How I Used Cognitive Restructuring to Overcome an Eating Disorder
The cognitive behavioral therapy skill that helped me repair my relationship with food and live a fuller, healthier life.
Growing up in a diet culture-filled world, I lived under a system of beliefs that promotes weight loss, demonizes fat people, and moralizes health. As a result, I feared two things: food and being fat. Under those umbrellas, I also feared hunger, as normal as it is, as well as weight gain and “junk food.” I feared being judged for what I was eating or how I looked. And frankly, I don’t remember a time when I didn’t dislike my thighs or have anxiety over food. When I was 8 years old, I told people I was on a diet.
This worsened as I got older. When I was home alone, I would “stock up” on food, eating for as long as I could. I also flirted a good bit with restriction, skipping meals and limiting how much I ate. When I got to high school, the “stocking up” turned into full-blown binging, and the skipping one meal turned into skipping multiple meals in a row.
While my eating disorder truly had all the control, I thought I did. After all, in our society, people pride themselves on eating little and losing weight — which is what I was doing, at least in front of others. I felt comfortable in my skin because no one could judge me over what I was eating or how I looked — unless they realized the harm in my behaviors, which was far from my concern.
I’m grateful I can say I’m mostly recovered now, thanks to loved ones, therapy, and educational books. I struggle less with disordered thinking about food and weight; I eat enough and what I want, and I don’t weigh myself anymore. I know my value is in who I am, not what I look like, and my life is about so much more than food or the lack of it.
However, this took time and work, especially from where I was at my lowest. Keep reading to learn more about how I realized I needed help and how to engage in cognitive restructuring, a therapeutic tool that essentially saved my life.
Realizing I Was Sick and Starting Therapy
While I told myself what I was doing was “healthy” and “sustainable,” I always knew, deep down, that I was experiencing an eating disorder. When you’re sticking your fingers down your throat, especially, and even if only a few times, you can’t help but have one resounding and terrifying thought: This is wrong; this is dangerous.
When I looked up the criteria for an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), I realized I had an other specified feeding or eating disorder (OSFED). I didn’t quite meet the weight criterion for anorexia, the disorder my behaviors looked most like, which meant I had OSFED. When I turned 18, a psychologist administered the Minnesota Multiphasic Personality Inventory, a 567-question test that helps determine a diagnosis, for me; she later confirmed I had an eating disorder, anxiety, and depression.
But it didn’t take a formal diagnosis for me to know I was a) sick, and b) sick of being sick. The binging-restricting cycle I was stuck in caused me a lot of stress and kept me from fully enjoying time with friends, something I value deeply. I also didn’t want to be chained to the scale every day, my mood depending on if the number was higher or lower than it was a day or even 30 minutes ago.
“I have one question,” I remember texting my dad quite dramatically one night after having those realizations. “How much does a shrink cost?” As much as I thought my eating disorder “helped” me cope with my emotions, I knew I was out of control and the time to recover had arrived. The constant worrying about food and weight exhausted me, and I felt like God was telling me it was time to get better.
After looking through Psychology Today’s mental health professionals database, I found a therapist nearby who specialized in eating disorders. While I felt hopeful about getting better, I didn’t realize just how much therapy with her would help me. When we started, I told her I loved doing therapeutic worksheets and talking things out, so we engaged in both. Additionally, we practiced cognitive restructuring, a tool found in cognitive behavioral therapy (CBT).
The Role of Cognitive Behavioral Therapy and Cognitive Restructuring
Cognitive restructuring is a process in which you work to change negative thoughts into more positive, helpful ones by looking at the evidence. A helpful technique for practicing this is “putting your thoughts on trial” in which you look at the facts on both sides and then determine the “verdict.” Below is an example:
As mentioned previously, cognitive restructuring is a tool in CBT. CBT helps change the ways people think, feel, and behave so they can respond to difficult situations in more helpful, productive ways. CBT believes that someone’s perception of a situation can affect their reaction more than the situation itself.
CBT is one of the most effective kinds of therapy for people struggling with depression, anxiety, and eating disorders — all of which I had. This is probably because all three disorders share a common symptom: cognitive distortions, or irrational thoughts that can affect your emotions. The particular distortions I experienced most within my eating disorder were magnification, catastrophizing, magical thinking, mind reading, emotional reasoning, “should’’ statements, and all-or-nothing thinking — so basically, almost all of them. Below are personal examples that explain what those can look like for someone with an eating disorder.
- As far as magnification, I exaggerated how awful gaining weight or eating a little extra food would be. I weighed myself daily, and an increase on the scale would practically ruin my entire day. And if I engaged in reactive eating, or eating a lot after starvation, I believed I was a failure and feared I would suddenly gain 10 pounds overnight. In fact, overeating scared me so much that I’d have nightmares about binging. This only encouraged me to restrict even more.
- Those weight worries are also examples of catastrophizing. One dessert couldn’t cause me to gain 10 actual pounds overnight — even a binge couldn’t do that. But I was so caught up in my eating disorder and its distortions, I lost sight of logic.
- I also engaged in a variety of magical thinking-style thoughts. I thought my eating disorder gave me control. I thought if I was skinny, I’d always feel confident. And pair up magical thinking with the invalidation that people with eating disorders often feel, and I thought I’d never face a medical ramification from my behaviors. These were all so far from the truth.
- Additionally, I thought I was a mind-reader. I always worried people were judging what I was eating, when in fact, they were probably more focused on themselves. Within that, I employed emotional reasoning. When I “felt fat” (even though “fat” is not a feeling) or as though others were judging me, those anxieties solidified into facts in my mind.
- The “should” statements I experienced are probably not foreign to many people. I told myself what I “should” and “shouldn’t” eat, moralizing food and ignoring my body’s signals. Nobody knows my body better than my body does, but somehow I believed my body could be wrong, or that it would just have to put up with the gnawing hunger because weight loss and “control” were more important.
- Lastly, all-or-nothing thinking is prominent with binge eating behaviors especially. If I “ruined” a “good restricting day” by eating dessert, I figured I might as well go all out and binge, then try again tomorrow. And, you guessed it, my behaviors dug me deeper into my eating disorder, causing me to feel worse.
Cognitive restructuring helps people realize the false logic behind those anxieties and disordered thoughts. Through its process, you find facts that back up why those distortions are, well, distorted. Here are some corrected thoughts I realized through practicing this skill:
- One night of binging won’t cause me to gain any actual weight. After multiple nights of binging and weigh-ins the next morning, I’ve ascertained this.
- But, if I do gain weight for whatever reason, people will still love me. It’s okay to be fat. Plus, I had friends and family who cared about me at my highest weights, and many fat celebrities are well-loved.
- Eating disorders are dangerous. Mine told me I “wasn’t sick enough,” yet I struggled with lethargy, headaches, and more.
- Losing weight won’t make me feel unconditionally confident in which I love my body all the time. Plus, the more I lost weight, the more I cared about that weight loss and hated my body for every pound it gained. And when I gained weight consistently, I had a healthier mind that realized life offers too much goodness to worry about weight and food constantly.
- My body knows what it needs and will tell me — it was programmed that way. When I trust my body and eat intuitively, I’ll feel less of a need to binge because I’ll be well-fed and nourished.
- Binging will and has only made me feel worse. “Going all out” is not the answer. Self-compassion, however, makes me feel better and is a more helpful choice.
My Experience With CBT and Cognitive Restructuring
My therapist first brought up helpful truths like these in normal conversation. “I feel guilty about eating so much fried food,” I remember saying to her. In response, she said this: “What if you don’t see food as having moral value, but simply just as food?”
Having never heard this before — which is a wild thought, because I now preach it all the time — I was a bit taken aback. I felt relief, because that’s exactly what I needed, but also a bit of fear, because I’d be going against everything people had taught me my entire life. However, I knew what I’d learned about food over the course of my life had only hurt me, so I welcomed her suggestions with open arms. I’ll always be grateful I did.
Besides our conversations, she also gave me worksheets and activities to do both in session and at home, knowing I had an interest in using them as a tool to recover. One of the most helpful assignments was writing my thoughts and then my arguments for and against them. This helped me figure out the actual truth and how it could help me in my recovery journey.
I later learned this practice is the “cognitive restructuring” skill I’ve been talking about. While it didn’t completely cure me and while it took practice, how much and how quickly it helped both encouraged and impressed me.
The Specific Steps For Cognitive Restructuring
To help you implement cognitive restructuring so you can live an eating disorder-free life, I’ve explained the exact steps I took and examples that can help get your brain going.
Step 1: Write your anxious thought
What thoughts are you having that are giving you distress or triggering you to engage in an eating disorder behavior? Some examples include:
- Example 1: “I’m hungry, but if I eat anything else, my friends will judge me.”
- Example 2: “I need to ‘get sicker’ so people will take me seriously. With no medical complications and without being underweight, I don’t truly have an eating disorder.”
- Example 3: “I’ve already overeaten, so I might as well binge.”
This step may be emotionally difficult. You’re having to confront and address what may be some of your deepest anxieties, and your eating disorder voice may convince you that those anxieties are correct. My advice here is to write what you can, regardless of whether you truly believe it’s a distorted thought, all while being as honest with yourself as possible.
Step 2: Write evidence for the thought
Write down truths you know that support or back up your original anxious thoughts. What experiences of yours make you believe those anxious thoughts could be true? For this step, you’re essentially pretending you’re a prosecutor, arguing why your anxious thoughts are factual. Below are examples you might find relevant with the thoughts in step one, respectively:
- Example 1: “My friends are finished eating now, so they may wonder why I’m still hungry. And that one time I ate more than them, Emily gave me some confused looks. (I’m crossing out that last line because that’s more of an interpretation than a fact. I may have been projecting my worries, or she may have felt confused because I rarely eat much around others.)”
- Example 2: “People in general and even some doctors tend to take mental health more seriously when it shows physically, as wrong and misinformed as that is. They may not take me as seriously since I’m not underweight.”
- Example 3: “Binging may distract me from my thoughts and give me temporary relief from the anxiety I’m feeling.”
I want to make sure you know it’s okay to feel emotional as you write these down. Eating disorders are difficult mental illnesses that often stem from serious, hard-to-fix situations. You’re allowed to feel sad for yourself and for the world.
Step 3: Write evidence against the thought
Next, either below or beside those arguments, list some facts that negate your distorted thoughts. What do you know to be true that proves those anxieties wrong? For this step, you’re acting as the “defense attorney,” trying to prove why your anxious thoughts aren’t based in fact. Below are examples of ways you can disprove the thoughts in step one, respectively:
- Example 1: “If I restrict my eating like I used to, I’ll only end up binging. It’s best for me to listen to my body and have a snack. My friends likely won’t judge me — people are often more focused on themselves than anyone else — but if they do, I can handle that distress. I’m doing the right thing for my body, and I know they still love me.”
- Example 2: “Not everyone with an eating disorder is underweight and suffering from deathly medical complications. Further, going deeper into my eating disorder and experiencing physical ramifications will only make things worse. My eating disorder is valid as is.”
- Example 3: “I may be more full than I want to be right now, but according to dietitians, that’s a normal part of eating. I can choose to move forward positively by eating healthily. Binging will only make me feel more shame and guilt, as it has in the past.”
This step may also be hard, especially when you’re deep in your eating disorder. If you can’t think of anything to write for this section, I encourage trying free support groups or reading examples like those above. You may not totally believe the truths you read, or you may have to repeat them to yourself over and over for them to stick. However, I can tell you that after practicing this for years, it gets a lot easier, in which you think of disproving truths more quickly.
Those facts will also feel more true to you over time. For example, you may continue to gain weight, and your friends will still want to hang out with you. You’ll continue to eat and nourish your brain, and you’ll realize that life is about more than just food and weight. In other words, continue practicing this tool as patiently as you can, and you will see results in time. Recovery isn’t linear, but it gets better as you get stronger.
Step 4: Look at both sides and decide your “verdict”
The last part of this exercise entails looking at both sides you’ve written and figuring out what the actual truth is — which likely incorporates some aspects from both sides. Using the examples above, here are some realizations you may come to in the end:
- Example 1: “My friends may or may not wonder why I’m still hungry, but either way, I don’t have evidence showing they’re judging me or don’t like me anymore.”
- Example 2: “While people may unfortunately pay better attention to those who are visibly sick, that doesn’t mean they won’t believe me when I share my experience. And regardless of how they respond, I know my eating disorder is valid and that medical complications will only worsen my quality of life. Further, going deeper into my eating disorder will make it harder to come out of.”
- Example 3: “While binging can release dopamine and help me feel better at first, I’ll only feel worse in the end. I trust what I know from past experiences.”
As you can see, these final realizations don’t negate the validity of either side. The goal is to write truths that are honest and lead to healthy, helpful choices. You also want to aim to go through this process for each anxious thought you wrote down, but don’t feel bad if you struggle to do so. Creating these statements may be harder at the beginning, but don’t be afraid to reach out, whether online or with someone you know in real life. You don’t have to believe your “verdicts” fully yet, but write them down anyway. You also don’t have to write something down for every single anxiety; just write as much as you can.
How I’m Doing Years Later, and Final Thoughts
As I mentioned above, this process takes time. While I wish we could remind ourselves of those helpful truths just once and be recovered, it doesn’t work that way. Eating disorders are sneaky, insidious, and convincing; they creep in when we’re already feeling vulnerable from other stressors. The only way out, unfortunately, is through.
Repetition is an integral part of this experience, both in CBT’s reliance on it and in what I know helped me. The more we hear something, the more we believe it, and I’ve seen this in my own life. When my therapist first told me food doesn’t have moral value, for example, the concept was new. I mostly believed it because I trusted her knowledge, but I still felt heavy guilt when I ate “bad” or “unhealthy” foods. Now, I can confidently and easily say that food has no moral value — it’s just food — and I eat what I want without a second thought.
Additionally, engaging in further research that backs up those above helpful truths played a crucial role in my recovery. I’m currently reading (and loving) “The F*ck It Diet” by Caroline Dooner, and I plan to read “Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating” by dietitian Christy Harrison next. Repetition can’t come from only ourselves or others; it’s best when we can experience it both internally and externally.
Six years have passed since I started recovery the first time, and I still struggle. I still feel guilty about what or how much I eat sometimes, and I don’t always feel great about my body’s size. But when these thoughts arise, I can quickly change them to be more helpful. I remember that my food intake doesn’t change who I am as a person, and that I’m loved for who I am, not what I look like. I struggle a lot less, and I keep fighting. I engage in cognitive restructuring probably every day, because eating disorders can be an ongoing battle, but I know they’re an opponent worth fighting against. I’m also less tired from doing the work because it requires less from me now. For example, I don’t have to write my thoughts down anymore — I just think about them. They come to me naturally; I don’t have to try so hard.
I’ve been in active recovery after a minor slip for about a year now, and I don’t see myself going back to my disordered behaviors. I know they aren’t sustainable or healthy. I can also better discern when my thoughts are coming from my eating disorder, which wants me to be stuck worrying about food forever, and I ignore them. I also reach out to loved ones and other resources to support me in this endeavor. Through changing my disordered thoughts internally and with others’ help, I have a more positive, healthy relationship with food in which I don’t fear it or feel guilty after enjoying it. If you told me a few years ago I could order whatever I wanted off a menu without worrying about the calories, I wouldn’t have believed you — but that’s where I am today.
I want to be clear that I have a lot of privileges that many don’t have. With my family’s help, I could afford therapy and educational books. I’m also a white woman with thin privilege, meaning people believed me when I told them about my struggles, and I face less identity-based oppression. While cognitive restructuring probably saved my life, it may not work for everyone. If this tool or another tool doesn’t work for you, it’s not your fault — we all have different experiences and feelings that shape our different needs. Don’t feel guilty or shameful, just respect yourself and know you’re not weird or hopeless.
Possibly most of all, however, I want everyone struggling with an eating disorder to know this: You can overcome your eating disorder, and you are worth recovery. Your eating disorder won’t serve the same purpose it used to, but that’s okay, because you’ll learn new coping strategies and truths that can help you live a happier, freer life. I have faith in you.
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