Nationwide, 24 million Americans struggle with eating disorders. As a psychologist specializing in the treatment of eating disorders, I have had the honor of providing therapy in my practice in Torrance, CA to adolescents and young adults for a wide range of issues over the years. Though eating disorders are one of the most challenging and deadliest mental health diagnoses, many patients are able to stop or reduce the frequency of these self-harming behaviors after few months of therapy.
In early recovery, many of my clients learn how to manage the challenges and triggers they face on daily basis in without engaging in disordered eating. The hardest part following early recovery is getting through unexpected events such as a break up, a divorce, or being fired from your job without falling back on old negative behaviors. Unfortunately, many people stop treatment prematurely, just after stopping the eating disorder behaviors. This robs them of the opportunity to learn in a therapeutic setting how to troubleshoot life’s challenges.
A few years ago, I was working with a 20-year-old female college student, Katherine (for confidentiality reasons all the information has been changed). I first met Katherine in my Torrance office after she returned from college during summer break. Her mother encouraged her to come to therapy after Katherine admitted her frequent binging and purging to her mother. These behaviors had been going on since her freshman year. Katherine was an insightful, motivated young woman and from the first session, she was ready to get rid of her eating disorder. We talked about the factors contributing to it and practiced effective coping mechanisms. By the end of the summer, she had stopped her binging and purging cycle and drastically improved her relationship with food.
As she was getting ready to return to college out of state, she promised me that she would continue with her treatment with a therapist closer to her school. I praised her for her success but also emphasized that terminating binging and purging is only the beginning of eating disorder treatment, and she still needed to continue working on other aspects of her disorder.
I received a call from her 8 months later. She had to get a leave of absence from college due to the severity of her eating disorder behaviors. She said that she had been doing “just fine” for the first three months after her return to college, until she broke up with her boyfriend. She added that the moment she learned that her boyfriend of 3 years was cheating on her, she felt so overwhelmed that she couldn’t think of anything other than purging. She told me that she locked herself in her room for months, drinking and binging and purging. She added that the emotions were so intense that she did not know how to manage them and felt trapped. Finally, she was admitted to an eating disorder residential facility after her roommate contacted her mother out of concern.
Unfortunately, Katherine’s story is not unique. Throughout the years I have witnessed many of my clients relapsing into their past destructive behaviors after experiencing a loss without processing the resulting emotions or using effective coping mechanisms to manage the overwhelming emotions. Below you will find some tools that will help them with this process:
Identifying and Labeling Emotions
Pain is a normal reaction to a loss. I would not be concerned if my client expressed sadness, despair, frustration, or anger after a breakup or divorce. These are natural, and I understand the consequences of losing someone you love. I would be more concerned if my clients were reporting “not feeling anything” or saying “I don’t care.”
Because of the sheer range of emotions that one experiences after a break up, many people try to block or suppress them with the hope that they will go away. Others engage in impulsive, dysfunctional behaviors such as binging and purging or diet restriction to fix their painful emotions. Needless to say, these behaviors not only will not help you to address the issue long term but will also result in additional painful emotions such as shame, frustration, and self-loathing.
Scientific studies show that identifying and labeling emotions decrease their intensity. Although this is a difficult skill to master, especially if you didn’t learn it early on in life, it is powerful one, and it is worth putting an effort to master it now. It is easier for many people to identify the physiological cues and behavioral expressions that in turn will help them to identify their emotions. If coming up with the “right word” is a challenging you can use this list to get some ideas.
I recommend you set up an alert to journal for about 5 minutes twice per day to track your emotions in a journal. In your journal, you may identify what feelings you are experiencing in the moment, where you feel those emotions in your body, and the context in which emotions occur. If writing it down in a notebook does not appeal to you, you may use the following application on your phone to track your mood.
Practicing Radical Acceptance
One of my favorite tools from Dialectical Behavioral Therapy is Radical Acceptance. It is based on the premise that pain is part of life but suffering is optional. Most of the time, our emotional pain stems from wanting to control reality. This is expressed in ineffective strategies to reduce or get rid of our emotional pain. Radical acceptance is about letting go of the struggle to control or modify reality and embracing all experiences, even if it means those that are extremely painful. Accepting reality does not translate to “liking” the situation. It just affirms that you are in the situations that you are. Which in turns will free much of your energy to help you move on from this unpleasant state.
For example, after a breakup I so often see a client spending a great deal of time trying to win their ex back by sending messages and phone calls. They put meaning in their ex’s slightest words and gestures to validate their own reality. Sometimes, they make themselves miserable just to prove to their ex that the ex made a mistake in ending the relationship. Sometimes these control strategies keep confine them for years and put them at a higher risk of relapse, because their fantasy bubble might burst at any moment.
The largest part of radical acceptance is tolerating what you are experiencing without judging it. Radical acceptance is about dealing with situations that we can’t change. Although it is a choice you make, you need to practice it over and over again. It is normal for our brains to want to go back to the rumination phase and our job is to redirect it when we notice the pattern.
Taking Opposite Action
Most of the time, we engage in behaviors that match how we are feeling inside. If we are feeling depressed, we want to stay away from others. When we are angry, we might be ready to pick a fight or yell at someone. The more we take actions which are congruent with how we feel, the more our negative states are exacerbated.
Taking opposite action is engaging in a behavior that is inconsistent with your current emotion. For example, if you start feeling sad and want to isolate yourself from others, using this technique, you would reach out to your friends and plan a lunch date. This in turn might reduce your depression. If you are angry and want to cut yourself, the opposite action would be doing something very nice for yourself, e.g., going to the spa, doing an overnight trip, getting a massage.
These are some of the techniques I found helpful for my clients during challenging times, in my work as an eating disorder therapist. It is important to keep in mind that not every technique works for everyone, and recovery is about creating a toolbox that will work for you! Most importantly, it is very important to work with a therapist if you are experiencing overwhelming emotions. Although your emotions might change from day to day, it is important to have support when you feel overwhelmed to minimize the chance of engaging in destructive behaviors that will have negative consequences and might exacerbate your emotional pain.
Dr. Nazanin Moali is an eating disorder psychologist in Torrance, CA. After completing two master’s degrees in psychology and clinical psychology and a doctoral degree in clinical psychology, Dr. Moali completed a post-doctoral residency where she received extensive training in the treatment of eating disorders, including anorexia nervosa, bulimia nervosa, Avoidant/restrictive food intake disorder (ARFID), and binge eating disorders. Dr. Moali is currently serving the South Bay community, including Palos Verdes, Torrance, Redondo Beach, Hermosa Beach, and Manhattan Beach.