When Challenging Your Eating Disorder Thoughts Isn't Working
Updated: Mar 7, 2019
When challenging your eating disorder thoughts isn’t working
By Laura Machado, PsyD
If you’ve had any eating disorder treatment before, you’ve probably heard: challenge your thoughts! Talk back to that eating disorder! Your therapist may have had you “dialogue” with the eating disorder (ED). Something like this:
ED: You can’t eat that muffin. It has too many calories.
YOU: Yes I can. My therapist and dietitian said I can.
ED: Yeah but that’s a big muffin.
YOU: Muffins come in all shapes and sizes and all of them are okay to eat.
ED: (Silence… nothing more to say)
(You proceed to eat the muffin)
If that is how it has been going for you, that is awesome! You don’t need this blog post.
However, there’s a good percentage of people for whom talking back to the eating disorder thoughts does not work. Worse, it seems to almost worsen the whole situation. You talk back to the eating disorder thought…. but it responds with something pretty convincing. So you talk back again, but it responds back with something still convincing. So you talk back again, and it responds, and you talk back again, then it responds again, then you talk again, then it responds again. There’s no end…until your brain is basically on fire and you feel all amped up and like you don’t know which way is up and which way is down anymore and so to quiet the whole thing, you just engage in the eating disorder behavior.
If this happens to you, you’ve probably been told: Just keep talking back to that eating disorder! This is supposed to be hard work! And so…. You try. Oh my do you try! You go at it, year after year maybe, “talking back to that eating disorder.” But… you’re getting nowhere. Instead, your head feels hot with overthinking - like literally hot. You feel a little bit crazy. And you feel like a failure.
Maybe other people can “beat” their eating disorder but not you.
You are not crazy.
You are not a hopeless case.
It’s just that, for people with brains like yours, “talking back” to the eating disorder doesn’t work. In fact, I would go so far as to say it might worsen the whole situation.
If you resonate with this, I really want to reach out to you to offer you hope. There is another way to deal with eating disorder thoughts besides “dialoguing” with them.
This is a little detailed, but hear me out. I think I can help.
First, let’s start with some education: many people with eating disorders have an obsessive thought process called “Pathological Doubt.” It means that you are a relentless truth seeker, always doubting your most recent conclusion, and then re-thinking the whole thing only to come to a conclusion (maybe even the same one as before), but then doubting that conclusion and re-thinking the whole thing again...in an endless cycle.
This thinking style is such an amazing strength for something like analyzing research, participating in debate, writing a dissertation even. But this is a super terrible process when it comes to choosing your lunch.
If you apply pathological doubt to lunch, it’ll go something like this:
Okay, I set a goal with my treatment team to eat a philly cheesesteak with a soda for lunch. My eating disorder says that’s too rich, but it’s okay because I’m going to trust my treatment team and people are allowed to eat rich food. Yup, totally going to eat it. The sandwich is officially okay to eat.
Hm… I wonder if when my treatment team approved this meal they knew the sandwich-maker was going to put a sauce on the sandwich. There appears to be both mayo and a sauce. Since there’s an extra sauce, maybe that sauce “counts” as the soda? So maybe I shouldn’t have a soda. No, I think the treatment team would call skipping the soda because of the sauce “restricting.” If I want to not have an eating disorder, I can’t restrict, so I am going to eat the sandwich and the soda. Plus, one meal will not have an effect on my body. I’ve decided: I will have the sandwich and the soda. And it is all officially okay to eat.
But... this appears to be more meat than normal. Maybe the sandwich-makers thought my order was “double meat.” They do have that option on the menu, but I didn’t say that. That would throw off the whole calorie count if they thought I said “double meat.” I wonder if they got my order wrong. Maybe I should get the sandwich, take it home, take it apart, and weigh the meat. No, normal people don’t weigh meat, so I won’t do that. You don’t have to eat the exact same amount of calories everyday. My body can handle variability. It’s okay if my sandwich has more meat than I’m used to. Having more meat will not have any harmful effect on me. Okay, I’m going to eat the sandwich as is. It is again officially okay to eat.
But… is the meat organic and pasture raised? Let me pull out my phone and research this restaurant to see if they say where they get the meat from. No, I am allowed to eat this sandwich even if I can’t perfectly know where all the ingredients come from. I am not going to google. It’s decided. Yup, it’s definitely okay to eat.
But… they are apparently cooking the meat with oil. I can’t tell how much oil they’re putting on here. Maybe I should just eat 70% of the sandwich to compensate for the vague amount of oil? No, normal people don’t do that. Plus, lunch doesn’t have to look the same every day. Oil is not bad for you. Okay, I won’t do that. I’ll eat the sandwich and soda exactly as it comes. Ok, now for sure the sandwich is okay to eat.
You see how this goes. Even though you keep concluding it's okay to eat, it doesn't feel settling.
So if that is your thought process, and no matter if you challenge your thoughts, they just keep going and you get more and more revved up and your head feels crazy, then you probably have a pathologically doubting, obsessive thought style.
And for people with that brain style: THERE IS ANOTHER WAY to “overcoming” your thoughts.
Step one: As soon as you sense the over-thinking, LABEL THE PROCESS AS PATHOLOGICAL DOUBT. DO NOT RESPOND TO THE CONTENT OF THE THOUGHT.
LET ME REPEAT: DO NOT RESPOND TO THE CONTENT.
The thing is, if you have an obsessive thought style, challenging the thought content just keeps that neural pathway alive. It is like adding fuel to the fire. It just ramps it up until your brain is spinning so fast you’re exhausted. In this way, challenging your thoughts in the traditional sense has made it worse and has strengthened the very thought process it was trying to beat.
You will know when Pathological Doubt is starting up because you probably know what that feels like in your head - relentless and super seductive. Or, you know that certain topics (e.g., food) have been hijacked by pathological doubt for now. Anytime that topic comes into your mind, you can treat it like you would Pathological doubt: by labeling the process but not responding to the content.
So how do you label the process and not respond to the content of the thought?
It looks like this:
ED: Did the sandwich-makers think you said “double meat?” That’s a lot of meat...
(You realize that this is how over thinking begins! You know that wondering about meat is a common breeding ground for pathological doubt for you. A-ha! You know what’s going on here!)
(Now… do not say anything back to yourself about the content. That is, do not say anything back to yourself about meat at all. Or the sandwich. Or food in general. Instead….)
YOU: This is pathological doubt. This is pathological doubt. I see you, pathological doubt.
Step two: Monologue back to Pathological Doubt and tell it you know what’s going on in a calm, casual way. Feel your strength as you do it.
You: This is pathological doubt. Pathological doubt is here. Okay, pathological doubt, I’m not engaging. Pathological doubt, I know you. You think, and you think again, and you think again and again. You analyze every conclusion. That’s you, pathological doubt. You will come in handy at another time. Right now, I’m not engaging. You can keep talking, but I’m moving on.
Note: when you do this, you are talking from a different part of yourself. You are not strengthening the obsessive neural pathway. You instead have diffused, or separated, or jumped out of, that thought loop. That’s a huge win! That’s the whole goal. To jump out of that thought loop. You're also talking from a space of calm instead of intensity. This calm energy also helps you to activate another way of being, which is another huge win.
Step three: Shift-focus to anything else. And act excited to do so!
You might have to initially plan in advance what you will shift focus to (e.g., a phone game, call a friend, sing a song, etc.). Actually, it can even work to choose to shift the attention to the taste of food or to the conversation with the person making the sandwich.
If you haven’t planned anything in advance and you can’t think of anything in the moment to shift your attention to, you can just start calmly narrating what you’re doing in the moment and where you are:
“Here I am, standing here, I’m standing here on my two feet, I’m about to order a sandwich. That’s right. Sandwich time. Because I am not engaging with pathological doubt. Pathological doubt is an awesome strength but not right now. Oh look, my hand is holding my wallet. My wallet has money in it. My feet are in my shoes. Yup, Yup, Here I am, standing on the tile floor.”
And don’t say this all in an anxious tone, like you’re afraid of pathological doubt. Say it in a confident and calm tone. Again, in doing that, you are stepping out of the problematic, obsessive thought loop and into a different one. And if you do it while embodying calm - and not fear - then you really step into a different part of yourself that is the part that can and will recover. Victory!
Pretty soon, pathological doubt will quiet down.
If the pathological doubt doesn’t quiet down….that’s expected at first. You just label the process again. So, for example, it pipes up, “Yeah but do you know what kind of bread this sandwich is on?” And you interrupt it as soon as you notice and say “Not talking to you, pathological doubt.” And just keep repeating “Not now, pathological doubt.” Do it as many times as needed, with a tone of confidence.
The key here is this is not about finding a more convincing way to talk to pathological doubt - this is just you being a broken record, gaining confidence that no, you’re not talking to pathological doubt. The energy is confident and calm throughout. It's not forceful. It's just calm.
Now if you want to take this even further to deepen your recovery, here’s a little task: the part of you that can observe and note the pathological doubt is a part of you. Take that in. There is a part of you that is not obsessive, that doesn’t overthink, that is sturdy. Write a monologue or a journal entry or make an art project ONLY from that part of you! If Pathological Doubt tries to participate, just say “I see you, but right now I’m the one doing this [art project, writing project, whatever].” And keep going.
Your obsessive brain is beautiful. It is thorough. It is smart. It is an incredible strength! The task is to use it when it helps you and learn to disengage when it tries to talk to you about your food or body ;)