Are Eating Disorders a Choice?
One thing that led me down the rabbit hole of exploring the concept of whether restrictive eating disorders are a form of addiction and to the conclusion that they very much are a brain based addiction to the state of energy deficit (which ultimately led me to write my two books, 'Addicted to Energy Deficit' and the more recently published, 'Aiming for Overshoot') was a conversation with a client. This client had been told by a health professional that developing an eating disorder was not a choice but to recover or not recover very much was a choice. I had heard this statement before from others but something about it on this occasion made me reflect on it more deeply, which led me into addiction territory because the same is often said about other forms of addiction. In this post, using some of the information that's included in my book, Addicted to Energy Deficit, I explore whether eating disorders or other forms of addiction are a choice in the first instance and then how much choice there really is in whether you successfully overcome one.
When you have an eating disorder, these conversations about choice in relation to the addiction and the eating disorder compulsions and behaviours can trigger a range of negative emotions, including feelings of shame, weakness or low self-worth. Of course, any negative emotions can make eating disorders more powerful as the eating disorder has become a way to manage difficult feelings and so these conversations about choice have the potential to create additional challenges with addressing the eating disorder.
With this in mind, let's firstly make one thing clear for anyone who needs to hear it.
Developing an eating disorder of any form is NEVER a choice.
No one ever chooses to develop an eating disorder and to deliberately enter the driven, addicted, lonely and hard life that an eating disorder inevitably creates. Never ever let yourself believe that you chose this way of living. You didn't. The fact you developed an eating disorder comes down to the mixture of an unlucky genetic blueprint and certain triggers* (entering an initial state of energy deficit with or without some form of life stress) that then kicked those genes into life, so that they manifested as the restrictive eating disorder you have today. You didn't choose any of that.
If you made any conscious choices when the eating disorder started, it might have been something like to embark on an innocent diet or an exercise kick. Or perhaps the choice was inflicted on you by well-meaning parents or professionals, encouraging you to lose weight for your health. When you did so, you had no insight into the consequences. You couldn’t have predicted the energy deficit created by the harmless diet would lead you into a dangerous and life-limiting eating disorder.
But what about choice with overcoming an eating disorder?
As I said above, an eating disorder becomes a powerful means to soothe pain. Even after the initial attraction that was once present to the behaviours no longer holds any rational appeal, or they have even become less tolerable to live with, those behaviours can still retain a powerful allure. This is because they blunt mental pain, suppress crippling withdrawal symptoms, allow you to avoid the fear that arises from making changes, and they ease cravings. Plus, at the end of the day, brains are biology, with biases, attractions, associations to things and habitual thought patterns that will drive automatic behaviours. Your brain is strongly driven by emotions, desires or fears and rarely by logic. And brains are changed at a deep level by an eating disorder when it comes to embedded brain circuits that will push you with force to behaviours that will pursue your drug of energy deficit.
Therefore it can't be reasonable to say that anyone is choosing to continue to pursue the behaviours and compulsions associated with a restrictive eating disorder. And neuroscientists now know that any decisions that we believe we are making at a conscious and rational level are in fact made by the unconscious part of our brain around half a second before they enter our conscious awareness. So, we all have less deliberate agency over our actions than even the most self-controlled believe of themselves.
Having said that though, people DO overcome restrictive eating disorders and that doesn't happen by magic. Choice and self-control are key factors in how effectively someone does overcome an eating disorder or not so we can't say that there is no element of choice involved when it comes to overcoming eating disorders or other forms of addiction. And with other forms of addiction, research has also found that when people are allowed to believe that things they really want from their future, beyond the addictive disorder, are possible for them to achieve, these incentives can be key factors in choosing to stop the pursuit of their addictive drug (whether that's an ingested drug or a behaviour).
For many, the ability to choose to stop and to find the strength to make that choice depends on them having very meaningful reasons to do so. Even then, it’s more complicated to overcome a compulsive behaviour than just saying no to it. It takes hard work, mental effort, focus and support from others, but it can be easier to make that choice towards new opportunities when allowed to believe that it's possible and empowered to do so.
The ability is within you to make changes and overcome the compulsions created by the eating disorder. But it can come from how you perceive your options and choices, alongside your ability to recognise the impact of continuing to pursue the behaviours.
Self-control can be used to pull yourself back from acting on an addictive desire, even when it’s painful, anxiety-provoking and holds risk of failure. Resisting the lure of the behaviours and the hit they create isn't impossible, but, yes, it can be incredibly difficult.
When it comes to overcoming an eating disorder, choice is involved. But to optimise your chances of making the 'right choice, it helps to be able to believe in your abilities to change. If you have ever been told that the eating disorder is chronic, it puts the burden onto you and reduces your ability to view it as something you do have the choice to overcome. It disempowers you when what you need above all else is to be empowered.
If this is your current reality, then you need to recognise that the eating disorder is not something you want anymore, notice that it’s wrecking your life and destroying your future opportunities, and you want things to be different. You do have the choice to decide that you will stop the behaviours in the pursuit of energy deficit. If you make that choice, you are more likely to do it. Focusing on new goals, pursuits and a life outside the eating disorder will also make a big difference. You need strong reasons that are emotive to you as to why you will change. Allow these goals to drive your desire for more, nurture them and choose to move towards them.
Believe in your ability to change and you will be better able to resist the urges when they arise time and again, even when they are at their most powerful and alluring. When those urges hit, remind yourself that responding to them in the now might reduce the discomfort in the short term but will keep you in the misery of the eating disorder in the long term.
You didn’t choose to have an eating disorder or deliberately set out on that path, and choosing to overcome an eating disorder is far from simple or easy. It’s not about simple choice. It's far more complicated than that, so don’t feel you are to blame just because you have not succeeded yet in overcoming the eating disorder. You must remove any self-blame that might be there as those inappropriate negative feelings towards yourself will only hurt you more and may lead you to hold onto the destructive eating disordered behaviours for longer.
There are choices to be made to overcome an eating disorder, but it takes support, empowering yourself and finding meaningful goals beyond it so that you can keep making the choice to move towards your free life, even when it's feeling nearly impossible in the moment you are in. You CAN.
*I will write more about the genetic link to eating disorders in a future post or you will find a chapter about the current understanding of the genetic links to eating disorders in Addicted to Energy Deficit
The information for this post is taken from my first book,
'Addicted to Energy Deficit - A Neuroscience Based Guide to Restrictive Eating Disorders' which is available to buy now.
And if you are interested in picking up a copy of,
Aiming for Overshoot—The Handbook You Need to Overcome a Restrictive
Eating Disorder & Addiction to Energy Deficit,
Then you can find out more by clicking here.
If you like to listen, as well as (or instead of read!) then this blog post is the transcript of a podcast episode which you will find on my podcast series,
available on this website, all mainstream podcast platforms and on YouTube.