Is My Eating Disorder a Choice?
There’s a question that sufferers don’t want to think about and supporters don’t want to ask:
Am I to blame for my eating disorder?
Responsibility is a thorny issue when it comes to eating disorders, as it tends to be with mental illnesses in general. There is no talk of blame when it comes to physical illness like cancer, or lupus, or pneumonia. But for psychogenic illnesses, things aren’t so cut and dry. The origins of these diseases are hidden deep within the brain’s circuitry, where no diagnostic test can obtain concrete answers. In the absence of an adequate explanation for these illnesses, it’s tempting to cast suspicion onto the patient herself.
This is true for supporters and patients alike. I have often felt like a prisoner to this intangible illness, brainwashed by a voice in my head that sounds frighteningly similar to my own. And yet, despite feeling out of control, I know deep down that no one forced an eating disorder upon me. My disordered behaviors were just that — mine.
Without any solid evidence otherwise, I inevitably asked myself: Is this eating disorder my choice? The guilt and confusion from this conflict can be paralyzing.
I Didn’t Bring This On Myself…
In her article “Bulimia Comes Out of the Closet,” published Thursday in The Cut, Rachel Hills says that there is a deep sense of shame that comes with bulimia. Hills, who recovered from the disorder, is haunted by the possibility that she brought her illness upon herself. She writes that she has felt anger both toward for the thin-obsessed culture that seduced her, and toward herself for portraying herself as a victim of that culture, when she was partly responsible for her own suffering.
I too am haunted by the possibility that I am to blame for the years of agony I have caused my loved ones and myself. I want so badly to point the finger at a dysfunctional family, or an unstable environment, or a virus that hijacked my mental faculties. But I can’t do that.
Even worse, I can’t always bring myself to feel sufficient shame about my eating disorder, which would at least seem to salvage my integrity. Because, in the depths of my eating disorder, I felt proud of the “discipline” it took to lose weight, and it made me feel accomplished.
At times, I liked being anorexic.
…So I really am to blame, aren’t I?
Wrong. Treatment taught me that the world is not as black-and-white as I tend to view it. Eating a healthy meal won’t double my weight; feeling an emotional attachment to my eating disorder does not make me a horrible person; slipping and using a symptom does not mean I am a hopeless case.
Eating disorders are messy illnesses. No one person or event is to blame for causing an eating disorder, because that “cause” is a sundry mix of neurobiology and genetics, family of origin, social and societal environment, and sometimes trauma. And if you lack the psychological tools to deal with life stressors, then you will seek relief in any way possible. For some, that relief comes with the starvation high of anorexia, or the dopamine rush of binge eating, or any number of eating disorder behaviors.
Unless you are a natural-born psychologist who can troubleshoot those stressors before they warp your thoughts and actions, chances are you did not see your eating disorder looming on the horizon. You didn’t realize you were in danger until it was upon you.
…But It’s On Me to Find Freedom
But that doesn’t absolve us from ALL responsibility. There is a delicate balance to strike. Assuming too much responsibility will lead to self-blame, guilt, and utter helplessness when you realize you can’t simply pull the plug on an ED. But accepting too little responsibility tricks you into believing you have no control over your thoughts and behaviors, which also ends in helplessness.
So how do you strike that balance?
First, you have to forgive yourself for developing an eating disorder, because it was not your fault. Then, you have to take responsibility for how you want your life to be going forward.
The hard truth is that you cannot make anyone recover from an eating disorder. Yes, it is an illness just like cancer, or lupus, or pneumonia. But unlike those illnesses, you can’t eradicate an eating disorder by surgically removing the source or saturating the body with drugs. Clinicians can help patients reduce symptoms, but mere symptom-reduction will not necessarily amount to recovery. That responsibility belongs to the eating disorder patient alone.
Recovery only happens once you decide to let it happen. Eating disorders are an outward sign of an inward unrest. That means you will have to deal with the unrest that has driven you into an eating disorder. “Deciding” to recover means that you will give yourself over to the treatment process. You will work to develop healthier coping skills; you will trust your team’s recommendations; you will trust the food you eat to nourish you; you will trust your own body to do its job. You will take every step that takes you a little further from your eating disorder, no matter how overwhelming, or frightening, or silly it seems.
And then, every time you eat a meal, or banish a negative thought, or talk to a friend instead of isolating yourself — all of these moments weave together until a net has formed to keep you from descending back into disorder. And in doing so, you let recovery happen to you.
Of course, all of this is easier said than done, as the saying goes. Moreover, there’s a certain level of physical/mental health that one must attain in order to even start making recovery-oriented choices, since, as we know, malnutrition and other medical consequences of eating disorders can severely impair cognitive function.
At some point, though, you are the one who has to take the baton and keep running with it. Standing in that middle ground between recovering and recovered, I am still working to patch the holes in my net. Some days I struggle to trust that it’s there at all. But I have heard over and over again from therapists, mentors, and peers that recovery is a process — and a conscious one, at that.
So, at the most basic level, that is what I am trying to do — to question my choices and make new ones as needed.
I didn’t choose to have an eating disorder. But I am choosing to recover from it.
UPDATE: Is Anorexia a Choice?
Hello again – I just wanted to add one point after getting feedback yesterday about this post.
I truly believe that every eating disorder is about more than what you do or don’t eat. I use the term “inward unrest” intentionally, in the hopes of keeping that idea as vague and open as possible. That “unrest” can be something like family conflict, or trauma, for which the eating disorder serves as a coping mechanism. But that unrest could have nothing to do with your past experiences — it could be purely about body dissatisfaction. I think that if your eating habits have gone beyond potentially dangerous dieting or disordered behaviors to a full-blown eating disorder, then it’s fair to conclude that there is some “unrest” contributing.
This does not take away from the fact that eating disorders, like all mental illnesses, are a complex interplay between one’s unique neurobiology and his or her environment. Lots of people face life stressors and lack coping mechanism to deal with them properly, but they do not develop eating disorders. Tens of millions of people in our country are unhappy with their bodies and go to extreme measures to alter them, but they do not develop eating disorders. The people who DO develop them have something else at play — namely, their biology.
Of course, you do not need to put off treatment until you identify this “unrest.” Understanding the underpinnings of an eating disorder is helpful, but it is in no way requisite to begin treatment. If I had waited until I understood why my eating disorder began, or even waited until I was fully ready to tackle it, I would still be sick.
Eating disorders are dangerous. Treatment can never wait. But as I have moved further into recovery, I have found that coming to a better understanding of WHY I slipped into an eating disorder has helped me to now be vigilant about when those same factors start bugging me again. When I sense some of that unrest being disturbed, it’s time for me to reach out for help (whether that’s to a professional or just to a close friend).
I may never fully understand what happened to me and why it happened. But if you don’t learn from your past, you’re bound to repeat it. And, as I said above, learning from the past does not mean placing blame. It means accepting responsibility where it’s warranted, and relinquishing it where it’s not.
Again, thank you for reading, and thank you for your feedback.
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