People don't develop anorexia because they're shallow or obsessed with looking attractive. They don't continue starving themselves because they enjoy suffering. Eating disorders are severe psychiatric illnesses with one of the highest mortality rates of any mental disorder. They distort perception, hijack judgment, and convince people that self-destruction is synonymous with self-control. They narrow a person's world until calories, rituals, and fear eclipse almost everything else.

That remains true whether the person is your classmate, your sister, or Ariana Grande.

Over the past several years, public discussion of Grande's appearance has become trapped between two extremes. One side insists that any conversation about her body is inherently misogynistic or body-shaming. The other treats her appearance as gossip, spectacle, or evidence of personal failure.

Neither response is adequate.

I believe Ariana Grande appears visibly unwell.

I also believe that, as one of the most recognizable women in the world, her visibility carries responsibilities that cannot simply be dismissed with "it's her body."

Those statements are not contradictory. In fact, our inability to hold both ideas simultaneously says something revealing about how we think about illness.

We often imagine compassion and accountability as opposites. If someone is suffering, we assume criticism becomes cruelty. If someone's actions have consequences, we assume empathy excuses those consequences. Real life is rarely that simple.

Compassion explains behavior. It doesn't erase impact.

One of the most devastating aspects of eating disorders is that they rarely affect only the person who has them. Families watch loved ones disappear in slow motion. Friends become amateur detectives, monitoring meals and deciphering excuses. Clinicians spend years trying to persuade patients that survival is not a moral failure.

The illness radiates outward. When the person struggling is one of the most famous celebrities on Earth, those ripples become impossible to ignore.

Millions of girls and women have grown up watching Ariana Grande. Many are vulnerable themselves. Some are already living with eating disorders. Others are just beginning to absorb the relentless cultural message that smaller is always better.

Influence doesn't require intention. Grande does not have to want to inspire anyone for her image to influence them. Every celebrity understands this in other contexts. Fashion trends spread without instruction. Hairstyles become popular without campaigns. Makeup sells because someone admired wears it.

Bodies influence people too. 

Eating disorders are profoundly competitive illnesses. They thrive on comparison. The illness is constantly searching for evidence that someone else is thinner, more disciplined, more "successful" at disappearing. For someone already trapped in that mindset, seeing an extremely emaciated body repeatedly celebrated, photographed, and circulated can become fuel for the illness itself.

This isn't about blaming Ariana Grande for other people's disorders. It's about acknowledging that visibility has consequences regardless of intent.

I don't know Ariana Grande. I don't know what happens before a red carpet appearance or after the cameras leave. I don't know whether she is in treatment, in denial, recovering, relapsing, or living with something entirely different. None of us do.

Speculating about her private life accomplishes very little. But refusing to acknowledge what is plainly visible accomplishes even less.

Some people argue that commenting on a celebrity's apparent illness is inherently harmful. I understand the instinct. For decades, women's bodies have been scrutinized, criticized, and treated as public property. Many people understandably want to push back against that culture.

But there is an important distinction between rejecting body policing and denying obvious illness. If someone appeared visibly jaundiced, we would not insist their skin looked healthy to avoid stigmatizing liver disease. If someone appeared dangerously malnourished because of cancer, we would not call concern "body-shaming."

Eating disorders are unusual because their symptoms often resemble traits our culture has spent decades rewarding. Extreme thinness can be applauded long after it has become medically dangerous. That creates a strange social paradox: we have become so afraid of stigmatizing eating disorders that we sometimes refuse to recognize them at all.

I don't think that's compassion. I think it's another form of denial. That denial doesn't protect people who are struggling. In many cases, it protects the illness itself.

One of anorexia's cruelest features is that it thrives in silence. It tells people they are fine. It reframes concern as jealousy, control, or misunderstanding. It rewards secrecy and interprets intervention as hostility.

The illness already does enough gaslighting on its own. The rest of us don't need to help it.

At the same time, compassion should not depend on whether someone is otherwise admirable. Grande's public life has included controversies unrelated to her health. Plenty have criticized her choices, including countless instances of cultural appropriation and her relationship with Ethan Slater. Those criticisms remain fair.

But these controversies do not make her less deserving of empathy if she is living with a serious mental illness. Likewise, mental illness does not erase accountability for unrelated actions.

Too often, public discourse insists on flattening people into heroes or villains. If someone suffers, they must become morally untouchable. If someone has made mistakes, their suffering becomes easier to dismiss. Human beings are more complicated than that.

I don't spend much time thinking about Ariana Grande—or at least I didn't before images of her increasingly frail body became impossible to avoid. I think she is one of the most gifted vocalists of her generation. I think she has made choices worthy of criticism. And I think she deserves the same compassion I would extend to anyone living with an illness that kills thousands of people every year. Holding all three ideas at once should not be controversial.

What concerns me most isn't Ariana Grande herself. It's what our reaction to her reveals.

We have become remarkably uncomfortable acknowledging visible suffering. We confuse observation with cruelty and denial with kindness. We have convinced ourselves that saying nothing is always the most compassionate option.

Sometimes it is. Sometimes privacy is exactly what someone needs. But sometimes refusing to acknowledge obvious illness simply leaves vulnerable people alone with the message that this, too, is health.

I hope Ariana Grande recovers—not because I miss an earlier era of her career, not because the public deserves an explanation, and not because I think strangers are entitled to her medical history. I hope she recovers because she is a human being whose life appears, from the outside, to matter more than any image.

And I hope we become capable of holding two truths at once.

She deserves compassion.

And the influence of what millions of people see every day deserves to be acknowledged, too.

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My favorite home-cooked meal growing up was Hainanese chicken rice. My mom began by simmering chicken with aromatics to create a deeply flavorful broth. Then she stir-fried pearls of jasmine rice with fragrant sesame oil and garlic before adding pandan leaves, whose delicate, grassy aroma perfumed the entire pot. She poured in the broth and steamed the rice until every grain absorbed its richness. The poached chicken was dressed simply with soy sauce, sesame oil, ginger, garlic, and cilantro. There were always vegetables—pea shoots, gai lan, or bok choy—because that was simply how meals were built in our house. After dinner, my mom would slice fruit, perfectly chilled, and arrange it on a plate for us to share.

I savored every bite. I never wondered whether the white rice had too many carbohydrates. I never questioned whether the sesame oil added too much fat. I never chastised myself for taking an extra helping. Food was just food. Or rather, it was something even bigger than food.

It was family.

It was care.

It was culture.

It was home.

I think about those meals often now—not because they're gone, but because I miss the version of myself who could receive them without fear.

My eating disorder didn't begin with hating food. It began with wanting to be healthy. Like many people who develop orthorexia, I wasn't chasing thinness at first. I was chasing health, discipline, and the promise that if I just ate "correctly," I could optimize my body.

Nutrition advice was everywhere. Eat whole grains instead of white rice. Swap noodles for quinoa. Avoid refined carbohydrates. Limit processed foods. Again and again, I encountered the same message: the healthiest way to eat was the Mediterranean diet.

The Mediterranean diet is supported by substantial evidence for cardiovascular health and longevity. That isn't the problem. The problem is what happened when evidence-based nutrition became moralized into a universal ideal. Somewhere along the way, "healthy" stopped being a description and became an identity. Foods became virtues. Diets became hierarchies. And cultures became ranked.

Without anyone explicitly saying it, I absorbed a devastating conclusion. My family's food wasn't healthy enough. The rice my grandparents ate. The noodles I grew up loving. The dumplings my family made together. The foods that had nourished generations somehow became nutritional compromises.

My mother's cooking had always been balanced. Every meal included vegetables and protein in abundance and variety. Fruit followed dinner every night.

But diet culture taught me to fixate on one thing. The white rice. Eventually, I couldn't see anything else.

What diet culture couldn't destroy, treatment overlooked. Over the next several years, I cycled through nearly every level of eating disorder care. Hospitals. Residential treatment. Partial hospitalization. Intensive outpatient. Outpatient therapy. Dietitians. Psychiatrists. Medical providers.

I met clinicians whose compassion undoubtedly helped keep me alive. But there was another truth that became harder to ignore with every program I entered. Recovery was built around someone else's idea of normal. The menus reflected a narrow understanding of what eating without an eating disorder looked like. Breakfasts of oatmeal, cereal, scrambled eggs, and bagels. PB&Js. Spaghetti with meatballs. Macaroni and cheese. Burgers. Americanized tacos. 

Chinese food, if it appeared at all, meant takeout. Orange chicken, chow mein, eggrolls. Not the everyday food my mother actually cooked. Not the meals that represented comfort. Not the meals I had stopped allowing myself to eat.

No one ever asked what recovery might look like around my family's dinner table.

No one asked which foods I feared most because they belonged to my culture.

No one asked what traditions my eating disorder had interrupted.

Instead, I learned how to recover into someone else's normal.

Sometimes cultural blindness was subtle. Sometimes it wasn't. One evening in a partial hospitalization program, our dietitian ordered Korean food for an experiential dinner. She picked up a small container of gochujang, squinted at it, and said, "I think this is called boog-loog-i sauce."

Then she looked at me. "Ella, is that right?"

I am not Korean.

The table fell quiet.

It wasn't malicious, but it was revealing. The irony wasn't lost on me. Here I was in specialized eating disorder treatment, expected to heal my relationship with food, while the professionals guiding that recovery couldn't distinguish between the cultures those foods came from.

It was a small moment. But eating disorder treatment is full of small moments. Moments that quietly communicate whose cultures are familiar and whose are foreign. Who gets to feel at home. Who is expected to adapt.

My experience wasn't unique. For years, I wondered whether I was asking for too much. Then I started reading the research. I discovered that Asian Americans remain dramatically underrepresented in eating disorder research. Even when we are included, researchers frequently aggregate dozens of distinct ethnic groups into a single "Asian" category, obscuring meaningful differences in migration histories, family dynamics, food traditions, and lived experiences. If research treats Chinese, Indonesian, Korean, Filipino, Japanese, Vietnamese, and South Asian communities as interchangeable, it should not surprise us that treatment often does the same.

Researchers have also argued for decades that eating disorders in Asian populations have been misunderstood because clinicians often rely on simplistic assumptions about culture rather than examining how eating disorders actually develop within different Asian communities.

Perhaps most strikingly, systematic reviews have found remarkably little research on culturally adapted eating disorder treatments. While evidence-based therapies have transformed countless lives—including mine—the evidence base has largely been developed within Western contexts. Adaptations, when they exist, often focus on translating materials or making modest dietary substitutions rather than fundamentally asking what recovery looks like across different cultural foodways.

In other words, what I experienced was not simply an unfortunate oversight by a few providers. It reflected a blind spot in the field itself.

Recovery cannot be culturally neutral. Eating disorder treatment often emphasizes food flexibility. The idea is important. Recovery means being able to eat a wide variety of foods without fear. But I increasingly wonder whose definition of variety we're using.

If recovery teaches patients to comfortably eat bagels, pasta, and turkey sandwiches while leaving them terrified of the meals that define their own cultural identities, is that really flexibility?

I became practiced, if not comfortable, eating foods served in treatment. But eating a bowl of rice, noodles, or dumplings my mother had prepared still filled me with guilt.

No treatment team recognized that this was one of the most important exposures I needed. The challenge wasn't carbohydrates. The challenge was allowing myself to reconnect with love after diet culture had convinced me love looked unhealthy.

Eating disorders do not exist outside culture. Neither should recovery. Yet treatment often operates as though recovery is culturally neutral, when in practice many of its assumptions about "normal eating," "balanced meals," challenge foods, and family meals are rooted in white, Western food norms.

For patients from immigrant families and communities of color, food isn't simply fuel. It carries memory. Language. History. Identity. Belonging. When treatment overlooks those dimensions, it doesn't simply miss an opportunity for cultural competence. It risks asking patients to recover by becoming culturally disconnected versions of themselves.

Recovery should not require assimilation. It should not require replacing your grandmother's recipes with someone else's definition of balanced eating. Healing should make room for all of us.

Recovery, for me, has become less about learning new rules and more about remembering old truths. The healthiest relationship with food I ever had wasn't built by nutrition influencers, wellness podcasts, or meal plans. It existed long before I knew what the glycemic index was. It existed in my mother's kitchen. A kitchen where vegetables shared the table with white rice. Where noodles weren't "cheat meals." Where fruit wasn't dessert because it needed to compensate for anything. Where every meal reflected care instead of calculation.

Now when my mother places a bowl of Hainanese chicken rice in front of me, I try to see what I once saw as a child. Not carbohydrates. Not refined grains. Not something to earn or burn off.

I see my mother standing over the stove, stirring jasmine rice with garlic and sesame oil.

I smell pandan leaves blooming in the steam.

I remember the plate of chilled fruit waiting afterward.

I remember what love tasted like before my eating disorder convinced me it was dangerous.

The deepest work of recovery has not been learning how to eat. It has been learning that healing is not complete until I can receive that love again. Because the food my eating disorder took from me was never just white rice.

It was home.

Selected reading

Akoury, Liya M., et al. “Disordered eating in Asian American women: Sociocultural and culture-specific predictors.” Frontiers in Psychology, vol. 10, 4 Sept. 2019, https://doi.org/10.3389/fpsyg.2019.01950.

Cummins, Lillian Huang, et al. “Eating disorders in Asian populations: A critique of current approaches to the study of culture, ethnicity, and eating disorders.” American Journal of Orthopsychiatry, vol. 75, no. 4, 2005, pp. 553–574, https://doi.org/10.1037/0002-9432.75.4.553.

Yim, See Heng, and Ulrike Schmidt. “The Effectiveness and Cultural Adaptations of Psychological Interventions for Eating Disorders in East Asia: A Systematic Scoping Review.” International Journal of Eating Disorders, vol. 56, no. 12, Dec. 2023, pp. 2165–2188. Wiley, https://doi.org/10.1002/eat.24061

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I couldn't have been more wrong.

No one warned me about recovery burnout—the moment when you still know your eating disorder is destroying your life, but you're so emotionally exhausted by fighting it that relapse starts to feel less like giving up and more like getting a break.

It's a part of recovery that people don't talk about enough. And I think that's one of the reasons so many of us feel ashamed when we get there.

I wanted recovery. Really, I did. I developed anorexia when I was thirteen. Over the next several years, I cycled through periods of recovery and relapse, each one convincing me that maybe this time would be different.

When I relapsed at eighteen, I knew I couldn't keep living the way I was. By nineteen, I was hospitalized again before stepping down into a partial hospitalization program. Walking into treatment, I wasn't being forced to recover. I wanted my life back. I knew exactly what anorexia had stolen from me. My physical health. My relationships. My ability to be present. My personality. The version of myself that laughed without calculating calories in the back of her mind.

So I did everything I was supposed to do. I followed my meal plan. I ate my fear foods. I showed up in individual therapy. I participated in every group. I journaled. I challenged my eating disorder thoughts. I gave recovery everything I had.

But after two months, I hit a wall. Every meal still came with overwhelming guilt. Every snack felt like I was doing something wrong. Resting felt unbearable. My brain insisted I'd become lazy, irresponsible, weak.

At the same time, my body was changing in ways my mind simply couldn't keep up with. Everyone around me celebrated weight restoration. I mourned it. I understood why my body needed nourishment. Understanding didn't stop me from grieving the body I'd spent years believing was the only version of myself worthy of existing.

Recovery felt less like becoming myself again and more like watching my identity disappear. And maybe the hardest part was this:

I was still consumed by thoughts, fears, and obsessions about food. Constantly. Sometimes even more than before treatment. Except now I was eating more, gaining weight, resting more—and still feeling mentally consumed by anorexia.

That wasn't what I thought recovery was supposed to feel like. So I became angry. Not just at my eating disorder. At everyone. I resented my treatment team. I resented my family. I even found myself resenting online recovery advocates. Everywhere I looked, I saw messages that recovery was freedom. That one day food would just be food. That I'd get my life back. That it'd all be worth it.

I wanted to believe them. Instead, I felt cheated.

Because I wasn't free.

I was terrified.

Even having been through treatment before, or perhaps because I had spent so long with an eating disorder, I hadn’t been prepared for the possibility that recovery would feel so much harder before it felt better. That my motivation had an expiration date, and couldn’t carry me past the difficulty and discomfort. That recovery would become emotionally exhausting long before it becomes emotionally rewarding.

Eventually, I discharged from treatment. I claimed it was because of difficulties with my medical and psychiatric providers, and increasing inability to tolerate witnessing the behaviors of my disordered peers. All of these issues with the program were very real, valid, and inhibitory to my recovery. But looking back, I think I left because I had convinced myself recovery wasn't for me. 

Plain and simple, I was burned out. I still wanted a life beyond anorexia. I just couldn't imagine surviving another day of feeling so guilty, uncomfortable, and emotionally raw. Quitting felt easier than continuing. 

Not long after leaving treatment, I relapsed. Eventually, I found myself back in the hospital. For a long time, I looked at that relapse as evidence that I'd failed. Now I see it differently.

Recovery burnout is what happens when you've spent weeks—or months—doing the hardest psychological work of your life while your brain is still screaming that you're making a mistake.

Of course you're tired. You're grieving. You're rewiring your brain. You're learning to tolerate fear and withstand distress instead of obeying it. You're asking yourself to trust your body before your mind believes it's safe.

That's exhausting.

Somewhere along the way, many of us begin to mistake exhaustion for evidence.

"Maybe this isn't working."

"Maybe I don't actually want recovery."

"Maybe my eating disorder was easier."

Burnout has a way of making those thoughts feel like facts.

The messy middle deserves more attention. I wish we talked less about dramatic before-and-afters and more about the months in between—the months where your body changes faster than your thoughts, where every meal still feels terrifying, where you miss your eating disorder even while knowing it was destroying you, where you're grieving a version of yourself that was never actually free but still felt familiar.

That's where so many people relapse. Not because they don't want recovery. Because they're exhausted by it.

And when we don't talk about recovery burnout, people assume they're the only ones experiencing it.

They're not.

I wasn't.

If you're reading this while wondering whether you've simply run out of fight, I hope you'll ask yourself the question I wish someone had asked me before I left treatment:

Am I certain recovery isn't possible—or am I just exhausted?

Those aren't the same question.

Maybe my story still would have unfolded the same way. Maybe it wouldn't have. I'll never know.

What I do know is this: recovery isn't just learning how to eat again. Sometimes it's learning how to keep going after the hope, motivation, and certainty have all disappeared.

Because healing isn't only built on the days when you believe in it.

Sometimes it's built on the days you don't.

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Despite decades of advances in neuroscience, psychology, and psychiatry, eating disorders remain among the most misunderstood mental illnesses. Public discourse continues to frame anorexia nervosa, bulimia nervosa, and related disorders as products of vanity, superficiality, or lifestyle choice rather than as severe psychiatric illnesses. This narrative persists despite overwhelming clinical evidence demonstrating that eating disorders are associated with profound psychological distress, serious medical complications, and among the highest mortality rates of any psychiatric illness. The persistence of these stereotypes is not merely inaccurate; it actively contributes to stigma, delays treatment, undermines therapeutic relationships, and exacerbates suffering.

Unlike many other psychiatric disorders, eating disorders are frequently interpreted through a moral lens. People are judged not only for having an illness but also for the behaviors that characterize it. Restrictive eating is interpreted as stubbornness. Concealing symptoms is labeled deception. Ambivalence toward treatment becomes manipulation. The illness itself is transformed into evidence of flawed character.

This tendency reflects a broader cultural assumption that eating disorders are fundamentally voluntary. Because eating behaviors appear observable and, at least superficially, controllable, many people conclude that recovery should simply be a matter of making better choices. Such reasoning overlooks one of the defining features of psychiatric illness: the capacity of illness to fundamentally alter cognition, perception, motivation, and decision-making.

Eating disorders are not simply disorders of eating; they are disorders that profoundly alter how individuals perceive food, weight, body image, safety, and even their own identities. To characterize them as choices makes about as much sense as describing obsessive-compulsive disorder as choosing rituals or major depressive disorder as choosing hopelessness. The observable behaviors are symptoms of underlying psychopathology rather than evidence of moral failure.

Sociologists and philosophers have long observed that illnesses perceived as involving behavior are more readily moralized than illnesses perceived as biologically determined. Eating disorders occupy a particularly vulnerable position within this framework because eating is a universal human activity. Since everyone eats, many assume everyone understands eating disorders.

This assumption creates an illusion of familiarity while obscuring the extraordinary psychological complexity of these illnesses.

The result is a form of diagnostic reductionism. Rather than recognizing restrictive eating, bingeing, purging, compulsive exercise, or body image disturbance as manifestations of severe psychiatric disease, observers frequently reduce these behaviors to vanity, self-discipline, or attention-seeking. Such interpretations fundamentally misunderstand the nature of eating disorders.

Although concerns about appearance are often present, extensive research demonstrates that eating disorders are multifactorial conditions involving interactions among genetic vulnerability, neurobiological factors, personality traits, trauma, environmental influences, and cultural pressures. Restriction or purging often functions as an attempt to regulate overwhelming emotional states, reduce anxiety, establish predictability amid chaos, or cope with experiences that feel psychologically unmanageable. Body weight becomes the visible focus of an illness whose origins and functions often extend far beyond appearance.

Scholar Kristen Gay offers a particularly useful framework for understanding how stigma operates within eating disorder treatment. In “Ethical Dilemmas and Digital Subcultures: Silencing Self-Starvers as Epistemic Violence,” Gay argues that individuals with anorexia frequently experience not only medical intervention but also the systematic dismissal of their capacity as knowers of their own experiences. Drawing on the concept of epistemic violence, she suggests that patients’ voices are often discredited before they’re even heard.

Gay illustrates this argument through David Epston’s Biting the Hand that Starves You, which documents years of clinical observations and patient testimony. Epston describes women who repeatedly characterized psychiatric hospitalizations as resembling “concentration camps,” emphasizing experiences of coercion, force-feeding, surveillance, and profound psychological powerlessness. The comparison is not intended as a literal historical equivalence but as an expression of the extreme loss of autonomy patients reported during treatment. Their accounts reveal that surviving medically does not necessarily translate into feeling psychologically understood or respected.

Perhaps more revealing than these descriptions of hospitalization are Epston’s observations regarding professional attitudes. He recounts hearing clinicians describe patients as “prima donnas,” “spoiled brats,” and “manipulative attention-seekers.” Such language reflects more than frustration with difficult clinical presentations. It illustrates how psychiatric symptoms become moralized through pejorative character judgments.

This distinction is significant. A patient who refuses nourishment because of overwhelming psychopathology is fundamentally different from a person refusing treatment out of obstinacy. Yet when clinicians interpret illness behaviors primarily through moral categories, empathy risks being replaced by suspicion. The patient is no longer understood as someone experiencing distorted cognition but as someone intentionally creating problems. This shift fundamentally alters the therapeutic relationship.

Gay’s analysis suggests that one of the greatest harms experienced by individuals with eating disorders is not only the illness itself but also the repeated invalidation of their lived experiences. She argues that responses motivated primarily by fear, disgust, or paternalism can silence patients in ways that ultimately undermine recovery.

Importantly, acknowledging patients’ experiences does not require validating eating disorder beliefs. There is an essential distinction between validating subjective suffering and affirming pathological cognition. Evidence-based treatment often requires challenging distorted beliefs about food, weight, and body image. However, challenging beliefs is fundamentally different from dismissing the person expressing them.

The therapeutic alliance consistently emerges in psychotherapy research as one of the strongest predictors of treatment engagement across psychiatric disorders. Patients who perceive clinicians as respectful, collaborative, and empathic are generally more likely to remain engaged in treatment than those who feel controlled, shamed, or misunderstood. Epston’s observations therefore raise important ethical questions about whether coercive or paternalistic approaches may inadvertently reinforce the very illness they seek to eradicate.

Few psychiatric illnesses expose individuals to as much interpersonal blame as eating disorders.

Patients are frequently accused of manipulating family members, wasting healthcare resources, refusing recovery, or choosing illness over health. Family members are often blamed as well, reflecting a long history of unsupported theories that attributed eating disorders to dysfunctional parenting before contemporary research established their multifactorial etiology.

Blame functions as a form of stigma because it assumes intentionality where illness exists. This assumption obscures the reality that many hallmark behaviors of eating disorders—including secrecy, ritualized eating, body checking, food avoidance, and resistance to weight restoration—are themselves symptoms of the disorder. These behaviors are not evidence that the illness is voluntary; they are evidence of how profoundly the illness alters cognition and behavior.

Understanding this distinction does not diminish personal responsibility in recovery. Individuals remain active participants in treatment, and meaningful recovery requires sustained effort. However, responsibility should not be confused with culpability. Patients may be responsible for engaging in recovery without being morally responsible for developing the illness itself.

The ethical implications of Gay’s argument extend beyond eating disorders. They challenge healthcare professionals and society more broadly to reconsider how psychiatric illness is interpreted.

When symptoms are viewed primarily through moral categories, treatment becomes correction. When symptoms are understood as manifestations of illness, treatment becomes care.

This distinction matters because language shapes clinical practice. Referring to patients as manipulative, difficult, or attention-seeking influences not only how clinicians think about them but also how patients come to understand themselves. Internalized stigma has been consistently associated with poorer mental health outcomes, reduced treatment engagement, and diminished hope for recovery.

Replacing moral judgment with compassionate curiosity does not require abandoning clinical boundaries or minimizing the seriousness of eating disorders. Rather, it requires recognizing that individuals deserve dignity even when their illness makes treatment extraordinarily complex.

The question should not be why people with eating disorders fail to recover quickly. The more important question is why a society that increasingly recognizes mental illness continues to treat eating disorders as exceptions—as illnesses that remain uniquely deserving of blame.

Until that changes, recovery will continue to involve more than healing from starvation, bingeing, or purging. It will also require healing from the profound social and clinical misunderstanding that has too often accompanied these illnesses.

Perhaps the most radical act in eating disorder treatment is also the simplest: listening to patients not as stereotypes, moral failures, or diagnostic labels, but as individuals whose experiences deserve both scientific attention and human respect.

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In many ways, that's progress. For people living with irritable bowel syndrome (IBS), the trend has helped chip away at the shame that has long surrounded digestive illness. It has given people permission to talk about symptoms that are often dismissed, minimized, or hidden altogether, and reminded many women that they aren't alone.

But somewhere between destigmatization and normalization, something has gotten lost.

Not every stomach problem is "just IBS." Not every bloated stomach is simply part of being a woman. And in a culture that simultaneously glorifies restriction while joking about constipation, nausea, and feeling painfully full after eating, those memes can make it dangerously easy to overlook one important—and often overlooked—cause of gastrointestinal dysfunction: not eating enough.

I know that because I have lived on both sides of that conversation. I've lived with genuine digestive problems—and I've lived with an eating disorder that learned to use those problems as evidence that I should keep starving myself.

I have struggled with an eating disorder since I was thirteen years old. Like so many people with eating disorders, my story doesn't move neatly from illness to recovery. It is a story of progress interrupted by relapse, of convincing myself I was getting better only to realize my eating disorder had simply become more convincing. Recovery, I've learned, is rarely linear. More often, it is a long negotiation between the part of you that wants to live and the part that still finds comfort in disappearing.

Throughout those years, one thing remained remarkably consistent: my stomach never seemed to work the way it was supposed to.

While I was actively restricting, I was constantly bloated, nauseated, and painfully full after eating what most people would consider a small snack. During recovery, those symptoms often became even more noticeable before they got better, which felt deeply unfair at the time. It seemed impossible that nourishing my body could make me feel worse, even temporarily. I interpreted every stomach ache as proof that something was wrong with me, never considering that my digestive system might simply be trying to recover from years of not having enough.

Long before my relapse at eighteen, I had also developed what appeared to be stress-induced IBS during my sophomore year of high school. Academic pressure had become all-consuming, and my body absorbed every ounce of it. The relationship between the brain and the gut is remarkably intimate. Stress doesn't stay confined to your thoughts; it changes how your digestive system functions. It can speed digestion up, slow it down, heighten pain sensitivity, and leave your stomach in knots long after the stressful moment has passed.

IBS itself is a complex condition shaped by that same gut-brain connection, and it affects women far more often than men. Researchers believe hormones, differences in pain processing, and the way chronic stress interacts with the digestive system all contribute to that disparity. Looking back, I have no reason to doubt that my symptoms during high school were real. They were.

What I couldn't yet recognize was that, years later, my eating disorder would begin using those symptoms as evidence that food itself had become the enemy.

So when my digestive symptoms suddenly flared up again at eighteen, I did what anyone would do. I made an appointment with a gastroenterologist. After listening to my symptoms, he recommended temporarily avoiding a litany of foods and eating smaller meals because my stomach likely couldn't tolerate much more at the time.

I don't blame him for saying that. I do blame the eating disorder for hearing something completely different.

Permission to make my world smaller again.

Permission to count.

Permission to eliminate.

Permission to fear.

That is one of the most insidious things about eating disorders: they have an extraordinary ability to recruit almost anything into their service. A compliment becomes motivation to lose more weight. A stressful semester becomes proof that you're "too busy" to eat. A stomach ache becomes evidence that food itself is the problem.

Looking back now, I can see the cycle my eating disorder was quietly constructing. My stomach hurt, so I restricted more. Restricting slowed my digestion even further, making my symptoms worse. Worse symptoms convinced me that eating was dangerous, which made the restriction feel not only justified, but necessary.

The illness had created the very evidence it needed to keep itself alive.

At eighteen, I couldn't see that.

Now I can.

One of the things I wish people understood about eating disorders is just how profoundly they affect the digestive system.

We often think of eating disorders as illnesses of weight, appearance, or psychology. They are all of those things, but they are physiological illnesses, too. Every organ system adapts to prolonged undernourishment, and the gastrointestinal tract is no exception.

Digestion is an energy-intensive process. When the body isn't receiving enough nourishment, it begins conserving energy wherever it can. The stomach empties more slowly. The muscles that move food through the intestines become less coordinated. Constipation becomes common. Bloating can become severe. After weeks or months of restriction, even a relatively small meal can leave someone feeling painfully full—not because their body is rejecting food, but because it has adapted to functioning on far less than it needs.

The cruel irony is that these symptoms often reinforce the very behaviors that caused them.

If eating leaves you nauseated, bloated, or doubled over with stomach pain, eating less can feel like the obvious solution. And in the short term, it may even seem to help. With less food moving through an already slowed digestive system, there is less immediate discomfort. To an eating disorder, that relief feels like proof that restriction is working.

In reality, it often deepens the problem.

The less you eat, the more your digestive system slows. The slower your digestion becomes, the more uncomfortable eating feels. What begins as a symptom becomes justification, and what feels like relief becomes part of a self-perpetuating cycle. Looking back, I can see that my eating disorder wasn't just responding to my gastrointestinal symptoms—it was using them to keep itself alive.

Ironically, beginning recovery can make many of those symptoms temporarily more noticeable before they improve.

Nobody prepares you for that. After years of conserving energy, your digestive system doesn't immediately remember how to process consistent nourishment. As your body begins healing, bloating, early fullness, constipation, and abdominal discomfort can all persist for a time. It can feel like evidence that recovery is making you sicker, when in reality your body is doing the slow, painstaking work of relearning a function it was forced to downregulate in order to survive.

That doesn't mean every digestive symptom is caused by an eating disorder, nor does it mean IBS and other gastrointestinal conditions aren't real. Many people live with both. IBS is a genuine disorder of the gut-brain axis, and stress, hormones, and other biological factors all play important roles in how it develops and fluctuates. But eating disorders and gastrointestinal disorders frequently overlap, making it difficult to distinguish where one ends and the other begins. Untangling that relationship often requires time, adequate nutrition, and thoughtful medical care.

For an eating disorder, though, that uncertainty is fertile ground.

If eating hurts, surely eating less must help.

Except it usually doesn't.

I've thought a lot about why the "hot girls have IBS" trend bothers me as much as it does.

It's not because people with IBS joke about their experiences. Humor has always been one of the most human ways we survive difficult things, and if making memes about your digestive system helps you cope with living in a body that feels unpredictable, I genuinely understand that.

In fact, I think there's something undeniably positive about the trend. For generations, women were taught not to talk about their digestive health at all. Bloating, constipation, diarrhea, pelvic pain—these were things to hide, to endure quietly, or to dismiss as simply part of being a woman. Seeing thousands of people openly compare symptoms, recommend doctors, and reassure one another that they aren't alone represents a kind of progress. Shame has a way of thriving in silence, and social media has made some of those conversations easier to have.

The joke isn't the problem.

The culture surrounding it is.

We exist in an online world that simultaneously glorifies restriction and normalizes its consequences. We celebrate surviving the workday on iced coffee and ending it with “girl dinner.” We praise "clean eating" without always interrogating the fear that sometimes hides beneath it. We romanticize tiny appetites, shrinking bodies, skipped meals disguised as productivity, and the discipline of saying no to food over and over again.

Then we laugh about chronic bloating. About never being able to poop. About feeling sick after every meal. About digestive systems that seem to have stopped working.

We rarely stop to ask whether those things might be connected. Instead, we've turned symptoms into personality traits.

Social media is remarkably good at flattening complexity. A diagnosis becomes an identity. A symptom becomes an aesthetic. Very different experiences—IBS, food intolerances, recovery-related bloating, stress-induced digestive problems, endometriosis, or the physiological consequences of chronic undernourishment—are folded together into the same joke. The algorithm doesn't care why your stomach hurts. It only cares that enough people relate to the punchline.

For someone recovering from an eating disorder, that flattening can be dangerous. Eating disorders are experts at borrowing legitimate medical language to justify illegitimate restriction.

"I'm just eating clean."

"Dairy doesn't agree with me."

"I think gluten is the problem."

"My stomach is so sensitive."

Sometimes those statements are completely true. IBS is real. Food intolerances are real. Celiac disease is real. Endometriosis is real. Countless people live with chronic digestive conditions that deserve thoughtful medical care.

That's what makes eating disorders so difficult to untangle from gastrointestinal illness. They don't require you to invent symptoms that aren't there. They simply reinterpret real ones. A legitimate diagnosis can become a reason to eliminate more foods. A temporary flare-up can become proof that nourishment itself is dangerous. The illness doesn't need to lie outright. It only needs to whisper the right conclusion.

The internet has become remarkably skilled at aestheticizing illness. Exhaustion is rebranded as hustle culture. Anxiety becomes a personality trait. Burnout becomes a badge of honor. IBS becomes something cute enough to print on a t-shirt.

Sometimes I wonder how many young women scrolling through those jokes have eating disorders they don't yet recognize. How many have convinced themselves that surviving on one meal a day is simply adulthood. How many are experiencing bloating, constipation, abdominal pain, and nausea not because their bodies are inherently broken, but because those bodies have spent months—or years—trying to function without enough nourishment.

How many, like I once did, are searching for an explanation everywhere except the one that feels too frightening to consider.

One of the most painful things about recovering from an eating disorder is accepting that healing often feels indistinguishable from getting worse.

Eating consistently after prolonged restriction may leave you feeling painfully full. Your stomach may bloat. Your digestion may seem slower before it becomes stronger. Your body, after spending so long conserving every possible ounce of energy, cannot simply flip a switch because you've decided to recover.

I wish someone had told me that sooner. Maybe eighteen-year-old me would have recognized that discomfort wasn't evidence that I should eat less. Maybe I would have understood that my body wasn't rejecting food. It was remembering how to receive it.

I still see the jokes. Sometimes I still laugh.

But then I think about the girl I was at thirteen, already learning to distrust her hunger. I think about the eighteen-year-old who mistook temporary medical advice for permission to disappear again. And I think about everyone sitting in waiting rooms right now, convinced their bodies are broken when, in reality, those bodies may simply be asking—persistently, desperately—for enough.

There is nothing glamorous about losing the ability to trust your own digestion.

There is nothing enviable about a body that has forgotten abundance because it has known deprivation for too long.

And there is certainly nothing "hot" about an illness that convinces you the consequences of starving yourself are just another quirky fact about being a woman.

I don't want us to stop talking about stomach problems. If anything, I want us to talk about them more. I want us to feel comfortable saying "I have IBS" or "I'm bloated" or "Something doesn't feel right" without embarrassment or shame. I want women to be believed when they say they're in pain. I want digestive health to be treated with the same seriousness as every other aspect of health.

But I also want us to stay curious.

Is this IBS?

Is it stress?

Is it endometriosis?

Is it an eating disorder?

Is it a body that has quietly adapted to months—or years—of not getting enough?

Sometimes the answer is IBS. Sometimes it's something entirely different. Sometimes it's more than one thing at once.

Our bodies speak long before they give out. They whisper through bloating. Through constipation. Through nausea. Through stomach pain that seems to appear out of nowhere.

The question isn't whether we hear those whispers.

It's whether we've become so accustomed to explaining those whispers away that we forget they're asking us to pay attention.

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It appears in recovery videos, "storytime" posts, before-and-after transformations, and, perhaps most of all, in the comment sections. Someone shares their experience with an eating disorder, and almost inevitably the conversation shifts toward numbers. People begin volunteering their lowest weight, their calorie intake, their BMI, their resting heart rate, how long they went without eating, how much they exercised. 

Sometimes the original creator hasn't shared a single number. They're talking about fear, obsession, isolation, or what recovery has meant to them. But scroll through the comments, and you'll find strangers filling in the details themselves, almost as if disclosing the most extreme parts of their illness is the price of participating in the conversation.

Most of these people aren't trying to glamorize eating disorders. Many are trying to do the opposite. They're looking for connection. They're trying to say, I understand. I went through this too.

And yet, every time I come across these posts, I find myself wondering the same thing: Who is this detail for?

It's a question I've started asking more and more—not because I think people should stop talking about eating disorders online, but because I think we underestimate how differently an eating disorder interprets information.

If you've never experienced one, it's easy to assume that a number is just a number. A weight is simply context. A calorie count is just part of the story. A before photo is evidence of how far someone has come.

But eating disorders don't process information that way. They are relentlessly, almost compulsively, comparative. Not because the people who have them are inherently competitive, but because the illness itself is. It turns numbers into hierarchies. It transforms suffering into something that can be ranked. It convinces you that someone else's story says something about your own.

One person's vulnerability becomes another person's benchmark. One person's lowest weight becomes someone else's goal. One person's recovery becomes someone else's evidence that they "weren't sick enough."

The tragedy is that comparison doesn't require bad intentions. It only requires information.

One of the cruelest things about eating disorders is how they distort the way we interpret other people's experiences. A healthy person can hear someone describe losing a significant amount of weight and think, That sounds frightening. An eating disorder hears the same story and immediately starts calculating. How long did it take? Could I do that? Why wasn't I able to? Maybe I wasn't actually that sick.

The illness is always looking for a scoreboard. Who ate less. Who exercised more. Who weighed less. Who was hospitalized. Who looked sicker.

None of these comparisons are rational. They don't measure pain, or fear, or the extent to which someone's life has been consumed by an illness. But eating disorders have never been particularly interested in rationality. 

That's part of what makes online recovery spaces so complicated. I genuinely believe social media has helped countless people feel less alone. Recovery deserves to be visible. People deserve to tell their stories. Silence has never been the answer. 

But recovery content isn't automatically safe simply because it's recovery content. Sometimes a video that's meant to celebrate healing spends more time showcasing the body that existed during the illness than the life that exists after it. Sometimes the emotional centre of the story gets buried beneath statistics: the lowest weight, the calories, the BMI, the clothing size, the medical complications. And sometimes the comment section becomes even more revealing than the video itself, as strangers begin swapping numbers and details that no one actually needed to understand the point of the story.

I also think there's a more uncomfortable conversation we need to have—one about validation. Sometimes we share these details because they're relevant. Sometimes they're necessary. But sometimes, if we're willing to be honest with ourselves, we're also looking for confirmation that what happened to us was real.

Eating disorders are notorious for convincing people that they aren't sick enough. Even after diagnosis. Even after treatment. Even after serious medical complications. The goalposts move constantly, and the illness keeps insisting that everyone else had it worse.

So it's understandable that we start looking for external proof. If enough people are shocked, maybe we'll finally believe we deserved help. If enough people say, "You were so sick," maybe the voice in our own head will finally quiet down. I don't think that impulse makes someone manipulative or attention-seeking. I think it makes them human.

But I also think it's exactly the kind of validation an eating disorder loves to hijack. Because it never lasts. The relief is temporary, and before long the illness starts negotiating again. Someone else was thinner. Someone else had more complications. Someone else's story gets more engagement. Once your sense of legitimacy depends on comparison, there is always another comparison waiting.

Social media only amplifies this dynamic. These platforms reward attention, and attention often goes to the most visually dramatic or emotionally shocking version of a story. The before-and-after transformation gets shared. The graphic confession gets comments. The post with the most startling details gets the most engagement.

Without realizing it, we can begin to absorb those incentives. We start believing our stories need increasingly dramatic evidence to be worth telling. But recovery isn't compelling because someone reached a particular weight. Recovery is compelling because someone chose life over an illness that wanted to take it away. Those are two very different stories.

Whenever I write about eating disorders now, I try to ask myself a simple question: If I removed this detail, would the story become less true? Would readers understand my fear without knowing my exact weight? Would they understand the severity of the illness without seeing my body at its smallest? Would they understand what I lost without knowing the precise numbers?

More often than not, the answer is yes. The emotional truth survives perfectly well without the metrics. "I couldn't think about anything except food." "I believed I wasn't sick enough." "I cancelled plans because I was afraid of eating." "My world became smaller." Those sentences tell us far more about the reality of an eating disorder than any statistic ever could.

I don't think responsible storytelling means censoring ourselves or pretending the difficult parts never happened. I think it means recognizing that authenticity and specificity are not the same thing. The question isn't, What happened to me? It's, What does someone else actually need to know to understand what happened to me?

Those aren't always the same thing. Some details deepen understanding. Others simply give the eating disorder more material to work with.

We'll never be able to remove every trigger from the internet, nor should that be the goal. Someone might find a recovery meal difficult to see, while someone else finds hope in it. We can't predict every response. But we can be thoughtful about the responses we know are predictable. We know eating disorders compare. We know numbers become goals. We know before photos can become inspiration for people we never intended to inspire. Knowing that, I think we owe one another a little more care.

Maybe the most radical thing we can do is stop asking people to prove they were sick enough. Stop measuring recovery by visible transformation. Stop treating the most extreme stories as the most important ones. Because an eating disorder doesn't become real once it reaches a certain weight. Recovery doesn't become meaningful because it has a dramatic before-and-after. And suffering doesn't need to be quantified before it deserves compassion.

One skipped breakfast, counted every calorie, ignored hunger, and exercised despite feeling exhausted. Friends complimented their discipline.

The other ate far past the point of fullness after spending hours trying not to eat at all. They went home feeling ashamed, convinced they had failed.

Both people may be experiencing symptoms of an eating disorder. Yet one is far more likely to receive admiration, while the other receives judgment.

That contradiction reveals something uncomfortable about the way our culture understands eating disorders. Although psychiatry recognizes multiple eating disorder diagnoses, society often treats them as though they exist in a hierarchy—one in which restriction appears disciplined, binge eating appears shameful, and thinness is mistaken for evidence of health. The hierarchy is unofficial, but its influence reaches healthcare, media, online communities, and the people living with these illnesses.

Eating disorders are complex psychiatric disorders shaped by genetic vulnerability, neurobiology, psychological traits, and environmental influences. Culture does not create eating disorders on its own, but it profoundly shapes which symptoms are rewarded, which are dismissed, and which people are believed when they ask for help.

One reason restrictive disorders can remain hidden is that many of their symptoms resemble behaviors our culture actively encourages. Skipping meals, fasting, rigid food rules, compulsive exercise, constant calorie tracking, suppressing hunger, and equating self-worth with body size are often celebrated as signs of commitment to health. Eating disorders frequently hide in plain sight because pathological behaviors are mistaken for wellness, discipline, or self-improvement rather than recognized as symptoms of psychiatric illness.

Stigma, however, is not distributed equally across diagnoses.

While restrictive behaviors are often interpreted as evidence of self-control, binge eating carries a particularly heavy burden of shame. Psychologists Rebecca M. Puhl and Chelsea A. Heuer found that people with higher body weight—and particularly those who binge eat—are frequently stereotyped as lazy, lacking willpower, or personally responsible for their condition. Those assumptions persist despite overwhelming evidence that binge eating disorder is a legitimate psychiatric illness with substantial biological and psychological underpinnings.

This pattern extends beyond weight stigma. A systematic review by Farah Ali, Rachael Finneran, and Sian Griffiths found consistent evidence that eating disorders are stigmatized differently depending on diagnosis. Across multiple studies, individuals with anorexia nervosa were generally viewed as more deserving of sympathy, whereas those with bulimia nervosa and binge eating disorder were more likely to be blamed for their symptoms or perceived as lacking self-control.

The consequences extend far beyond hurt feelings. In 2020, an international commission of more than 100 experts led by Francesco Rubino published a consensus statement in Nature Medicine concluding that weight stigma is pervasive across healthcare, education, employment, and the media, and that it worsens both physical and mental health without improving health behaviors.

Psychologists Laura M. Hart, Michelle A. Granillo, Anthony F. Jorm, and Susan J. Paxton reached similar conclusions when examining public attitudes toward eating disorders. They found that people with anorexia nervosa consistently elicited greater sympathy than those with bulimia nervosa, whose symptoms were more likely to be attributed to personal failings rather than illness.

Restriction is romanticized. Binge eating is moralized. Neither response reflects the reality of psychiatric illness.

These stereotypes influence diagnosis as well as public perception.

For decades, anorexia nervosa became the public face of eating disorders. Awareness campaigns, textbooks, documentaries, and news coverage overwhelmingly portrayed emaciated young women, reinforcing the mistaken belief that someone must look severely underweight to have a serious eating disorder.

That stereotype has consequences. Clinical guidelines from the National Institute for Health and Care Excellence emphasize that eating disorders occur across the weight spectrum and should never be ruled out on the basis of body size alone. Yet numerous studies continue to find that people living in larger bodies experience delayed diagnosis, fewer referrals, and reduced access to specialized treatment. Individuals with atypical anorexia nervosa, for example, may experience the same cardiovascular, endocrine, and metabolic complications as patients with anorexia nervosa despite remaining within or above what society considers a "normal" weight.

The misconception that someone must "look sick" remains one of the greatest barriers to treatment.

Online eating disorder communities can unintentionally reinforce these same cultural messages. These spaces have helped countless people find validation and support, yet researchers studying digital eating disorder communities have observed that conversations often center on restriction, weight loss, and visible emaciation because those symptoms already dominate public narratives about what eating disorders are supposed to look like.

As a result, people living with bulimia nervosa or binge eating disorder frequently describe feeling invisible. Others come to believe that if they cannot restrict "successfully," they are somehow failing at having an eating disorder.

These beliefs have no basis in diagnosis.

They emerge because illness becomes intertwined with achievement. The eating disorder encourages comparison—who eats the least, exercises the most, loses the most weight, or appears the sickest—and cultural messages reinforce those comparisons by rewarding visible self-denial while condemning visible loss of control.

Psychiatry recognizes no hierarchy of suffering.

The DSM-5 recognizes anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder (ARFID), and other specified feeding or eating disorders (OSFED) as serious psychiatric illnesses. Their symptoms differ. Their medical complications differ. Their treatment approaches may differ. Their legitimacy does not.

Restriction can lead to malnutrition affecting nearly every organ system. Bulimia nervosa can produce electrolyte disturbances, cardiac arrhythmias, gastrointestinal injury, and dental erosion. Binge eating disorder is associated with profound psychological distress and elevated medical risk independent of body size alone. Compulsive exercise can result in stress fractures, hormonal dysfunction, cardiovascular complications, and chronic injury. None of these illnesses is inherently more deserving of compassion than another.

Perhaps the greatest harm of the hierarchy is that people begin to believe it themselves.

Someone who binges concludes they simply lack willpower. Someone who purges decides their symptoms are too shameful to disclose. Someone with atypical anorexia believes they are not thin enough to deserve treatment. Someone whose compulsive exercise is applauded receives encouragement while their illness quietly worsens.

The hierarchy protects the illness by keeping people silent.

That silence matters. Across mental health conditions, stigma is consistently associated with delayed help-seeking, reduced treatment engagement, and poorer outcomes. Eating disorders are no exception.

Recovery requires rejecting the moral language that surrounds symptoms. Restriction is not virtue. Binge eating is not a moral failure. Purging is not evidence of weakness. They are different manifestations of psychiatric illness.

No one earns compassion by becoming thinner. No one loses compassion because their symptoms are less visible, more chaotic, or less socially acceptable.

The hierarchy exists because our culture already praises self-denial and condemns perceived loss of control. Recovery begins when we stop confusing symptoms with character—and recognize that every person with an eating disorder deserves the same urgency, the same dignity, and the same hope for recovery.

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Works Cited

Ali, Khalida, et al. “Perceived Barriers and Facilitators towards Help-Seeking for Eating Disorders: A Systematic Review.” International Journal of Eating Disorders, vol. 50, no. 1, 2017, pp. 9–21. Wiley, https://doi.org/10.1002/eat.22598.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text rev., American Psychiatric Association Publishing, 2022.

Hart, Laura M., et al. “Unmet Need for Treatment in the Eating Disorders: A Systematic Review of Eating Disorder Specific Treatment Seeking among Community Cases.” Clinical Psychology Review, vol. 31, no. 5, 2011, pp. 727–35. Elsevier, https://doi.org/10.1016/j.cpr.2011.03.004.

National Institute for Health and Care Excellence. Eating Disorders: Recognition and Treatment (NG69). NICE, 2017, updated periodically, https://www.nice.org.uk/guidance/ng69.

Puhl, Rebecca M., and Chelsea A. Heuer. “The Stigma of Obesity: A Review and Update.” Obesity, vol. 17, no. 5, 2009, pp. 941–64. https://doi.org/10.1038/oby.2008.636.

Rubino, Francesco, et al. “Joint International Consensus Statement for Ending Stigma of Obesity.” Nature Medicine, vol. 26, no. 4, 2020, pp. 485–97. https://doi.org/10.1038/s41591-020-0803-x.

“You look sick.”

To the person saying it, the words are often an expression of alarm. A plea. An attempt to communicate what they can see from the outside when language has otherwise failed them. They hope the observation will land as concern. They hope it will penetrate the logic of the disorder and awaken a desire for recovery.

Yet for many people with eating disorders, those words do not arrive as concern at all. They arrive as validation. This is one of the most painful and misunderstood paradoxes of eating disorders: the appearance of illness is often not an unfortunate side effect of the disorder but one of its goals.

To understand why, we have to look beyond the popular narrative that eating disorders are primarily about beauty, thinness, vanity, or a desire to be attractive. These explanations persist because they are simple and reassuring. If eating disorders are merely exaggerated attempts to conform to beauty standards, then they remain comprehensible within familiar cultural frameworks. 

But anyone who has lived through an eating disorder knows how inadequate that explanation is. At a certain point, the pursuit is no longer attractiveness. Often, it never was. The pursuit is illness itself.

Psychological suffering is notoriously difficult to prove. Depression has no cast. Anxiety leaves no visible scar. Loneliness cannot be measured on an X-ray. People can be falling apart internally while appearing entirely functional from the outside. For many individuals with eating disorders, physical deterioration becomes a way of making invisible pain visible. The body begins to tell a story that words have failed to communicate. If someone is emaciated, exhausted, faint, freezing, skeletal, surely no one can deny that something is wrong. Surely the suffering becomes undeniable.

Many people with eating disorders describe a persistent fear that they are "not sick enough." No matter how severe the symptoms become, there remains the suspicion that they are exaggerating, seeking attention, or somehow inventing their distress. The goalposts move relentlessly. What once seemed alarming soon feels ordinary. What once qualified as illness now feels insufficient. The body becomes evidence in an internal trial that never reaches a verdict.

Visible deterioration offers temporary reassurance. A protruding collarbone, hollow cheeks, jutting ribs, thinning hair—these features may be interpreted not as signs of danger but as proof. Proof that the suffering is real, and that it deserves recognition. Proof that help is warranted. In this context, being told "you look sick" can feel less like a warning than a confirmation. The disorder hears: Finally, someone sees it.

Another uncomfortable truth lies beneath many eating disorders: the desire to be cared for. This desire is often accompanied by immense shame. Adults are expected to be self-sufficient. Even children quickly learn that dependency can be viewed as weakness. Many people with eating disorders pride themselves on competence, achievement, self-control, and independence. They become experts at needing nothing from anyone.

Yet human beings are not built for complete self-sufficiency. We all carry longings to be comforted, protected, and tended to when we are in pain. Sometimes illness appears to offer permission for these needs. When someone is visibly unwell, expectations change. Others become gentler. They ask questions. They express concern. They offer support. The person no longer has to justify their distress because the evidence is apparent.

This does not mean eating disorders are conscious attempts to manipulate others into providing care. Such interpretations are both cruel and inaccurate. The process is usually far more subtle and unconscious. Physical illness can become entangled with the hope that one's suffering will finally be acknowledged. The fantasy is rarely only I want to be thin. More often, it is: I want someone to see how badly I'm hurting. Or: I want my pain to matter. Or: I want help, but I don't know how to ask for it. The body then becomes the request.

This creates a tragic communication gap between loved ones and those suffering from eating disorders. Family members, partners, and friends often believe they are offering a deterrent when they comment on a person's appearance. "You look terrible." "You're wasting away." "You look sick." From their perspective, these statements are expressions of fear. They are trying to communicate urgency. They want the person to understand the seriousness of the situation.

What they often do not realize is that the eating disorder may translate these comments entirely differently. The listener hears confirmation that the disorder is succeeding. The observation becomes a measurement of achievement.

This does not mean loved ones should never express concern. Silence is not the answer. But it does mean that appearance-focused interventions frequently miss their intended target because they assume the sufferer shares the same values as the observer. The concerned friend sees gauntness and thinks: This looks frightening. The eating disorder sees gauntness and thinks: This proves I am finally sick enough. Both are looking at the same body and interpreting it through entirely different psychological frameworks.

These misunderstandings are reinforced by the widespread belief that eating disorders are fundamentally about looking beautiful. Because of this assumption, loved ones often reach for a particular strategy. They say things like: "You looked better before." "This isn't attractive." "Men don't like women who are this skinny." The logic is understandable. If the disorder is motivated by a desire to be attractive, then highlighting its negative effects on appearance should weaken its appeal.

Unfortunately, many eating disorders are not operating according to conventional standards of attractiveness. Someone deep in an eating disorder may not aspire to look healthy, radiant, or conventionally beautiful. They may actively prefer the signs that others find alarming. Hollow eyes, visible ribcages, caved-in cheeks: to an outsider, these features signify deterioration. To the disorder, they signify accomplishment. Attempts to appeal to vanity therefore often fail because they misunderstand the motivation itself.

There is another layer to this phenomenon. In many treatment settings, resources are scarce. Care is limited. Insurance companies demand evidence. Waiting lists stretch endlessly. People learn, explicitly or implicitly, that severe illness receives attention while less visible suffering is questioned. As a result, many individuals develop the belief that they must reach a certain threshold before they deserve help. The body becomes a credential; a passport to legitimacy.

This dynamic is particularly cruel because it transforms treatment into something that must be earned rather than received. People begin waiting for permission to recover. They tell themselves they will seek help after losing more weight, after becoming more visibly ill, after crossing some imaginary line that proves their suffering is sufficiently serious. The line never arrives.

Recovery often demands relinquishing something rarely discussed: the ability to visibly demonstrate suffering. As weight is restored and physical health improves, many people experience an unexpected fear. What if no one believes me anymore? What if people think I'm fine? The anxiety is understandable. For years, the body may have served as a public record of private pain. Recovery asks us to trust that our suffering remains real even when it is no longer written across their bones.

This is one of the most courageous acts recovery requires. To believe that pain deserves compassion before it becomes catastrophic. To believe that needs deserve acknowledgment before they become emergencies. To believe that one is worthy of care without first looking sick enough to earn it.

When someone says, "You look sick," they are usually trying to communicate love. But eating disorders distort language. They scramble meanings. They transform concern into validation and fear into encouragement. The challenge for loved ones is not merely to comment on what they see but to connect with what lies beneath it. Not “you look terrible,” but “I'm worried about how much pain you're carrying.” Not “you’re becoming too thin,” but “you matter to me, and I'm concerned about your well-being.”

These conversations are harder because they move beyond the body. They require engagement with the emotional realities that the body has come to represent. And ultimately, that is where recovery begins. Not when someone finally looks sick enough. Not when their suffering becomes impossible to ignore. But when they discover that their pain was worthy of care all along—before the hollow cheeks, before the protruding bones, before the visible evidence.

Before anyone could look at them and say, “You look sick.”

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It is not the jealousy we are taught to recognize. It is rarely loud enough to announce itself. It does not arrive with obvious bitterness or hostility. More often, it appears as a fleeting thought while scrolling through photographs. A momentary tightening in the chest when someone walks into a room. A brief recalculation of your own body against another person's body, completed almost before you realize it has happened.

Recovery is supposed to make these comparisons less important. In many ways, it does. But recovery does not grant immunity from living in a culture that remains deeply invested in thinness. It simply means you experience that culture without the protective numbness of actively pursuing it. That can be a difficult position to occupy.

For a while, it seemed as though the conversation around bodies was changing. The language of wellness remained problematic in its own ways, but there was at least the suggestion of expansion—a widening of what kinds of bodies could be visible, celebrated, and considered acceptable. The ideal appeared to loosen its grip, if only slightly.

Lately, however, something feels different.

Bodies are shrinking again. You notice it everywhere. Celebrities appear on red carpets as skin and bones. Influencers document their journeys from lean and toned and shredded to… more lean and toned and shredded. Distant acquaintances stop you mid-scroll on Instagram.

The rise of GLP-1 medications has complicated this landscape further. Their existence is not inherently good or bad. Many people use them for reasons that have nothing to do with vanity, and discussions about them are often flattened into simplistic moral arguments. But culturally, their arrival has coincided with something undeniable: thinness has become newly attainable for many people who previously struggled to achieve it.

What changes is not merely what we see, but what starts to feel normal. Eating disorders used to sell a fantasy that was difficult to realize and even more difficult to sustain. There was, at least, some friction between the ideal and reality. Now the distance appears narrower. The transformation stories arrive faster. The before-and-after photographs multiply. The fantasy acquires a new sheen of plausibility.

For someone in recovery, this can create a uniquely painful tension. You have spent years learning that your life cannot revolve around the pursuit of a smaller body. You have fought for the ability to eat without negotiation. You have worked to measure your days by something other than calorie counts, clothing sizes, or the geometry of your own reflection. And yet the world around you continues broadcasting a different message.

Look how much happier she seems. Look how much prettier. Look how much more successful. The mind may know these conclusions are unsupported. The emotional response often arrives anyway.

One of the strangest aspects of recovery is discovering that jealousy is rarely about appearance itself. The body becomes a vessel for other longings. We imagine that the person who lost weight has gained certainty, social ease, romantic success, professional competence. The smaller body functions as a visual shorthand for a collection of desires that have little to do with body size and everything to do with being fully alive.

This is why comparison can feel so destabilizing. You are not merely comparing bodies. You are comparing imagined lives. Social media intensifies the distortion because it provides an endless supply of evidence while withholding nearly all context. We see the visible outcome without seeing the private cost. We see the photograph without the interiority. We see bodies but not relationships to those bodies. 

An eating disorder teaches us to treat appearance as the most important fact about a person. Recovery involves learning that appearance is often among the least informative. A photograph can reveal weight loss. It cannot reveal peace. It can reveal a jawline. It cannot reveal freedom. It can reveal discipline. It cannot reveal whether that discipline has become a prison.

Sometimes I think one of the most difficult truths in recovery is that some people really do receive rewards for becoming thinner. Pretending otherwise can feel insulting. People are often treated differently. Compliments, visibility, desirability, and personal and even professional opportunities can increase. We live in a society that confers status according to appearance, and denying that reality serves no one.

The more interesting question is whether those rewards are worth organizing a life around. Because there is a cost to making appearance the central project of your life. Not only in suffering, but in opportunity cost. Hours spent thinking about food are hours not spent elsewhere. Mental energy devoted to self-correction is mental energy unavailable for relationships, work, curiosity, pleasure, or rest. Recovery is, among other things, the decision to stop paying that price.

The tragedy of comparison is that it can make a recovered life appear less glamorous than it actually is. Freedom is not particularly photogenic. Nobody posts a carousel celebrating the fact that they ate dinner without calculating and negotiating every bite. Nobody announces that they spent an afternoon thinking about books or music or politics instead of their thighs. The victories of recovery are often invisible. Yet invisible does not mean insignificant. In fact, invisibility may be part of their value.

The recovered life is not one in which you become the person least affected by diet culture. It is not one in which jealousy vanishes forever or comparison ceases to exist. Those expectations merely create another impossible standard. Rather, recovery is the gradual construction of a self whose interests extend beyond the body. A self with passions. Curiosities. Devotions. A self capable of encountering the endless parade of shrinking bodies and recognizing, however imperfectly, that a human life cannot be measured in reductions. Because that is the temptation of the current moment: to mistake less for more. Less weight. Less softness. Less space occupied. As though a life becomes meaningful through subtraction.

But recovery teaches a different lesson. The best parts of being alive have always depended on expansion: an expanded capacity for pleasure, for intimacy, for attention, for surprise, for grief, for joy.

The irony is that comparison tries to convince us that another person's body contains the answer to our own unhappiness. Yet the people who have persevered through eating disorders know something many others do not. There is no body that ends longing. There is no weight at which self-consciousness evaporates permanently. There is no number capable of carrying the burden we ask it to carry.

And so the task, difficult and unfinished, is not to eliminate jealousy whenever it appears. It is to recognize it for what it often is: a signal pointing toward some deeper ache, desire, or fear. The body is simply where the feeling chooses to land. The feeling itself is almost always about something else. And that distinction, though subtle, may be one of the most important freedoms recovery offers.

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Not the grief of a single loss, but of accumulation. The slow realization that while everyone else seemed to continue forward—graduating, moving away, falling in love, collecting milestones and memories—you were occupied elsewhere, fighting battles invisible to most of the people around you. Years disappeared this way. Not all at once, but gradually, absorbed by hospital admissions and treatment programs, by relapses and recoveries and the exhausting labor of simply surviving.

At twenty, I often feel suspended between ages. There are moments when I feel far older than my peers, burdened by experiences that have compressed decades of fear, grief, and uncertainty into a few short years. And there are moments when I feel impossibly young, stranded at the edge of a life I have not yet figured out how to enter. The distance between where I am and where I imagined I would be can feel unbearable.

I was a child who grew up believing deeply in the transformative power of effort. Curiosity came naturally to me. Achievement followed closely behind. I devoured books, chased perfect grades, and learned early that praise often arrived hand in hand with accomplishment. Before long, excellence ceased to be something I pursued and became something I believed I owed the world. The arrangement seemed simple enough: work hard, succeed, feel worthy. What I didn’t understand was how fragile that equation was. For years, achievement functioned as the architecture of my identity. Every success reinforced the belief that I was building something stable. Yet the structure rested on a dangerous premise—that my value as a person was inseparable from my ability to excel.

When depression arrived, it exposed the fault lines. No amount of intelligence could reason its way around despair. No amount of discipline could eliminate loneliness. No amount of effort could guarantee that the people I loved would stay, that my mind would remain a safe place to inhabit, or that life would unfold according to plan.

And when those realities became impossible to ignore, my perfectionism simply migrated elsewhere. The eating disorder wore the familiar face of achievement. At first, it felt less like an illness than a continuation of everything I had already been taught to admire in myself. Discipline, dedication, self-control. The same traits that had once earned admiration in classrooms now found a new arena in which to perform. What began as an attempt to improve myself gradually transformed into an obsession with mastery. Hunger became proof of willpower. Restriction became evidence of commitment. Every ignored craving, every rule obeyed, every shrinking number carried the intoxicating promise that I was succeeding at something.

The irony, of course, is that the more my world contracted, the more accomplished I felt. As friendships frayed, ambitions stalled, and joy became increasingly inaccessible, the eating disorder offered something deceptively simple: a game whose rules I understood. Life had become bewilderingly complex. The disorder was not. Life asked me to tolerate uncertainty, disappointment, vulnerability, and grief. The eating disorder asked only for obedience. And obedience, I could do.

This is one of the truths about eating disorders that can be difficult to explain to people who have never experienced one: they do not survive solely because they cause suffering. If suffering were enough, most of us would abandon them immediately. They survive because they offer something. Not something genuine, or something sustainable. But something powerful enough to feel indispensable. For me, that something was achievement.

As the years passed and my illness continued interrupting my life, I became increasingly haunted by the sensation of falling behind. I watched family members, friends, and classmates move into futures that seemed impossibly distant from my own. They graduated. Started careers. Built relationships. Discovered who they were becoming. 

Meanwhile, I remained caught in a revolving door of treatment centers, medical leaves, and psychiatric interventions. Every relapse widened the gap. Every hospitalization became another reminder that my life was not unfolding according to schedule. I carried that awareness everywhere. It settled over ordinary moments like a shadow. Scrolling through social media. Running into former classmates. Filling out forms that asked about education or employment. Even innocuous conversations could leave me feeling as though I were standing outside a window, watching everyone else participate in a world from which I had somehow been excluded.

The feeling was not merely disappointment; it was shame. A profound and corrosive shame. And shame has always been fertile ground for my eating disorder. Because whenever I looked honestly at my life, I saw unfinished goals, interrupted plans, abandoned semesters, opportunities lost to illness.

The eating disorder saw something else. It pointed to numbers, to rules, to rituals, to metrics. It offered a version of success that remained available even when every other source of accomplishment seemed out of reach. I could still be good at this. That thought has accompanied more relapses than I care to admit. Not because I believed the eating disorder was making my life better, but because there were periods when it felt like the only domain in which I remained capable of excelling. While everything else seemed suspended in uncertainty, the disorder provided immediate and measurable feedback. It transformed emotional anguish into objectives. It converted despair into tasks. It reduced the overwhelming complexity of being a human being to a series of increasingly destructive benchmarks.

The cost was catastrophic. Yet the logic felt compelling. If I could no longer be the student, the friend, the person I wanted to be, perhaps I could at least be successful at this. That was the trap. Not the desire to suffer; the desire to succeed. One of the most difficult aspects of recovery has been recognizing that letting go of my eating disorder requires relinquishing one of the last remaining places where I consistently felt competent. 

People often imagine recovery as an act of gaining something. Health. Freedom. Peace. And it is. But before it becomes those things, it often feels like loss. Loss of certainty. Loss of identity. Loss of the familiar. Loss of a system that, however brutally, has structured your relationship to yourself for years. Recovery asks me to step away from the only measuring stick I have trusted for a very long time without offering immediate reassurance about what should replace it. It asks me to believe that a meaningful life can exist outside achievement. That worth can survive imperfection. That a delayed future is not a ruined one.

Some days I believe those things. Other days I find myself grieving: the years consumed by illness. The person I might have become. The simplicity of a disorder that always had an answer, even when the answer was slowly killing me.

But I am beginning to understand something I resisted for years. The feeling of being behind was never cured by the eating disorder. It was created by it. Every relapse I pursued in response to that fear only deepened the very losses I was mourning. Every attempt to regain control tightened the cage. Every promise that the disorder would help me catch up merely carried me farther from the life I wanted.

The tragedy is not solely that I lost years to anorexia. The tragedy would be continuing to lose them because I am still trying to recover what it already took. Perhaps recovery is, in part, the willingness to stop measuring life as a race. To stop viewing experiences through the lens of a résumé. To release the fantasy that worthiness can be earned through suffering.

I do not know exactly what my future will look like. Much of it remains obscured by uncertainty. But uncertainty, I am learning, is not the same thing as hopelessness. For years, I chose the certainty of self-destruction over the risk of change. Now I am trying, however imperfectly, to choose differently. To trust that a life interrupted is still a life. That growth is not invalidated by delay. That healing does not have to be spectacular to be real. And that I would rather spend the rest of my life learning how to live than continue perfecting the art of disappearing.

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I read recovery blogs. Listened to podcasts. Followed recovery influencers. Saved posts and articles about neural rewiring, set-point theory, extreme hunger, body image, and food freedom. I accumulated knowledge at an impressive rate. I understood that my eating disorder was hurting me. I understood why recovery requires adequate nutrition. I understood that weight gain would be necessary. I understood that fear foods lose their power through repeated exposure. And yet, despite all of that understanding, my life remained unchanged. Because insight is not the same thing as action.

Many of us unconsciously turn recovery content into a waiting room. We consume more information because we believe there is some threshold of certainty we have not yet reached—a final article, podcast episode, or insight that will make us feel ready. Ready to eat more. Ready to stop compensating. Ready to gain weight. Ready to let go.

But readiness is a feeling that recovery rarely grants in advance.

The eating disorder tells us that if we just learn a little more, we'll finally feel certain enough to begin. So we keep preparing. We keep learning. We keep gathering evidence. What often goes unnoticed is that preparation can become avoidance.

Researching recovery feels safer than practicing it. Watching someone else challenge a fear food is easier than challenging your own. Reading about weight restoration is easier than experiencing it. Agreeing with recovery principles is far less threatening than applying them at dinner tonight.

Information feels productive because it creates the sensation of movement. But movement and progress are not always the same thing. A person can become extraordinarily knowledgeable about recovery while remaining deeply entrenched in the behaviors that prevent it.

Part of the reason lies in how the human mind responds to uncertainty. Social psychologist Arie Kruglanski has shown that people differ in their need for cognitive closure—the desire for firm answers and relief from ambiguity. When uncertainty is high, the mind naturally searches for information, explanations, and reassurance. The more consequential the decision feels, the stronger that pull can become.

Recovery offers almost none of the guarantees the brain wants. You do not know exactly how your body will change. You do not know how long the process will take. You do not know when food thoughts will quiet down, how hunger cues will evolve, or what life without the disorder will feel like. For a mind craving certainty, this can feel intolerable.

Researching recovery feels productive because it creates the impression that uncertainty is shrinking. Every article provides another explanation. Every podcast offers another perspective. Every recovery account supplies another piece of evidence. The issue is that recovery is not primarily a knowledge problem. It's an action problem. At a certain point, additional information stops functioning as preparation and starts functioning as protection from action.

Modern neuroscience offers a similar perspective. According to predictive processing models advanced by neuroscientist Karl Friston, the brain continuously generates predictions about the world and updates them when reality differs from expectation. In general, predictable environments require less cognitive effort and feel easier to navigate. Few things are more predictable than an eating disorder. The rules are familiar. The rituals are familiar. The consequences are familiar. Even the suffering becomes familiar.

An eating disorder may shrink your life, isolate you from others, and consume enormous mental energy. But it is known territory. And the brain often mistakes familiarity for safety.

Recovery disrupts that predictability. Meals become larger. Flexibility replaces rigid rules. Weight may change. Hunger signals shift. Emotions that were muted by restriction become more visible. From the brain's perspective, the old map no longer applies. The resulting alarm is often interpreted as danger.

This is why so many people remain stuck despite fully understanding what they need to do. Knowledge alone cannot override a nervous system that is demanding certainty before it agrees to move forward. The uncomfortable truth is that recovery happens in behavior, not in understanding. 

Psychologists have long distinguished intellectual understanding from experiential learning. A person can fully comprehend an idea while remaining emotionally unconvinced by it. The gap is bridged not by additional explanation but by direct experience. This principle sits at the center of exposure-based treatments for anxiety disorders. Decades of research have shown that lasting change occurs when individuals approach feared situations and discover, through experience, that they can tolerate the uncertainty and discomfort they anticipated. New learning emerges from contact with fear—not from eliminating fear beforehand.

Recovery follows the same logic. You do not learn that eating enough is safe by reading about adequate nutrition, but by eating enough. You do not discover that a fear food is manageable by watching someone else eat it, but by eating it yourself. You do not become convinced that weight gain is survivable through research, but by living through the experience. The learning comes after the action. Not before it.

This is where many people become trapped. They assume confidence must precede recovery behaviors, when in reality recovery behaviors are what generate confidence. The first meal rarely feels comfortable. The first fear food is seldom empowering. The first week without compensatory behaviors may feel anything but reassuring. You act while still afraid. Your brain gathers evidence. Gradually, your expectations begin to change.

Another concept that helps illuminate this pattern is experiential avoidance, a central process in Acceptance and Commitment Therapy. Experiential avoidance occurs when people organize their behavior around escaping uncomfortable thoughts, emotions, bodily sensations, or uncertainty. Eating disorders often function as sophisticated avoidance systems. And sometimes, recovery research can serve a similar role. If consuming recovery content repeatedly postpones the anxiety of taking action, information-seeking may begin to perform the same psychological function as the disorder itself: protecting you from discomfort in the present moment.

The irony, of course, is that avoidance never resolves fear. It preserves it. When feared situations are continually postponed, the brain never receives evidence that they are survivable. The prediction remains unchallenged. Over time, this pattern becomes increasingly automatic. Habits form through repetition. Behaviors that are practiced thousands of times begin to feel natural—not because they are healthy, but because they have become deeply familiar. Each repetition strengthens the pathway.

Recovery therefore requires more than changing beliefs. It involves interrupting automatic patterns and practicing new behaviors until they, too, become familiar. That process is uncomfortable for a simple reason: the brain is being asked to abandon well-rehearsed predictions and construct new ones. Resistance is not necessarily a sign that recovery is failing. Often, it is evidence that recovery is occurring.

Many people imagine that one day they will wake up feeling ready—ready to eat more, gain weight, stop compensating, and trust the process. But readiness rarely arrives first. The certainty you are waiting for is usually a consequence of recovery, not a prerequisite for it. You do not become ready and then recover; you recover and gradually become ready. You do not challenge fear because fear has disappeared; you challenge it while fear is still present. You eat despite uncertainty. You continue despite doubt. You act before your mind offers permission. 

Because recovery is not something you prepare for forever. It is something you enter. And almost everyone who reaches the other side begins in the same place: frightened, uncertain, craving guarantees—and choosing action anyway.

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Trust a body that feels dangerous. Trust hunger when hunger feels threatening. Trust weight restoration despite every instinct insisting otherwise. Trust a future that remains entirely theoretical. Trust clinicians, meal plans, treatment teams, and a recovery process whose promises cannot yet be verified.

By the time I first entered treatment, trust was already in short supply. My relationship with my body had become adversarial. Food felt threatening rather than nourishing. Even my own judgment seemed unreliable. Most importantly, I had little reason to believe recovery offered anything worth choosing over the disorder.

From the outside, that reluctance can look irrational. If someone is critically ill, why wouldn't they want help?

But eating disorders do not sustain themselves by convincing people they are suffering. They sustain themselves by convincing people they are safe.

Anorexia had spent years presenting itself as a solution. It offered certainty where life felt chaotic, structure where emotions felt overwhelming, and a set of rules that seemed far more dependable than anything occurring inside my own mind. The disorder was slowly destroying me, yet it was also the thing I trusted most.

Treatment, by contrast, was largely a promise. Clinicians assured me that if I continued eating, gained weight, and tolerated the distress that accompanied both, my world would eventually expand. They were probably right.

The difficulty was that I couldn't see any evidence of it.

Recovery required faith in an outcome that existed entirely beyond my field of vision. It felt like standing at the edge of a cliff while people on the other side insisted there was a bridge hidden somewhere beneath the fog. They could see it. I couldn't.

That uncertainty followed me into every level of care that came after—hospitals, PHPs, residential programs, therapists' offices, family sessions. Looking back, I realize that what treatment demanded was not simply behavioral change. The meal plans, therapy groups, and recovery contracts were only the visible components of a much deeper process. Beneath all of them lay the same invisible foundation: trust.

Trust that nourishment would not destroy me. Trust that uncertainty was survivable. Trust that the people guiding me could see possibilities I could not yet imagine for myself.

People rarely recover because they are persuaded by a flawless argument. More often, they recover because they gradually come to trust something more than they trust the disorder.

Sometimes that trust develops through relationships. A therapist remains steady long enough that honesty begins to feel safer than concealment. A dietitian approaches fear with curiosity rather than frustration. A staff member recognizes that the person sitting across from them is not simply exhibiting symptoms, but relinquishing one of the only coping mechanisms that has ever made life feel manageable.

The best treatment experiences I have had were not necessarily the most sophisticated. They were the ones that made trust possible.

What treatment often fails to recognize, however, is how fragile that trust can be.

When people imagine harmful treatment experiences, they tend to think of dramatic failures. In reality, trust is more often eroded through accumulation: contradictions, dismissiveness, lack of transparency, exclusion from conversations about one's own care, or a careless remark that a clinician forgets within minutes but a patient carries for months.

Individually, these moments may seem insignificant. For someone with an eating disorder, they rarely are.

These illnesses thrive on uncertainty. Every inconsistency becomes evidence. Every disappointment becomes confirmation. Every breach of trust offers the disorder another opportunity to reassert itself:

See? I told you this wasn't safe.

I learned this firsthand.

Some of my treatment experiences were genuinely transformative. Others left me feeling unseen, invalidated, or excluded from decisions that directly affected my life. There were breakdowns in communication. There were moments when staff reinforced fears they were meant to help dismantle. There were situations that left me feeling less like a participant in my recovery than an object being managed by it.

What made those experiences difficult was not simply that they hurt. They made recovery harder.

When trust is damaged, patients do not merely lose confidence in individual providers. They begin losing confidence in the process itself. And when recovery already requires enormous leaps of faith, that distinction matters.

Every level of care asks patients to move before certainty arrives. Eat before it feels safe. Gain weight before it feels necessary. Rest before it feels deserved. Let go of familiar coping mechanisms before knowing what will replace them. 

The entire process depends on a willingness to tolerate uncertainty. That willingness does not require perfection from treatment providers. It does, however, require credibility, consistency, humility, and transparency. Expertise alone is not enough. Trust cannot be assumed; it must be earned. And when it is broken, repair matters as much as the original relationship.

The older I get, the less interested I become in debates about whether treatment "works." The question feels too simplistic. Treatment is neither miracle nor failure. It is a relationship. And like any relationship, its effectiveness depends in part on trust.

The hospitals I entered did not cure me. Neither did the residential programs, therapists, medications, or meal plans. Recovery was never something they could accomplish on my behalf.

What they provided, at their best, was something far more valuable: enough safety for me to begin risking trust again. Trust in my body. Trust in other people. Trust in uncertainty. Trust in my ability to survive emotions I once believed would destroy me.

That trust has been broken and rebuilt many times. Even now, it remains fragile. Most days, recovery feels less like certainty than a decision to keep moving forward despite uncertainty.

Perhaps that is what recovery has always been. Not confidence in the outcome, but willingness to proceed without guarantees. A decision to step forward before proof arrives. A decision to believe there may be a bridge hidden somewhere in the fog—and to keep walking long enough to find out.

"As for the body, it is solid and strong and curious and full of detail: it wants to polish itself; it wants to love another body; it is the only vessel in the world that can hold, in a mix of power and sweetness: words, song, gesture, passion, ideas, ingenuity, devotion, merriment, vanity, and virtue."

There is something almost startling about the expansiveness of her vision. Oliver does not describe the body as an object to be admired, corrected, improved, or controlled. She describes it as a vessel—a living, breathing container for everything that makes a life a life.

Words. Song. Passion. Devotion. Merriment.

The body, in Oliver's telling, is not the point. It is the means through which all other points become possible.

This can be a difficult truth to recognize after an eating disorder.

Eating disorders have a way of reversing the natural order of things. The vessel becomes the destination. The body, which was meant to carry us into the world, gradually becomes the world itself. Its size, shape, weight, and appearance begin to eclipse everything else. What was once a medium for living becomes the primary focus of life.

For years, I have related to my body less as a home and more as a perpetual renovation project. There was always something to adjust, improve, monitor, or perfect. I stood outside myself, evaluating rather than inhabiting, measuring rather than experiencing. The body became something to manage rather than somewhere to live.

Mary Oliver offers a radically different proposition—one that stands in direct opposition to everything an eating disorder taught me to believe.

And that raises a question I wish someone had asked me much earlier in recovery:

What is your body for?

The eating disorder has an answer ready. Your body is for being smaller. Your body is for earning approval. Your body is for demonstrating discipline. Your body is for controlling uncertainty. Your body is for disappearing. But none of those answers can withstand serious scrutiny. 

Because if the purpose of your body is simply to be looked at, what happens to the rest of your humanity? What happens to your creativity? Your curiosity? Your relationships? Your capacity for wonder?

What happens to the person who lives inside the body?

One of the cruelest aspects of an eating disorder is that it promises to make life bigger while gradually making life smaller. Food becomes mathematics; movement becomes obligation. Rest becomes negotiation; social events become logistical challenges. The world shrinks to the dimensions of a body and the management of that body.

And yet the body itself was never asking for this.

The body, according to Oliver, is "curious and full of detail." It "wants to love another body." Notice the trust embedded in those words. The body wants.

Not in the sense of endless appetite or reckless indulgence, but in the sense of having its own wisdom, its own intelligence, its own orientation toward life. Recovery often requires rebuilding trust in that intelligence.

For many of us, that may be the most frightening task of all. After years of overriding hunger, dismissing fatigue, suppressing desire, and distrusting instinct, the body's signals can feel foreign. We have been taught that our needs are dangerous and our appetites cannot be trusted.

But the body was never the enemy. The body asks for food because it is trying to keep us alive. The body asks for rest because it is trying to repair itself. The body seeks pleasure because pleasure is part of being human. The body reaches toward connection because isolation is not how we are meant to live. These are not flaws in the system. These are the system working.

The tragedy of an eating disorder is that it teaches us to view the body's needs as obstacles to a meaningful life, when in fact they are the foundation of one. A nourished body does more than survive. It creates the conditions under which we can think, imagine, love, laugh, create, and belong.

"[W]ords, song, gesture, passion, ideas, ingenuity, devotion, merriment, vanity, and virtue." These are the things the body can hold. And when I think about my sickest years, I realize how many of them became inaccessible.

I wrote less. Laughed less. Dreamed less. Wondered less. I had fewer ideas because my brain was preoccupied with survival. I had less devotion because so much energy was devoted to the illness. I had less merriment because joy struggles to flourish under constant self-surveillance. The tragedy of an eating disorder is not simply what it takes from the body. It is what it takes from the life the body was designed to carry.

Recovery is often described in terms of what must be surrendered. The behaviors. The rituals. The false certainty. The illusion of control.

And certainly, there is loss involved. But that framing misses something essential. Recovery is not primarily an act of subtraction—it is an act of expansion. You are not merely giving things up. You are making room for something larger. You are reclaiming the vessel. You are recovering your capacity to hold a full human life.

The goal was never to spend your entire existence thinking about your body. The goal was to inhabit it. To use it. To move joyfully through the world inside it. To let it carry your laughter, your work, your grief, your friendships, your art, your convictions, your love. To let it be what Mary Oliver says it already is: solid and strong and curious and full of detail. A vessel capable of holding far more than a number, a shape, or a reflection.

So perhaps the most important question in recovery is not, "How do I feel about my body today?" Perhaps the deeper question is:

What is my body making possible today?

Did it allow me to comfort someone? To create something? To learn? To dance? To rest? To speak? To love?

The answers may seem small at first. But they point toward a profound shift. Away from the body as an object; toward the body as a participant in a meaningful life. Away from appearance; toward purpose. Away from evaluation; toward experience.

The eating disorder asks us to dedicate our lives to managing the vessel. Recovery invites us to remember what the vessel was built to carry.

And that, I suspect, is where freedom begins.

This is not because we are unaware of the consequences of the illness. Many of us are acutely aware. We know what malnutrition is doing to our bodies. We know how much of our lives have been consumed by food, weight, exercise, numbers, rituals, and obsession.

From the outside, this can seem incomprehensible. If an illness is causing physical deterioration, emotional distress, social isolation, and relentless mental suffering, why wouldn’t someone want to recover as quickly as possible?

The answer lies in a feature of eating disorders that is often overlooked in public conversations about them: they are frequently ego-syntonic.

Most illnesses are experienced as intrusions. A person with a broken leg wants it to heal. A person with the flu wants it to go away. The illness is clearly separate from who they are.

Eating disorders are different. Over time, the rules, rituals, beliefs, and goals of the disorder can become woven into a person’s identity. The illness begins to shape how they evaluate themselves, how they spend their time, what they feel proud of, and what they fear. It becomes more than a set of symptoms; it becomes a framework through which they understand themselves and the world.

This does not mean people with eating disorders enjoy having eating disorders. Far from it. Most experience tremendous suffering: the constant mental noise, the obsession, the anxiety, the guilt, and the isolation. Yet many also feel deeply attached to the illness. This apparent contradiction is one of the defining features of eating disorders.

This attachment is often difficult for outsiders to understand because eating disorders are usually discussed in terms of their visible symptoms. People without eating disorders often view the illness primarily through its visible behaviors: restricting, bingeing, purging, compulsive exercise, body checking, and food rules. From that perspective, recovery can seem straightforward. Stop engaging in the behaviors.

But eating disorders rarely exist at the behavioral level alone.

For many people, the disorder provides a sense of coherence. It offers explanations for distress and establishes goals, routines, values, and measures of success. It can provide certainty, self-esteem, emotional regulation, purpose, belonging, achievement, safety, and a sense of control.

As a result, recovery is not experienced merely as changing behaviors. It can feel like dismantling an entire psychological structure—one that has organized daily life and served as a way of coping with the world.

Weight restoration and body image concerns are often treated as the central obstacles to recovery. They matter, but they are not the whole story. For many people, the deeper fear is existential.

Who am I if I am not pursuing weight loss?

Who am I if I am not the disciplined one?

Who am I if I stop organizing my life around food and exercise?

Who am I if I no longer have this way of coping?

Beneath these questions is a fear of becoming someone unfamiliar.

Often, the eating disorder emerged during adolescence or another formative period and remained long enough to shape a person’s relationships, habits, and understanding of themselves. Letting go of it can feel less like abandoning a harmful habit and more like stepping away from a version of oneself that has existed for years.

If recovery involves relinquishing something that once provided safety, certainty, or meaning, grief is almost inevitable. Yet recovery narratives often emphasize freedom and liberation while leaving little room for that reality.

People may mourn the body they fear losing, the certainty provided by rigid rules, the illusion of control, or the aspirations attached to thinness. Acknowledging this grief does not romanticize the illness. It simply recognizes that people can become attached to things that harm them when those things also fulfill important emotional needs.

This helps explain why recovery is so often marked by ambivalence. A person may desperately want freedom from the eating disorder while simultaneously fearing life without it. They may recognize that the illness is shrinking their world and still struggle to let it go. That tension is not hypocrisy, denial, or a lack of willpower. It is a predictable consequence of living with an ego-syntonic illness.

Conversations about eating disorders frequently become polarized. Either the disorder is portrayed as entirely unwanted, or recovery is portrayed as something people simply choose when they are “ready.” Neither framing captures reality. Most people with eating disorders exist somewhere in between, navigating conflicting desires. Part of them wants freedom, while part of them remains attached to the familiarity and perceived safety of the disorder.

The tragedy of an eating disorder is not that someone refuses health. It is that an illness can become so deeply intertwined with a person’s sense of safety, identity, and self-worth that recovery itself begins to feel threatening.

Understanding that reality does not mean accepting the disorder’s beliefs as true. But it does help explain why recovery is rarely as simple as choosing health over illness—and why people with eating disorders deserve compassion rather than judgment.