Friday, June 21, 2013

Lying And Eating Disorder Recovery. What Do You Do Now?

First, my confession: I lied to a patient yesterday, and I feel the need to come clean; it’s not my norm to lie. I told this new client struggling with an eating disorder that I have never lost a patient—and that I am determined to do all I’m able to keep my patients safe.

The truth is a bit different. I’ve lost one patient in the 26 years supporting patients with anorexia, bulimia and binge eating disorder. And while statistically one patient is a tiny percent of the thousands of individuals I’ve seen over the quarter century, one lost patient is one too many.

I think about her every time I open my dresser drawer—she gave me a gift just two weeks before she left this world—following my compliment of the shirt she was wearing. She knew I’d get a kick; she wore it to amuse me, for sure. I don’t think it was a parting gift; her death was rather impulsive.

And I think about her whenever I bike ride past the train station upon whose tracks she ended her life. She was being treated by a qualified eating disorder team and by all accounts she was doing quite well—based on what she shared with us, at least. 

Objectively, her eating had normalized and medically she was stable. I can’t recall now just how long it had been since she had purged, but she was doing well enough that we were spreading visits out a bit.

I’m not quite sure why I lied. Perhaps I wanted yesterday’s patient to know how determined I am to keep her safe and to know that one way or another I’ll support her and work with her to recovery. Maybe it has to do with my sense that Dahlia’s death was not because of her eating disorder, but her depression. Was it even a lie when her cause of death was not directly due to her eating disorder? Regardless, it made me think about this topic of lying, particularly as it pertains to recovery.

Years ago I had a new patient who, after introducing herself, immediately shared that she is a pathological liar. And that she steals. It’s a bit of a conundrum, then, to know if I should believe her. And should I hide my purse when I head out to retrieve some materials from the next room? Do I trust her—ever?

But more typically, I encounter patients whose lying is slowly revealed and we both need to make sense of it. And we both need to learn to move on after they’ve lied or mislead.

Daniel found himself in a bind several months ago when I proposed he increase his intake given his inappropriate weight loss. He looked me right in the eyes and emphatically swore he’d stuck with the recommendations from the preceding week—every single one of them. Yet he was well aware why he had lost weight. And he didn’t want to admit that he was struggling with following through with my recommendations. He silently hoped that his method of skimping on his intake would still hold his weight steady—even though I advised him otherwise. And now, if he agreed to my new add-ons, he’d have to lie again—because he had no intentions of eating more. Now he regretted lying as things had gotten quite complicated.

When this happened again some weeks ago, I knew that his eating disorder was at work and could not be trusted. Yes, Dan wanted to recovery, to head off to college, but his eating disorder had a voice all its own. I made sure that he was returning for medical assessments to help verify his progress—as his eating disorder was not tolerating his being honest with me. Surely he didn’t like not feeling trusted. Yet this was the only way I could begin to trust him again and keep him safe.

Sometimes lies aren’t so apparent. You know, like the lies of omission. “So you had the sandwich and the glass of milk?”, I’d confirm. “Yes, and the fruit”, she’d add. But only when I probed further with “And how much of the sandwich did you manage to get through?” did I hear “less than the half”. Or, when I asked about how the exercise limits were adhered to and told that she stuck with the agreed upon 30 minutes, for example. But when I asked “And what was the maximum time spent exercising?” I heard “Well, 40-45 minutes—on most days”.

And then there’s the lying to your self. You look at the cereal and you think surely that’s about the right amount, when truly you know that your portioning falls short. Or you ignore the fact that gardening and compulsively cleaning count as exercise too. You underestimate the number of planned binges or your need to throw out food so no one knows you even bought it and ate it, and you eat mindlessly so you can even fool yourself about your eating.

Your therapist can better explain the role lying plays for you and why you rely on it. But from my perspective, your feelings of shame about eating, of not being deserving, and of needing to be in control are just a few of the contributors. You want to please us providers so we won’t abandon you and truly you’d like to believe you’re doing as well as you state you are.

But like the boy who cried wolf, you leave us struggling with trusting your word. It makes it hard to know just when we need to offer more guidance and support if things always sound great.  I worry when you say that things are always going perfectly—really I do. How will you learn to pick yourself up when you slip if you never share your struggles?

I know this is hard. Nobody talks about it. But as a provider who is determined not to lose another patient to an eating disorder and its comorbidities, I urge you to push yourself to be honest—on your food records, in your sessions, about your difficulties. Volunteer the answers—even if your doctor or your other providers don’t know enough to ask. Tell your supports when your struggling. Hiding beneath your binging, your restricting, or your purging with vomiting or exercise or laxatives is only lying to your self.

I came clean. Now it’s your turn.

Thanks for your honesty. And thanks for reading and commenting.


  1. I can relate to the lying for fear of being abandoned. Much of my life for a long time has been lived either because of this fear or at a distance to prevent the pain in advance. I like to think I'm mostly honest with my therapist although there are times or tics that if I'm honest with myself, I'm not honest enough. This post gives me things to think about when it comes to honesty.

  2. Wow, that's a good one. I probably lie to myself way more than I even know...about food, exercise, etc. I don't care that I lie to myself, I'm not disappointing anyone and I don't feel guilty about it, but when I lie to my T about my weight, that makes me feel horrible. I do it to protect myself, so I can continue seeing her. If I didn't weigh what she wanted me to weigh, she would "fire" me and I didn't want that to happen, so I lied about my weight. I hate that I've lied to her, but it was because I didn't want to lose her. I guess it's also because I didn't want to give up my ED either.

  3. I am finally telling the truth to my RD. I am a recovering anorexic. I am medically stable now but ED is always there in my head. I am an exercise instructor (yes, I know not the best job for an ED patient) and I finally told her how I always feel hungry on my meal plan. She had me add calories and it scares me to death, but deep down I know that I need them. I felt weak admitting I was hungry and needed more food, but by lying and not honoring my hunger I let ED win.

  4. I think this was one of your best posts yet. Lying is a huge part of eating disorder behavior and a huge part of treatment/recovery. I never lie to my treatment team (on purpose, although sometimes ed tricks me into thinking I am being honest), my figuring is that if I am there to get help with this then lying is not going to get me any further along. However, I will say that I am tempted to lie almost daily. It is for some of the reasons that you mentioned, but it is also because I want my team to be proud of me and feel like I am doing well by them. It is so difficult to not follow recommendations, particularly for someone like me that is not a 'rule breaker'. As you stated, it brings up a lot of shame. Doing well and doing poorly can both lead to lying. However it shakes out though, mutual trust seems like a prerequisite for recovery.

  5. I don't know if this is the right place to ask but could you so a post about exercise and a healthy attitude toward it?

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  7. Hi Lori,

    I recently bought your new cookbook and absolutely love it. One day I thought to myself "There MUST be a cookbook for people recovering from EDs" and lo and behold! Then I found your blog, and have been enjoying it as well. I really appreciate this article, and I think it's important for patients to get a bit of a glimpse into the thoughts of a provider.

    I think something is missing here though, and that is the recognition that the lying and dishonesty are absolutely characteristic behaviors of an ED. As it is framed here, a bit of shame is placed on the patients for the difficulties their dishonesty may pose for their providers. But I really feel that this kind of shame is just as inappropriate to feel as any shame related to the disorder itself. Dishonesty ought to be treated like any other symptom. Rather, why not reassure patients that you understand that shame is inherent in an ED? Then you can reassure the patient that your office is a safe place for the him/her to be honest and make a promise that the truth is absolutely safe with you. Then together, you can work towards untangling the shame to uncover the truth, to work toward recovery.

    I know that as a provider with years of experience in treating ED patients these are things that you are very familiar with. I just feel that this was a crucial piece that was absent from your article in a way that left me feeling uncomfortably misunderstood.

    On another note, I appreciate so much the cookbook. Thank you thank you thank you a million times over for putting together such a gentle and comforting guide to learning how to eat again. I'm a year out from what I think of as the recovery phase of my ED, but cooking for myself and managing my hunger are still major challenges for me.

    All the best,

    1. Patty,

      I couldn't agree with you more! Lying is yet another symptom of the eating disorder and it was not my intent to create shame about it, as you describe. Rather, by writing about it I hoped to point out how integral it can become when living with an eating disorder, helping individuals realize that it is a part of the disorder one must guard against.

      And thanks so much for your praise of our cookbook Food to Eat! I'd love it if you'd cut and paste your comment and add it to Amazon reviews so others may benefit from it; I am working hard to get it the visibility it needs, as individuals struggling with eating disorders may not be sharing such things through social media.

      Hope to hear from you again on this blog!