Ten Phases of an Eating Disorder

The following phases are from a section  from the 8 Keys to Recovery From an Eating Disorder by Carolyn Costin and Gwen Schubert Grabb.

1. I don’t think I have a problem.

• It’s my body so leave me alone.
• There are people who are a lot thinner (worse) than I am.

It’s interesting looking back now and thinking how it wasn’t a problem. Even on the days when I wouldn’t eat all day and just consider it normal. Weighing myself and seeing the scale drop to a lower number, I still didn’t think it was a problem. Like they said above, it was my body and there were people who were a lot thinner than me. I wasn’t that thin. My eating disorder grabbed hold of that thought and held on as tight as it could.

2. I might have a problem but it’s not that bad.

• I only throw up once in a while.
• My physical didn’t show anything wrong so I am OK.

I remember when I realized I might have a problem. I was in the middle of high school. Of course it wasn’t that bad then. My pediatrician just told me the same thing he had told me my whole life, you need to eat more, you’re underweight. Nothing new. But nothing else, nothing concerning, so of course it couldn’t have been that bad. It was just a mild eating disorder. Ha. Oh how the eating disorder voice rationalizes everything.

3. I have a problem but I don’t care.

• I know throwing up isn’t good for me, but it’s working for me so I don’t care.
• I could change if I wanted to, but I don’t.

A significant trauma event happened weeks before I moved to Bend. I didn’t know anyone in Bend besides my parents and brother. I was alone. I was sad. I was hurt. I was angry. I was depressed. I hadn’t told my family or friends about the event because I was scared and I hoped I could just forget about it when I moved. Apparently that doesn’t work. Instead, I turned to my eating disorder. Restriction was working for me. It gave me a sense of control.  At that point my life I didn’t care about anything. I hated everything. I hated myself. So why not keep starving myself. I deserved it, right?

4. I want to change but I don’t know how and I’m scared.

• I want to eat normally, but I am afraid I will get fat (gain weight).
• I want to stop binging, but I can’t figure out where to start.

In January of 2018, I went to the movies with my parents and one of my brother’s and I passed out going to get popcorn. I remember feeling a little dizzy, but I never thought I would’ve passed out. The next thing I remember is being woken up by the lady who had taken my order and a gentleman who was apparently in line behind me. I was lying flat on my back. It was a terrifying moment for me. Luckily I was going to see my physician that week. I knew my anorexia was getting the best of me. I didn’t know how to stop it though. I met with my friend who is a dietician and she referred me to my current dietician who specializes in eating disorders. I was forming my outpatient team without even realizing it. I was meeting with a therapist and dietician every week, a psychiatrist and physician a few times a month. I was getting labs done to see where my levels were. Little did I know in January that I needed a higher level of care. I finally told my family in May that I was anorexic. A few days after that I passed out again at home. I had a pretty bad concussion and wasn’t allowed to go back to serving. I didn’t go back to work the rest of the summer. Even after passing out again, I still thought I was fine. I began to look into residential treatment centers with my dietician. I was scared. I was in denial. I was defeated. I couldn’t work. I couldn’t go on hikes. I couldn’t live my life. I had trips planned in the summer and I told my dietician and physician to let me go on those. If I can stabilize myself, let me wait until the end of the summer to go into residential. I did stabilize myself. I learned the tools to do that. I did what I had to do while traveling to make sure I wouldn’t end up in the hospital.

5,  I tried to change but I couldn’t.

• I told myself I would not (fill in the blank) but I found myself doing it again.
• I don’t feel like I can really ever (change) get well, so why keep trying?

It wasn’t enough for me though. I couldn’t keep it up without more support. After my trip and even during, I was still skipping meals. I didn’t want to eat. The voices in my head were getting louder. I didn’t want to gain weight. I didn’t want my body to change. If anything I wanted to get skinnier. I would hear that I was gaining weight and immediately would want to lose it. But I wasn’t allowed to work out because I could pass out. My parents got rid of the scale in the house so I would stop checking my weight multiple times a day. At the end of August, I was admitted to a Monte Nido residential facility.

6. I can stop some of the behaviors but not all of them.

• I could stop purging, but I will not be able to eat more.
• My heating has gotten better, but my exercise is out of control.

I was in residential for exactly two months. In residential we ate three meals and three snacks every day. I am proud that I didn’t ever refuse a meal. There was no way for me to restrict in residential which was really hard for me to accept. Obviously, a good thing. But very difficult. There were still behaviors. I started eating a lot slower at meals and snacks. I was still self-harming. As we were diving into my life and reasons that fueled my eating disorder, the urge to restrict was so strong. My body was changing and I had no control over it.

7. I can stop the behaviors, but not my thoughts.

• I can’t stop thinking about food and bingeing all the time.
• I keep counting calories over and over in my head and still want to lose weight.

That’s where I am at now.

8. I am often free from behaviors and thoughts, but not all the time.

• I feel fine all day, but under stress I revert back to my unhealthy behaviors.
• I was fine, but wearing a bathing suit triggered my eating disorder thoughts, and with it some related behaviors.

9. I am free from behaviors and thoughts.

• I feel mostly OK in my body and am able to eat things I want and not feel guilty or anxious afterwards.
• Once I had stopped the behaviors for a period of time, at some point I realized that I was no longer having thoughts or urges.

10. I am recovered.

• For a long time now, I no longer have thoughts, feelings, or behaviors related to my eating disorder.
• I accept my body’s natural size. My eating disorder is a thing of the past.