For help with
these issues, please contact:
Jane Rachel Kaplan, Ph.D., MPH
902 Curtis St.
Albany CA, 94707
Why Does Getting
Better Feel So Bad?
Optimal Eating's Five Stages of
By Jane R. Kaplan, Ph.D.
"I want to recover from
this eating disorder more than anything! I'd do anything to not be bulimic
any more." Yes, recovery is the goal. It spells freedom from obsession
with food, getting yourself back, getting your life back and having the
energy to concentrate on people and things without the haze of body and
self-hate clouding the way. There are so many benefits to you, from saving
money on binge foods and doctor bills to feeling you can go out to a
restaurant with friends and not worry. Recovery is great.
However, recovering from
an eating disorder using psychotherapy is also nothing if not a pain in
the neck. It takes time, money, perseverance, humor, trust, hope, support,
dogged persistence and some really good treatment. Understanding the
stages of recovery can make the process more bearable and maybe even
Of course, there are a
lot of theories about recovery and no one person could ever fit any theory
to a "T" nor could any theory fit all people.
stages of recovery presented here are based on my twenty years of
experience helping people recover from eating disorders.
Please note that many
people who recover from eating disorders are in "team treatment" which
includes medical management by a physician, nutrition management,
psychiatric management for medication evaluation, and psychotherapy. This
team treatment is, in fact, the state-of-the-art treatment for many people
with severe eating disorders. In this article, I am addressing the process
of recovery as seen from my point of view as a psychotherapist. I am not
addressing the many important aspects of recovery which have to do with
medical management and with nutritional management. Also, I'm not
discussing other forms of healing which are used in addition to
psychotherapy, such as Overeaters Anonymous. Yet, I believe that the other
forms of treatment and help listed above can be an integral part of the
healing process. The ways team treatment works will be discussed in future
When I discuss these
stages with my patients most agree that it fits a part of their experience
of recovery, and it also explains why recovery is such a pain in the neck.
I hope this overview helps you.
bingeing, purging, and starving are "acting out" behaviors. You are
using actions, not words, to express yourself. Conflict or inner need is
not dealt with directly, but is shrouded in behaviors like binge eating.
The good thing about acting out is that the inner pain is reduced. The
troublesome emotions, thoughts, and feelings all get channeled into the
actions. Between, for instance, bingeing and purging on the one hand, and
self-hate on the other, all kinds of other feelings, even excitement and
happiness, are pushed far away. Well, not entirely. Feelings really don't
let themselves be pushed that far away....they have a funny way of coming
back. But, in some ways, the Pre-recovery stage has the (negative) benefit
of keeping troublesome feelings and thoughts away.
Of course, when you
overeat or restrict food to cope with problems, avoid painful feelings or
maintain a sense of control, there is a real sense of frustration and
shame about it. At the same time, since the acting out behavior is
strongly in place, it functions to push away problems, including the
anxiety and shame about being eating disordered.
People seek help for a
variety of reasons. Shame may become overpoweringly strong and the eating
disordered person can no longer bear it. Another motivation is the passage
of time. When the "I can beat this myself, I don't need help" attitude has
lasted several years without results, help might be sought. Time can be an
influence in another way, too. Perhaps it was somewhat acceptable to be a
binge eater at 22, for it seemed that binge eating would surely be
outgrown by 25. At 28, however, it is quite another story and the eating
disordered person becomes clear about not wanting to take this problem
into her 30s, into her family life, into parenthood.
Another factor is
support. A supportive primary relationship or circle of friends may make
it possible to consider getting help. Growth of self-esteem in other areas
also plays a role. For instance, as esteem grows in the workplace or in a
parenting role, there is a sense that "I can tackle my anorexia too" and
treatment is sought. Economics, too, are a part of the picture. A new job
or new health insurance plan makes treatment more feasible and provides an
impetus. Usually, many factors converge to propel a person out of
Pre-recovery and into psychotherapy.
People in Stage Two of
recovery often look back with nostalgia on their old acting out days.
Ignorance is not bliss, but at least it's better than Stage Two Recovery.
Anything is better than Stage Two Recovery.
Stage Two: The End
of Many Illusions
Now we're talking pain in
the neck. In Stage Two, you engage in a therapeutic relationship and, of
course, try hard to use food less. You try to limit your acting out as you
should. However, this often hurts a lot.
Remember, the acting out
was used to manage troublesome feelings, and, indeed, all kinds of
thoughts and feelings. Now you're not engaging in the eating disordered
behaviors, or not engaging as much, and all those feelings are there, with
no place to go!
Even if you are engaging
in eating disordered behaviors, those behaviors begin to function less
well for you. They don't numb your feelings and thoughts as well as they
used to. You become more aware of your feelings and thoughts and can't
push them away....but you don't yet know what to do with them. Ouchhhh!
Stage Two is
The struggle to not act out
A heightened awareness of your eating
disorder, which can mean greater awareness of shame about it
A heightened awareness of your
feelings, including feelings of low self-esteem, guilt about having an
eating disorder, anger and a range of upsetting feelings
A desire to not use food to manage
Very underdeveloped skills for
managing these feelings without food
Increased anxiety that all this is
A desire to not use food to deal with
In addition there
An adjustment to the idea
of therapy -- "who is this counselor person and why is she/he helping
me...I don't deserve help"
An adjustment to the idea that one
cannot do it all oneself, but needs help
Annoyance and relief that a
professional counselor is getting to know about your eating problems,
which may have been largely secret
And worst of all:
Slow, maddeningly, painfully slow progress in developing other skills, in
building self-esteem, in learning how to not act out, in learning other,
healthier modes of self-expression. You can see that Stage Two is no fun.
It is, in my opinion and that of many of my patients, the most difficult
stage. It's also the stage where some people drop out of treatment, and
it's not hard to see why. Stage One's acting out is much less painful in
the short term. Of course, remaining eating disordered is much more
painful in the long term.
Stage Three: The
Payoffs Begin to Arrive
Throughout Stage Two you
may have asked yourself, "Why am I doing this?" The only answer that comes
back is "because I don't want to be eating disordered for the rest of my
life." But, on a day-to-day basis, there were no payoffs--no fun or
pleasing things about the recovery. It is dreary.
Stage Three is a lot more
fun. Slowly and painstakingly the work on not acting out begins to reap
benefits. It's easier to control the eating and/or restricting behaviors.
You learn new behaviors, and some of them actually work to make life
easier. For instance, a bulimic may binge and purge less. She may find her
new yoga class really is soothing. She may find she is less self-critical
and there is a better relationship to self. Self-esteem is noticeably, if
only a little bit, better. Understanding of the factors which led to the
eating disorder in the first place progresses. This understanding helps
further reduce self-hate and therefore enhances self-esteem.
Relationships to others
become noticeably, if only another little bit, better. There are things to
point to, things to feel proud of. Change doesn't feel bad all the time.
It feels bad only half the time. The other half of the time, there is a
tiny bit of satisfaction, of progress, of relief, "So this is what
recovery feels like. It's not so bad. I like feeling a bit more
comfortable with others. I like this strange lack of severe
Therapy sessions are not
as torturous. In fact, things can feel so good that you can declare,
"Therapy's over!" It's not, but there is a light in the end of the tunnel.
Therapy won't last forever. As Stage Three progresses, you consolidate
these gains. It's easier to not use food to handle problems or feelings.
It takes more to trigger a binge or restriction. Regressions or slips are,
of course, part of the picture. They are lessons and they show where more
work has to be done. Forgiving yourself for slips becomes a tiny bit
easier than in Stage Two. There is less all-or-nothing thinking. You learn
that a slip is not the end of the world.
Stage Three is characterized