Wellness in Recovery from Eating Disorders
Eating disorders represent a complicated cluster of conditions within the realm of addiction that often occur within the context of a prior history of alcoholism and/or drug addiction. In this column I will initially highlight both commonalities and differences pertaining to treating both classes of disorders. I will then discuss the application of basic wellness principles in treating eating disorders and promoting sustained recovery.
Commonalities and Contrasts
Clearly both eating disorders and substance abuse are devastating, life-threatening diseases in which peoples’ lives becomes unmanageable unless successful intervention is brought to bear. Both classes of disorders entail either compulsive use of a drug of choice or compulsive repetition of a highly dysfunctional pattern of behavior. In addition, a growing body of evidence points to a genetic predisposition to both types of disorders (Costin & Grabb, 2011). Personal observation leads me to believe that people suffering from both classes of addiction tend to exhibit extremely compulsive patterns of behavior. Whereas in chemical dependency the obsession centers primarily on maintaining a supply of drugs and pursuing the next high, in the realm of eating disorders we find that many if not most anorexics exhibit heightened compulsive perfectionistic tendencies as integral components of their personalities.
For obvious reasons the abstinence model employed in most approaches to treating chemical dependency does not apply to treating eating disorders. As we must eat in order to live, in treating eating disorders the emphasis is on helping clients attain a proper and balanced perspective regarding the role of food in their lives.
In addition, as Costin and Grabb point out, application of the Twelve Step, abstinence-based treatment model often entails a “black or white,” “all or nothing” mode of thinking (2011). In contrast, eating disorder treatment specialists are inclined to view their role as helping clients become more comfortable in dealing with the gray areas of life.
Another distinction pertains to the ultimate goal of recovery. While the abstinence-based model views recovery as an ongoing, lifelong process, eating disorders specialists tend to view the ultimate goal of treatment as enabling clients to completely eliminate the eating disorder from their lives, at which point clients are deemed to be fully recovered (Costin & Grabb, 2011).
Eating Disorder Interventions
The following is a brief recounting of two eating disorder interventions I instigated over the course of working in the addiction field for a number of years.
Working in an acute psychiatric hospital setting in the early 1990s I led a weekly wellness in recovery group. One of the patients was a very pleasant young woman in treatment for anorexia. Her compulsive perfectionistic nature came forth full force one afternoon as she vociferously complained about an “obnoxious” painting of a barn hanging on the wall. She remarked that her father was an artist who loved to paint pictures of barns, exclaiming that he would never tolerate such a disgraceful work of art! Intrigued by her strident criticism of the painting, I asked if she had ever noticed any perfectionistic tendencies in herself. She readily admitted to this and I responded “Carolyn (not her real name), I’m giving you a homework assignment. The next time you attend occupational therapy, I want you to spend the entire session sketching the most crazy, off-the-wall pictures of barns you can imagine.” She proceeded with the assignment, and later told me that through conducting this exercise she experienced a real breakthrough in directly confronting her perfectionism.
Years later I was lecturing on Gorski’s postacute withdrawal syndrome to a substance abuse counseling class at a local community college. During my talk a student commented that she was extremely frustrated with her weight gain ever since she quit her addiction to speed. Seeing before me an attractive young woman who appeared to have no weight problem whatsoever, I responded “Tara (not her real name), I would like to try an experiment. I will present two questions to the class: ‘How many of you believe Tara is overweight?’ and ‘How many of you believe she looks pretty damn good just the way she is?’” The greater majority of students, especially the guys, responded affirmatively to the second question. I then told Tara, “You know, I am here as a teacher, not a clinician. As such it is not my role to engage in diagnostic assessment. You may, however, consider reflecting on whether you might be experiencing some symptoms of an eating disorder.” She approached me after class and thanked me for my observation. She added that she had a history of anorexia and realized that she evidently had some more work to do in that area.
Wellness Applications in Recovery from Eating Disorders
In my book The Wellness-Recovery Connection (2004) I discuss the application of basic wellness principles in recovery from addiction. These include nutritional restructuring, exercise, stress management, meditation, building a strong support system in recovery, and imbuing one’s life with a robust sense of purpose.
Enlightened treatment professionals in both the substance abuse and eating disorders fields agree to the importance of pursuing balance in our nutritional intake. If I were counseling a recovering alcoholic who aspired to follow a vegetarian diet, I would probably encourage my client to move in that direction, and consider adopting the Mediterranean diet as an intermediate step (“Mediterranean,” 2015). In recognition of the fact that most eating disorder patients have locked themselves into an extremely rigid set of self-imposed rules regarding their food choices, most eating disorders specialists advocate adherence to common sense “conscious eating guidelines” as distinct from attempting to follow any particular dietary regimen (Costing & Grabb, 2011).
Likewise, for a variety of reasons I strongly recommend regular physical exercise as an integral component of recovery from alcoholism and drug addiction. Eating disorder specialists, however, must confront the reality that many of their clients risk sabotaging their recovery through exercise addiction. Compulsive exercise often manifests itself in these patients as either a compensatory measure to counteract bingeing or, in the case of many anorexics, as part and parcel of their overriding obsession with avoiding weight gain at all costs. While we may differ regarding the particulars, we are in full agreement concerning the importance of a balanced approach to exercise in recovery.
A seasoned psychotherapist often reminds me that “under stress we regress.” Hence, acquiring the skills needed to effectively manage day-to-day stresses is an important component in recovery from both substance abuse and eating disorders. Particularly effective modalities for taking the edge off stressors in our lives include both contemplative and active forms of meditation—such as yoga or tai chi—and cultivating the practice of mindfulness (Fields, 2008; Marlatt & Gordon, 2005).
As many counselors believe that addiction is often a manifestation of loneliness combined with a perceived lack of meaning in one’s life, experts in both the substance abuse and eating disorder fields endorse the importance of nurturing a healthy support system in recovery, together with cultivating and embracing a strong sense of purpose in life. In The Wellness-Recovery Connection I devote a chapter to “Cultivating Your Central Purpose, Spirituality, and Life Satisfaction” (2004).
A Final Note for Counselors
Due to the high degree of overlap between addiction to alcohol and other drugs and the presence of an eating disorder, substance abuse counselors need to be on the lookout for possible signs of eating disorders and make appropriate referrals for evaluation. This is particularly true during the continuing case phase of treatment, when “substitute addictions” often emerge.
In summary, while treatment of both substance abuse and eating disorders incorporate a number of parallel principles and approaches, the complexities entailed in the etiology and treatment of eating disorders may mitigate significant departure from generally accepted models of substance abuse treatment. Both treatment models, however, promote a balanced approach to sustained recovery from devastating, life-threatening addictions. They also embrace the basic tenets of wellness and recovery in laying a firm foundation for sustained recovery, with particular emphasis on promoting dramatically improved quality of life in recovery. As always, feel free to share this column with clients and others who may benefit from the message.
Until next time—to your health!
Costin, C., & Grabb, G. S. (2011). Eight keys to recovery from an eating disorder: Effective strategies from therapeutic practice and personal experience. New York, NY: WW Norton & Company.
Fields, R. (2008). Awakening to mindfulness: Ten steps for positive change. Deerfield Beach, FL: Health Communications.
Marlatt, G. A., & Gordon, J. R. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (2nd ed.). New York, NY: Guilford Press.
“Mediterranean diet pyramid.” (2015). Retrieved from http://oldwayspt.org/resources/heritage-pyramids/mediterranean-pyramid/overview
Newport, J. (2004). The wellness-recovery connection: Charting your pathway to optimal health while recovering from alcoholism and drug addiction. Deerfield Beach, FL: Health Communications.