Shaping an Environment for Eating Disorder Recovery

Minimizing Challenges in Recovery 101

close up of holding hands at dinner table Images

Recovery is hard! One element of recovery that is rarely discussed but that significantly helps to support recovery is a careful structuring of one’s recovery environment. This applies to adults working individually in treatment and to families helping adolescents to recover.

Most evidence-based treatments suggest that clients consider the timing of the start of treatment and consider postponing treatment if they anticipate major distractions will get in the way of recovery.

But few resources offer specific advice on minimizing challenges.

Recovery looks different for everyone. Some clients are ambivalent about treatment and the changes it will necessitate. Others are eager to be recovered from their eating disorder and just want to get on with life. Some clients are very hard on themselves for having had an eating disorder and don’t want to have to modify their lives. And many clients get caught in the pitfall of trying to rush recovery. Any of the above categories of clients may be tempted to avoid recommended advice from experts. It takes time. As the Alcoholics Anonymous adage advises, “one day at a time.”

Recovery 101

Recovery can be thought of as a set of skills that is learned, developed, and practiced in increasingly challenging environments. Whether you are transitioning to an outpatient level of care or beginning treatment as an outpatient, those first few months should be treated like “Recovery 101.” This is a training phase in which you are first learning and trying out recovery skills.

Your abilities will become more fine-tuned as you practice increasingly difficult skills.

In this phase, it is best to be in a highly structured environment without too many complexities. Most people do best with structure. This is why settings housing large numbers of people tend to be highly structured.

This is also why higher levels of care with the sickest patients are highly structured. Structure makes things predictable and reduces anxiety.

In a structured environment, it is easy to follow a routine, such as eating at a regular time, having a familiar meal, and facing fewer distractions. Chaotic and unstructured environments are unpredictable, are more challenging for recovery, and require more advanced and flexible recovery skills.

The Challenge of Environment

In Recovery 101, it is often easiest to start by keeping things simple and predictable. Each element that adds complexity or uncertainty to the environment presents an additional challenge to someone with an eating disorder. Novel situations, different foods, different food venues, and different companions can all bring anxiety to those in early recovery. Any deviation from a routine requires additional skills, so handling each of these should be viewed as a new skill to master.

We can think about this as a ladder with each rung adding new difficulty.

  At the bottom is generally the practice of eating meals at home with support from immediate family.  The next rungs might include:

  • Having friends or relatives over for dinner
  • Eating at a close friend’s house
  • Eating at a restaurant where individual entrees are served
  • Eating at a family-style restaurant
  • Eating at a buffet.

Each higher rung on the ladder requires more decisions and more skill. Each skill must be practiced.

Take It Slow

Many clients are tempted to climb the ladder quickly, rushing towards the more complicated and challenging situations. This is not advisable when someone is in Recovery 101. Some challenges are better left until recovery skills are stronger.  It is easiest to learn skills first in one place and then to practice them in different settings. It is in this way that skills will generalize.

More advanced challenges that may best wait until the basic skills are mastered will vary from individual to individual, but these can include situations such as:

  • Weekend schedules when you have slept late (do you count brunch as breakfast or lunch and how do you handle the rest of the meals when your first meal is 3 hours late?)
  • Cooking for oneself
  • Going to unfamiliar restaurants
  • Eating at a small-plates, buffet, or family-style restaurant
  • Foreign travel to countries where the foods may be entirely unfamiliar

Instead of taking on advanced challenges all at once, consider potential ways to structure the environment during early eating disorder recovery:

  • Having meals planned out for the entire week
  • Eating meals at regular times
  • Regular grocery shopping
  • Having a backup plan (in case you run late or a plan changes)
  • Always carrying snacks (and backup snacks)
  • Planning alternative activities for high-risk times (for many clients that is evenings spent at home. For one client, that meant going out on evenings her husband would not be home for dinner.)
  • Limiting meals at unfamiliar restaurants
  • Only bringing into the home small quantities of foods on which you have binged
  • Having a support person you can call
  • Structured schedules for every day of the week, including weekends
  • Careful planning ahead (with your team if you have one) for any situation you have not yet practiced

Keep in mind that you may experience setbacks. Sometimes you have to go back down the ladder before going back up again. This is a normal part of recovery.

When recovery is further along, you will be better able to handle more complex and challenging situations. Flexibility will come, but for now, keep it simple.

Continue Reading