Lifetime Eating Disorders Two

Don’t Just Fill the Backstop Bucket

When you have an enduring eating disorder and the food avoidance has been practiced for years and decades, you can spend all your time narrowly focused on backstops. In fact, it’s likely that your GP and/or treatment team are doing the same thing. They look at the biomarker trends then suggest a supplement, prescription or a shift in electrolyte replenishments. They change out prescriptions and doses to try to bring errant biomarkers out of unstable ranges to try to maintain the brittle-but-stable state of your living system.

Have you been asked by any healthcare provider: “What could I do in my treatment role to create an environment where extinguishing the eating disorder behaviours is something you might want to tackle?”

Have you asked yourself this question: “What could I do to create any space for extinguishing the eating disorder behaviours?” If not, try it out.  This question creates possibility rather than trying to expose your logical self to enough data that you hope will trigger a definitive drive to recover.

You’ll have to go through a few rounds of circling through this question because in the first go around you will define a perfect future state environment that will allow for a recovery effort, and that’s not going to get you there.

Usually, people with active eating disorders assume that once the stressors in their lives are gone they would of course focus on recovery. They will say things like “Once I’ve finished my university studies,” or “When the kids have moved out,” or “When this project at work is done and dusted.”

Once you’ve dismissed any scenario that is about waiting for a better/perfect future state, then you have to carefully evaluate whether the ideas you come up with are not still really about backstops rather than a genuine move towards recovery. The way to distinguish these things is whether the idea involves approaching and eating food or not. If it does, then that’s a true space of recovery. Can you swap out a food that is defined as safe for you with a food that tends to ratchet your anxiety? Can you add an “unsafe” food to your daily intake? These are just two examples of things that push at the core of how an eating disorder is sustained: practiced food avoidance reinforces further avoidance.

Extinguishing the practice of an eating disorder is very hard work. But every repeated effort to practice approaching and eating food is a very tangible step to putting that eating disorder into remission.

The Dialectic of Recovery

It seems as though I have just contradicted myself: going slow does not extinguish avoidance of food, yet I have just suggested any step towards extinguishing that avoidance is a tangible step forward.

However, this is the core contradiction of attempting recovery for anyone with an enduring eating disorder. It is not for me to assess what will work in your specific case, but the floor I can define in all cases is that any effort to approach and eat food, whether it is small slow efforts or full-blown recovery efforts, requires laser focus on halting any slide into compensatory behaviours.

Tolerance of Unpleasantness 

Eating food puts your system into a stress position basically. It triggers the threat identification system and you have all the physiological cascade readying you to address the threat. If you manage to get through a serving of ice cream or a plate of fries, you don’t enjoy that process from start to finish and beyond.

Unfortunately, the ice cream or plate of fries will only become enjoyable by teaching the threat system to stand down. That only has a chance of happening if you use your cognitive abilities to talk yourself over the limbic (threat) system hijack of your mind and body.

While not everyone has access to therapy and not everyone can find a therapist who really is a good fit, it’s ideal to have a therapist help you develop the techniques used to address phobias and obsessive-compulsive disorders. There are many online options for therapy as well as books on exposure and response prevention self-help guidance.

A word on using any large language model-based artificial intelligence (LLMs and AI): don’t use them for guidance on extinguishing the behaviours of an eating disorder or for any self-help and mental health care you might want. In May 2024, Daniel Dennett wrote an article in the Atlantic and I think it’s the first time the term “counterfeit people” was used to define the mimicry of LLMs/AI. He makes the case that counterfeiting anything historically was a serious crime because it undermines the trust on which a society depends in order to function.

A large-language model AI such as ChatGPT is essentially trolling the data available to it to vibe respond in the moment. It mimics a thought-driven response. It is a counterfeit of thought-driven answers. Yes, you can certainly come across human therapists who are of no help. However, in those cases you are optimized to identify intent in other humans. You can pick up on a whole host of nonverbal and physical cues often without being terribly conscious of it all. Furthermore, the interface between a therapist and a patient is not one of equals chatting. There are very specific guardrails placed around the duties of the therapist to help a patient. A therapist is not there to make you feel good about yourself, compliment you on your decisions, or reinforce your views and opinions. By contrast, an LLM is designed to be all those things and it’s therefore poorly designed to actually parse what you share and critically assess what might be the best path forward for you. It’s designed to spoof a real accredited, professionally-guided human.

There is absolutely nothing encoded in LLMs that protects you from yourself. We are all vulnerable to LLMs for this reason. We all overestimate our conscious ability to override evolutionarily older parts of our brain that optimize us for survival by interpreting the wants, needs and desires of others in our social group. While we might all consciously know that LLMs are not an actual intelligence distinct from ours, we will absolutely interact with them as though they are. We will apologize to a machine with a drawn-on happy face if we accidentally get in its way. We will wash our hands more diligently in a public bathroom if there are just two painted eyeballs slapped on the wall above the sinks.

It’s sufficiently fraught to find a human therapist who will create the safety you need and who has the training and skill to help you develop skills to handle the unpleasant feelings and sensations you experience when you refeed.

Remember Carl Elliot’s great quote: the best mark is someone who thinks they’re too smart to be duped (paraphrased). I would not ever engage an LLM in advice-giving for me under any circumstance because I recognize that the smartest move is always to assume you are as human as the next person and just as vulnerable as they are.

As I have said in numerous other articles on this site, melting down is understandable in refeeding as is feeling utterly flooded and overwhelmed. Crying is helpful. Distraction is also encouraged. Professional human support is recommended. Avoidance, however, remains the enemy.  

Part Three February 27

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Lifetime Eating Disorders