Thursday, January 9, 2014

Slip sliding away? Cutting corners and accepting sub par eating disorder recovery.

It's hard to tell that something's missing.
Kelli’s cutting corners on her meal plan. You know, measuring her cereal—but then picking off a few pieces to eat less than she measured. And Dan revealed that for months he would crumble some of his cookies, his planned dessert, and then leave it over, along with spilling—intentionally—a few ounces of his milk at meals, most every meal, at home.

In a way I was pleased.

No, I’m surely not looking to fill my schedule with long-term patients who stay stuck with their eating disorder. And I’m not giving them the half full perspective, suggesting that at least they’re eating something, that it’s only half empty and could be worse. Meal plans are not designed with the intention of our patients eating only 50% or even 95%; I never over estimate what patients need to eat.

But for Kelli and Dan, sharing that their eating was falling short was a significant step forward. It spoke to being real and acknowledging where they were struggling in an attempt to be held more accountable. They were positioning to overturn their eating disordered thinking and actions. It was a significant move toward recovery.

For Kelli, it was the first time she cared enough about recovery to rat on her eating disorder. Once she verbalized it, there was no going back; she knew I’d be asking her the details of her intake and about her tendency to cut corners, even if she later regretted her honesty with me. Yes, I knew what her eating disorder was up to now.

For Dan, it was his inability to maintain the facade of recovery when he truly wanted to be free of the deception, and perhaps the eating disorder as well. He was challenged to reconcile the inappropriate weight loss in light of his misleading overrepresentation of his eating when he confronted me each visit. In both cases, I was truly pleased to hear them come clean.

That said it is not my role to set the bar low. And while I appreciated their honesty, the work still needs to be done. It is not enough to simply acknowledge where things fall short. Like “oh well, I skipped my snacks this week—all of them!” Honest, yes, but not good enough for recovery.

"What if I’m stepping down from a program?"

Some things are just not acceptable.
I realize that moving from a more intensive level of care to working exclusively with your outpatient team is a very difficult transition. Recovery can feel like a full-time job, between the scheduled appointments and the mental energy and planning.  Juggling eating disorder management with a less than supportive environment, together with your day to day stressors is nothing short of challenging. And slips happen.

But expected or not, it’s not okay to cut corners.

You know it, don’t you? While some health care providers may tell you it’s normal, and they’re understanding and compassionate, I feel otherwise. Why? Because these behaviors speak to how active, how loud your disorder remains. It’s not okay to accept slips even though people often do. Meaning, simply acknowledging that your eating or behaviors are not what they need to be is not enough. Yes, slips happen, but there needs to be some action steps put in place to resume recovery.

And it’s not okay to accept a subpar food intake or weight gain because of such thinking as “at least your weight is higher than before” or “at least you’re eating something”. And let’s not forget that your activity—which doesn’t seem to you like exercise—is greater than when you were in your program. Yes, even day to day movement—casual walks, cleaning, caring for young kids—counts. Really, this is no time to be cutting back on your food intake.

There really is a way out.
If recovery is the goal, cutting corners has no place. It does nothing positive for your thoughts, nor for your medical stability nor your treatment success. Any short term allure of weight loss may be met with less than pleasant consequences.

The problem is that less than full recovery will become no recovery. It’s a slippery slope. In some ways it seems even riskier being at a better place than where you started, yet not where you need to be. Because you may breathe that sigh of relief, and feel you can relax now—and stop pushing. You’re feeling much better than you had before, so you no longer worry. And so the motivation drops.

It’s so easy to be drawn into the thinking that you really haven’t changed your eating much, just a bit here and a bit there. I mean, you’re still eating, right? Do the math—three meals and 2-3 snacks a day. Believe me, even cutting back a bit each time will add up over the days and weeks.

I don’t care that your labs are fine. It doesn’t matter that you have a runners’ pulse. And I’m surely unimpressed that your weight hasn’t changed much. I will not settle for cutting corners—nor should you. That is, if you really do care to move beyond your disorder. Am I sounding like that Tiger mom? 

What an amazing sign, from the Gates Foundation building, Seattle.
It’s time to come clean—reach out to your supports. Tell them how you’ve cheated—not you, but your eating disorder—and be forthcoming with your struggle. Then put a plan in place with your team, with your family or friends, to add the support you need to turn things around.

I hope you’re inspired. You do deserve better than this disordered life.

You may also like these posts about recovery:


  1. That about sums it up for me. I think I'm constantly cutting corners but think it's "no big deal" so I just go with it. Well, right now, my eating kind of sucks. There it is, I said it.

  2. This hits does the title. The slip sliding away happens easily. I don't always believe it. Cutting corners is incredibly easy, and even easier to deny or chalk up to being busy or not hungry or, or, or. I love that Kelli 'ratted' on her eating disorder. Its a hard step to take - once we tell you the real story we cannot take it back...cant put the toothpaste back in the tube! Less than full recovery becomes no recovery - what a great way to describe the slippery slope you always speak of. It is also so much harder for the people in our lives to 'catch on' to cutting corners - its easy to fool others with small changes that we call 'no big deal' which further perpetuates the slip. I also was struck by you saying that meal plans were not made to be followed at less than 100% - it is so easy to think that its ok to cut just a bit here and a bit there.