Is Anorexia a Choice?

Posted by on Jun 30, 2014

Is Anorexia a Choice?

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.

an eater's agreementEating 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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  1. I am completely on board with you needing to take responsibility for recovery–though I also believe that it may be impossible to do so unless you are fully-nourished. Your writing is lovely. Where I seen an issue is here, “That means you will have to deal with the unrest that has driven you into an eating disorder.” What I think you may mean is you need to learn to deal with the stressors of life in ways that acknowledge restricting food intake or forgetting to stay on top of your meal plan is never an option for you. We don’t suggest that those with schizophrenia or bipolar came to them via unrest driving them to their mental illness and I think the same is true of eating disorders. Some people have issues on top of their eating disorders, some (my daughter is one) just had an eating disorder; the distinction is an important one in terms of society understanding there is no self-inflicted “underlying cause” to an eating disorder and our most important conversations should revolve around treatment.

    I wish you the best of luck in your recovery!

    • Hello,

      Thank you very much for taking the time to comment. I really appreciate the feedback, as I’m still learning about EDs and recovery. I responded to your points (which are very good ones) in an update above.

      Thank you again!

  2. Love your clarification and desire to learn. My daughter — almost 20– has been very good about talking to me about what’s in her brain through this journey. Her opinion, based on her experience, is that while the original disorder is not a choice and, for her had zero “underlying cause”, relapse after good treatment is. This is very much in line with your thinking about “unrest.” You have to protect your sleep patterns, your nutritional intake, etc. to ensure you stay physically and emotionally healthy just as you would in recovery from cancer or some other disease.

    So pleased to have met you!

  3. Thank you for the reply 🙂 So glad to hear your daughter is doing better. Even more glad to hear that she has a mom who is with her 100% on her journey.

    Yes, it seems like the important thing is to make sure you stay vigilant about self-care, as you point out. EDs can be sneaky — on more than one occasion, I let my guard down just a little bit and the ED thoughts came flooding back. Now I am learning to identify what triggers me so that, if those things come up, I can do something about it.

    Thank you again for the feedback. All the best to you and your daughter.

  4. Thanks very interesting blog!

  5. Awesome post.

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  7. Great post.

  8. It’s hard to find experienced people on this topic, but you sound like
    you know what you’re talking about! Thanks

  9. I am so glad I found your blog. Keep writing. In the middle is exactly the way I feel. I understand every word you write. And I was so relieved to find another real person who put it in words for me.

  10. Thanks Joanna for sharing your thoughts and experiences in such an eloquent way. The one clarification I would add is that while EDs are certainly not a choice, one doesn’t have to necessarily ‘choose’ to recover. We know that the severe weight loss and debilitating physica symptoms of all EDs begin to abate when weight is restored and when purging and other ED behaviors are interrupted. I would posit that many of us developed he beginnings of eating disorders during a time of pre adolescence or adolescence when the brain is already going through a period of rewiring. Just as in adulthood we might look back at those childhood days and laugh at some of the silly things we did – so too would be query why our brains suddenly catapulted us into ED. I saw this most clearly when my then 11 yo began fat obsessing, body checking and restricting and within 3 months was in need of a major intervention. She also had a weight loss due to food poisoning and I point to that event, as well as her desire to begin eating more ‘healthy’ that in just a few months brought hard core anorexia to home plate. Fast forward 18 months of hard work using a family based treatment approach, doubling of her weight and generally on the right path. As ED quieted the OCD voice (again another unexpected brain disorder) has joined us at the table! But through hard work her health is restored and we didn’t allow a very long descent into anorexia . Juxtapose this with my own experience which was a year of anorexia, no treatment and almost 20 years to be what I would consider fully recovered. Or my fourth daughter who began displaying signs of OCD/ED/personality change at around 14, anorexia at 16 and a long 5 years of more traditional therapy as we weren’t aware of weight restoration and FBT even those 7 short years ago . The point is that if we catch kids when they first display symptoms and when they have no clue what is happening – if we take control for them and do the work to refeed them and ensure weight restoration and maintenance, we can help move them out of ED almost before they realize they are in it. Of course at a point my children have accepted that their brains are different and that’s why mom makes them eat and they must also eat on their own as time goes on. They have to be attentive to things other people don’t need to. And that’s ok. But I don’t think they needed to choose to recover to initiate and stick to therapy. Just like taking them to soccer or the library or school, ensuring treatment is my job with the support of the most evidence based treatment support team I can find. Slowly we hand responsibility back to them – but it takes time and patience! Thanks again and I look forward to reading more!

  11. Thank you for being brave and speaking what your truth has been without throwing a blanket statement out there regarding all the eating disorders of all the people. I related so much to what you wrote, especially about “sufficient shame.” I’m looks forward to reading more from you.

  12. I believe people did not want to suffer from anorexia. But many people made the choice of conforming to the society’s concept of beauty and health. They were lured into thinking that being thin is beautiful. Anorexia can be life threatening especially the person will starve to death. We need food and we need to recover from anorexia.

  13. The Middle Ground

  14. Hi there, your post has been a potent, vital reminder to me at a time when i really need it. Thank you, for sharing your experience and your very sound advice. I have been in therapy inconsistently for the past 2 years and i feel i am at a plateau. Your points have reminded me of things i had forgotten i knew, like where to accept responsibility… I too am at a middle ground, which sometimes can feel like its slipping into a quicksand descent, slowly, while I’m conscious of it, but i can’t do anything to stop it happening. I want to share my story to help others know they are not alone, and hopefully help my recovery too. Keep doing what you’re doing, and i wish you every luck in your journey. Much love xxx

  15. There’s definately a great deal to learn about this subject.
    I like all of the points you made.

  16. Great post.

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  19. Hello Joanna,

    I am writing ask you if it would be okay to feature this blog post in my up coming blog post about whether or not we choose to recover from mental health issues, in particular, eating disorders.

    This is such a fantastic piece and believe in very similar to yourself on my points you have made so it would be great to have you as part of the message I am trying to address.

    Best Wishes