When Eating Disorder Treatment Creates More Fear

Over the past week, I was reflecting on my years of illness with anorexia and the periods of time I spent in eating disorder treatment (with more than one admission to an eating disorder unit). These are not the most happy memories to look back on but as I did so, I realised with no doubts in my mind, that one of the biggest and most difficult mindset shifts I had to make in my recovery (which was subsequently done well away from traditional treatment) was a mindset that was created by the treatment providers treating me.

I have not been near an eating disorder treatment provider for a good few years now and I truly hope that things have changed in that time.

However, when I was in treatment, we were fed to a very prescribed meal plan each day and this was adjusted according to our weekly weigh-in results.

As much as I was terrified of eating more food in treatment, I was also incredibly hungry (as most of us with restrictive eating disorders are, with intense mental hunger, as well as frequent physical hunger). Despite this, my meal plan would feed me just enough to gain the amount of weight that the professionals deemed correct each week and I was not permitted to eat more food than the plan, even if I did ask for it.

This alone was enough to add more fear to my eating disordered mind and ensure my brain formed even stronger neural pathways around the beliefs that I could eat ‘too much’ and that my weight did have to be tightly controlled through diet and so my body could not be trusted.

Beyond this, however, the biggest anxiety I had in treatment and I now realise, the greatest factor that stopped me ever going ‘all the way’ in treatment was down to the standard practice of setting a target weight for patients (which were set to the low end of the healthy BMI range, no matter what your pre-ED weight had been) and then once the patient reached that weight, adjusting their meal plan down so that they maintained that weight and (heaven forbid) did not gain a single lb above it.

I still have that target weight clear in my mind and it was f**ked up enough to be down to the 0.99 of a kg!!

Now, I said earlier that in treatment I was hungry on my weight gain meal plan.

I was therefore terrified of hitting my target weight and being told that I then had to eat less each day so as not to go above this weight that a professional had decided was the healthiest place for my body to stay at. And reflecting on this, I now know that this was why I always ran from treatment a few kgs short of that target weight because I did not want to be told I had to eat less.

I was already hungry enough but I could not fathom a future in which I was supposedly ‘recovered’ but still hungry and still having to tightly control what I ate each day.

Therefore, I repeatedly left treatment at a lower weight than I ever should have done, so that I could justify to myself the need to eat higher ‘weight gain’ amounts (if the fear generated by the ED let me that is!). This was also why I held onto other behaviours (such as compulsive exercise) in a desperate bid to control my weight as I wanted even more ‘permission’ to eat larger quantities.

Sadly, these experiences really did exacerbate my eating disordered thoughts over the years and reinforce those beliefs that weight gain beyond a certain point was to be feared, that weight was something we have to control through our diet and living with hunger was normal, rather than the reality, which is our body will control our weight and we just have to trust it and feed it.

Later, of course, I learnt much more about the amount of food that is really needed in recovery, true unrestricted eating (which is for life!) and about set weight, overshoot and extreme hunger and all these things that eating disorder treatment services (at least when I was under their care a few years ago) did not incorporate into their treatment.

The fear of the consequences of reaching a target weight and so having to reduce my intake when I did, was a fear that I should never have had to face and I know that others will have had this fear reinforced in themselves too by misguided treatment professionals.

The impact of these experiences and anxiety created as a result undoubtedly made my illness and my subsequent recovery journey longer and more challenging than it ever should have been.

And I write this now, not for pity and not even to bash the professionals who are merely working in a fat phobic and diet obsessed world, but to say to you… if you have had these experiences and you have the same fears as a result… it is ok.

It is ok for you to go against anything a well meaning but misinformed professional has told you and it is ok to eat more than your meal plan (even if that is 3 or 4 times more or more again!) and it is ok to gain a lot more weight than a ‘target weight’ that has been set for you.

And not only is it ok for you to do all these things, it is actually very very necessary, if you really do want to fully recover and get a life back which is unrestricted in every way…. because you can!