How effective are the 12 Steps for eating disorders?
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Dr. Kimberly Dennis is the Medical Director at Timberline Knolls Residential Treatment Center. She maintains a holistic perspective in the practice of psychiatry, incorporating biological, psycho-social and spiritual approaches…
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How effective are the 12 Steps for eating disorders?
In a prior post, I talked at length about how eating disorder symptoms impact the brain circuitry in ways that produce a response similar to drug or alcohol addiction. These findings represent a major step forward in understanding the complex biology of eating disorders and the challenges associated with both treatment and recovery.
Many patients, professionals and those in recovery have asserted that the 12-step recovery model can’t reliably help with food-related addictions and eating disorders. Their reasoning? We need food to live – we can’t abstain from eating food.
But this misses an important contradiction and is at odds with my experience in treating both addictions and eating disorders. While we do need regular food intake in order to maintain our health, we also need to drink fluids in order to live. In fact, we would die quicker by abstaining from liquids than by starving ourselves. So from that standpoint, people with alcoholism need to keep drinking, but in recovery, they focus their efforts on abstaining from drinking one specific liquid: alcohol.
Similarly, people with eating disorders need to keep eating (or start eating, as the case may be!), and in recovery they focus on abstaining from eating disorder behaviors: starving, restricting, binging, using diet/laxative pills or over-exercising. Many people with eating disorders, particularly those with bulimia nervosa or binge eating disorder, can pinpoint specific trigger foods that functions for them like alcohol or drugs. Those particular foods trigger either a binging cycle or a purging cycle in the same way a sip of alcohol can trigger a substance abuser. This is the challenge for people with eating disorders: they need to continue to eat, yet while in recovery, they must develop tools to resist the urges they feel when encountering or thinking about their “alcohol foods.”
We have found that the 12-step process for recovery from addiction can be equally successful in supporting recovery from eating disorders. One common element among treatment centers utilizing the 12-step approach is holistic attention to the entire person through an integrated focus on the patient’s physical, mental, emotional, social and spiritual needs. By addressing all aspects of their being and learning to tap into a “higher power” that is meaningful for them, patients gain a broader, more objective perspective on the challenges they’ll face in their recovery. The 12-step recovery model also provides tangible tools and supportive resources an individual with an eating disorder can rely on for life – whenever they encounter triggers, or life changes create new pressures to cope.
Many people using the 12-step recovery model for both eating disorders and addiction also benefit from professional help from a comprehensive treatment team. This may include individual, group and family therapists, regular consultation with a psychiatrist and internal medicine specialist, and ongoing work with a nutritionist. Combining medical and psychological treatment with the 12-step model can greatly enhance the set of tools a patient can employ to maintain their recovery and manage the long-term risks their disease may present for their overall health. The promise of recovery for a person with an eating disorder is that her relationship with food will be healed and restored to sanity, and that she will have a fuller living experience with her disease in remission one day at a time for the rest of her life. A common myth associated with 12-step recovery models is that the patients never get better and have to struggle through life battling food (or alcohol)—which couldn’t be farther from the real life experience of the millions of people who have and continue to benefit from 12 step mutual support groups.
For some patients with advanced disorders or with co-occurring conditions that may not have been properly diagnosed, more structured treatment may be required, either in an inpatient, residential, or outpatient setting. But this does not preclude focus on the 12 steps. These may be meetings of Anorexics and Bulimics Anonymous, Eating Disorders Anonymous or Overeaters Anonymous, as well as other 12 step meetings for co-occurring addictions or compulsive behaviors, or family of origin issues. In addition, many sufferers from eating disorders are increasingly finding this type of support and fellowship online, 24 hours a day. Meetings like these are an integral part of each resident’s aftercare program, designed to provide ongoing recovery support when she leaves our treatment center.
Dr. Dennis
Many patients, professionals and those in recovery have asserted that the 12-step recovery model can’t reliably help with food-related addictions and eating disorders. Their reasoning? We need food to live – we can’t abstain from eating food.
But this misses an important contradiction and is at odds with my experience in treating both addictions and eating disorders. While we do need regular food intake in order to maintain our health, we also need to drink fluids in order to live. In fact, we would die quicker by abstaining from liquids than by starving ourselves. So from that standpoint, people with alcoholism need to keep drinking, but in recovery, they focus their efforts on abstaining from drinking one specific liquid: alcohol.
Similarly, people with eating disorders need to keep eating (or start eating, as the case may be!), and in recovery they focus on abstaining from eating disorder behaviors: starving, restricting, binging, using diet/laxative pills or over-exercising. Many people with eating disorders, particularly those with bulimia nervosa or binge eating disorder, can pinpoint specific trigger foods that functions for them like alcohol or drugs. Those particular foods trigger either a binging cycle or a purging cycle in the same way a sip of alcohol can trigger a substance abuser. This is the challenge for people with eating disorders: they need to continue to eat, yet while in recovery, they must develop tools to resist the urges they feel when encountering or thinking about their “alcohol foods.”
We have found that the 12-step process for recovery from addiction can be equally successful in supporting recovery from eating disorders. One common element among treatment centers utilizing the 12-step approach is holistic attention to the entire person through an integrated focus on the patient’s physical, mental, emotional, social and spiritual needs. By addressing all aspects of their being and learning to tap into a “higher power” that is meaningful for them, patients gain a broader, more objective perspective on the challenges they’ll face in their recovery. The 12-step recovery model also provides tangible tools and supportive resources an individual with an eating disorder can rely on for life – whenever they encounter triggers, or life changes create new pressures to cope.
Many people using the 12-step recovery model for both eating disorders and addiction also benefit from professional help from a comprehensive treatment team. This may include individual, group and family therapists, regular consultation with a psychiatrist and internal medicine specialist, and ongoing work with a nutritionist. Combining medical and psychological treatment with the 12-step model can greatly enhance the set of tools a patient can employ to maintain their recovery and manage the long-term risks their disease may present for their overall health. The promise of recovery for a person with an eating disorder is that her relationship with food will be healed and restored to sanity, and that she will have a fuller living experience with her disease in remission one day at a time for the rest of her life. A common myth associated with 12-step recovery models is that the patients never get better and have to struggle through life battling food (or alcohol)—which couldn’t be farther from the real life experience of the millions of people who have and continue to benefit from 12 step mutual support groups.
For some patients with advanced disorders or with co-occurring conditions that may not have been properly diagnosed, more structured treatment may be required, either in an inpatient, residential, or outpatient setting. But this does not preclude focus on the 12 steps. These may be meetings of Anorexics and Bulimics Anonymous, Eating Disorders Anonymous or Overeaters Anonymous, as well as other 12 step meetings for co-occurring addictions or compulsive behaviors, or family of origin issues. In addition, many sufferers from eating disorders are increasingly finding this type of support and fellowship online, 24 hours a day. Meetings like these are an integral part of each resident’s aftercare program, designed to provide ongoing recovery support when she leaves our treatment center.
Dr. Dennis
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I agree, not everyone fits my statement. Unfortunately you might be one among thousands, probably millions. The overwhelming majority are on the other side.
Hi guys, Im a newbie. Nice to join this forum.
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This is simply incorrect- there are many foods which cause dependency- the most well known being an additive in many foods called MSG- It's the one we've all heard of but by far not the only one. Apparently emotional or psychological dependency also goes over your head.
You state: "A common myth associated with 12-step recovery models is that the patients never get better and have to struggle through life battling food (or alcohol)—which couldn’t be farther from the real life experience of the millions of people who have and continue to benefit from 12 step mutual support groups."
That's not a myth. People never get better there. I've seen it and experienced it. Furthermore, people in 12-steps believe that they are the one and only thing there is for recovery. That mentality is like the one in cults.
There are healthy alternatives to the 12-step model.
http://www.seekwellness.com/wellnes...
When I see the "old timers", people who have been in programs for a long time, they are certainly not an example of who I want to become. I have NEVER, EVER heard one single person express happiness, fulfillment or even joy, even when things turn right in their lives. They keep going on and on and on about how bad things are in their lives, even when they have made major accomplishments they find something bad to say about it. The keep making an analysis of every simple thing in their lives, fostering a sense of inadequacy in what should be just simple human spontaneity. God forbid you act spontaneously in those programs!
You state: "The promise of recovery for a person with an eating disorder is that her relationship with food will be healed and restored to sanity, and that she will have a fuller living experience with her disease in remission one day at a time for the rest of her life."
After over a decade of being in touch with people in 12-step programs, I'm still waiting to see anyone who has anything good or positive to say about restoring sanity or healing.
12-step recovery programs foster dependence upon the programs, tend to keep people in an eternal "powerlessness" state, and constantly try to convince participants of their woeful inadequacy without the support of the group, the 12 steps, and/or a vague higher power.
You state: "While we do need regular food intake in order to maintain our health, we also need to drink fluids in order to live. In fact, we would die quicker by abstaining from liquids than by starving ourselves. So from that standpoint, people with alcoholism need to keep drinking, but in recovery, they focus their efforts on abstaining from drinking one specific liquid: alcohol."
Aside from common allergies and food poisoning, there are no food that chemically causes dependency the way alcohol does. Therefore, your analogy is just faulty. Comparing the CHEMICAL effects of alcohol in the body to the NATURAL effect of food is preposterous. The human body needs food. The human body doesn't need ALCOHOL. It needs fluids but not that type of fluids.