If you have an eating disorder, or know someone who does, you probably know how difficult experiencing an eating disorder can be. Part of what makes an eating disorder so difficult is the experience of distress, which unfortunately is a fundamental aspect of having an eating disorder. This post will explore some ways of managing distress in eating disorders.
In many ways, the behaviours that produce an eating disorder, come about as way of avoiding distress related to food, exercise, and weight and shape. To illustrate this point, if someone is very fearful of gaining weight and believes eating particular foods will lead to weight gain, in order to reduce their anxiety, they will avoid the thing they’re afraid of e.g. eating that particular type of food. When thinking about an eating disorder this way, the behaviours that are part of an eating disorder start to make more sense: restricting eating, exercising compulsively, purging, etc. are all ways of avoiding an intense and often ‘bad’ feeling (usually anxiety). In terms of these symptoms, they are basically driven toward mitigating distress and promoting feelings of safety. As human beings, we are all wired to do what is necessary to feel as safe as possible at all times.
Of course, while the behaviours that are part of an eating disorder might help someone feel safe, an eating disorder does not actually equal safety, and has the potential to be life-threatening. To make matters worse, individuals with an eating disorder must continually adhere to rules and routines around the eating disorder in order to feel safe. If anything gets in the way of being able to do this, we can predict that distress will escalate.
The levels of distress can be excruciating for individuals with an eating disorder – if it’s hard to imagine, think of the most terrifying thing that has happened to you in your life; you’re probably close to what it feels like for someone battling an eating disorder. We now have strong evidence from brain imaging studies that areas of the brain responsible for the ‘fight or flight’ response (an ancient biological response that allows us to escape from danger), are activated when someone with an eating disorder is presented with images of feared foods. At a biological level, this heightened fear response is actually very similar to someone who is being chased by a sabre-toothed tiger.
This distress often poses a significant barrier for individuals with an eating disorder, especially when it comes to challenging eating disordered thinking and behaviours. The equation becomes: without distress, there is no change. Keeping things the same will satisfy the eating disorder and keep anxiety levels lower, but it will not allow for change, and freedom from the eating disorder itself. This is quite the conundrum and can leave people feeling very ‘stuck’.
The thoughts we have about our feelings are also instrumental in setting us up to manage them. When we start to feel anxious, we may think in response: “I can’t bear this feeling, I can’t handle it”. Other ways of responding to distress might include thinking that the feeling itself is bad (“I shouldn’t be feeling this upset, I’m weak for feeling this”, or that there may be disastrous consequences (“This feeling is dangerous, I could go crazy”). These sorts of responses to strong feeling makes it harder to sit with that feeling, and can increase the urge to use unhelpful behaviours. In the case of an eating disorder, the eating disorder behaviours are often what will reduce the distress. However, other unhelpful ways of managing distress include self-harm, drug use or other behaviours that might be effective in the moment, but leave the person feeling much worse in the long run.
While this distress can be incredibly hard to feel and to bear, the good news is that there are ways to manage distress effectively – it just takes a bit of trial and error to find out what works. Most importantly, it is essential to try to commit to your plan to do something different – this is often the hardest part, as it is common not to want to try a different way of coping that presents the risk of feeling worse.
Some of the best ways of managing distress in eating disorders come from a treatment called Dialectical Behaviour Therapy (DBT). DBT is a treatment that looks more broadly at effectively managing intense emotions no matter what is causing the distress, eating disorder or not. Her Distress Tolerance module has a range of different approaches, including paced breathing, distraction, and self-soothing.
One of the most powerful ways to influence our bodies when we are distressed, is through breath. If we slow our breathing down, we’re sending signals to our nervous system that we are safe. Paced breathing involves breathing in and out slowly for an average of 5-6 breaths per minute, ensuring that you breathe from deeply from the abdomen.
To do this, it’s useful to have a clock nearby so you can watch the seconds tick over. You can choose how many seconds you want to breathe in and out for, but the general idea is to ensure the out-breath is longer than the in-breath. For example, breathe in through your nose for a count of 5 seconds, hold for 2 seconds, then breathe out through your mouth for a count of 7 seconds, hold for 2 seconds. Repeat. To get the best effect, practicing paced breathing for at least 4 minutes is needed. It’s best to practice this before you get distressed, so that you have a sense of how to use it when you really need it.
Finding a way to occupy your mind and divert it away from feeling how you’re feeling can be a powerful tool to get through an intense feeling like anxiety. Try watching your favourite TV show, going for a gentle walk with a friend, calling a friend or loved one, playing a board game, knitting, or colouring in.
Self-soothing involves finding ways to be kind to yourself and to give yourself comfort when distress is present. It also helps address feelings of deprivation which can often trigger emotional distress. Ideas for self-soothing might include wrapping yourself in a soft blanket, soaking in a warm bath, or patting/cuddling your pet. You might like to light a scented candle, or step outside and get some fresh air. Other options could include watching a movie, listening to soothing music, or reading a book.
Mindfully Sitting with the Feeling
While distraction can be very useful, it’s important that we don’t overuse distraction as a way of responding to feelings. The reality is that we cannot erase feelings. Feelings themselves are not dangerous, they are important signals telling us that there is something we need to pay attention to. Sometimes the best thing to do is to just let the feeling be there, reminding yourself that the feeling will pass, it cannot stay super-intense forever.
A powerful way to confront strong feelings is to just sit with them; find a comfortable chair, couch, or even get into bed under the blankets. Just let the feeling be there, see if you can give it a label. Does the feeling produce a sensation somewhere in your body? Does that remind you of other times you may have felt this way? Just notice the feeling and let it be without reacting to it. Eventually it should feel more manageable and less intense. If it doesn’t, that’s a good point to use another strategy.
Reaching out to someone close to you (sending a message, calling them, organising a catch up) and letting them know how you’re feeling can be really helpful. Things are often easier when we share the load with someone.
If you don’t feel comfortable reaching out to someone, then another option is to write down how you’re feeling, in a journal or diary or even in your phone. Getting the feelings written down can be very helpful, and can sometimes provide a bit of distance from what you may be feeling.
Coping cards can also be useful. Write down some helpful things on colourful/decorated cards to remember during times of distress. These might be inspirational quotes, the reasons you’re committed to recovery, or encouraging words that will help you get through.
Things to Remember
It’s important not to try to rely on one distress tolerance strategy alone, having a list of about 10 things you can do to manage distress is really important. Fine-tuning your distress tolerance toolkit is something you can work on by yourself, or you can take it to therapy to work on with your therapist.
At times of distress you aren’t going to feel like doing any of the things you’ve planned to do to manage the distress, but it’s important to try them out anyway to see what works and what doesn’t. It may not feel easy to do for a little while. Distress tolerance takes motivation and practice.
Remember that if your distress starts to feel unmanageable, and you start to have thoughts about hurting yourself, it’s definitely time to get other people involved. Call someone who can help you, or reach out to LifeLine on 13 11 14. If it’s an emergency, call 000, or present to your nearest emergency department.