Reprinted from "CBT" issue of Visions Journal, 2009, 6(1), p. 10
If you had asked me when I was 16 if I thought I'd be sharing my life with an eating disorder, I'd probably have said not likely. I may have added something about not having the strength or the willpower to defy hunger. I had no idea that within a year I'd be popping diuretics like Tic Tacs and weighing my worth in pounds. Like so many other young women—and men too—I wandered unknowingly into the arms of an eating disorder. We've been inseparable ever since.
I used to believe that if I tried hard enough, I could do anything. Not because I was smart or capable or even creative, but because I was thin. It took me four years of trying to be perfect before I was finally exhausted enough to admit myself into a treatment program. And it has taken another almost four years of working with a multidisciplinary team of professionals—a psychologist, a doctor, a nutritionist and a psychiatrist—to unravel all the years of lies I've been selling myself. But before I talk in depth about my experience, I think it's important for you to understand why I couldn't just eat a pizza and get over it.
Me, the marionette
Life with an eating disorder (if you can call it "life") is basically like a puppet show. You are the dancing, smiling marionette, and your disorder is the puppeteer. It calls the shots; it tells you when you're going to eat and how much. It even writes the script, putting its own values where yours used to be. All of a sudden, you don't care about your health, your friends or your dreams. All you care about is being thin, and you don't even really know how it happened or when or why.
So there you go, smiling as your bony body bounces around onstage, and everyone claps at your slenderness and compliments you on how amazing you are. They don't know that you go backstage and cry because you're tired and hungry and afraid.
CBT vs. the 'puppet master'
If you're in treatment for an eating disorder, chances are pretty high that your recovery will include some form of cognitive-behavioural therapy (CBT). The outpatient treatment program I entered in the fall of 2005 was no different.
Essentially, CBT operates on the assumption that your thoughts and behaviours are linked. If you change one, the other follows suit.
Now, my treatment team knew that asking me to just change my eating-disordered thinking would be about as successful as asking someone with a brain tumour to change their cancer cells back into healthy ones. This is because the harmful pattern of thinking is so deeply ingrained and so sensitive to anything that might threaten it that you almost have to trick yourself into changing it. Whenever I went to eat something, the eating disorder always had something to say, dictating what I was allowed to eat: "Are you stupid? You can't eat that!"
From the beginning, my doctor and psychiatrist prescribed medication to help reduce the depression and obsessive thinking patterns that kept me locked into the disorder. At the same time, my therapist (psychologist) helped me challenge my thoughts. Luckily I clicked with her, so I hung in there. But my attitude was: "We can talk about change, but I'm not ready to make changes." After all, my original motivation for going into treatment was to get information that I could use to further manipulate my diet and sustain my eating disorder.
The treatment team's plan was to have me make small, manageable changes in my behaviour. Sounds simple, right? Well, it was neither small nor manageable. They asked me to do things that horrified me, like eating regularly whether I was hungry or not. They explained that because I'd been ignoring my body's hunger signals for so long, the signals weren't working properly any more. To me, however, eating more often sounded like a quick and dirty recipe for weight gain.
No matter what the treatment team said and how much sense it made, I told myself I could never do any of it. Being thin and perfect was more important.
But they pushed on. My nutritionist said that I was falling asleep in class because I was hungry and needed to eat something. I pushed back. My eating disorder said that I was just being lazy and that my nutritionist was trying to make me fat. My doctor told me that I was getting dizzy at the gym because I wasn't eating enough to sustain physical activity. My eating disorder told me that I was just being a wimp and that my doctor didn't know anything about fitness. I firmly convinced myself that if I listened to them, I'd lose all control, gain a million pounds and become a lazy, pathetic and horrible person.
After about a year of this kind of internal arguing and resistance, I was able to admit that I had a problem. I was tired—attending school full-time, holding down three different jobs and working out in the gym seven days a week. The busier I was, the less I had time to eat; but I had no energy and was falling apart. Even worse, despite all of my efforts to avoid it, I'd been gaining weight—I felt that my body had finally betrayed me.
Challenging the mind traps; tripping up the puppeteer
Clearly, my thinking had to change so my behaviour could change.
First I worked with self-monitoring worksheets. When I noticed a sudden shift in my mood, I tried to identify the automatic thoughts by noting what the situation was, how I felt and what I was thinking. For instance: I could be at the store buying food, when suddenly I feel a need to go work out for two hours. I was able to discern that the thinking part had to do with seeing a magazine cover glaring something about cellulite and weight. My therapist and I did a lot of talking about what was on my sheet.
Then my therapist helped me learn to identify what are called mind traps. I was a big "black and white" thinker: "If I'm not size zero, then I'm obese."
I was also very good at "catastrophic" thinking: "If I don't get an 'A+', I might as well have an 'F' because I'll never get into grad school and I'll be stuck working at some minimum wage job forever."
My therapist would guide me to play out the 'logic' of my thinking. For instance, if I told myself that I deserved to die because I'd gained five pounds, she might ask me to take a third-person point of view. "What if your friend gained five pounds? Would you tell her she deserved to die?" And, of course, I wouldn't; I'd never think that way about others.
My therapist sometimes had me play devil's advocate and talk about why I felt that I deserved to die for gaining five pounds. Then she'd point out that, according to my own logic, everyone who gained five pounds deserved to die. "No," I would say, "it's only me that deserves to die." But when she asked me to explain, I couldn't because I knew it didn't make any sense.
At first, this CBT process felt like barrelling through untamed woods: you don't get anywhere. I had to keep going over and over the same path to forge a trail and shift my thinking. It's taken years, but slowly I've been able to reconnect with myself and push the eating disorder aside.
Many strings severed; more to go
Every single day I work hard at recovery. I'm still in treatment—I see the therapist every two or three weeks now, instead of weekly. I'm learning to accept my vivaciousness, my sensitivity and my own humanness. I don't have to be size zero; it's okay if I don't get an A+ in every course I take in school; and I'm not going to die if I have a chocolate bar. My ultimate goal is not to have to rationalize every perceived "failure."
When things get tough, however, the marionette version of myself—that negative, eating-disordered voice—still comes around. Most of the puppet strings have been severed, but not all. Even though I'm not cured, I am definitely getting better.
This article is dedicated to Danielle's little sister, Shannon
About the author
Danielle is a 24-year-old psychology student at Kwantlen Polytechnic University currently living in Maple Ridge. Always a fighter, Danielle has been battling an eating disorder for almost eight years; she has been in treatment for the last four