All of us have thoughts and beliefs that are negative, problematic and distressing. If you have an eating disorder you probably have a disproportionate amount of these thoughts centered on your behavior, your food intake, weight, and body size/shape. These thoughts and beliefs become automatic and habitual over time and can perpetuate eating disorder behaviors. These thoughts and beliefs can be viewed as your eating disorder voice or “ED.” During the recovery process, it is important to challenge ED’s messages that keep you feeling negative about yourself and stuck in your disorder. ED may say such things as:
“Eating less than XXX calories will make me feel in control.”
“Eating carbs will make me fat.”
“I can eat only if I exercise for XXX amount of time.”
“I can only eat from XX time to XX time.”
“No one will accept me at this size.”
These messages can lead to behaviors including restrictive food intake, binge eating, purging, over-exercising, and isolating yourself. There are many ways to challenge ED and change your thoughts and beliefs.
Compassionate Self Talk
Take a minute and think about how your eating disorder talks to you. Does ED talk to you in a critical judgmental voice that is filled with what you are doing wrong and what you should be doing? Does ED say to you, “you should try harder to lose weight,” “you need to exercise more,” “you don’t need to see your friends, they’ll just get in the way of your work out,” or “you can’t go out of the house because you don’t look good enough.”
Instead of allowing ED to dominate your self-talk, practice talking to yourself in a caring and compassionate voice. Think of how you speak to your friends and family in similar situations. You probably speak to them with kindness and care and don’t speak to them with the same harsh voice you use on you. Instead of holding yourself to a different standard, hold everyone, yourself included, to the same standard. Learn to speak with care, love, and compassion to yourself and those around you.
Unhelpful Thought Patterns or Cognitive Distortions
Limited thoughts or cognitive distortions can keep you stuck in a negative head space. To help you get out of it, you need to be able to recognize the different types of limited thoughts and which ones you tend to use to make changes.
Black and White Thinking or Polarized Thinking: To view things as all or nothing; good or bad; right or wrong; yes, or no. There is no in-between, no middle ground, or grey area. There is no room for making mistakes. It prevents us from being able to see circumstances in a neutral or moderate way.
Example: You think, “Only organic foods are healthy.” So, if you are at a friend’s house that doesn’t have any organic foods available, you don’t allow yourself to eat what’s in her house.
Overgeneralization: You reach a general conclusion based on a singular incident or piece of evidence. You use your past events and experiences to predict the future. If it happened once, you think it will continue to happen again and again. If you are using “always,” “never” and “every” you are overgeneralizing.
Example: I binged last night! I’m never going to recover from my eating disorder!
Mental Filtering: When we focus on a single negative aspect of a situation and exclude the positive.
Example: Jenny was able to follow her meal plan consistently for the entire week but on Saturday she missed getting in her afternoon snack. Jenny labeled herself and the week a failure because she didn’t complete 100% of her meal plan.
Disqualifying the Positive: Having a positive experience or getting positive feedback and reject it instead of accepting it.
Example: You may get positive accolades after giving a presentation but reject the idea that you did a good job. You attribute the positive comments as people just being nice to you and they really didn’t mean it.
Personalization: You assume that everything people do or say is some kind of reaction to you. You also compare yourself to others, trying to determine who is smarter, more competent, better looking, more successful, and so on.
Example: You send a group text to your friends and after not getting a reply from them immediately you think that it’s because you did something wrong and they are angry with you or don’t want to talk to you.
Catastrophizing: We tend to blow everything out of proportion. You notice or hear about a problem and start asking yourself, “What if…?” What if tragedy strikes? What if it happens to you?
Example: You go out to dinner with friends and in addition to eating what you ordered, you want to try a bite of food from your friend’s plate. Before you do you think, “What if I gain weight from having a bite of her dinner…what if I can’t stop eating after I take a bite…what if I start taking a bite from everyone else’s plate?
Labeling or Mislabeling: You can view this as an extreme form of overgeneralization. This is when we make global statements about ourselves and others based on situation-specific behaviors not on hard facts and concrete evidence. We judge and place value on ourselves and others based on one experience or incident.
Example: When you make a mistake, you label yourself as “stupid” or “a loser” or another negative label instead of saying “I made a mistake.”
Example: You have a bite of your friend’s meal and now you believe you are “overeating” or “out of control” or “a pig”.
Should’ves and Mustings: This is when we make unrealistic and unreasonable expectations on ourselves and others leading to guilt, frustration and anger towards our self and others. This is not helpful as this sets you and people in your life for failure. It doesn’t take into account the possibility of alternatives or options.
Example: After getting into 3 of 5 colleges you applied to, you say to yourself, “I should’ve done more to get accepted into all the schools I applied to.
Emotional Reasoning: This is the tendency to interpret reality based on how we are feeling in the moment. Our perceptions and our interpretations of the situation we are in are based on feelings rather than facts. Your mood influences how you experience the world around you; therefore, you cannot see the world clearly.
Example: “I feel really nervous and fearful before my presentation. It must be true that I am not prepared.”
Magnification and Minimization: This is when you exaggerate the degree or intensity of a problem. When it comes to people, you magnify the positive qualities about the other person while minimizing your own positive qualities. You put others on a pedestal. You minimize yourself to lower other’s expectations of you. This negatively impacts your self-esteem.
Example: You feel bloated during your period and think that you look as big as a pregnant person.
Mind Reading: Without their saying so, you know what people are feeling; what they’re thinking; and how they will act/react. In particular, you have certain knowledge of how people think and feel about you.
Example: You want to invite your girlfriend out to the movies but before you do, you think that she isn’t going to want to go with you because you weren’t able to meet her for drinks the night before. You think that she thinks you are a flake and that she doesn’t like you.
Fortune Telling: When you make a prediction about how something will turn out as though it were a fact.
Example: In the above example for Mind Reading. Take the example further, and you predict that she will say “no” to you when you invite her to the movies.
Example: You’re depressed and you tell yourself you will never get better.
As you can see, there are many forms of unhelpful thinking patterns. Once you are aware of them and identify them, you can work to challenge and change these thoughts and beliefs.
Relabel and Rephrase
Once you are aware of your thoughts, you can work towards change. One technique is to externalize these thoughts and label them as “ED” thoughts. Relabeling these thoughts will help give you distance from them which will help you recognize and challenge these thoughts. For example, you may have the thought, “I can’t eat carbs or I will gain weight.” Relabel the thought as an eating disorder thought and rephrase the thought as “ED is telling me not to eat carbs.”
Reframe, Rethink, Retrain:
Reframing or rethinking is a cognitive-behavioral technique that helps to challenge and change dysfunctional thoughts and beliefs. Here are the steps:
Start with being aware of limited thinking patterns and identify the ones you are using. Become familiar with the dysfunctional thought patterns so you can become aware of them when they arise.
Next, challenge the limited thinking patterns. Now that you are aware of the destructive thought patterns, you can analyze your thoughts. Ask yourself:
- Is the thought based on fact?
- Is it destructive or is it productive?
Then, consider other ways of thinking: After determining that the thought pattern is limited, you can come up with alternative ways of thinking about yourself and/or the situation.
- Come up with at least 2-3 alternative thoughts
Now select one of these alternative thoughts and test the thought:
- Select the thought that seems most productive and apply it.
- Is this thought based on fact?
- Is this thought productive?
Finally, replace the thought and practice: Now that you’ve come up with a new thought, you can use it in place of the limited thought.
- Be aware when you slip back into old patterns of thinking.
- Stop the thought immediately and replace it with the new thought.
- Repeat the new thought over again.
- Practice this new thought so that over time, it can become the automatic thought.
A helpful tool to guide you through this process and get into the habit of challenging and changing your thoughts and beliefs is a Thought Record. Below are two versions of thought records, use one of them or one similar to it to help practice reframing your thoughts as it will help provide some distance from the spiraling thoughts in your head. After practicing for a time, you can probably do it in your head when an anxiety-provoking thought comes up.
Are my thoughts in column B based on fact?
Are they realistic?
Are they productive or destructive?
What is an alternative thought I can tell myself in the future?
Dialogue with ED
Another way to challenge your eating disorder thoughts is to have a dialogue with it. I recommend doing this with pen and paper, not on a device. Doing this activity on a laptop, pad or phone does not provide the same connection and therapeutic benefits.
Here’s an example from one of my client’s conversation with ED:
ED: You ate that extra piece of toast at breakfast so you blew your day!
Healthy Self: No I didn’t blow it. I was still hungry and having another piece of toast helped me feel satisfied.
ED: You overate. You’re not supposed to feel satisfied. You need to feel a little hungry after eating or you’re out of control.
Healthy Self: I am in control because I am honoring my body and choosing to nourish it.
Initially, it may be hard to come up with responses from the Healthy Self. If you are having a difficult time, take a step back and ask yourself what you would tell a friend or loved one who shared the ED thought with you. More than likely, you would be compassionate in your response to your friend and that is what you need to do for yourself.
On a sheet of paper make two columns and under the first column, write down “ED says…” and under the second column write down “Recovery Says…”
Under the column titled “ED Says” list the things that ED tells you to do and on the corresponding line but under “Recovery Says…” write down specifically how you will defy ED. What you’ll do instead. “ED Says…” are rules that keep you stuck in your disorder and “Recovery Says” are behaviors that can challenge ED and move forward in recovery. Here are some examples:
The next time your eating disorder tells you that you “can’t” do something, test it out! If ED says to you that you can’t eat a bagel or you’ll gain 10 pounds, weigh yourself (or better yet, have your dietitian weigh you) let yourself eat a bagel a few times or even every day and then get reweighed after a week and see whether you gained 10 pounds or not. Maybe ED says that you have to exercise every day for you to follow your meal plan and maintain your weight. Test it out by giving yourself a rest week and see if your prediction came true or not.
Practice, Practice, Practice!
It takes time and a lot of practice to challenge and change your thought patterns and to develop automatic thoughts that serve you well. Initially, this will be a challenge as you work towards changing these thoughts and beliefs. After a period of time, your brain’s neural network will rewire itself to the new and healthy thought patterns.
Consider this analogy. When you go to work or school, you probably take the same course. Driving down the same streets and freeway without really thinking about it. That’s the same as when you have your current automatic thoughts that arise each day. Now, you are asked to take a different path to work or school. This path is unfamiliar to you so you really need to pay attention to the directions and the signage as you take each twist and turn. This is the same as challenging and changing your automatic thoughts to new and alternative thoughts. It takes a conscientious effort to be aware of the self-talk, ED’s voice, and dysfunctional beliefs but after a while, like the new road, it becomes more and more familiar and eventually becomes a new and healthier way of thinking and behaving. Replacing the negative thoughts and beliefs will help you have a more positive view of yourself which builds positive self-esteem and self-worth.
About The Author
Anne H. Lee, MS, RDN, LMFT, CEDS is a Licensed Marriage Family Therapist and Registered Dietitian Nutritionist who specializes in eating disorders and co-occurring disorders. She was the clinical director at Mission Hospital Laguna Beach Eating Disorders Program for over 17 years. She currently is in private practice in Orange County, California, where she treats adolescents and adults.
Burns, D. 1999. The feeling good handbook. New York, New York: Penguin Putnam, Inc.
McKay, M., Davis, M., and Flanning, P. 1997. Thoughts & Feelings: Taking control of your moods and your life. Oakland, CA.: New Harbinger Publications, Inc.
Written – 2019