Learning to Live Without Being "Rescued" by Ed

Learning to Live Without Being "Rescued" by Ed

Written by Vanessa Osmer, LCPC, NCC

When you have an eating disorder, learning how to interact and make room for those pesky and uncomfortable internal experiences, such as thoughts and feelings, can be difficult. The eating disorder usually jumps into the "rescue," leaving the person feeling a massive sense of relief, control, and maybe even comfort. The truth is that when someone is chronically "rescued" from their own internal experiences, they lose their sense of self-efficacy, and their tolerance for those uncomfortable thoughts, sensations, and feelings reduces dramatically. Self-efficacy is a person's belief in their own capabilities to navigate situations and perform specific tasks. As you can imagine, if you already have it in your head that you won't be successful or that you can't handle the situation or internal experience, it could be easy to give in to the directives of the eating disorder, earning a huge sigh of relief.  

The bad news is that the relief of being "rescued" is fleeting. While there is undoubtedly a short-term benefit to feeling the relief wash over you, the cost is most concerning, as the price has a long-term effect of reducing a person's window of tolerance to everyday stressors. A person who is "rescued" by an eating disorder, which I like to refer to as their frenemy, starts to notice the symptoms of the eating disorder getting worse with more minor stressors or internal experiences. Their world gets smaller. Usually, a person doesn't realize the severity of their symptoms until the disorder overtakes them. This can be particularly difficult because, as you remember, the eating disorder damages self-efficacy, so recovery can feel too uncomfortable even to consider. 

There are several treatment approaches that are focused on re-building self-efficacy, increasing psychological flexibility, and violating the beliefs that hold people captive to eating disorders. I firmly believe it is easier to engage in therapeutic services when you know what you may be working on. Below, I am sharing 3 of my favorite therapy tools that I often utilize with my clients who are learning to live without being "rescued."

The Personification of the Eating Disorder: The personification of the eating disorder is an excellent way to help a client disentangle themselves from the disorder. Often, it can feel like you ARE the eating disorder. When we personify the eating disorder, it creates distance and allows clients to start to challenge and question the information that the eating disorder is presenting as truth. I often encourage my clients to give the eating disorder, their frenemy, a name. Some stick with Ed and others develop a whole new name. The trick is to ensure that the client knows that they are not the eating disorder and they still have a voice and can take action against the disorder that they have distanced themselves from.  

Defusion and Function Management: Defusion from an eating disorder involves learning to allow thoughts, sensations, urges, and feelings to be present without needing to take action or give them a lot of attention. I help my clients identify which internal experiences are important to defuse from and which are legitimately helpful and deserve more of their time and energy. My clients learn to ask themselves, "Is this thought helpful for me to spend my time and energy on right now, or can I let it be and move forward?" There are many defusion techniques that we use in treatment, but the one I start clients with is putting the phrase "I am aware of (the feeling of), (the sensation of), (the urge of), (the thought of)" and then communicating those feelings, sensations, urges, and thoughts. Generally speaking, acceptance and tolerance of discomfort follow when someone identifies and communicates their internal experiences accurately and makes room for them without willing them to stay longer with more energy and attention than they deserve. 

Once clients become skilled at implementing their favorite defusion techniques, they are more equipped to identify the function of eating disorder behaviors that present as urges. Learning the function can help clients identify other methods for meeting those needs without engaging in harmful behaviors. Every behavior has a function, and when clients discover their triggers, they can manage the function in more productive ways that align with recovery. 

Exposure and Behavioral Experiments: What we know is that the eating disorder tends to put an obsessive focus on food and, sometimes, the body. For instance, in Anorexia Nervosa (AN), we notice that most clients have rigid rules about food consumption and their bodies. The eating disorder cultivates deeply feared consequences that are maintained by compensatory behaviors (restriction, self-induced vomiting, over-exercising, misuse of laxatives, etc.) the client engages in. The feared consequences never get challenged, and data that violates those belief sets are never internalized because the person is usually really good at compliance with the directives of the eating disorder. In my opinion, exposure is one of the most important therapeutic tools. 

Exposure starts by collecting data from the client on triggering internal and external situations, specific feared consequences, and compensatory behaviors used to obtain temporary relief. Once the information is collected, the client collaboratively develops an exposure action plan. Together with their therapist, they can determine what triggers they are willing to face AND what compensatory behaviors they are willing to withhold. A willingness to test their feared consequences allows them to gather evidence of their self-efficacy. Usually, it also provides them evidence that the eating disorder has not been honest about their ability to cope effectively and/or that the outcomes are different than what was initially hypothesized by the eating disorder. More often than not, exposures become easier with time and practice, allowing clients to tackle the most difficult items on their action plan list. 

Eating disorder treatment is hard work, but it is good work! Most people are apprehensive and scared when they start, and with the eating disorder buzzing in their ears, they have likely gone back and forth over treatment. Luckily, the real self outside of the eating disorder is still capable and present, and seeking out a qualified therapist and registered dietitian who has expertise in the area of eating disorder treatment is possible. I like to remind my clients that the determination and will that got them into the disorder is the same determination and will that will get them out of it, just refocused.  

If you are interested in counseling for Eating Disorders or in general, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.