Facing Your Fear Foods in Eating Disorder Recovery

Facing Your Fear Foods in Eating Disorder Recovery Eating Disorders Treatment Print Facing Your Fear Foods in Eating Disorder Recovery By Lauren Muhlheim, PsyD, CEDS facebook twitter linkedin Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy. Learn about our editorial policy Lauren Muhlheim, PsyD, CEDS Medically reviewed by Medically reviewed by Steven Gans, MD on February 02, 2017 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on February 18, 2020 GlobalStock/Getty Images More in Eating Disorders Treatment Symptoms Diagnosis Awareness and Prevention Restricting the range of foods one eats is a common eating disorder symptom among those with restrictive eating disorders,  such as anorexia nervosa, as well as those with overeating disorders, such as bulimia nervosa?? and binge eating disorder.?? Among the former, avoiding calorically dense foods contributes to a ?suppressed weight and maintenance of the disorder. Among the latter, binges often result from the pressure created by setting rigid rules against certain foods, which then become irresistible to the person who violates the rule and binges. Overcoming food avoidance is, therefore, an important therapeutic task for most patients. This avoidance behavior usually emanates from internalized dietary rules about which foods one is  â€œpermitted” to consume and a long list of “forbidden foods.” Recovery from both restrictive as well as binge/purge eating disorders typically includes the reintroduction of these fear foods. In fact, research indicates that reincorporating these foods is an important element of treatment.?? For those with eating disorders, one of the most commonly avoided categories is calorically-dense foods. In the case of orthorexia, the categories avoided might vary and include primarily processed or nonorganic foods. Regardless of restriction “theory” or which foods are avoided the treatment is similar. Tackling the Fear  Foods Developing a list of feared situations in order of fear level is called an exposure “hierarchy” and provides a roadmap for practicing exposure in a way that moves you forward gradually without being too overwhelming. Taking incremental steps makes this process easier.?? Step 1: Make a List Begin by making a list of all of your feared foods and dividing it into three sections: Super Scary Foods, Medium Scary Foods, and Slightly Scary Foods. You might look at the sample list below for inspiration. Slightly Scary Medium Scary Super Scary Salad dressing Pasta Steak Tortillas Pizza Cake Bread Chinese Food Pasta in cream sauce Guacamole Soup Cheeseburgers Cereal Ice cream Candy bars Sausage Butter Bacon Orange juice Pancakes Cookies Make your own categorized list. Try to be as honest and open-minded as you can. Many of these foods will be foods you might only ever eat occasionally (such as cake or donuts), but it is important to include them anyway. Don’t worry: listing them doesn’t mean that you must eat them frequentlyâ€"one suggestion is to spread them out so that you eat a fear food once or twice per week. Include foods you’d rather not eat and foods you make excuses not to eat. Even if you think there might be another reasonable non-eating disorder explanation for avoiding these foods (you think you don’t like them) you are encouraged to add them to the list. Eating disorders can be tricky illnesses. Quite often patients with eating disorders insist they don’t like certain foods, but further on in recovery, they are able to see that it was fear rather than dislike that kept them from those foods. You may also include those foods on which you binge. Now you have your hierarchy and you can determine how slow or fast you go up the ladder. Some people like to go faster and some people like to go slower. Step 2: Plan and Carry out Your Exposures Here’s the thing: exposure is supposed to raise your anxiety. It must do so in order to work.?? Over repeated exposures, the brain is retrained that the scary situation is not truly dangerous. Only with exposure does the brain truly habituate and learn the situation is not dangerous. By contrast, avoiding feared things only perpetuates the fear of them. Thus, we usually advise starting with something from the Slightly Scary list. You don’t need to overwhelm yourself; it should feel “slightly scary” but manageable. Plan to incorporate a single serving of one or two foods from this list per week. Plan to eat this fear food in place of or part of a normal meal or snack. However, plan carefully and be thoughtful. You may want to introduce the food on a day you feel more confident or will have company. If you have had a history of bingeing on pizza, it is inadvisable to order in an entire pizza when you are home alone and expect it to go well. Instead, plan how you can eat a normal portion of it and be successful. Instead, you might go to a pizza restaurant with a friend and order 1 or 2 slices along with a salad and eat it there. How Meal Support Can Help Each food on your list will likely need to be consumed several times (over a period of time) until the thought of eating it no longer causes extreme anxiety. It may also help to break things down into smaller steps. For example, if you are fearful of eating cake, you could start with a bite and over repeated exposures (over a period of weeks or months) work your way up to a full slice. (Don’t worry; you don’t need to eat cake every day!). When working on pasta you can start with a small side of pasta, over time, eat pasta as a main dish with a marinara sauce, and then eventually have a main course of pasta with a richer sauce. It may be helpful to seek support as you do these exposures. You may consider reaching out to friends, family members, or members of your treatment team and ask them to eat with you when you are facing your fear foods. Step 3: Keep Records Many people find it helpful to keep a chart of their exposures.?? On this record you can record the date, the food eaten, and your anxiety rating (on a scale from 0 to 10). It can be reassuring to see the anxiety ratings for certain foods coming down and it can feel good to have evidence for your bravery in facing forbidden foods. Step 4: Behavioral Experiments You may also want to make a note of what your fear is of eating that certain food and run an experiment to see if it comes true. For example, “If I eat a piece of cake I will gain five pounds.” Or “If I eat a piece of pizza I will not be able to stop eating pizza and will continue eating pizza all night.” Make sure to record whether or not your prediction comes true. You will find that it usually does not. After you have conquered all of the foods in the Slightly Scary list, then work on the foods in the Medium Scary list, and finally the Super Scary list in the same way. How to Adapt This to FBT If you are a parent helping your child to recover,?? you can make a list of all the foods they used to eat about two to three years before they showed any signs of an eating disorder. It is often the case that in retrospect, there were subtle signs of restriction long before the eating disorder was diagnosed. This is why it is suggested you go back even further:  this will give you a more accurate picture of the broader range of foods to which you will want to expose your child. Don’t worry about ranking them and if your child is in early recovery, please don’t expect them to willingly participate in this exercise or even to admit that they are afraid of certain foods. It is common for adolescents and young adults in recovery to vehemently assert that they truly do not like these foods. Despite this, keep them on your private list. One of your goals is to help your child to be able to eat all of the foods on this list. In summary, many people find this a scary part of treatment, but it is often the most rewarding. Food expresses culture and offers the opportunity for connection to others. Once you have worked through your fear foods, the whole world of food is open to you. A Word From Verywell Facing your fear foods will likely be distressing, especially in the beginning. By nature, exposure is designed to be! However, with practice, it will become easier. Acknowledge and give yourself credit for taking this brave step towards recovery. Meal Planning Is Important for Anyone Recovering From Eating Disorders