Brian Pollack, LCSW, CEDS-C
Brian is the Founder and Clinical Director of Hilltop Behavioral Health, a boutique eating disorder specialty practice in Summit, NJ. He is one of the few male master’s-level Certified Eating Disorder Specialists in the country, with expertise in FBT, male clients, athletes, and muscle dysmorphia. He hosts the Minding Men podcast and serves as an adjunct professor at Yeshiva University.
Learn more about Brian →It is 4:15 in the afternoon and your child is bargaining again.
If she skips the snack now, dinner will feel earned. If dinner feels earned, maybe tonight will be different. Maybe tonight she will eat a normal amount, feel a normal amount, and go to bed without the loop starting. She has run this negotiation hundreds of times. She knows, somewhere underneath the bargaining, exactly how it ends. The hunger builds through the evening until it stops feeling like hunger and starts feeling like panic. Then the eating happens fast, almost outside of her, and the shame arrives right behind it. By morning she has a new plan. The new plan is the old plan.
What confuses her most is not the eating. It is that she is smart, disciplined, and capable in every other part of her life, and none of that seems to matter here. She keeps asking the same question: why can’t I just stop?
If any of this sounds familiar, the question you are asking may be the wrong one. Not because you are broken, but because “why can’t I just stop” assumes the problem is effort. It rarely is. This is where radical acceptance eating disorder work begins: not with a better plan, but with a different relationship to the moment you are actually in.
The Cycle Runs on Refusal
Look closely at the loop: restriction, rising anxiety, eating, shame, and back to restriction. Every stage of it contains the same hidden sentence: this should not be happening.
The loop constantly has a place of creating a wall, a finite completion that can feel like control. Sometimes its about not givin in because it would create a connection in the moment and vulnerability presents during that moment which may reveal some really uncomfortable.
At the same exact time, the restriction says: my body should not need this much. The anxiety says: I should not feel this out of control. The eating says: I should not have to feel this at all. The shame says: I should not be someone this happens to.
Each “should not” is a small act of war against what is actually true in the moment. And here is the pattern clinicians see over and over: the war itself is the fuel. The more you refuse the reality of hunger, the louder hunger gets. The more you refuse the reality of anxiety, the more the eating becomes the only exit. Fighting reality does not change reality. It just adds a second layer of pain on top of the first one.
Dialectical Behavior Therapy has a name for that second layer. Pain is what happens to you. Suffering is pain plus non-acceptance. You do not get to opt out of pain. You do get a say in the suffering. And this distinction matters clinically: the National Institute of Mental Health recognizes eating disorders as serious, treatable illnesses, not failures of discipline, which is exactly the reframe the cycle depends on you never making.
What Radical Acceptance Means in Eating Disorder Recovery
Radical acceptance is a core distress tolerance skill from DBT, developed by psychologist Marsha Linehan, whose work is carried forward through the Linehan Institute’s Behavioral Tech training organization. The word “radical” means complete: accepting reality all the way down, with the mind and the body, not just intellectually nodding at it while the whole nervous system keeps fighting.
Two things radical acceptance is not, because these misunderstandings stop people before they start.
It is not approval. Accepting that you binged last night does not mean deciding binges are fine. It means acknowledging that it happened, that it happened for reasons, and that arguing with a fact changes nothing about the fact.
It is not giving up. This is the one that scares people with eating disorders most, because so much identity gets built on the fight. But acceptance is not surrender to the disorder. It is surrender of the exhausting side-battle against reality, so that your actual energy becomes available for change. You cannot leave a place you refuse to admit you are standing in.
Applied to the 4:15 bargain, radical acceptance eating disorder work sounds like this: I am hungry right now. My body is asking for food because I under-fed it earlier. This is not a character flaw. This is biology doing what biology does. Notice what that sentence does not contain: no plan, no punishment, no promise about tomorrow. Just the ground under your feet.
Does that feel almost unbearably plain? It should. The disorder survives on drama, on the next plan, on the constant renegotiation. Plainness is the threat.
Building a Radical Acceptance Eating Disorder Practice in the Body
Acceptance is not an insight you have once. It is a skill you practice in the body, hundreds of times, mostly in small moments. DBT gives it physical handles precisely because the mind alone cannot hold it.
Turning the mind. Linehan describes acceptance as a fork in the road you will pass thousands of times a day. Each time you notice yourself back in refusal (“I shouldn’t be hungry,” “I can’t believe I ate that”), you turn back toward acceptance. Not once. Every time. The turning is the practice.
Willing hands and half-smile. Unclench your hands, palms open. Let the muscles of your face soften. These sound almost too simple to matter, and then you try them mid-urge and discover that the body cannot fully brace against reality and open to it at the same time. The posture leads and the mind follows, imperfectly, a little.
Noticing the urge without obeying or fighting it. The urge to restrict, or to eat past fullness, is a wave. Refusing the wave does not flatten it. Riding it, naming it, breathing while it peaks and passes: that is present-moment embodiment. You are learning that an urge is a weather system, not a command.
None of this feels like progress at first. It feels like standing still while the disorder screams that you are wasting time. That is exactly why the next piece matters.
Why This Skill Is Built With a Therapist, Not a Worksheet
Radical acceptance eating disorder skills are relational skills, and that changes where they can be learned. You can read about the concept in an afternoon. People do, and then they turn it into one more thing to perform perfectly, one more standard to fail. The skill does not live on the page. It lives in relationship.
Here is what actually happens in the room. You come in after a hard week and start the familiar confession, braced for judgment, and it does not come. Your therapist receives the week as information, not evidence against you. That moment, repeated across months, is radical acceptance modeled from the outside in. You are being accepted, mid-cycle, exactly where you are, and slowly the nervous system learns the move by feel.
There is also the harder relational work: the sessions where you feel misunderstood, where you want to quit, where the old pattern of hiding shows up in the therapy itself. A skilled clinician does not smooth those moments over. They name them, stay in them, and repair them with you. Every repair is a rehearsal for staying present with discomfort instead of escaping it. That rehearsal is the treatment.
Hilltop Behavioral Health builds this kind of work into eating disorder treatment in New Jersey across our team: therapists and a registered dietitian working together, so that acceptance of hunger gets paired with real nourishment structure, and the DBT skills get practiced somewhere they can actually hold. For patterns that center on the restrict-then-eat loop specifically, our work with binge eating disorder starts from the same premise: the eating is not the enemy. The war is.
The Decision Underneath the Question
Return to her, at 4:15, mid-bargain. Radical acceptance does not hand her a better plan. It asks her something quieter: what if there is nothing to win here? What if the hunger is just true, the anxiety is just true, and the only real choice is whether to keep fighting the truth or to stand inside it and start from there?
Standing inside it is not the end of the work. It is the beginning of it. Change built on acceptance holds, because it is built on the ground instead of on the next negotiation.
You do not have to master this before you reach out. You do not have to accept anything yet. You only have to be willing to stop doing this part alone. Contact Hilltop Behavioral Health to talk about what working through this could look like for you.
