Disobey: Finding Freedom From Your Eating Disorder
Eating disorders are serious mental disorders, associated with high rates of psychiatric and medical complications. And they can be fatal: anorexia nervosa has the second highest mortality rate of any psychiatric disorder. Although there are solid evidence-based treatments available, even our best treatments result in only about 50% of patients fully recovering. Thus, there is an urgent need for new and additional resources for people struggling with these terrible disorders. In particular, there is a need for resources for adolescents and young adults going through treatment. For years, I have had parents ask me for a book that would be appropriate for their child to read and that would support their recovery, and for years, I have had nothing to offer. The books that are out there are written for parents or for adults, or they are highly triggering and inappropriate memoirs. This led my co-authors, Drs. Christina Tortolani and Melissa Freizinger, and me to address this significant gap in existing resources. The result is a new book entitled, “Disobey: Finding Freedom from Your Eating Disorder”, a resource for adolescents and young adults struggling with eating disorders or disordered eating, and the professionals who work with them.
It was important to us to write this book in a way that would engage young readers. As clinical psychologists, we are trained in evidence-based approaches, which are considered the gold standards for treatment. But we have learned that especially when working with younger patients, they do not always engage in treatment, despite our best efforts. Why does this happen? In part, because adolescents generally do not care all that much about what we have to say. They are often much more likely to listen to others their own age. They want to know how their peers have recovered, and that recovery is possible for them, too. This realization led us to rethink the approach we took to our work with adolescents, and to repackage it in a way that would be more accessible and relevant to young people.
While in development, the book was reviewed by an advisory board of recovered individuals from a range of ages and is therefore presented in a way that feels relatable for a young audience. Visually appealing, each chapter includes a personal narrative from a recovered individual, and the book is full of inspiring art from recovered patients. Disobey also includes journal prompts, creative exercises, and spaces for art from the reader, as different aspects of the book may resonate differently for various readers as they each go through their own unique recovery journeys. The book is not a replacement for therapy, but can be used as an adjunct to therapy or while someone is trying to find an eating disorder specialist.
Disobey is organized around 7 “Ds”: Distinguish, Disobey, Disagree, Dialectic, Dig Deep, Disconnect, and Discover, each of which is rooted in evidence-based approaches. Two chapters are dedicated to each D: the first is the “What” chapter, which explains what the D is, and the second is the “How” chapter, which reviews strategies on how to implement that particular skill. Developed on a foundation of years of research, Disobey provides patients and therapists alike with an important new clinical resource. It is our sincere hope that this book will change lives.
Overview of the 7 Ds
“Distinguish” refers to the process of separating oneself from the eating disorder; this is called “externalization” and is a fundamental tenet of family-based treatment and a way for those with eating disorders to create psychological distance between themselves and the disorder. It can be an important step during the recovery process, enabling someone to remember that they and the eating disorder are not one and the same, even though it can often feel that way. Naming the disorder something like “Ed” is often done by patients and their families and is an effective way not only for patients to separate themselves from the disorder, but also for parents to direct any frustrations about the disorder toward “Ed” where it belongs, and not toward their ill child.
“Disobey” refers to breaking free from the rigid rules of the eating disorder. These disorders have so many rules about what can be eaten (nothing), and how someone should feel if they do eat (bad). The rules are horrible to follow, but if someone breaks them, the disorder makes them feel terrible about it. Further, the disorder tells people that something terrible will happen if they do break the rules. It’s easier to just keep following these rules rather than trying to break free from them. But breaking the rules is a necessary part of recovery. Many people with eating disorders have trouble with “set shifting” (cognitive flexibility) and “central coherence” (the inability to see the forest for the trees). Eating disorders take advantage of these characteristics: lack of cognitive flexibility lends itself well to rigidly following the disorder’s rules, and a hyper-focus on details lends itself well to things like obsessive calorie counting. In addition, the inability to see the forest for the trees blinds someone to what the eating disorder is actually doing to them: it’s slowly killing them. “Disobey”, grounded in cognitive-remediation therapy and exposure therapy, encourages readers to start breaking their own rules, such as following rigid routines, before starting to break the eating disorder’s rules.
“Disagree” likens the eating disorder to a bully – a mean inner voice that is always trying to tell people what to do. Rooted in cognitive-behavioral therapy, “Disagree” encourages readers to talk back to the bully, replacing eating disordered thoughts and behaviors with new thoughts and behaviors that are more truthful and recovery-oriented. Readers are guided through exercises that help them to examine the evidence for and against unhelpful eating disorder thoughts, and then to come up with more helpful and balanced ways of thinking and acting. The individual’s own, authentic voice is described as a muscle that needs to be strengthened, on a regular basis, until it drowns out the eating disorder’s loud, cruel voice.
“Dialectics” introduces readers to the concept of “dialectical thinking”. It is a way of thinking that allows for two seemingly opposite thoughts, views, or beliefs, to both be true at the same time. It encourages readers to think about the world in a very different way. Many people with eating disorders tend to rigidly see the world as black and white, good or bad. Instead of thinking of things as “either/or”, dialectics encourages readers to think of things as “both/and”. One way to do this is to replace the word “but” with “and”. This is a powerful way of expanding and changing the way we think about things. Saying something like, “I love my friend but she drives me crazy” has a very different feel than, “I love my friend and she drives me crazy”. Both can be true at the same time. “Dialectics” is rooted in dialectical behavior therapy.
“Dig Deep” refers to exploring the purpose that the eating disorder serves for people. Eating disorders narrow one’s focus to be just on food, weight, shape, or calories. It is a restricted, limited, and sad existence, but it can help someone to avoid dealing with the real, sometimes messy world. Eating disorders also often numb someone’s emotions so that they don’t have to experience anxiety, stress, or fear. However, although eating disorders can help people avoid negative emotions, they don’t just numb negative emotions, they numb positive emotions too. Readers are encouraged to allow themselves to experience the full range of human emotions. In order to better deal with negative emotions, they are taught emotion regulation skills, rooted in dialectical behavior therapy. Being better able to manage negative feelings will help readers to feel less of a need to rely on their eating disorder as a way to cope.
Eating disorders try to control everything that a person does. The disorder’s rules and thoughts are all-encompassing. This is, in part, an effort to cut the person off from everything that is important to them. The eating disorder becomes all that there is, making the person easier to control. This process eventually isolates people from their friends, family, hobbies, interests – even themselves. The disorder becomes their only source of connection. “Disconnect” refers to disconnecting oneself from the eating disorder and reconnecting the reader to their real life and real self. Rooted in radically open dialectical behavior therapy, “Disconnect” teaches readers that we are all social creatures in need of connection to other people, and helps them to become more expressive in their feelings and more open to new experiences, which will result in becoming less isolated and being able to participate more fully in real, authentic relationships, thus leaving less room for, and need for, the eating disorder.
Most eating disorders make people feel terrible about their appearance. In addition, they make people forget what used to be important to them by keeping them solely focused on doing things to change how they look. “Discover”, based in acceptance and commitment therapy, not only encourages body acceptance, but helps readers to identify their pre-disorder values and to identify ways that they can start living in accordance with those values. They are encouraged to treat themselves with kindness and compassion, and to use self-validation to get them through hard times. Many people with eating disorders are not used to treating themselves kindly because they have been following the disorder’s ruthless edicts for so long. Learning to be kind to themselves is a welcome change from the brutality of the eating disorder and reminds people that they do not deserve that kind of treatment.
I’d like to end this post with a short excerpt from the personal narrative of one of our book’s contributors. After sharing her recovery story, Meryl writes:
Regardless of whether your story sounds a lot like mine, or your circumstances are entirely different, what I hope you take away is that full and enduring recovery is possible. And if you lack that hope for yourself right now, you can borrow some of mine.