Ambivalence in Eating Disorder Recovery

Dr. Joy Zelikovsky

A common phrase that people hear in eating disorder treatment is “recovery isn’t linear.” Often it feels like people take one step forward just to take three steps back, or that they feel like they are progressing in one area, but they are having ambivalence or intrusive thoughts that are conflicting with their desire to recover and therefore they are not in “real recovery,” whatever that means anyway. When this happens people are left questioning if the work they have done towards their recovery is valid, or if they are even in recovery at all?

I was working with a client today and they told me that they had received news that something they had been attempting to resolve medically had not resolved. They had discussed it with their medical team and the medical team felt that a medication needed to be adjusted. They discussed it with their dietitian and the dietitian felt like the answer was more nutrition rehabilitation and the issue would resolve. The client shared that they were frustrated as a part of them hoped that it was a medication issue, and they wouldn’t need to eat any more than they were already doing. And then they shared that they were disappointed in having that thought as it meant they were not really working on recovery as if they were they wouldn’t be disappointed that they would have to potentially eat more.

I’ve heard some variation of this scenario a million times from clients. They are working very hard in recovery, but they don’t want to eat more, or they don’t want to do something that is challenging for them and they or sometimes their family/friends/team, question their commitment to recovery. But the reality is that these thoughts are normal! It’s so incredibly normal to experience ambivalence when working on recovery. It’s normal to have setbacks or the feel like you’ve stepped off the path, or at times to feel that you need to take a break from the path and pause where you are for a moment. None of the negates the work you have done or means that you are no longer in recovery.

There are many reasons why eating disorder recovery work is difficult, here are a few that may provide insight into why folks may have a desire to hold onto the eating disorder; even while they are working hard to recover:

1. Comfort in Familiarity: The eating disorder may be the primary coping mechanism for many and the idea of giving it up may be terrifying. For some, the idea of life without an eating disorder is so foreign that it’s inconceivable and feels totally undoable. Some people will still venture forth, others may choose a harm reduction path that better meets their needs.
2. Fear of Change: Eating disorders are highly linked to anxiety. For many, even the prospect of a positive change can still create so much anxiety that it feels paralyzing. This is where having a supportive team and trying to find other positive supports like family, and friends can help make this transition more bearable.
3. Sense of Identity: Often people can create an identity around their eating disorder. It has taken over their lives to the point that they do not know who they are without it. Therefore, the idea of giving it up also leaves them without an identity which can feel equally as scary. Who am I without this thing that has helped me through so much, even if it is also harming me?
4. For some the risk of failure is so prevalent that they feel like they don’t want to try at all – the devil you know is better than the devil you don’t. Therefore, it’s better to stay in the eating disorder even though it’s harming them, rather than risk recovery and relapsing or recovery being worse than their life with their eating disorder.

Why Accepting Ambivalence Is Important

Having conflicting feelings during recovery is not a sign of failure or lack of commitment. It is normal and part of the process. It is important to try to understand where those thoughts are coming from and attempting to find ways to manage to move forward.

Remember, recovery is not a linear path, and it’s okay to take things one step at a time. Every step towards healing, no matter how small, is a significant achievement. Stay patient, be kind to yourself, and trust that you can overcome the obstacles on the road to recovery. You are not alone in this journey, and there is hope for a healthier and happier future ahead.