Each year, as the calendar flips to November, I'm hit with a reminder of how complex the holiday season feels in eating disorder recovery. Of course, that's not unique to those with a history of eating disorders. This time of year can be overwhelming for anyone. In 2021, three out of five surveyed Americans felt their mental health worsen over the holidays, with 60 percent noticing a rise in anxiety and 52 percent noticing a rise in depression. Now couple all that with eating disorder stressors or behaviors, and this hectic season can become even more fraught. So with the 2022 festivities just around the corner, let's acknowledge it: The holidays are complex in eating disorder recovery—and that is alright.
Anxiety and Eating Disorders
Anxiety can negate your appetite. Anxiety and eating disorders often co-occur—that's hardly a shock to those who live with the harsh realities and ramifications of both illnesses. As the National Institute of Mental Health reveals, 65.1 percent of those with binge eating disorder, 47.9 percent with anorexia, and 80.6 percent with bulimia meet the diagnostic criteria for anxiety.
Terminal uniqueness is a concept I first learned about in eating disorder residential treatment. At the time, my restless, irritable teenage brain had no interest in the phrase. But over the years since, I've come to realize that terminal uniqueness is a common barrier to eating disorder recovery. In fact, it's not a unique or rare phenomenon at all—ironically enough. So what does terminal uniqueness mean, and how can it affect recovery? Let's unpack this further.
I constantly move—so much so that I feel anxious if I have been sitting for more than about 20 minutes at a time. In fact, even as I type this sentence, I am doing calf raises while standing in front of my computer. On most days, I run or walk an average of 20,000 steps, and if I fall below that threshold, I frenetically pace around the living room while I watch TV at night. I happen to be someone with a lot of natural energy, but I often wonder: Am I just active, or is it my exercise addiction? Moreover, how can I strike a healthy balance in this area?
Confession: sometimes, I'm afraid of complete eating disorder (ED) recovery. What does this mean exactly? It's hard to articulate, but there is a small (albeit influential and persistent) voice in the back of my head that warns me not to lose the ED behaviors I relied on for so long. As irrational as this might sound, I feel a sense of comfort and reassurance in knowing I can re-access the eating disorder anytime I need it.
As someone who started flirting with anorexic behaviors in early adolescence, I have cycled in and out of many toxic, compulsive traits over the years. But although I consider myself to be in a stable, consistent recovery mindset now, the competitive nature of my eating disorder still pulls me back into its orbit sometimes. In fact, I noticed this competitive streak reassert itself as recently as last night.
If you have experience with trauma-informed mental health care, it's quite possible that you're also familiar with eye movement desensitization and reprocessing (EMDR) therapy. This therapy is an intervention used to help the brain resolve unprocessed traumatic memories, as well as the thoughts, emotions, beliefs, and physical reactions or sensations connected to those memories. But, is EMDR therapy useful for eating disorder treatment? That's a nuanced question without a one-size-fits-all answer. However, as someone who is currently in the thick of EMDR sessions myself, I want to examine its potential benefits for eating disorder recovery.
I will never forget one specific breakfast during my time in residential treatment. An on-staff clinician supervising the meal told me to throw out my pancakes and grab a new batch. When I asked her why, the answer was confusing, but as with most rules at this inpatient facility, it left no room for further questions. "You spread peanut butter on your pancakes—that's a food ritual," she replied.
Suicide prevalence in the eating disorder community is a serious concern. Eating disorders are some of the most lethal forms of mental illness—in the United States alone, one person dies every 52 minutes as a result of eating disorder complications. But this high mortality rate is not just a reflection of the various health risks that eating disorders cause. Suicide accounts for many of those deaths as well. In fact, the prevalence of suicide attempts is a tragically common trend among those who suffer from eating disorder behaviors. (Note: This post contains a trigger warning.)
During a recent session with my therapist, I felt compelled to ask for her professional take on my relationship with exercise. I told her that I prioritize running over just about every other line item in my routine. I told her that I feel immense amounts of shame if I cannot squeeze in an hour-long workout on a daily basis. I told her that I consistently run in the 105-degree Arizona heat, no matter how miserable the experience is. I told her that I rarely feel like the choice to stop running is even an option. I told her that I am afraid that without exercise, I will lose control of my entire life. She listened to me rattle off all this information, then replied matter-of-factly: "You have an exercise addiction. How is it working for you?"