people who were fighting similar battles.

In my darkest hours, people told me to never give up, even if I couldn’t see the light at the end of the tunnel, and for a while I couldn’t see it. However, I am soon celebrating a year since being discharged from the hospital, I have handed in my university application to study psychology in the hope of helping others, I am going traveling for nine months in my gap year, I have a job, and I am soon taking my final exams. Choosing recovery from anorexia has been the hardest thing I have ever done, and it certainly has not been a straight line. There have been relapses and breakdowns, but there have been such beautiful moments, too. And for me, each of those happy moments makes the worst moments worth it.

To those who struggle to see the light at the end of the tunnel: In the end, I don’t believe anybody can say they regretted recovery. Choosing recovery can give you infinite opportunities that you may miss out on if you continue to believe what anorexia tells you. I could never imagine myself in the place I am today; however, each day living in recovery, my life keeps improving, and I know every step I take in recovery will lead me to one day being fully recovered.

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If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

We want to hear your story. Become a Mighty contributor here.

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