The topic of eating disorders has been in the media a fair bit recently, and a recurring theme is that of ‘choice’. So for what it’s worth, here are my (unfinished) thoughts on the subject. I wonder what it will take for society to realise that eating disorders are no more an active choice than any other mental health problem. I also sometimes whether we need to think differently about the role of choice within recovery.

The issue of cause and mental distress is complex, and I definitely can’t claim to know even half of what there is to know about it. However I do believe my own issues were, at least initially, linked to experiences of not feeling safe. It’s also fair to describe my temperament as being somewhat ‘anxious’. I can be a bit of a perfectionist. I don’t know how much these ‘vulnerability factors’ are linked to early experiences, or how much is just ‘me’. Obviously we don’t choose our biology, early life experiences or environment, and placed within this context, I didn’t choose to develop anorexia. I didn’t even know what eating disorders were when I began to restrict my food choices. My aim was to be ‘disciplined’, to ‘take control’, improve myself. Given that I never needed to lose weight, it wasn’t a ‘diet gone wrong’. On reflection, I did feel unable to say what I needed, and I did find that focusing on weight helped me to feel more in control. I would say anorexia gradually took over. At the same time, culture, diet and food trends do tap into the ‘anorexic’ love for rules, self discipline and pushing things to the limit.

The issue of choice is a thorny one for me. I often feel tremendously ashamed of (still) having an eating disorder.As much as I’d like to think it isn’t my fault, no one can force me to change my eating apart from me. I am the one stuck in this and I have to change it. I know it impacts on others and I know it can appear selfish.  I also feel guilty for making the ‘recovery focused’ choices I am now making, and allowing myself to gain weight. Going against ‘anorexic’ thoughts by choosing higher calorie foods and eating extremely regularly, still feels all wrong. The result of this is that it doesn’t always feel like ‘choice’ when I slip up and find myself working through lunch, skipping things, choosing something ‘safe’, or being more active than is helpful. Sometimes it just feels reasonable. Other times, I’m probably aware that it is ‘punishing’ yet I do it anyway, because I’m angry and frustrated. My awareness seems to vary. But on some level, I am making choices. And recently, the accumulated effect of this has brought me the closest I’ve probably ever been to my personal definition of ‘recovery’. The fact that it all feels so difficult tells me I still have some way to go, even setting aside my tangible ‘weight’ goal. I always believed I ‘chose’ to not eat, to remain underweight, but so far, eating more has been such a battle and so anxiety provoking that I recognise that other forces are at work apart from pure capacity to choose. I do now have increased awareness, and with that comes responsibility. I have to capitalise on it. Now, at this moment, perhaps I do have more opportunity to make ‘recovery focused’ choices. What I do not choose, is the distress and guilt I still feel when I eat.

It seems that when we reduce change down to a simple choice of ‘going against the anorexic thoughts’ or ‘choosing recovery’, it carries an implicit judgement that those who aren’t able to do this are just not trying hard enough, or are deliberately choosing to ‘hold onto’ their eating disorder. When people trot out cliches – ‘I recovered and you can too,’ it sits uncomfortably. Because actually, we don’t all start from the same place in life, we don’t all have access to the same opportunities, and we haven’t all had the chance to build the groundwork for change. But I suppose I would say that, because I’ve never been a healthy weight as an adult. Maybe it’s just looking for excuses.

Consider the variables that make change possible. Even leaving aside apparently straightforward issues such as access to treatment. Social factors can be complex: is a person’s home environment supportive of recovery – and is it experienced as supportive? What about opportunities to build a life beyond an eating disorder – education, work, satisfying relationships and financial stability? What about the person’s sense of confidence that they are able to make and sustain change, that they are ‘allowed’ to change and deserve something better. What about their ability to tolerate the emotional distress and uncertainty that come with the process of weight restoration or resisting certain behaviours?  And what about the impact of the physical effects of starvation, which to varying degrees can make it difficult to think flexibly, and become self perpetuating? And eating disorder ‘symptoms’ generally serve a function – they have, at one time or another, enabled us to survive some degree of psychological pain. So change is difficult.

The trouble is, in order to untangle yourself from an eating disorder, you do have to begin to make significantly different choices. And those choices have to be repeated relentlessly, when you feel like it and when you don’t. And the learning grows over time. And people do manage to do this. Sometimes that choice is not entirely your own, you might get so exhausted and tired of being trapped by your own mind that desperation forces you to act, to consider the possibility of asking for support, to keep going to appointments even when the things you talk about feel acutely exposing. Sometimes other seemingly unrelated things shift, and that opens up the possibility of making different choices. Other times, things shift negatively, change becomes more difficult, and that isn’t always entirely within our control. And other changes are so subtle as to be almost invisible – acknowledging that maybe I am a bit trapped, maybe there is a better way – and then feeling guilty for allowing yourself ‘off the hook’ so much that you even considered such a thought.

I’d say my ability to change was significantly reduced when working in my old job (long hours, emotionally draining and almost no energy to think about myself. I also really needed the reassurance my eating disorder gave me). I haven’t always had supportive relationships. I haven’t always felt able to ask for help. I think without outside help I would definitely still be confused about which attitudes and behaviour were the eating disorder and which weren’t. I still am sometimes. But right now I’m in a situation where I can do things to increase my likelihood of consistently making the choices I want to make. I can ask people to help me. I am also in a place where I want to make those choices. 

The reality is that circumstances do change, individuals change, family systems change, barriers can be removed, new opportunities present themselves – and that is why the possibility of recovery is always there. Because change, in some form always happens. And often there are things we can do to improve our chances, and things other people can do to make it easier for us to make helpful decisions. But let’s not be so naive, or worse, blaming, that we boil it all down to individual ‘choice’.

Join the conversation! 2 Comments

  1. Well no – you’re right: it’s not a choice, not when you’re living it day to day. It’s controlled by your subconscious. People who think it’s just a choice who have never suffered – and lucky them! It’s not a choice to start an ED – your subconscious thoughts do that. Choice, if there is one at all, I would say, comes years down the path of recovery. You have to get to your lowest possible point, and then you have the choice of whether you keep going or you have the realisation that you don’t need to do this to your self any more. That realisation is a conscious thought. That’s the difference I would say – a battle of subconscious vs conscious thought.

    At least, that was my conclusion after 20 years battling with it. It wasn’t till 18 years in when I realised I could take on that subconscious and re-train it from zero. Anorexia for me was a reaction against bullying at school. Once school was finally through it carried on into work life into what was quite a harsh bullying environment I suppose.

    It becomes a learnt pattern. But you can un-learn it. The shame & guilt kept me away from the medical system so I self-healed. I got into self help & amateur psychology. Analysing what was behind my ED I found it was the broken self esteem & self confidence. I was using the hunger pains from anorexia as punishment against myself. Once I realised what was behind it I could work on changing that. This can take quite a long time – I think this is where you are right now – you’re working hard on the conscious recovery thoughts, but the subconscious anorexia thoughts are still working away and trying to drag you back. It’s a battle, but you can win!

    The “sense of confidence that they can actually make and sustain change” thing – you can do that! You can build up your own confidence with positive thinking!

    “the impact of the physical effects of starvation, which can make it difficult to think flexibly” – this is a good point. Looking back, my head was all over the place. The thing here is little steps. Don’t try to do too much at one time. Slowly you get somewhere.

    And “eating disorder ‘symptoms’ generally serve a function” – yes they do. But there’s a lightbulb moment which I hope you have, or have had, when you realise you’re done with it. It served a function, yes. But it’s job is done. Maybe you don’t need to feel so bad about yourself, actually, rather than using hunger pains to punish yourself you can use eating to reward yourself.

    You’re right – if you’re going to untangle yourself from an ED you do have to make significantly different choices – I quit my job, moved back to the first place I ever felt really happy, set up my own business. That sorted out the financial stability bit – you have to fight for your own cause to survive! The relationships bit is still a work in progress – recovery can take a looooong time.

    Anorexia ties in with other mental illnesses too – I also suffered from anxiety, social anxiety, paranoia, depression at the same time. They’re all interlinked and linked back to some trauma, or. like you say, oppression and not feeling safe. Everyone suffers for a different reason (something else which is little understood by the outside world). What I found was you start working on sorting out one issue, and it helps your other issues too. I also found all these mental illnesses seem to thrive on fear.

    The first and biggest choice though, I guess, was to be kind to your self. Certainly from my experience, the feelings of self-hatred with anorexia were high. Changing that around was an amazing step! That did require relentless day-to-day work. Still does, 9 years on (you can’t ever stop!) Worth it though!

    If you’re a perfectionist, easy feel criticised and are quick to criticise yourself, this may to do with self esteem and ego. You can seek out the answers to these issues, and ways to improve, and then the anorexia, which might be a reaction against it, is no longer needed.

    Liked by 1 person

  2. I agree. The narrative of choice is too simplistic. We (i.e. people with anorexia) don’t choose to have the intrusive thoughts, and choosing not to act on them is complicated. Sometimes you just have too much on and have to hold it all together, so restricting to maintain calmness is the correct survival choice in that moment. And even if you do have success once in relaxing control over food, it still has to be done over and over again: in my experience, it takes a long time before these decisions start to become any easier. At the beginning each one feels really wrong, even potentially dangerous. I think, for many people, it *can* become easier – possibly because some kind of brain rewiring takes place. But making changes can be difficult, especially if other life stressors are around. Anorexia often develops as a functional adaptation to stress, and it gets automatically reactivated under stressful conditions.

    Liked by 1 person


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About Emma


Eating Disorders, Recovery, Therapy


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