Setting Healthy Boundaries in Eating Disorder Recovery

I recently read an article in which Alanis Morissette addresses her struggle with an eating disorder.  I appreciated her comments for a couple of reasons.  One, she is willing to tell her story, which can often help others accept and understand their own struggles and move toward healing and recovery.  And two, she brought up a question I have thought about and been asked about quite often.   I’ll quote her below:

The big question for me around eating-disorder recovery is, What is sobriety with food?
We know with alcohol, you just don’t drink it and don’t go to a bar. With heroin, you just don’t go near it.
Whereas with food, you have to eat, so how can one go from, in my case, bingeing and purging, starving, overeating, the scale going up and down—how can I go from that to a “sober” approach?
— Alanis Morissette

Great question, right?  In essence, after struggling with disordered eating, how can you find a peaceful relationship with food and your body?  I would like to make it very clear that I believe wholeheartedly in full recovery from disordered eating patterns.  We know the causes of eating disorders or disordered eating are many and they include both genetic pre-disposition and environmental triggers.  We can’t do much to change our genes, but we can do a lot to set boundaries in our environment.  In my experience, committing to a full recovery means committing to certain boundaries around food and body image, which may be different than some may assume.  

1.  Avoid any and all forms of dieting, strict meal plans or even “clean eating” programs.  You should be aware of the subtle way these types of programs or plans can lure you back into problematic behaviors.  While they may look innocent and promise great “results”, they will NEVER replace the connection you have with your internal wisdom.  EVER.  Find refuge inside of yourself and don’t be tempted to leave the safety of your own wholeness.  Use your mindfulness practices to bring yourself back to that place deep inside your heart and mind where wisdom lives.    

I have found for myself that anxiety about and rigidity with food causes way more problems than any food in and of itself could cause.  When I keep my heart and mind open, my body uses food in a completely different way.  Mindful eating has been a literal lifesaver.  I was reminded of this actually just recently.  I had let some negative thoughts creep back into my mind (see #3) and was having a hard time shaking them.  My husband had planned a weekend away with family members and I found myself anxious about going.  When in the deepest clutches of my disordered eating, eating out and traveling were impossible.  I knew I didn’t want anxiety to win and felt the best way to work through it was to go and prove it wrong.  I threw myself into planning and getting my kids excited to go.  The last night we were there, brownies and ice cream were served for dessert.  I found myself really wanting some, which I know, for me, is a craving that needs to be met in order to stay on the other side of an eating disorder (honoring and trusting your body are essential to healing).  I took some and ate it mindfully, immersing myself in the experience and not allowing any negative thoughts to come into my mind.  I was about half way through when it was obvious that I felt satisfied and had had enough (which is exactly what happens with mindful eating and why I know we can trust our bodies if we are willing to get quiet and listen).  After dessert, we started packing up the house and the car and about an hour later I realized that I had not had one thought about the brownie and ice cream since I had eaten it.  I was flooded with emotion as I closed the trunk of the car.  At that moment I realized that when I think of Intuitive Eating and Mindful Eating, it makes sense in my brain and I feel it’s right in my heart – a sure sign that I am on the right track.  

I feel that a healthy relationship with food is one that brings you to the table when you are hungry, allows you to truly feel satisfied and well-fed physically and psychologically, and then to push away from the table and move on with life, without feeling guilty or preoccupied with what you just ate or what you “should” or “shouldn’t” eat in the future.  I hope you can see from this example that even far into recovery, it is essential to continue to be vigilant about keeping healthy boundaries and being true to yourself and your story.  

2.  As mentioned in #1, continue to use a mindfulness practice to discern between rationale fear and irrational fear (and even continue meeting with your therapist and dietitian).  Cognitive Behavioral Therapy (CBT) and/or Dialectical Behavior Therapy (DBT) are two forms of therapy used in treatment for all sorts of mental health disorders.  Using a personal story here is likely the best way to illustrate why I feel continuing to practice these skills will be effective for you.   

As someone who has struggled with anxiety, obsessive-compulsive behaviors and Orthorexia, I can remember back to one morning during my recovery when this finally clicked.  I was eating Muesli and was very much enjoying it.  It was as if as soon as my mind realized just how much I was enjoying my breakfast, it felt the need to protect me from possibly getting hurt.  My mind immediately went to the bag of Muesli and I had intense anxiety about the fact that I may have not shaken the bag before pouring it and therefore not gotten the exact most perfect mixture of cereal I should have.  I recognized that my mind was trying to keep me safe, but that these thoughts were only thoughts – just mental activity – and not necessarily reality.  That realization led to an intense feeling of peace that washed over me from the top of my head to the tip of my toes.  I wish I could find words to adequately describe what relief I felt as I finished my breakfast.  

3.  Do not say mean things to yourself about yourself.  It’s definitely the hardest of the bunch.  Regardless of whether you do or don’t have food or body image issues, all of us would benefit from fostering a healthy self-respect, which is only possible when we are patient, compassionate and honest with ourselves.  Positive self-talk doesn’t mean becoming selfish or self-absorbed (which are actually insecurity at their roots).  It means being kind and supportive of yourself.  

A common misconception is that eating disorders are caused by body image issues, which is not the case.  Many people can have poor body image and not have an eating disorder and many individuals have eating disorders caused by other factors.  However, as I illustrated in the story above, my personal and professional experience has been that negative thoughts (especially about your body) seems to be a common TRIGGER for wanting to engage in disordered eating behaviors.  The tendency is already there and then negative self-talk may encourage it.  In nutrition therapy sessions, we can almost always trace these urges back to unhealthy comparisons, negative thoughts about their body and/or society’s unrealistic beauty standards - so this is a very essential practice in the recovery process.  Remember – do not say mean things to yourself about yourself.  

4.  Avoid all forms of “fitspiration” and other media messages that encourage manipulating your body.  While these can sometimes appear well intentioned for promoting healthy behaviors, they are anything but – especially for someone predisposed to poor body image or disordered eating.  As I mentioned in #1, connecting with YOUR body and what it needs will always be most effective.  These media messages can pull us away from that.  

While my body was (and essentially still is) recovering from malnourishment, taking a break from physical activity was essential.  I actually had developed a severe exercise addiction, which made abstinence for a time even more necessary (just to give you an idea, I had a pelvic stress fracture that took a year to heal).  For someone who is exercising that intensely and not fueling their body adequately, exercise makes them more anxious rather than less anxious.  However, since I was addicted, I was anxious if I did and I was anxious if I didn’t.  It was a really horrible way to live.  

Anyway, as my mind and body got stronger, I felt able to ease back into some sort of gentle body movement.  However, I made the mistake of still relying on exercise to make me faster, leaner and stronger as many of these “fitspiration” messages encourage.  I recognized just how easy it would be to fall back into old bad habits and realized quickly that I needed to work on my relationship with exercise, just as I was working on my relationship with food, my body and myself.  A turning point for me personally was the realization that being active meant I could be active with my kids.  Rather than kill myself at the gym in the morning and then have no energy for the rest of the day, fitness could allow me to play tennis or basketball with my oldest, practice soccer with my youngest, train for 5K races with my husband, take hikes as a family, be active on vacations, or use yoga as a way to breathe and relax.   Exercise and fitness could enhance my life rather than leave me too tired and exhausted to live it.  

While your experience may not be as extreme as mine, be wary of using exercise to manipulate and change your body.  The benefits of exercise have more to do with how it makes you feel than what it does to your weight.  Research shows us the sweet spot for exercise is 20-40 minutes a day with varying types and intensities being best.  No need to go hard for good health.  If you choose to, take it from me - be sure to fuel your body accordingly and take rests when it asks for one!

It seems that in terms of health and fitness, a common belief is that strength and self-improvement comes from eating a certain way, sticking to a diet or pushing through the pain in exercise.  I don’t believe it.  I feel that true strength and self-improvement comes from being true to yourself and respecting yourself enough to avoid the demoralizing world of weight, body shape and diet obsession.  

For me, I have found that the best way to treat anxiety is by staying “anxiously engaged” in my life.  My intention for each day is to stay open, present and connected.  When I focus my heart and mind on my family, meaningful work and those I come in contact with throughout the day, my thinking feels much more integrated, functional and healthy.  I hope you will find the same as you set safe and healthy boundaries. 

Emily Fonnesbeck RD, CD