Book Review: Eating Disorders: The Journey to Recovery Workbook, 2nd Ed.
There is no such thing as a life free of distress. And yet in the distress — by learning to move through it, find strengths that help us cope, and most importantly, not avoid it — we often find the path to growth.
This path, from finding escape from the distress of life to finding growth in it, is also the journey that underlies the recovery from an eating disorder.
“People with eating disorders, like all people, flourish when they feel a sense of agency,” write authors Laura J. Goodman and Mona Villapiano.
In their new book, Eating Disorders: The Journey to Recovery Workbook, 2nd Ed., Laura J. Goodman and Mona Villapiano, both experts in the field of eating disorders, provide not just a newfound depth of understanding of eating disorders — and the complications that often confound them — but the very practices, skills and exercises that highlight the path to recovery.
Since a characteristic feature of recovery from an eating disorder is the increased incidence of relapse, the authors explain how the stages of change affect recovery.
“In attempting to understand the high relapse rate for our clients, we saw that they were able to do well in a highly structured and supportive environment, but on discharge, if they were not in what Prochaska coined the “stage of action” they were increasingly vulnerable to relapse, which, in turn, brought increased feelings of frustration, disappointment, depression, and anxiety, for both the individual and loved ones,” write Goodman and Villapiano.
While the stage of action includes exercising agency in the form of implementing skills and strategies, it is preceded by stages such as pre-contemplation, where denial of the issue continues to cause unwillingness to address it or take steps to overcome it.
It is very common for those struggling with an eating disorder to be in denial, and this is understandable when considering that an eating disorder often serves as a protective shield, hiding vulnerable parts of the self.
Goodman and Villapiano write, “As destructive as they are, eating disorders serve individuals by leaving them feeling protected from something larger and more terrifying than the eating disorder itself.”
However, the effects of restrictive dieting alone can lead to severe and dramatic changes in perception, attitude toward food, thoughts and behavior. Goodman and Villapiano cite a study where 36 men were put a restricted diet for three months and then gradually refed (back to their original caloric intake) for the next nine months, and the participants exhibited many of the same emotional, social, and thinking changes observed in clients with eating disorders.
They write, “What we have learned about the behavior, thoughts, and attitudes we see in those who suffer with eating disorders is that many of the symptoms that we might think of as primary psychiatric symptoms may actually be the artifacts of the restricted eating and weight loss.”
Changing the individual’s relationship toward food is an indispensable component of recovery. Some steps Goodman and Villapiano suggest are: normalizing eating as opposed to dieting; eating smaller, more frequent meals; not skipping meals or allowing ourselves to become too hungry; not dieting; and separating eating from watching television, looking at the computer or phone, reading, or having an emotional discussion.
The underlying beliefs, distortions and misperceptions that fuel an eating disorder can also have wide cultural implications. Goodman and Villapiaono write, “Bridling appetites appears to be women’s lot. Today, in the land of plenty, restraining one’s appetite for food is the moral equivalent to restraining sexual appetite in the 19th century.”
Body distortion continues to plague women today, leading to astronomical amounts of plastic surgery, liposuction, and breast augmentation procedures, and yet, Goodman and Villapiano tell us, “The frenzied quest for the perfect body at any cost siphons off women’s emotional and physical energy, vibrancy, motivation, creativity and joy.”
What women should be doing is decreasing the superficial focus on themselves, stop reading about celebrities, diets, fitness, and fashion, and instead look for examples of female achievement in academia, research, human rights and social justice.
They write, “In particular, we recommend that you limit the time spent on all forms of electronics and technology, as messages and images conveyed through mass media have been shown to have a negative impact on society.”
While an eating disorder can act to protect a person from pain — especially in the case of trauma — acknowledging the strength in surviving a trauma can offer a tremendous sense of fortitude and courage. Similarly, in learning to move from a life of loneliness, fear, vulnerability and denial to a place of connection, hope, trust, and compassion is, in itself, an act of courage.
Offering a vast breadth of knowledge and clinical expertise, combined with illuminating exercises, strategies and tips, Goodman and Villapiano have provided a much needed addition to the field of eating disorders and what will likely become a vital component of recovery for many.
Eating Disorders: The Journey to Recovery Workbook, 2nd Ed.
Routledge, November 2018
Paperback, 282 pages