One of my readers, Renee, asked me this question:

I am just wondering what keeps you from trying to negotiate about your weight. I don't want to go back to where I used to be, scrawny and starving and cold, but there is about a 10 pound difference between where "they" want me to be and where I'd like to be. And I am finding it harder to keep on those last 10. I keep telling myself that this time will be different, I won't lose any more than 10. I am not stupid, I know this is all ED talking. But still, lately it's all I can hear. How do you stay so resolute, even though you feel "fat"?

It's a really good question, so i thought I would answer the question here.

And my honest answer is this: I still haven't stopped negotiating.  Seriously.  At my last session with TNT, I raged for more than a little while about how I wanted to lose weight, that I didn't need these extra pounds, blah blah blah.  And TNT said, basically, that losing weight was not an option, that maybe my weight would go down, maybe it wouldn't, but I wasn't to influence the process.

Here's the thing: It's not your job to stop negotiating.  Of course, yes, acceptance of a healthy weight comes with recovery.  Yes, one of the goals of recovery is to learn to fight these thoughts internally and squash or ignore them.  All of that is true.

It is your treatment team's job to stand firm in the face of your anxiety.  Your ultimate goal is to manage your anxiety about weight and weight gain.  But don't confuse your ultimate goal with staying healthy in the meantime.

A brief metaphor, perhaps.  The ultimate goal for a young kid would be to learn how to cross the street by herself.  But when they're two years old, it's the job of the adult to hold their hand and take them across the street.  As they get older, you teach her (slowly) how to get back and forth across the street as you walk next to them, as you watch, across a slow street, and finally across a busy street (I think it's fairly safe to assume she'll pick up jaywalking on her own).

You're the little girl, your treatment team is the grown-up.  A two-year-old will almost certainly insist that she can cross the street by herself, that she knows best.  There's no point in arguing with her, because she really truly believes she's fine.  That's just what two-year-olds do.

Your eating disorder is making you anxious about your weight.  Of course you're going to try and decrease your anxiety--it's normal.  It makes sense.  Yes, the anxiety does get better, but it can last for a really long time, just like it takes a long time to learn how to dash across a busy intersection.

I'm sure my therapist-readers will be thrilled to hear that I'm advocating being a little argumentative and pugnacious about this.  But by talking about it and being forthcoming and honest, it can help you learn how to better cope with your feelings and anxiety.

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Cate said...

I have often compared my recovery to putting my baby to bed. She fights going to bed but I know she needs to because she is tired, and I'm the grown up so I do what's best regardless of her protests - and my doctor will treat me because she knows best, regardless of MY protests! I'm just glad that she does know best!

Katie said...

You know, I have a different answer. I didn't have a ED specialist for a therapist, the practical side of my recovery - designing my meal plan, picking a target weight, monitoring my weight, etc - was all up to me. A lot of experts would say that it's impossible for an anorexic to recover by herself like that, but myself and several of my friends did. It was just a matter of motivations and circumstances lining up at the right time I guess. Anyway, it worked much better for me than having other people dictating my recovery, because my target weight was MY decision, and I couldn't argue with myself! I looked at the research, the women in my family and where my body had seemed to settle in the past when I was far less eating disordered and I picked a weight range that seemed sensible in light of all of those things. Then I made myself stick to it. I reminded myself all the time why I was sticking to it, to the extent of carrying around postcards in my bag with my motivations for recovery on. Yeah it was hard, but I was obviously just ready to do it. So I would say that it's great if you have a treatment team to calm your fears for you, but not everyone does, and that DOES NOT mean that those people will never recover. It is extremely hard, but possible, even down to things like not allowing yourself to negotiate your target weight. And I think my recovery is all the stronger for having taken charge of it myself.

hm said...

Katie, that is REALLY cool. You are a strong girl. And then there's me- I've had this ED since I was a kid and have NO CLUE where my body would have settled if I didn't have it- I've got nothing to go on. Seems like every person has different needs, and if you are searching to find the truth about what to do and how to do it, you can find a way, whether that means finding the truth yourself or needing others to find it for you and trusting in them.

Katie said...

hm - I had an ED for 13 years from the age of about 12, so I had no idea where my body would have settled either because I'd never reached an adult weight. I found out as I went along but the people/research I looked at for guidance turned out to be fairly accurate. I know being ill for years can make you feel quite helpless but don't give up, I know several people who have been ill for decades who have taken their lives back. You're in good company.

A:) said...

I kind of agree with Katie on this one and I think this is where our recovery philosphies diverge.

You are correct in that it is the job of the treatment team to stand firm in the face of any ED trickery, desperate negotiations, etc. This MUST happen because the team cannot be guided by the mentally ill individual.

However, given that the team has set target weight at XYZ, it IS the job of the patient to attempt to accept that weight and begin to understand it was recommended for a reason. I would argue that this process needs to begin from day ONE because there is no magical time in recovery where one suddenly becomes accepting of weighing 30+lbs more than they are used to.

This doesn't mean that the bitching and complaining and fear doesn't happen. . . Simply that there is a willingness to trust the advice of others.

It IS really up to you, Carrie. This doesn't mean APPROVING of the target weight but rather the DBT skill of radical acceptance. . . You go with the weight or you do not. Arguing with one's team is pointless because ultimately you ARE free to do what you want as an adult.

No one -- parents or team-- can stop you from losing the 10lbs you desire and attempting to stay there. The treatment team can strongly recommend a target, but they cannot force an individual up to that weight.

There is power in that acceptance as Katie mentioned -- the fact that it was an active act of STRENGTH on the part of the individual to decide to accept the professional advice and work WITH the team toward recovery.

EDs are nefarious illnesses and certainly denial/distorted thinking is part of it. However, this does not mean you need to be ruled by this thinking -- this does not mean you need to accept it as true or something that cannot be changed because of diagnosis.

There IS a factor of individual choice, consequence evaluation and impulse contorl (that's why we have a prefrontal cortex!)


Elizabeth said...

I can relate to the being 2 years Not that I remember it of course but for me I always say I am like a 6 year old and know what I want, why I want it and I am going to get it no matter what, when my ED is in full bloom. Throw in some stomping feet and you can get the picture. It was really good to know that other people feel the need to negotiate. I thought it was just me and my thinking. Right now I am at a point of learning to trust my own judgement in things and it is a hard process to learn. I always say the "smart" me knows what to do, but the ED is more like the Eddie Haskell (now that ages me a little~I only watched reruns though!) inside me who convinces me otherwise.

Since I am in the beginning of recovery and tend to bounce back and forth still, the negotiations are very high. I sure hope this is normal!! Thanks for such a great blog site!!

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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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