A symptom of choice

Worried young woman being accused

“I feel so guilty. I purged last night and I have been restricting all this week. I don’t want to tell my parents because I know they will be so disappointed in me.”

“Honey, if you are having moments of weakness, just tell us and we can help you be strong.”

“I just don’t want to let go of the eating disorder. I probably shouldn’t be in counseling at all because I am not ready to change.”

“You know, I had a friend who died of Anorexia. Do you want that to happen to you? Don’t you know what this is doing to your body?”

One of the most unfortunate things about eating disorders is that they are seen as a choice, a lifestyle, a diet, or a stubborn play for control. Eating disorders are real illnesses, and yet they so often evoke guilt and shaming. Would you feel guilty if you had cancer or the measels? Why do people with eating disorders blame themselves for having symptoms? Worse, why do people who don’t have eating disorders blame the affected individual for ‘choosing’ to be sick? Guilt implies choice, and the symptoms you experience while sick with an eating disorder are not a choice. The whole phenomenon of wanting to have the illness? Also not a choice–it’s a symptom of the illness itself.

You don’t have to be ‘ready to change’ to recover. Not being ready to change is a symptom of the illness itself, therefore waiting to be ready to recover requires that recovery has already started. So often, counselors set a prerequisite that their clients have to be ‘ready to change’ in order to benefit from treatment. This is wrong. When you are sick with an eating disorder, you will most likely “want” the eating disorder in a large part. Instead of using that as a criteria for determining potential responsiveness to therapy, we should look at it as a sign that the person needs treatment. My clients tell me they are ‘not ready to let go of the eating disorder’, as if I am going to be disappointed and wag my finger at them. I tell them the desire to let go of the eating disorder comes when the eating disorder lets go of you. This doesn’t make them resistant to therapy and it doesn’t mean they are not doing the work they need to do. It means they are sick. They are with me because they are sick, and as they get better the desire to be healthy will grow.

If you have an eating disorder, remember your symptoms are not choices. You are not a bad, irresponsible, stubborn, resistant person because you have symptoms. If you know someone with an eating disorder, don’t approach them with a lecture, don’t pretend to know better than they do what the experience is like. Don’t give them oversimplified advice like “you just need to come over and eat with us” or “you are so beautiful, you just need to gain some weight.” These illnesses are not forms of dieting, they are not a manifestation of lack of logic or common sense. Guilt and shaming make eating disorders worse. Almost everyone I come into contact with knows very little about eating disorders, and yet people hardly ever shy away from condescendingly presenting themselves as experts on the topic.

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