Insight and eating disorders

Earlier today, Laura wrote that insight and eating disorders might be overrated. In many senses, she has a point. Often as a patient, therapists and treatment providers would ask me why they thought I was going downhill but made no real move to stop me from going downhill. "What's really bothering you?" they would ask me. "I dunno," I would say. I felt guilty about slacking off on exercise, so I tried to make up for lost time. I felt I ate too much, so I started cutting back. "No, no," they responded. "What's underneath that?" "Um...I dunno." And my task for the next week would be to figure out what was really going on. That, and try to cut back on the exercise.

No kidding.

Often, I had insight--or at least enough insight to start parroting back to my treatment team what they wanted to hear so they would stop asking me such asinine questions. Insight wasn't really my problem. I knew I had issues with depression and anxiety and perfectionism that was a big part of my eating disorder. I could talk to you at length about obsessions and compulsions and neurobiology and all of that. Still, I remained afraid of eating and entrenched in my eating disorder.

No amount of insight would have gotten me better. I wavered between extreme denial and anosognosia (I'm fine, there's nothing wrong) and pretty good insight. But insight is as insight does. I didn't stop being afraid of food until I was forced to eat 5-6 times every day, and do it over and over and over again. I'm still wary around food. But I'm not terrified of it. That wasn't insight. That was eating.

My insight often frustrated me. I knew that starving and overexercising and purging were ruining my health and making me miserable. Yet I also knew that stopping would make me more miserable. I knew that my symptoms were helping me deal with unbearable anxiety and depression. And what of it? I knew all of this, and I had been taught that this knowledge should have been enough. It wasn't. That's where I often got frustrated and gave up.

I'm not anti-insight, though. I think developing insight is a very important part of the recovery process. I haven't found much use in finding insight into why my ED developed--I know that I used my symptoms to self-medicate for anxiety and depression, and that explanation is fine for me. I know others have found such insight very useful, and that's great. What I have found insight very useful for is relapse prevention.

Eventually, I came to realize that very stressful situations--exam time at school, applying for jobs, moving, family issues--were major ED triggers. My brain could only cope with so many stressful things at once. Since recovery was stressful (and, in my eyes, often stupid and therefore optional), it was the first thing to get jettisoned. Enter relapse, stage left. It took me a long time--remember, I have a very thick skull, osteoporosis be damned--to realize that in these times of stress, when I felt that therapy and eating were the last things I had time for, therapy and eating needed to be at the top of my list. (I'm still not very good at this, to be honest.)

Now, with TNT, I'm working on developing insight into the depth of my negative self-talk. I often don't realize that I'm engaging in such self-hatred because it's such a part of my inner monologue that I don't think about it. And then developing insight to see the subtle ways it plays into my ED thinking. If I usually think of myself as a lazy pig, then it's not a hard leap to see how restricting food (negating the "pig" bit) and increasing exercise (negating the "lazy" bit) might make me feel better.

Of course, feeling like a lazy pig doesn't mean I am a lazy pig. I understand how that applies in other people, but I don't have much insight into why that wouldn't apply to me.

So yes, insight. It is useful, and it can be a good goal. But it often isn't enough to get someone over the initial hump of moving towards recovery. For me, it took having no other choice than to eat. Others have found different ways and different motivations. Insight can be a part of that, too. But I have found insight more useful later, after my thinking had cleared a bit, when I can look back at the craziness and be more rational about what the hell I had been thinking.

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Anonymous said...

Another post that resonates with me!

I think that I have a lot of insight into my ED and depression/anxiety. And the whole self-talk that goes on about how we would never call other people a "lazy-pig," but somehow, we apply it to ourselves. It's sort of like the whole you-wouldn't-talk-to-a-friend-like-that comment therapists like to throw out if I'm sharing my negative self-talk.

I'm struggling with my issues currently and it really is frustrating that, like you mentioned, that just having insight into our own struggles doesn't fix the problem. I'm pretty sure I've been told that I have a lot of insight into my health issues. And yet, am I better because of it? Nope. I can have insight into other's problems as well, but I can't seem to apply my own advice to myself.

Anonymous said...

Yes, yes, good point- Just do the work, and worry about why later. Sometimes it is about putting one foot in front of the other. And trusting others to tell you when to stop. The disordered brain is, unfortunately, not always able to process rational whys.

Anonymous said...

oh, couldn't agree with this more. I had 'great' insight even while very sick, in that I understood perfectly well the barriers to recovery and what I needed to do to overcome them, and even why I was opposed to recovery and that it was a fairly irrelevant point. but I still wanted to stay how I was. and I could justify for hours about why, and how obviously I was just screwed because there was nothing to force me to eat, and until I ate I wouldn't want to, and the whole thing was a catch-22 situation etc etc. I think I was also kind of a master at self know the kind 'oh I know that I COULD recover but I'm obviously just too crap to do so...guess I'll just go eat worms' kind of thing. which was making myself feel better about languishing in the whole thing by beating myself up about it, ironically. anyway, I think the only form of insight necessary for my recovery was 'oh wait, I CAN force MYSELF to eat'. can't believe that took seven years coming :P

Anonymous said...

Really interesting thoughts. I also find that I've got a lot of insight but it's the applying it that is the seemingly impossible part at times.

I think - for me personally - the insight develops and grows and hat makes me stronger. By the sound of it it's not the same for others, but I feel that the it's the bedrock on which I build recovery and health. On its own though, progress isn't going to be made.

It's the difference between knowing and acting, I guess. Thanks for yet another thought-provoking post Carrie!

A:) said...

For me I felt insight was important because it gave me the motivation to recovery. . .

I was insightful enough to realize that after relapsing immediatey after leaving treatment I would NOT be able to go to university that year and I would be TWO years behind my class. I could realize that the longer I stayed out of life and away from school, work, etc. the more I gave to my AN.

Insight also gave me useful tools for seperating disordered thoughts from my own. I don't ascribe to the ana, ed, etc. personification, but I found that it was useful to use logic during a body image crisis, etc (ex. if these pants fit yesterday, they cannot be tighter today. . .)

I think insight makes recovery much easier. However, it is only one ingredient in recovery. There needs to be SOME type of motivation -- and not necessarily toward 100% recovery but toward positive change (whether it is just to maintain weight, slow down weight loss, increase calories).

I don't know if it would work very well not to have insight and attempt to recovery. The individauls I have seen (regardless of their treatment method) without insight have always relapsed.

Perhaps insight isn't necessary to begin recovery (or more specifically refeeding) but I do think it is necessary for recovery and self sufficiency.

Jade said...

I've always thought that no matter how much I learned about eating disorders it didn't really help me to recover. I had to believe it, not just know it. The problem is using an eating disorder to manage stress can work so well, but is feeding into the lie the eating disorder tells. My biggest challenge has been facing the problems in my life, not just numbing myself to them by restricting.

Anonymous said...

I found that it took almost 2 years before I fully began to understand my eating disorder roots. Even now, I still learn about myself, my temperament and the way my family structure works. During the first year of my nutritional recovery, I could think and "function," but not reason, understand and truly think about things beyond a superficial level.

I learned to let go of the eating disorder traits of rigidity and be free of obsessiveness. Fear is hard, as most "normal" people has this, so this is a struggle.

Learning how you "work" is helpful. Luckily, I had someone with a psychoanalytical background as well as CBT. They helped me to think critically through issues and repair relationships.

As you get older, you realize how little you actually know, myself included.

Marisa said...

Your comment about your treatment team not catching you before you slid resonates with me. I'm currently sliding a bit and have been for about 2-3 weeks. I feel I've been pretty open and vocal with my treatment team about my behaviors and such, but they, too, encourage me to "look inside" and "determine the root". While insight is the key to understanding the eating disorder and eventually talking back to the proverbial ED Voice, sometimes I just want to scream at them: "just f-ing help me in this moment and we'll think about it later!"

Missy said...

Great Post!

I am pretty certain I will never discover why I developed an eating disorder and what the main trigger is...but it does help to identify some of the things in your life that trigger it.


C J Good, Author said...

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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