My next piece will use a step by step guide to demonstrate how to sit in the urge feeling of an eating disorder. It will be in two parts. In Part I below, I address the background, process, and emotional components of a technique I’ve adapted for eating disorder recovery. Next Wednesday in Part II, I will provide specific examples of how to apply these techniques to common components of an eating disorder. Part II is written to be used as a reference guide, so feel free to skip any sections that you don’t feel apply to you.
A more important note: I write to share my experiences and show that recovery is possible. But it’s important to understand that I am not a medical professional. If you are suffering from an eating disorder please reach out to your doctor or a trusted medical professional for help. Tell your coach, a friend, a family member. There are a ton of excellent resources out there. ANAD is a great place to start. They even have a free helpline available: 888-375-7767.
Part I
In the previous article, I used a specific running example to demonstrate how your strength as an athlete, and your desire to seek out pain in racing and training, can be your secret weapon in eating disorder recovery. Your ability to sit in the uncomfortable allows you to willingly set up single moment decisions where you must choose yourself or the eating disorder. The repetition of this confrontation will begin to rewire your brain. It will be excruciating. But over time, we learn to trust that this feeling will shift. The moments of being uncomfortable will diminish from five hours to five minutes, to mere seconds.
An eating disorder will create an all consuming feeling of urge inside of you. The urge to binge or purge, the urge to restrict, or the urge to compulsively exercise may come once a month, a couple times a week, or multiple times in one day. Your ability to confront this urge, and your willingness to sit in the emotional and physical pain that it brings, is essential to recovery. But how do you do this?
The following is a step by step guide designed to answer that question as well as:
How does it feel?
What do I do when I’m in it- no, like literally, what do i do?
I have an eating disorder but no exercise addiction component — does this apply to me?
I’m an athlete — how will I allow myself to eat if I get injured and am unable to train?
The pain that comes from sitting still feels so different from other pain I have felt — how do I sit in that?
When I was very young I dealt with debilitating obsessive-compulsive disorder. The American Psychiatric Association defines obsessive-compulsive disorder (OCD) as: “a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions).“ 1
This was the cycle as I experienced it at the time:
I have an unwanted thought that becomes an obsession.
I feel an urge to do a compulsion in order to immediately relieve the anxiety that the obsession evokes.
Upon completion of the compulsion, I get an incredible sense of relief.
I am then able to function.
This relief lasts a moment, or a minute, or five minutes, and then the unwanted thought pops back into my head and the cycle ensues.
An example might help:
Unwanted thought: I am terrified that a fire will cause the death of my family.
Urge to do compulsion: I feel an immediate and intense need to quell this thought, alleviate my fear, and make the house safe.
Act of compulsion: I wake up to check the light sockets, light bulbs, stove, oven, heater; anything potentially dangerous.
Relief: I find them all turned off, cool, safe.
There is a problem: the relief feeling is short lived. Inevitably I do not trust that the act of checking had actually occurred, and there is an intense fear that I have missed or forgotten something crucial. A few minutes later, I get out of bed and repeat the process. I do this all night long. The act of compulsion is reinforcing the fear, urge, anxiety, and the cycle continues to feed itself. It is literally consuming and I find it impossible to function without this coping mechanism.
As a child, my mind was dominated by these types of thoughts. I would repeat prayers in my head, convinced they would keep my parents alive. And I would watch them breathe at night, believing that as long as I kept this up, they were safe. I would check doors to make sure they were locked, the stove to make sure it was off, and organize my room until everything sat in its place; each item the perfect distance from the next. I washed my hands repeatedly. My mom found me one morning when I was about five years old standing at the sink with my hands submerged in the plugged bowl of water. When she asked what I was doing, I said “it feels good like this because I know they’re clean and I can rest.”
At times, the OCD was strictly compulsion based without the fear/thought component. When this was the case, I needed to get a very specific feeling of relief to land in my body. I would turn on and off light switches thirty times, count sit ups late at night in my room, or spin in circles until I got that feeling. All of this made me feel crazy and weird and like a complete outcast. I was too ashamed to tell anyone what I was thinking, feeling, or what my days and nights consisted of.
Why am I talking about OCD all of a sudden?
Because the treatment I received for these OCD behaviors is what taught me how to sit in the uncomfortable feeling of urge. It is what forced me to consciously and constantly set up the single moment decision I keep referring to. It’s what taught me to trust that the extreme discomfort would eventually pass. And it was the daily repetition of these observations that allowed me to overcome the obsessions and compulsions that had consumed me.
Exposure and response prevention (ERP) is the type of cognitive behavioral therapy I was taught. It is often used in the treatment of OCD and “uses repeated and prolonged exposures to fear-eliciting stimuli, combined with strict abstinence from compulsive behaviors.” 2
I am grateful to have parents that recognized what was going on with me, and sought out the help of a specialist. When I was eight years old, I met with Dr. Christine Braden three times a week and she taught me how to do variations of ERP. I would then return home to practice these skills.
The lessons began with the least threatening urge/act combo: turning on and off light switches. We worked our way up to the two most terrifying and challenging urge/act combos: the act of spinning (terrifying because of the ridicule in elementary school for doing such a thing in public), and the repetitive prayers aimed at protecting the lives of my parents.
This meant that everyday, before and after school, I did the behavioral therapy alone in my room. I was too embarrassed to have help or company, and found it best suited to grit out solo.
What a session of ERP looked like:
I feel the urge to spin.
I do not spin.
I sit.
I start a timer.
I write down a number from 1-10 (1 insignificant, 10 the worst) in my notebook to gauge how bad the intensity of the urge is, how bad the anxiety feels, and how badly I want to spin.
It always starts at 10.
Sitting in this urge feeling makes me want to die.
I cry and yell and hit my bed and the floor; the thought of having to wait this feeling out is too intense and too terrifying to rationalize.
What if it doesn’t stop? What if it doesn’t go away?
Then, I feel that single moment appear and I make the decision not to proceed in urge.
I choose to sit in stillness and break the “act of compulsion”.
It feels like I am jumping off of a cliff and free falling into the depths of who knows what. My heart pounds and I am paralyzed in knowing that I cannot spin. It’s too difficult to think ahead, or back; so I stay still.
But that moment, that split second decision, though torturous, lets me know the urge will not win here. Not in this session.
I hold on.
I sit for 10 minutes.
20 minutes.
60 minutes.
I sit for however long it takes.
Every three minutes, I track the intensity of urge that I am feeling with the 1-10 scale, and mark the latest number in my notebook.
I repeat this process until the intensity drops to a 3 or below.
This result will conclude a session.
I get up, take a deep breath, and put the notebook away.
I go about my day — off to school, or off to play with friends.
I was free to act on the compulsions at any other time of day, just not in the designated daily ERP sessions.
This daily practice saved me. The sessions became easier and less intense over time. And it taught me an internal strength that would translate later in life. By the age of 13, I was able to conquer the OCD compulsions and resume what felt like a normal childhood. But I was afraid to think about it, talk about it, or remember it, for the fear that all of the compulsions would return. So I shut it away. Two years later, I developed bulimia nervosa. Many years later, I learned the correlation for me between OCD, eating disorders, and exercise addiction. I then taught myself how to apply the above process to eating disorder recovery.
You keep talking about urge, but what does that actually feel like?
I feel urge shallow in my chest. It flutters and pounds and spins in chaos while there. My heart races, I sweat, shake, can’t breathe. Pressure and weight press down. Drowning. It’s like I was pumped full of adrenaline or had five too many cups of coffee. It feels like I want to scream and hit and throw things. Like I’m coming out of my skin, and am on the brink of exploding or crying or disappearing. A new level of anger is reached, destroying everything in its path. It is consuming and overwhelming and leaves me lost.
The experience of this feeling will be different for everyone. Start to examine where in your body you feel urge and what specifically it feels like. Get to know the sensations and thoughts, and examine the fears that surface. Become intimate with these feelings because the more you understand them, the easier it becomes to embrace them — then you can use them to your advantage in recovery.
I know what pain feels like — isn’t sitting in urge the same thing?
No. The pain of urge is different. It’s not the type of pain I feel from great emotional loss. It’s not the type I feel from an injury or sickness. It’s not the type of pain I feel deep in a race when everything in my body wants to quit.
It’s the unification of physical, mental, and emotional pain. It masks itself as infinite, creating a sense of terror and loss of control. It’s the type of pain that makes me feel like I am on the brink of losing myself. A battle with my inner being, my gut instinct, my intuition. All of my internal and external fears collide at once. It does not feel rational. To sit in urge feels like I’ve fallen off a cliff but somehow managed to catch my foot along the way; keeping me from imminent death. Each movement made to claw myself to the top produces a new moment of fear, exhaustion, adrenaline, pain. But there is no other option than to climb, because I’ve chosen to put myself in this moment. The battle culminates here: the understanding that I must climb out, but feeling lost at how to execute such an act. We have to be willing to let this foreign type of pain consume us every day, over and over, in order to make progress in recovery.
And the relief part…how will I know when I am there?
Relief can be a bit sneaky. I categorize relief in two parts:
Relief from getting rid of urge: This is the feeling of relief that comes when the “act of compulsion” is done to alleviate an urge. It is disingenuous and false. It is shallow, and short lived. It’s as dangerous as the urge because it reinforces the fear and anxiety by tricking me into thinking the cycle is complete, and will not return. (How many times have we said, “this is the last time I will throw up. No matter what. Life starts over tomorrow…”? Exactly.) It’s the high that makes me feel shaky and a bit badass and a bit terrified at the same time. It’s the relief that helps me function for one more hour, but never really feels safe. I don’t trust this version of relief.
Examples: The relief that comes from purging after a binge, finding the stove off after checking it for the third time, sneaking in extra exercise routines, restricting more calories than the day before.
Relief from sitting in urge and letting it pass: This relief is quite different. It’s the feeling in your body when everything is settled. The “ah, I can breathe. '' Solid. At peace. I feel this deep in my stomach, between my belly button and my back, deep, deep in. It’s a feeling that stands alone, that is so specific and recognizable, I can’t help but look it in the eye when I’m feeling fearless. There is a power here that represents pure grit. It’s that feeling when I know I made the right decision about a relationship, a job, a way of treating another. It feels like my true self. It feels comforting and genuine and safe. When I was a teenager my aunt told me that things will get really shitty in life, and when they do: “hold onto that gut place inside of you.” Grip it with every ounce of your being while the world spins, the waves crash, darkness consumes, and nothing makes sense. Do not let go. For when the spinning stops, and the dust settles, and the wave succeeds, you will remain. Intact. Whole. Stronger. Braver. Willing and beyond freaking able. This is what relief from sitting in urge feels like to me.
Examples: Not giving in to the urge to purge, hitting calories on a day when I am sad or angry and don’t want to eat, not secretly adding extra miles onto my run, doing any and all hard things.
Cheat Sheet:
My therapist and I have interpreted the second type of relief feeling as “gut” (as in gut instinct) and often use the phrase “Gut vs. Urge” as a way to recognize when the eating disorder voice is getting too loud. It helps guide me in knowing when to sit in the uncomfortable and do some good old fashioned work.
Urge = Eating disorder voice, exercise addiction voice, OCD voice, unsettled fear and anxiety. Discover where you feel this in your body (I feel it shallow in my chest), and use it as your tell to know when the eating disorder voice is sneaking in and getting too loud. Do not act on this feeling.
Gut = Peace, true self, gut instinct, feeling of “ah, I can breathe”, honest relief, feels like everything is in sync. Discover where you feel this in your body (I feel this deep in my stomach), and use it as your tell to trust yourself. Remind yourself that the gritty work is worth this gut feeling. Act when you feel this.
A quick way to keep yourself in check is to ask the question: “Is it gut or urge that I’m feeling right now?” and then act accordingly. This is why it helps to know where you feel it in your body — your brain will trick you, but you body will remain a true tell.
You have to sit in urge to get to the gut.
Trust your body, quiet your mind.
A recap:
Years of honing the behavioral therapy skills needed to overcome the compulsions of obsessive-compulsive disorder now assist in my recovery from bulimia nervosa and exercise addiction.
When I speak of sitting in the uncomfortable, and the single moment decision, I am talking about sitting in the “urge to do compulsion” section on the chart above. In that single moment decision you can choose NOT to act in urge.
To break the cycle of an eating disorder, there have to be moments where the “act of compulsion” does not happen. The repetition and consistency of this work will rewire the brain to feel true relief from sitting in the pain of urge, rather than acting out the compulsion. And the process will get easier over time.
Next week I will break down specific scenarios and demonstrate how to apply this process to various components of an eating disorder.
American Psychiatric Association. (2020). “What is Obsessive Compulsive Disorder?” https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder
Grant, Jon E. (2014). The New England Journal of Medicine. “Obsessive-Compulsive Disorder.” https://www.nejm.org/doi/full/10.1056/NEJMcp1402176