The Habit Rut

Calling an eating disorder a “bad habit” would probably make the ED community wince.

But Dr. Joanna Steinglass, a psychiatrist at the Columbia Center for Eating Disorders, says the habitual nature of EDs actually deserves a lot more attention.

In an , Steinglass says new clinical research shows that eating disorders, specifically anorexia nervosa, have a lot to do with developing habits. In neuroscience-speak, these are behaviors that lead us to “[respond] to a specific cue even when the outcome of that response is no longer rewarding.”

In other words, she writes, habits are behaviors that you do without thinking, that take effort not to do, or that feel uncomfortable if you refrain from doing them. The more habitual these behaviors are, the harder it is to change them.

That’s basically what happens in anorexia and other eating disorders, Steinglass says—namely, engaging in persistent, maladaptive behaviors even when they are not useful. Anorexic patients habitually choose low-fat, low-calorie foods—a habit that forms the crux of the disorder:

“The selection of low-fat foods is a behavior that is a core problem in anorexia nervosa, as it is the inadequate food intake that leaves patients starved. The starved state, in turn, contributes to the medical, behavioral, and psychological symptoms of illness.”
— Dr. Joanna Steinglass

Cognitive neuroscientists are working to identify the brain circuits that underlie these habitual maladaptive food preferences. The goal is to figure out how new behavioral and psychological treatments can help to break eating disorder habits.

Habits Gone Awry

My eating disorder wasn’t a habit at the outset, but it certainly became one.

I developed anorexia at 14 and battled with it for the next eleven-and-a-half years. At first, I wasn’t consistently engulfed by the disorder. I’d fall into ED behaviors and then something would draw me back—a friend threatening to tell my mother, or my own tiring of feeling weak and sick. Because of these mini remissions, I refused to believe I had a “legitimate” problem.

Eating disorders don’t go away. Left untreated, they will get worse. For me, attempting to ignore the issue resulted in a decade of losing weight, then gaining it back, only to lose it again. As time went on, intervals between “anorexic episodes” became shorter and shorter, until there was no breaking out of it. It eventually consumed my thoughts, my daily activities, my goals—my entire life. Nothing good came from it, yet I pursued it anyway.

By some miracle (that is, a very caring and persistent therapist), I gradually accepted that I could not simply will anorexia away. I was in a rut. It was as if a furrow had been carved into my brain by years of practicing the same behaviors. I knew that this furrow was deep, dangerous, and made me miserable, but every time I tried to climb out, I slid back down again. Eventually, its walls became too steep to even see over. In the same way that athletes and musicians develop muscle memory, I had honed my practice of starving and losing weight to the point that it was instinctive.

But I still had a quiet internal voice fighting for survival (and that very vocal, persistent therapist). I decided that if I couldn’t manage to break these habits, I would have to put myself in an environment could break them for me. I needed someone to actually push me out of the habit rut.

Treatment did help. It provided a structure that interrupted the bad habits and helped me cope with the anxiety that ensued. Unfortunately, treatment doesn’t last forever (especially given the insurance situation). To solidify these new healthy habits, I would have to keep practicing.

How? Well, therein lies the million-dollar question, right?

Steinglass says that even patients well into recovery can continue to struggle with ED choices. However, by better understanding how habits function in eating disorders, clinicians might be able to pinpoint which kinds of treatment will most likely help individuals break old habits and make new ones.

So while the scientists work to map these neural labyrinths, what can patients do?

For me, complying with these healthier habits required finding the right motivation.

“Finding motivation” might sound banal, but it can actually be somewhat complex. For me (and also for many of my peers), it was not convincing enough to simply be told (or even believe) that establishing healthier habits was the key to subduing the ED. Health is rarely a sufficient motivator, no matter how sick you are. The eating disorder takes a higher priority.

My strongest motivation was a negative one—the thought of losing my husband. Thinking about the absence of my husband made me more anxious and depressed than thinking about the absence of anorexia. That one possible consequence was enough to help me regain my balance when I started to tumble backward into the rut.

Granted, my motivator, at its core, was fear: I was afraid I would lose my husband. But instilling fear in patients isn’t exactly helpful, and I doubt any (good) therapist would want to propose scare tactics to spur them into action.

However, a negative motivator can be just strong enough to maintain the habits learned in treatment. Some amount fear is healthy (just like it’s appropriate and healthy to fear poisonous snakes)—as long it’s not posed as a threat or an ultimatum. Rather, it should be an invitation to realistically consider what your eating disorder will cost you if you allow it to continue. Is that cost worth the benefit that the eating disorder offers?

No one chooses to develop an eating disorder. Even if you engaged in certain behaviors knowingly and willingly, other powerful factors (such as genetics) fanned those flames into a full-blown eating disorder. But you can choose to do whatever it takes to recover—which, in part, will mean admitting you’ve lost control of your habits.

To that end, education and awareness campaigns are crucial. Without understanding how the illness works, it’s easy to fall into thinking that 1) ED sufferers can just renounce the illness and launch new behaviors, or 2) sufferers are utterly powerless against the ED and cannot change their situation.

Habits are difficult to break. If breaking them on your own feels impossible, it can help to join an environment that supports you through those first steps. And if habits are really as central to eating disorders as Steinglass believes they are (and I, too, believe they are—although I am no psychiatrist), then it’s crucial to incorporate that concept into the treatment process.

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