Treating Anxiety and Perfectionism in Eating Disorder Recovery
Like many in eating disorder recovery, I made an already immensely arduous undertaking 10 times harder for myself than it needed to be.
- It wasn’t because I wasn’t showing up and doing the work.
- It wasn’t because I wasn’t taking risks and pushing through the discomfort.
- It wasn’t because I didn’t trust the process and the guidance of my treatment team.
- It was because my highly perfectionistic, self-critical, anxiety-ridden self second-guessed nearly every decision I made pertaining to recovery.
This meant that even when I made what seemed to be the “next best choice” at the moment, my inner critic/eating disorder voice almost always had a snarky retort, such as:
- Did you really need that third cookie?
- Salads are a pretty diet-y food. Are you sure that was the recovery-focused choice?
- Two rest days in a row? But you’re weight-restored now. Shouldn’t you at least do a short yoga practice?
While learning to respond to and silence that judgmental chatter was helpful, it was ultimately facing my anxiety and self-sabotaging traits head-on, and in ways that best equipped me to make decisions in recovery without getting trapped in analysis paralysis.
Don’t Leave It to Anxiety Medication Alone to Treat Anxiety Symptoms
Medication is often a default component of anxiety treatment but is sometimes the only component of the treatment plan. On its own, medication isn’t the most effective strategy for helping you navigate the daily decisions (and the discomfort that comes with those decisions) throughout eating disorder recovery. This is especially true if you’re the high-achieving, perfectionistic type like me who second-guesses every decision you make.
In fact, according to the National Institutes of Health (NIH), approximately 65 percent of eating disorder sufferers meet the criteria for at least one anxiety disorder, such as generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and social anxiety disorder.
Fortunately, there are various other strategies to modulate and treat your anxiety so you can make decisions more confidently and peacefully in recovery.
Working Through Anxiety and Perfectionism at Home
So much of eating disorder recovery involves learning to be your own internal caregiver (something that seemed so foreign to me for a big part of my life). But once I began making daily self-care a non-negotiable aspect of my recovery, I realized how instrumental it was in helping me curb my anxiety and check “Ms. Perfectionist” at the door.
Here are a few key strategies that may also help you regulate your own anxiety, especially when your inner critic is coming on extra strong.
Practice Relaxation Techniques
A common saying in the recovery space is that “Your energy flows where your thoughts go.” The more you engage in mindfulness—being aware of what you’re sensing and feeling in the moment, without interpretation or judgment—the less likely you are to exhaust your energy on overthinking your every move.
Here are some relaxation techniques you can incorporate into your day-to-day life. Even just 5–10 minutes of mental pausing can help you recenter and replenish.
Though I was once a skeptic, I am now a firm believer in the power of mindfulness meditation. In addition to the myriad long-term effects it has on improving mental and physical well-being, mindfulness meditation helps you manage your thoughts and emotions, and experience a greater sense of calm and clarity in your daily life.
To practice mindfulness meditation, sit in a comfortable position, and direct your attention to your breath, bodily sensations, or other sensory experiences in the present moment. The goal is to observe these experiences without judgment or distraction and to bring the mind back to the present moment when it wanders.
You can either lead a mindfulness meditation practice yourself or search for guided practices online. Whether using it to ground yourself first thing in the morning, wind down at the end of the night, or to calm physical symptoms of anxiety you experience in making recovery-focused decisions, mindfulness meditation is a helpful strategy to incorporate into your recovery playbook.
Deep Breathing Exercises
There’s one recovery tool you have access to at all times of the day, every day, and that’s your breath. With little to no specific skills required, you can use your breath to calm your nervous system and reduce the side effects of negative thoughts or emotions.
Deep breathing exercises are a simple and effective relaxation technique that involve taking slow, deep breaths to calm the body and mind. There are many variations of deep breathing exercises, including square breathing, diaphragmatic breathing, and progressive muscle relaxation, among others.
Personally, I’m in awe of the near-instantaneous anxiety relief I feel when engaging in a deep breathing exercise. The softening of my body. The slowing of my heart rate. The release of tension in my muscles. All of it, together, allows me to recenter and respond more wisely to any lingering chatter in my head.
Don’t Compromise Your Sleep
One of the most essential yet sometimes overlooked keys to success in eating disorder recovery is getting a good night’s sleep.
While undergoing outpatient treatment, I was a full-time (and highly involved) college student who worked early mornings on the weekends. At best, I averaged six hours of sleep each night.
There were countless days where I couldn’t, for the life of me, “do” recovery, despite my go-getter attitude. It eventually dawned on me that my lack of sleep might be interfering with my motivation and ability to access the rational-thinking part of my brain when I needed it the most.
Once I started getting enough sleep, I had more mental energy to not only make the recovery-focused choice but also to silence the eating disorder voice whenever it tried to convince me I was failing.
Findings from recent studies suggest that adults should aim for seven to nine hours of sleep each night, and adolescents aged 13–18 need between eight and 10 hours. Consult your treatment team or PCP if you believe inadequate sleep may be affecting your recovery and general well-being.
Working Through Anxiety and Perfectionism with a Licensed Mental Health Practitioner
Self-regulation is foundational for managing anxiety, but specialized interventions administered by medical professionals are often necessary for treating it.
In particular, if you struggle with severe anxiety or co-occurring mental health conditions that intersect with any over-analytical tendencies you possess, seeking help from a mental health professional such as a psychologist, psychiatrist, counselor, and/or therapist may be in your best interest.
Here are some ways mental health professionals can help you in ways you can’t help yourself.
Cognitive Behavioral Therapy
It feels like a bit of a buzzword these days, but cognitive behavioral therapy (CBT) didn’t earn its notoriety out of nowhere.
In CBT, a trained therapist works with you to identify negative or unhelpful thought patterns and behaviors contributing to your distress. They then help you develop more positive and realistic thoughts and behaviors, which can improve mood, reduce anxiety levels and feelings of worry, and help you cope more effectively with challenging situations.
So, if you’re constantly scrutinizing yourself for every food choice you make in recovery, cognitive therapy enables you to appropriately respond to or silence that internal chatter. With practice, not only does the anxiety you’ve attached to those negative thoughts diminish but the frequency in which those negative thoughts appear diminishes, too. This frees up so much mental space for you to direct toward things that truly matter to you.
One of the most uncomfortable but often highly effective treatment strategies for modulating anxiety and overcoming analysis paralysis is exposure therapy, which is a type of CBT. With exposure therapy, a trained mental health provider plans a real-life scenario of you engaging in an event known to trigger unhelpful thought patterns or difficult emotions so you can practice responding to and processing them in real-time.
For example, if you know every time you go to a restaurant you spend way too much time anxiously deliberating what to order and typically end up feeling like you made the wrong choice, your treatment team member may coordinate a restaurant outing with you. Throughout the exposure, they can observe your behaviors, help you cope with your anxiety, and facilitate how you respond to any sabotaging thoughts you’re having during and following the meal.
With repeated exposures, you’ll not approach the historically triggering situation with less anxiety, but you also won’t be left parsing out an endless string of thoughts suggesting that you made the wrong choice.
Visualization Techniques and Imaginal Exposures
Meeting up with your treatment team member at your neighborhood bistro likely won’t always be an option. The good news is you can partake in a visualization practice or imaginal exposure that has a similar effect as a real-life exposure but from the comfort of your provider’s office (or even your couch if meeting virtually).
Using very detailed dialogue, your trained provider will guide you through a series of mental images or scripts related to the anxiety-provoking event. Simultaneously, you’ll imagine the details of the event and the emotions associated with it. Your provider may also ask you to describe your anxious thoughts and feelings during the exercise and help you respond to and process those as they would in a real-life exposure.
Whether imagined or real-life, exposure therapy can help minimize and even fully eliminate any anxious feelings and unhelpful thoughts often experienced in recovery.
Being indecisive, overly analytical, and self-critical are common traits of those battling an eating disorder and are even more likely when symptoms of anxiety or an anxiety disorder are present.
While taking anxiety medication may be necessary for you in the short term, the inner work you do—both on your own and with the guidance of a licensed, trained mental health provider—can set you free for the long term in ways you couldn’t have imagined.
You can learn to speak to yourself with kindness and respect.
You can learn to silence the inner critic.
You can learn to make a choice and move on.
And when it all seems too overwhelming, don’t forget to take a big, deep breath (or 10).