It’s true. The longer you struggle with an eating disorder, the harder it is to recover, period. There is hope, though. In my 10+ years as a registered dietitian in the eating disorder industry, I’ve seen similar recovery trends that lead patients to thriving lives, and their disease to a mere memory. As my mission remains to remind people of the power they possess to recover their way, and expose every trick in the book to make recovery less painful, it is my duty to release what I’ve seen really work.
Why do we become stuck in the pattern of disordered eating? It’s a quest worthy of exploration. From what I’ve seen, my patients seem to synonomize familiar thoughts and habits with the feeling of safety or temporary pain/anxiety relief. This is a very human behavior we call “harm avoidance.” This is where, for millennia, we have evolved by avoiding harmful situations. Being ever vigilant and hyper aware of ANYTHING that represents a threat to our safety has kept us alive. So that’s just normal and has allowed us to evolve without becoming an extinct species.
The problem of harm avoidance has also evolved naturally as well, so that instead of our adrenalin raising with a tiger chasing us down, it now raises the same or more with losing a smart phone, or what I like to call “iPanick.” This is in our general population, though, not specific to eating disorder patients. As we get into the eating disorder population, harm avoidance becomes even MORE intense to attain even a general feeling of safety.
With my experience and research in treating eating disorders, I’ve witnessed the genetic response to stimuli as instinctually sensitive. My patients have all shared a genetic level of hypersensitivity, making their level of intuition almost psychic. The hypersensitive nature of these magical folks allows them to read a room from their gut, and see right through any, and most bullshit. This is a big reason they can manipulate eating disorder professionals without even blinking.
They know when they’re being lied to, and trust must be earned through 1,000% authenticity. If you’re not real as a professional, they’re only going to take your sessions as time they need to log to convince their friends and family of their successful road to recovery. They know what their providers need to hear, and they’ll tell them exactly what is needed to have their chart show undying progress. A provider’s self awareness and genuineness is, and in my professional opinion, will always be, the only skill needed to treat these intuitive geniuses.
Let go of the knowledge you THINK you have, and be real. They’ve got the rest without your help. I consistently reiterated to my team in Seattle that the only thing our patients needed was for them to care, genuinely. Their schooling did not matter, as our patients knew way more about nutrition than we ever could. They spend the majority of their time researching nutrition if they’re not obsessing about it.
So their sense of harm avoidance is on point to the tune of being anxious about 99.5% of the time, consistently looking for those with agendas to disrupt their sense of what they believe to be safe. They are pros. Suffice it to say, they only have about 0.5% thoughts to entertain anything other than obsessive harm avoidance. My treatment with my own patients, therefore, focused the majority of our time together on building enough trust, through expressing authenticity and genuineness, to entertain that 0.5% of their thoughts. This is where their dreams and hopes live.
I remember thinking, “Yeah, yeah. We have to talk about progressive food improvement, but they know what they need to do, and I’m not going to spend my time talking about what they obsess over the majority of their lives.” My goal was ALWAYS to grow that 0.5% by being the safe person to let their guard down around. My authenticity led me to tell them everything I was thinking.
I told them at the start of a session that we would be increasing their food next week, so they had some time to think about what they wanted to do. They appreciated the notice, and because I gave them the control, they could think about how THEY wanted to increase. Less work for me anyway, let’s be honest. Once I got this out of the way, they could relax knowing we got the worst out of the way, and they didn’t have to sit on pins and needles waiting for the surprise other providers would spring on them.
Love it or hate it, they knew I was up front with them from the very beginning. I would even tell them if I wanted them to think about “thinking about” a food increase. As long as I honestly exposed all I was thinking, they felt easier about growing the 0.5% to start including more dreams and hopes. By default , and I exposed this too, they had to choose to let go of the minuscule fractions of their obsession to grow this area, but because I focused on the growth of their hopes and dreams, THEY got to decide what part they’d sacrifice, when to do it and how much to give up.
So how hard is it to shake an obsession you focus on 99.5% of the time? Fucking hard. The only way I’ve been able to help permanently eradicate this obsession is to grow the time they spend thinking about their dreams. When you give a person, who is scared most of their lives, the control to decide the what, when, why, and where of their recovery, and just be cheerleaders of their hopes and dreams, guaranteed, they’ll do it. Infantile steps at first, I’ve witnessed so many patients CHOOSE to let go of obsessive thoughts in lew of ones giving them hope for their future. They enjoyed seeing me because for even a session they got a break from anxiety and got to talk about life, their life.
In conclusion, my method is not to take the obsession away, but to get people excited about life, little by little, until the obsession starts to get boring in comparison.
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Yours in love and support,
Scarlett Ramey, MS, RDN, CD
P.S. Hope to see you in the comments. Let’s rally together during this time and stay connected in supporting YOUR Recovery journey. The world deserves the BEST of you.♥️