National Eating Disorders Association

Eating Disorders: Recovering through Relationship

Nicole Siegfried, Ph.D., CEDS

Thank you to Alsana for sponsoring this blog post.

Eating disorder recovery does not occur in isolation. In fact, research shows that a full recovery is achieved through relationships with self, others, and a higher purpose. Treatment is most successful when clients develop a relationship with self beyond their eating disorder; a connection to others; and a deeper sense of self-worth and purpose. This relational work instills the hope and motivation needed for the recovery journey – and the inspiration to continue to thrive once clients leave treatment. 

Relationship with Self: Developing Self-Compassion

Clients with eating disorders often experience deep shame that blocks them from connection to themselves and to others. Self-compassion is the antidote to shame and creates a foundation for relationships. Self-compassion is a skill that can be developed as part of recovery. Self-compassion allows us to “be” with ourselves tenderly, while also allowing ourselves to take action, so that we can support ourselves and thrive. Self-compassion allows us to operate from a place of authenticity and vulnerability to provide a true foundation of relationship with self and others.

The practice of self-compassion can often feel threatening during the recovery process. As part of the eating disorder, clients often engage in critical self-talk, which can feel protective and predictable. Clients can often feel like self-compassion will result in things getting out of control or that they will decrease their standards or start feeling sorry for themselves. Instead, self-compassion is a component of healthy internal parenting. We know that the best parents are ones who provide nurturing and structure. Children of parents who only provide structure and demands often lack confidence and a sense of well-being. Yet, this is the way we often parent ourselves. Instead, clients need to re-learn how to internally parent themselves with nurture and structure, which includes the practice of self-compassion. When clients learn to demonstrate self-compassion, they provide the framework for a healthy relationship with self.

Self-compassion has three components (Neff, 2015)

1. Mindfulness: Mindfulness in self-compassion is simply the act of recognizing our own emotional pain. It may be the simple observation of “I am in pain.” The mindful step in self-compassion allows us to separate from our pain rather than being merged with it.

2. Common Humanity: The step of common humanity is reminding ourselves we are not alone in our pain. It may be that others have not experienced our exact brand of suffering, but feeling emotional pain is part of the human condition and connecting through that pain is part of the healing.

3. Self-Kindness: Self-kindness is simply talking to ourselves the way that we would to a friend who is in emotional pain. We often tell ourselves to “toughen up” and “don’t be such a wimp.” We should instead tell ourselves what we would say to a friend, “this is hard. This feels lonely.”

Relationship with Others: Healing Relationships

In addition to relationship with self, relationship with others is important in the recovery process. Eating disorders often leave a wake of relational carnage. Families and loved ones are also impacted by the eating disorder and often feel helpless in their loved one’s recovery. Healing these relationships can create repair for the ruptures that have occurred and can build a template for how to work through future relationship conflict. The eating disorder often can play a role in relationships in either pushing people away or pulling them near. Clients can learn ways to be present in relationships without their eating disorder and form relationships on a healthy foundation.

Relationship with Others: Developing Recovery-based Connections

In addition to healing past relationships, recovery offers an opportunity for creating new relationships with authentic connection. Those affected by eating disorders often suffer in silence – hiding a painful secret that separates them from others. The eating disorder often blocks connection and prevents true vulnerability. Through recovery clients are able to be fully seen and known. Through the treatment process clients develop relationships with their peers who are sharing their recovery journey. When these relationships are developed with authenticity and a recovery-focus, they can serve as a foundation for a life of recovery outside of treatment.

Relationship with a Higher Purpose: Finding Meaning in the EverydaY

Relational work also links clients to the larger world around them, opening their eyes to the richness and beauty of life. A meal becomes a source a pleasure. An afternoon walk is an opportunity to appreciate nature. Art, words and music allow for expression. Research shows that individuals who fully recover often identify their spiritual work as a defining factor in their recovery process. Unfortunately, spiritual work is often neglected as part of treatment.  It is important for clients to identify their values and purpose in recovery. We discuss that clients are recovering from their eating disorders, but it is equally important to determine what it is they are “recovering to.” When clients can incorporate a higher purpose and meaning into their recovery, they find that their recovery has a wholeness and intentionality.

Relational aspects of recovery must be addressed and integrated into treatment. Relationship with self, others, and a higher purpose is integral to who we are as humans and to building a life in recovery. Incorporation of relational work into treatment provides clients in treatment for a foundation for a full recovery.

Neff, K. (2015). Self-Compassion: The Proven Power of Being Kind to Yourself. New York: Morrow.

Smith, F. T., Hardman, R. K., Richards, P. S., & Fischer, L. (2003). Intrinsic religiousness and spiritual well-being as predictors of treatment outcome among women with eating disorders. Eating Disorders, 11, 15-26. doi:10.1080/10640260390167456-2199

Dr. Nicole Siegfried, PhD, CEDS is a recognized leader in eating disorder treatment and serves as the chief clinical officer at Alsana. She is a member of AED and former co-chair of the Suicide AED Special Interest Group. Nicole has almost 20 years of experience helping patients with eating disorders and helping them transform their lives.