I could retire from my career if I had a dollar for every time a client said some rendition of, “I’m not sick enough to recover.” Variations on this include,
- “I’m weight stable so I’m fine.”
- “My labs came back normal, so I’m not that sick.”
- “My EKG has a slight prolonged Qt interval, but my doctor doesn’t seem that worried about it so I’m fine.”
- “I’m the largest person in this room so I don’t deserve to be here.”
- “I feel fine, so I am fine.”
- “I have never gone inpatient. I’m not that sick.”
- “There are others far sicker than me. They deserve to recover, but I don’t. I’ve just failed at my eating disorder.”
Particularly unique to individuals with eating disorders is this belief that you have to cross some nebulous threshold that establishes you as “sick enough.” Once you cross this undefined, vague, threshold, then you magically qualify or are suddenly “worthy” to pursue recovery. If you believe you haven’t achieved “sick enough,” there can be intense ambivalence about treatment, which makes getting proactive, consistent traction toward recovery nearly impossible.
From my perspective as a clinician, this is all complete bullocks.
First, medical problems resulting from an eating disorder are data points to consider, but are not the “tell all” about how sick someone is. Some people develop medical complications fairly quickly after the onset of an eating disorder, while others may experience almost no medical concerns despite years of struggling with severe eating disorder behaviors.
The latter doesn’t mean the individual isn’t severely sick. If anything, it speaks to the body’s resiliency and striving for homeostasis. It speaks to variability in genes and resilient ancestors. I have witnessed this resiliency numerous times in several, very ill clients.
Second, weight is not a good indicator of health. Period. Some of the sickest individuals I have ever worked with have been at ,or above “normal” weight. You can take several different people and have them engage in the very same eating disorder behaviors, and their bodies can all react differently.
How someone’s brain and body respond to nutritional deprivation varies from person to person and depends on factors outside of one’s control (e.g. genetics). Someone’s body may also change over time in how it responds to repeated deprivation. For example, perhaps at the beginning of an eating disorder, some bodies responded to deprivation with rapid weight loss. However, a few years later, it is not uncommon for these individuals to complain that their bodies now refuse to lose weight despite continued deprivation.
Third, your body can’t always bear witness to the suffering you experience inside. On the outside you may be- by all indicators – “healthy,” while on the inside you’re suffering immensely. You may obsess about food and your body all day. You may feel chronically anxious and insecure.
You may feel afraid when confronted with social situations that include food, or when the day doesn’t go according to your perfectly manufactured plan and you can’t get your workout in. You might feel that if you aren’t “perfect” you are unworthy of connection, belonging, love, and success.
You may feel on the threshold of failure at any minute. And that “failure” may be defined by “giving in” and eating a brownie. You might feel lonely and sad. Maybe you are isolated and believe others won’t accept you if they “knew who you really are.” You may be using eating disorder behaviors or obsessing about body image as strategies to cope with trauma, depression, anxiety or a host of other mental health concerns. The suffering someone experiences in an eating disorder is wide and deep. It is vast and feels endless. It is miserable.
Finally, if you “just” have a disordered relationship with your body or food, this is worthy of seeking help. You don’t have to have a “full-blown” eating disorder before knocking on a therapist’s door.
Dieting, striving for weight loss, and anxiety about one’s body are all vulnerabilities that can ultimately lead to a full-blown eating disorder. But that vulnerability aside, these experiences cause significant distress and misery in their own right.
I believe we are here to be partners with our bodies and to live fully embodied and at peace with food. If you also value this and suffer from not having the relationship you want with food or your body, I pray you find your way to help! It is never too early to start!
It is also never too late to seek help. No matter where you are on your journey in recovery or in the depth of an eating disorder, help is here. We are here. We want to help you find connection, freedom, empowerment, and peace. From a clinical perspective, there is no such thing as “sick enough” to finally move toward healing. Wherever you are, you are worthy of healing now. No matter what.