Feeling Worse in Eating Disorder Recovery? This is normal!

As a therapist, let me explain why it will take some time to actually feel better

May 12, 2024

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You just started recovery. You made the decision to recover and eager to see progress – immediately. Understandable. You have been struggling for so long, it’s only natural that you want quick relief. You deserve to feel better too.

Reflecting on Your Journey

You attend your first session, then your second, fifth, fifteenth, and twenty-fifth. It’s been 6 months and you reflect on your recovery journey.

While reviewing your food and body image issues, you realise you are able to identify your triggers and maybe resist engaging in eating disorder behaviours when the urges come. That’s a win! Fewer eating disorder behaviours? Check.

However, as you reflect on your mood, you notice that you haven’t been feeling great. Not really. Not at all. In fact, you’ve been feeling more negative emotions. More discomfort. You think to yourself “Isn’t eating disorder therapy working? Why do I feel worse in recovery?” Improved mood? Checkbox left empty.

At this point, it’s a good idea to do a real check-in with yourself. Is this your Demanding Voice, controlling and setting high standards about recovery? The voice that wants you to do more, be more, see better results, recover faster. If you would like to read more about this voice, check out my previous blog post:

[

The Shapeshifter: Demanding Eating Disorder Voice in Recovery

Zeynep Demirelli Sağ, MSc.·November 30, 2023Read full story](https://realisticbodytherapist.substack.com/p/the-shapeshifter-demanding-eating)

The Reality of Recovery

Maybe it’s not the Demanding Voice but just a curious and non-judgmental reflection on how you have been doing in recovery. This moment of doubt is common among many clients. It’s normal to feel discouraged because there is a misconception that you are going to feel wonderful and delightful while recovering from your eating disorder. That you will quickly start feeling like yourself again, empowered and free from pain. Sun will shine bright and birds will chirp. But this may be far from the reality, as opposed to how eating disorder recovery is presented on social media.

Eating Disorder Behaviours As “Protective” Shields

The reason why recovery rarely feels empowering and fierce at the beginning is because some mechanisms that you relied on heavily to cope with feelings and unmet needs are being lifted. Most eating disorders behaviours develop as a way to cope with unmet emotional needs, perhaps when you were just a child or a teenager.

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The Impact of Unmet Emotional Needs

We have universal emotional needs, alongside physical needs, that need to be met in order for us to live a happy and fulfilled life. (Think of Maslow’s hierarchy of needs.)

The pain of not having emotional needs met is intense and leaves us vulnerable.

Think of a child whose whole world is their caregiver. When the caregiver feeds them, plays with them, cuddles them; they feel safe. When the baby cries, they show up. They are taken care of. But imagine no one showing up. Or not being fed. Not being held. Not being smiled at. These are physiologically distressing for the child and they pose serious threat to their well-being and survival. Yet, there is nothing they can do. They cannot just get up and walk away. They cannot say “Let me crawl out to find another person to take care of me”. They have to survive in the current environment because there is no other. Same goes for a child, a “usual” adolescent. Survival mechanisms develop unconsciously. Keeping quiet. Not crying a lot. Detaching. Suppressing hunger. Finding distractions. (A both lovely and terrifying example of this is the Still Face Experiment. You can find the video here:

Therapy Lifting the Protective Shield

By nature, you are left vulnerable with all these emotions and unmet needs. To assure survival, you do anything you can to get away from this vulnerability; get away from feeling it constantly. The coping mechanisms help with that. At least in the short term, they provide detachment and a false sense of security, as if the needs are met. But in the long term, they start causing problems. And this is where therapy comes in. You work on understanding this protective shield, how it helped you survive yet it is no longer helpful but harmful. Because you are no longer that little child who only had their caregiver to meet their needs. Now you have your own family (if you are in a partnership or marriage), your friends, colleagues and most importantly, yourself to meet these needs.

Recovering actually means learning discard this outdated shield, tolerating the distress of the unmet needs and taking action to meet your needs in healthier ways. When you are recovering, the unresolved distress from the past resurfaces, in addition to current life distress. This is why you might be feeling “worse” while recovering; your protective shield made up by your eating disorder is no longer as present, so you are more in touch with your feelings and your needs. As they are. No suppressing, no avoiding. But fully mindful of them as they arise.

Why Recovery Takes Time

In therapy, I often assign my clients small behavioural tasks to practice between sessions. They come to the session upon completing the task, and ask me “ Okay, what now? I did the healthier behaviour, so what? When will I be recovered?”

“ Now you do it again. Again. Then again. And again. ”

They look at me with eyes that say “Really? That’s it?”, really frustrated.

I always share the Snow Analogy with them (Sadly, I have no record of where I learned this analogy from, but I am definitely not the original resource.)

Creating New Pathways: The Snow Analogy

Imagine the brain as a snow-covered ski hill. As you look around, you will notice several pathways that you can take – some that are familiar and ‘regulars’ for you. These paths have already become a defined and sculpted, from repeated pressure from skiing down there, making them feel more familiar and also relatively easier and faster. However, their familiarity and already defined ruts make it difficult to manoeuvre out of the rut. That path has become self-sustaining, now when you are at the beginning of the hill, because you have been down that path many times and it’s automatic and easier, you tend to go down there. So when you want to go down a new path, it will require more effort and deliberate action from you, and it will take some time until this path becomes your new ‘regular’. This is similar to how we form habits; the more we engage in a behaviour, the more ingrained it becomes.

Now, on a neurological level, the brain operates in a similar way. It is made up of neurons that make up neural pathways each time we learn something new–whether it’s riding a bike, absorbing new information, new coping mechanism to survive; it fires some neurons at the same time to form a neural pathway. When we active these pathways, by recalling information or practicing the behaviour, the same group of neurons fire together. As they had taught us in Biopsychology class: Neurons that fire together, stay together. Over time, these connections strengthen and each time, it becomes a little easier to perform/remember. Each repetition solidifies the pathway, just like skiing down a new path on the hill gradually makes it more defined. The brain does this to make things practical and save some energy.

Same logic applies to eating disorder behaviours. In recovery, you are trying to form new pathways by choosing a different path than you are used to. This requires a lot of deliberate practice to form ruts and troughs in this new healthier path. You will create deeper cavities in the snow going down this path by responding healthily each time the eating disorder urge arises. At the same time, the snow will level out the old unhealthy path, making it not so easy to ski down anymore. Meanwhile the healthier path will be much easier.

Embrace Discomfort as Progress

It is going to feel uncomfortable because you will be faced with feelings and unmet needs maybe you have never faced in your life. You will use all of your willpower, not to attempt dieting this time but to resist acting on the eating disorder urges that come up. Meaning, if you feel discomfort, it means you are going against the Eating Disorder Voice. That is great! That is already a sign that you are venturing onto different ski slopes, creating new pathways, which is a significant step forward in your recovery.

Final words…

In other words, if you are feeling validated in recovery, working through your stuff with your therapist and notice negative and unpleasant emotions showing up more… You are on the right path. As therapy progresses, your protective shield will be lifted, exposing raw emotions. At the same time, you will have healthier coping tools and your therapist right beside you to deal with these feelings. Unlike when you were a child, you will not be alone. This time y ou have your Healthy/Wise Self, nurturing, guiding and surrounding your Little Self. When the Eating Disorder Voice tries to be louder, you can depend on your Wise Self to negotiate and meet your emotional needs. And when the Inner Critic shows up, you have the strength to confront and fight it.

So keep on skiing, you fierce skier!

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