Working With Ambivalence in Eating Disorder Recovery

“I want to recover but I don't want to gain weight.”

“I know my eating disorder is ruining my life, but part of me still doesn't want to let it go.”

“I’d be worried if someone else was hurting themselves this way, but I feel like those concerns don’t apply to me.”

“I want to be able to eat normally, but I don't want to lose the control I have over food.”

If you've experienced an eating disorder, you may recognise these kinds of conflicting thoughts. You may desperately want your life back while simultaneously feeling frightened about what recovery will require of you.

This is ambivalence: wanting two seemingly conflicting things at the same time.

And in eating disorder treatment, ambivalence isn't unusual; it's often the norm.

“I want to recover… but I don't want to.”

One of the first things I want people to know is that you don't have to be completely certain about recovery in order to begin recovering.

It's easy to imagine that someone who is “ready” for recovery will reach a point where they simply decide, “Enough. I don't want my eating disorder anymore.” From there, recovery should presumably be straightforward.

Unfortunately, that's rarely how it works. You can want to recover and still want to lose weight. You can know that your eating disorder is harming you and still feel attached to it. You can be exhausted by the rules, rituals and restrictions while simultaneously feeling terrified of giving them up. You can want freedom from your eating disorder while also believing that your life would be better if your body were smaller.

These aren't necessarily signs that someone isn't committed to recovery; they're often signs that two important needs or beliefs are in conflict.

Why would anyone want an eating disorder?

From the outside, it can be difficult to understand why someone would continue doing something that is clearly causing them harm. Families might understandably think:”You can see how unhappy this is making you. Why don't you just eat?” Or“if you know you're sick, why don't you want to get better?”

But eating disorders don't persist simply because someone doesn't understand that they're harmful. The eating disorder is usually doing something for the person.

It might provide a sense of control when everything else feels uncertain, temporarily reduce anxiety, or provide a way of coping with difficult emotions or traumatic memories. It might offer a sense of achievement, discipline or identity. For some people, changing their body has become closely tied to feeling attractive, worthy or successful.

Of course, any benefits come at an enormous cost. The problem is that the eating disorder is often very good at delivering short-term relief, while simultaneously moving someone further away from the life they actually want.

That's one reason simply telling someone that their eating disorder is “bad” isn't particularly helpful. They already know that. A more useful question is: “What does the eating disorder give you, and what does it take away?”

When the eating disorder feels like part of you

Another reason eating disorder recovery can be so difficult is that the illness isn't always experienced as something completely separate from the person. This is particularly relevant in restrictive eating disorders. The restrictive part of the illness can feel egosyntonic, meaning that aspects of it feel consistent with the person's values, beliefs or sense of self.

Someone may genuinely value discipline, achievement, health, being organised or feeling in control. The eating disorder can latch onto those existing values and convince the person that restriction is simply an expression of them.

“I'm not being disordered; I'm being disciplined.”

“I'm not avoiding food because I'm afraid; I'm making healthy choices.”

“I'm not exercising because I have to; I just really value fitness.”

“I'm not underweight because I'm unwell; this is simply the body I want.”

This can make eating disorder treatment particularly complicated. The clinician may be asking someone to question beliefs and behaviours that, at least in the short term, feel deeply meaningful and even rewarding. This is why I don't find it particularly helpful to tell someone, “That's just your eating disorder talking.” Sometimes it is the eating disorder part talking. But sometimes the eating disorder has become intertwined with genuine fears, values, preferences and aspects of identity. The goal isn't to argue someone out of their own experience. It's to help them become curious about it.

The eating disorder can be right about the short term

One of the most useful ways of understanding ambivalence is to recognise that the eating disorder may actually be offering something that works; at least temporarily.

Restriction may genuinely reduce anxiety in the moment. Avoiding a particular food may genuinely make someone feel safer. Seeing a lower number on the scales may genuinely produce a feeling of satisfaction. Following rigid rules may genuinely create a sense of control.

AND short-term relief isn't the same thing as long-term wellbeing. A behaviour can work in the short term and still be profoundly unhelpful over time.

Think about someone who wants to reconnect with friends, travel, fall in love, have children, pursue their career, study, play sport, be spontaneous, enjoy meals with family or simply stop thinking about food and their body all day.

The eating disorder might promise: “I'll help you feel more in control.”

But gradually, the price might become: “You can't go to that restaurant.” “You can't eat until 8pm because you've already had your allowance.” “You can't go away because you won't know what food will be available.” “You can't concentrate because you're thinking about food.” “You can't be fully present with your partner because you're preoccupied with your body.” “You can't stop exercising, even when you're exhausted.”

The eating disorder may be helping you achieve one particular goal while quietly undermining many of the things you care about most.

What kind of life do you actually want?

This is where treatment moves beyond simply asking, “How do we get you to eat more?” Of course, nutritional rehabilitation and behavioural change are essential parts of eating disorder recovery. But recovery is ultimately about getting your life back.

So rather than only fighting against the eating disorder, we can also work towards something. What do you want your life to look like? Who do you want to be? What matters to you outside of your weight, shape and food? What experiences are you missing because of the eating disorder? What would you do if food and body thoughts weren't taking up so much mental space? What kind of relationship do you want with your partner, children, friends or family? What opportunities are you postponing until your body is “good enough”?

Recovery doesn't have to be framed as: “Give up your eating disorder because it's unhealthy.” It can also be: “Let's look honestly at whether the eating disorder is helping you build the life you want.”

Sometimes the answer is uncomfortable. The eating disorder may be giving you something you genuinely value, but asking you to sacrifice far too much in return.

Staying aligned with the person, not the eating disorder

For families and therapists, this can be particularly challenging. We may be desperate for someone to recover. We can see the physical and psychological consequences more clearly than they can. We may watch someone becoming increasingly isolated, medically compromised or consumed by food and exercise and think, “How can you not see what this is doing to you?”

Those feelings make sense. Eating disorders can be life-threatening illnesses. There are circumstances where medical monitoring, nutritional rehabilitation or a higher level of care aren't optional simply because someone doesn't feel ready for them.

At the same time, being appropriately firm about safety doesn't require us to become adversaries. The therapist isn't trying to win an argument. The family isn't trying to force someone to want recovery. We're trying to keep the person connected to the part of themselves that wants a life beyond the eating disorder.

You don't have to feel ready for everything

One of the most important things about ambivalence is that you don't have to resolve every fear before you take the next step.

You don't have to love the idea of weight restoration before beginning treatment. You don't have to feel completely comfortable eating foods you've been avoiding. You don't have to know exactly what your recovered body will look like. You don't have to be certain that you'll never miss your eating disorder. And you don't have to wake up one morning and suddenly want recovery with every part of yourself. Sometimes recovery involves doing something that one part of you really doesn't want to do while another part of you knows that it matters.

That might mean eating the meal. Going to the appointment. Taking the day off from exercise. Allowing someone else to prepare your food. Challenging a rule. Having your physical health monitored. And then noticing what happens.

Over time, the aim isn't simply to silence the ambivalent part of you; it's to develop enough distance from the eating disorder that you can decide which voice gets to determine the direction of your life.

Ambivalence doesn't mean you can't recover. Sometimes, recovery starts with acting on the part of you that wants your life back, even while another part is still afraid to let the eating disorder go.