National Eating Disorders Association

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Fiancé ED is getting worse with therapy

This is my first post on the forum as I am new to ED support. My fiancé admitted this summer that she has an ED and we sought professional help shortly after. She has been in therapy for 3 months, and is also seeing a nutritionist.

Long story short, I feel things are spiraling and getting worse since starting therapy. It almost seems to me as if it is some type of withdrawal, similar to how a drug addict would spiral. Is it normal to continue going down this path after 3 months?

My advice to her is to stick with the treatment and I am constantly supportive, even as her behaviors continue in front of my eyes. She goes to all the appointments but has seemed to fallen off the track in terms of commitment to the plan. I think the next step is for me to sit down with her and her therapist.

She has a highly demanding job which consumes her mental energy and causes much stress. I am hoping to not go this route, but I fear she may have to quit in order to save her mental state. We are also getting married this coming year and I fear if we cannot improve, the marriage may need to be postponed for the sake of her health.

How do I keep her on track with treatment habits without being perceived as controlling or aggressive?
How should I react when I witness her fall off track (happens at least once a day, once a day is considered a "good" day in my mind)?

Getting better, getting worse.

Hey Thgil,

One thing about therapy : people can start to face issues that they've never had to face before. Or that they've avoided facing. Issues that don't necessarily have to do with their ED, but which are important ones nones none the less. This can cause a lot of stress, because it's not like "Now I understand my issue, so now I'm fine." Often it's OK, here's my issue, and it's important, but how in the world am I supposed to feel better about it ? What am I supposed to do to reduce it's influence on me ?

These sorts of thoughts can be really stressful, or make a person feel like they're not really in control of their life. Which often means they feel worse rather than better. Particularly at the beginning of therapy.
And what to people with EDs turn to, to feel more in control of things ? Their ED habits and rituals. Which can seem like the only thing in their life that helps them feel in control.
So what can you do ? As you said, it's tempting to try and control the situation, but I guess you've seen how well that works.
My sense is that it helps to try and put yourself in her shoes. "I can imagine that things at work must be stressful. " "It must feel like things are out of control." " I know it can be hard to like yourself sometimes." What I mean is, often the person feels better if they can believe that the other person understands what they are going through.
It's also likely that she worries that she's not really getting better. That may be a touchy subject, but it may be another of the worries she has. " I know it may feel like you don't want to recover." Which is often the case with people too. And not really something you can blame them for, if their EDs are still fulfilling certain emotional roles for them.
One other thing - It can be difficult for them to take the sorts of risks that recovery involves. Which is another legitimate issue for them. Because EDs are about a lot more things than just eating., even if those issues are played out on the stage of food.
I'm sorry if none of this seemed very helpful. We'd love for there to be something that we could do, that would help fix the other person.
Fixing may be out of our hands, but support can make a difference I think, if we can figure out what actually feels supportive to them.

Although your partner has

Although your partner has been in therapy for three months, her eating disorder could take a lot longer to overcome.
The nutritionist will provide ongoing help for your partner's diet.
However. That's only part of the journey.
There can be many underlying issues that cause the eating disorder.
This is where the counselling becomes integral to the recovery.
During counselling, your partner may be exploring some deep, personal past experiences and be doing this for the first time.
This can be a form of personal self-discovery, leading on to some strong emotions and serious reflexion.
The 'withdrawal' and 'downward spiral' may be your partner facing the true reality of her problems - perhaps for the first time.
People are good at hiding their problems. They can even become successful at hiding problems from themselves.
As the eating disorder progresses, the harder it is to conceal.
Facing the reality can be overwhelming, leading to what you consider the 'withdrawal' behaviour.
Then it's looking at the challenging journey to recovery that lies ahead.
Imagine you're going to de-clutter your spare room. Look at all the stuff that needs sorting out. It's enough stress in itself.
Where do you start? Then once you start.....The task seems to get harder as you open things up and sort through them....
Admitting to her eating disorder will have been difficult for your partner.
It may be an idea to allow the counselling to continue as it is for a little longer. See how things progress.
We're all different with regard to time scales when attending counselling because each person and their circumstances are so different and individual.
If you still feel that there is no change in your partner's situation, then it may be time to question if the counselling sessions are really helping her.
Your partner's eating disorder will be the result of a culmination of life experiences and these are the issues that will need addressing.
If you feel that - after a little more time - your partner is not improving, it may be because the counselling is not really addressing the underlying issues that are causing her eating disorder.
There's the nutritional side of the eating disorder that is important to address but there's also the psychological side.
Your partner has 'fallen off track' with the plan which may suggest she is not fully benefitting from the counselling.
This may depend upon how well your partner and the counsellor are engaging or the therapy is not thorough enough. Perhaps you partner feels that she is not really progressing with the counsellor.
As with any service, the counsellor may be working a high 'case-load' and be very limited for time and resources. This means the therapy sessions are not as immersive as they could be.
Encourage your partner to persevere with the therapy for a little longer and see how things go.
It may help if you do see the therapist with your partner. However. You may need to bare in mind that it could breach the 'client confidentiality' that your partner and the counsellor will have agreed upon.
There may also be the issue of your partner feeling uncomfortable with you being present at the session and she may not be so willing to discuss her issues in the session.
If there is no change (or she even appears to get worse), then it may be time to consider a different counsellor. Your partner seriously needs to ask herself what she hopes to achieve from the counselling.
It's a case of being able to engage fully with the counsellor to address the underlying issues that relate to the eating disorder(s).
Your partner has a very demanding, stressful job.
If you partner is willing to continue working, then encourage her to do so. This will be benefit her financially, physically and mentally.
Upholding a full-time, demanding job will keep your partner active throughout the day and help take her mind off her problems. The job will give her something to focus on.
Some people can somehow thrive successfully within a highly stressful work environment and that stress can be a source of motivation.
Giving up a full-time job can mean less pressure. Yet it can also result in a feeling of not being productive and difficulty getting used to the extra time.
Many dream of the day when we can just quit the aggravation of going to work. We can only wish.
For others, it can become a primary reason for depression because giving up a full-time career can be a major shock for someone who's so used to living with the demands of today's working environment.
It may be an idea to carefully take into consideration that your partner - however stressed at work - may not be willing to give up the full-time career just yet.
It's something to give careful consideration.
As for getting married. There's risk of further Covid related restrictions and the complexities/stress of organising a wedding.....Can it be put on hold for a little longer?
Keep maintaining a strong relationship. That's what really matters.
Putting the wedding on hold will mean one less thing to worry about.
Encourage your partner to continue with her new eating programme and psychological therapy.
Put aside forthcoming events and home projects if you both feel that they are going to be too stressful - unless it is something essential.
It's important to keep busy and active if possible, which means that if your can both continue working without being stressed, then do so. Outside of work, do other things (such as exercise) rather than just sitting in the house.
Take things one step at a time and keep providing your partner with the encouragement she needs.
This will take time. Hopefully you'll both find a way through this.

I would suggest

Not including exercise. This could make the eating disorder spiral further downwards.