Eating disorders and thought patterns

This section includes people describing their experiences of negative thoughts at the time when they were ill. Some people might find reading about these experiences distressing. All the material on this website is intended to support a better understanding of why these unhelpful thoughts in eating disorders happen, how to get help for them and to support genuine recovery from eating disorders.
‘Eating disorders are serious emotional and physical illnesses in which sufferers use food and sometimes exercise in different ways to manage difficult circumstances in their lives and the feelings that come with them. It is important to remember that food and weight is not necessarily the problem, it is embedded in the underlying factors which can be low self-esteem and lack of self-worth.’ Men Get Eating Disorders Too – 2018.
From the outside, eating disorders may not appear to make sense but for those with an eating disorder, there is an ‘inner logic’. The psychological problems that people can experience include: negative thinking, low self-esteem, perfectionism and obsessions. Despite the difficulties eating disorders cause, it can be difficult for someone to want to get better. People can feel that obsessive behaviour, for example, helps them to cope with anxiety.
Here young people we spoke with describe their thought patterns and their state of mind when they were ill. They explain the impact that these negative habits had on their lives and why it could be so difficult to want to get better. (For more see ‘Obsessions and rituals around eating‘.)

Negative thought patterns

Many of the people we talked with described being taken over by constant negative thoughts, particularly about themselves. Some people referred to this as the ‘eating disorder voice’; a ‘supercritical’, ‘relentless’ and ‘intrusive’ voice. They said that voice makes them feel low and ‘not good enough’, pushing them to restrict (severely limit eating), binge (eat excessively) or purge (rid the body of food).

Rob compared the internal voice to having a bully in your head.

Age at interview 17

Gender Male

Age at diagnosis 14

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Your internal dialogue, my own kind of internal dialogue was extremely disrupted. It was extremely complicated because I had this, people described it as like a voice, but and yeah, I think it’s definitely, I call it the voice, you know, it was like… But it was it wasn’t actually audible but it was it’s like this this kind of super critical negative, relentlessly sort of horrible series of intrusive thoughts that appear, you would kind of appear as a reaction to everything in in my head and yet I wasn’t in control of them. And they almost seemed like this external kind of, they didn’t seem like they were my thoughts even though I knew that it was part of me, it wasn’t something completely separate but it was it wasn’t like I willed them into being there. They would just occur kind of almost spontaneously as like a default reaction to any kind of difficult situation or they could just come about any reason. It would be and it would be, you know, kind of, it’s like it would be like having an abusive, like a bully inside your head really.

I think perhaps for me I almost internalised a lot of the things that I’d experienced at school that kind of the sort of low level sort of being picked on, put down constantly that contributed to that building up. So it was almost like I had that inside my head but I was doing it to myself but there was nothing I could do to stop it.

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‘It’s like having somebody in your head telling you that everything you do is wrong, like you can’t please it no matter what you do. If you go for a walk, you’ve not walked far enough. If you eat a lettuce leaf you still should have not had it. It’s like nothing you can do is good enough for it.’ -Eva
Andrew described how the voice was ‘shouting and calling me a disgrace’. A few people commented that they felt like the voice belonged to a different person, compelling them to behave in harmful ways.

Maria had a constant ‘screaming voice’ inside her head. It was exhausting to have conversations…

Age at interview 18

Gender Female

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At that whole, that whole time all that was on my mind entirely was what I’m going to eat or not, exercise and everything like that. I would, I remember sitting there in lessons and just that’s all that I was thinking about. I remember like sitting there and listening but also making notes, sort of numbers and calculations, and all that sort of horrible things. It was on my mind all the time. And I think that’s also the real change that my parents noticed, and started noticing things were wrong. Because I would just sit there starting, absolutely vacantly, and say nothing at all for days, and of course whilst I was sitting there all sedately, in my mind was this angry rush of , you’ve probably heard, but you do kind of associate the illness actually as a different a voice almost. And actually you would it’s your, it’s my own voice.

But yeah, thinking about it all the time, all the time and so it, inside I was sort of loud and screaming but outside I would just sit there vacantly the whole time. And I couldn’t think about anything else, I couldn’t talk about anything else. You do start to think, talking about food a lot, and you watch a lot of cookery programmes and then you read all the recipes, all that kind of obsessive stuff, which isn’t healthy.

And yeah when I was talking, if I’d be with my friends there’d just be, what’s really sad I’d be with my friends outside and they’re all chatting away normally, and all I would want is for them just to shut up, so I could think about what I want to think about. And not have to talk about this stuff that doesn’t matter, because obviously my, my habit is what matters, why do they not realise that? That’s what’s important.

So I’d just want to, I just loved it if I were just on me own for two minute and they would just leave me alone. I could sit there and not talk, not make the effort, because that point, physically as well it was so much effort to talk to anyone and to think about anything else. But the illness was something that I knew, something that was certain. Something that I could think about, which would then, also meant that I didn’t think about any of the difficult things that I couldn’t cope with. I didn’t have to think about anything like that.

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If bad things happened in life, people often felt it was their fault. They were first to blame themselves if anything went wrong at home. Such feelings could delay the initial contact with their GP as they didn’t want to feel like ‘a burden’.

Young people often described themselves as ‘worriers’. Their minds were filled up by ‘worst case scenarios’, worry about failure or what other people thought of them or even ‘the world ending tomorrow’. Some even worried about other people being worried about them. Fiona-Grace said her challenge was to learn to live in the moment, rather than worry about the future and ‘endless what ifs’.

People talked about different ways they coped with negative thoughts. These included getting the thoughts out into journals or blogs, having positive walls and compliments books and doing things that made them feel good about themselves. Distractions and mindfulness or relaxation techniques worked too. (For more see Coping with an eating disorder and self-help.)

Control

Young people we spoke with often described an eating disorder as a form of control they could have over their own lives. People could feel out of control because of things happening around them such as:

  • Unsettled home lives
  • Parents’ divorce
  • Witnessing domestic violence
  • Death of a loved one
  • Changing schools
  • Bullying
  • Personal factors (such as puberty, changing body, loneliness, a feeling of ‘not fitting in’)
Often the eating disorder was described as the only thing they could ‘control’. Some called it ‘my thing’ that they ‘didn’t want to let others in on’. An eating disorder was something that was just for them and not for others to decide. Sometimes people felt that it was an ‘escape’ and helped them cope.

A lot of people had experienced more than one type of eating disorder (often anorexia nervosa and bulimia nervosa) and said that one of the differences between them was the amount of control they felt they had.

Zoe found it harder to cope with bulimia than anorexia. Restricting gave her a sense of control,…

Age at interview 23

Gender Female

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Why do you think it (bulimia) was worse for you or made you feel worse than anorexia or restricting?

I think because when you arewell, I think several reasons. Because my whole my whole thing is about control, you know. It still is and it probably always will be. I like to be in control and this was not in control. This was disgusting, out of control. I, even though my whole anorexia thing wasn’t about being thin, the fact that I started to feel very disgusting and actually, started to feel a lot worse about my body. And also, I think it was hard, inside I was really sort of crumbling and quite distressed and quite like psychologically still having a lot of issues. But everyone else thought, Oh, she’s done so well. She beat anorexia. Gosh, she’s, you know, this case casebook, you know. She’s done such a great job with the anorexia And they didn’t realise what was going on behind the scenes as it were.

And I really and it wasn’t and because it sort of, it felt quite disgusting and quite greedy. It wasn’t something I wanted I felt comfortable talking about, whereas anorexia, you know, you’re not eating. it’s not good but it’s not you’re not sort of over indulging and, yeah.

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Perfectionism

People we talked with commonly described themselves as having ‘perfectionist’ tendencies, being ‘driven’ and ‘hard-working’. Desire to ‘do things right’ and to achieve the highest possible goals could extend into many areas in life such as school or exercise. At the same time people often struggled with low self-esteem and could lack self-confidence even when they were in recovery.

For some, the eating disorder itself became a project in which they ‘excelled’. It provided a source of ‘achievement’ and self-worth. In particular, people with anorexia nervosa described restricting food as a form of achievement. Felicity said that through therapy she learnt to understand how being ‘successful’ at weight loss was a ‘marker of achievement’ for her and made her feel good about herself.

Rachel felt that anorexia was her best friend and the one thing she was good at.

Age at interview 24

Gender Female

Age at diagnosis 15

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Anorexia nervosa to me was my way of control, my best friend, the one thing I was good at and the way I dealt with my problems. The unit did take my anorexia away from me. They stopped my life and forced me to eat 3 meals a day, two snacks and three ensures straight away. My life was controlled by other people and the one thing that was keeping me going was taken away.

What do you mean by saying that anorexia was the one thing I was good at?

At school, I struggled to fit in and it was the same at college. Although I was very academic and got very high grades, I never felt they were good enough for my parents, especially my Dad. I was on the hockey team at school but more for fun than anything else. Although I had my own hobbies, to me, I never felt like any of them was good enough. Instead I excelled at anorexia, something none of my friends could do, considering they couldn’t even last a day on a diet. I guess at the time anorexia gave me an identity and something to be proud’ of.

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People’s perfectionism wasn’t necessarily driven by wanting to be the best, or even comparing oneself to others, but instead by a fear of failure or not feeling ‘good enough’.
‘It’s a race that you’re just never gonna win. It’s always going to end badly if you just keep going.’ -Hannah O
‘It’s definitely not pleasant and it’s not sustainable for me personally. I have an element of that and I guess I consider myself quite driven but I think I’ve tried to because I’ve worked on coming to terms with the fact that nothing I ever do will ever be perfect because perfection is, by definition, impossible.’ Rob
It was important for young people to find other areas in life they could be good at, and not value themselves for their eating disorder. When recovering, people also started to learn to accept themselves for who they were, not try and be different or “better”.

Punishment

Throughout their illness, people developed complicated emotional relationships with food, bingeing, eating and not eating. As part of the negative mindset, people could feel that they didn’t deserve enjoyment or pleasure. The eating disorder could become a form of self-harm. People with anorexia nervosa sometimes described restricting their food intake as a way of punishing themselves. Elizabeth used to think that ‘pleasure meant failure’ and that by restricting her food intake she was also restricting the fun she didn’t feel she deserved. Rob felt ‘he had no right to have fun’ in life, either through food or in other areas of life. Georgia even said that she felt she didn’t ‘deserve to eat’.

Elizabeth said she needed to restrict food to compensate for having any fun. Feeling weak and…

Age at interview 20

Gender Female

Age at diagnosis 12

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Restricting food is like restricting pleasure and it’s like a compensation for any kind of fun. So the kind of example I use is this sort of holiday periods where I feel I can’t control what I’m eating and I feel like having the freedom to wander off around Europe and like see loads of different countries and visit loads of different places that had to be compensated for by not eating. And to kind of punish myself for that, for that freedom. And that experience. I had to like I had to kind of dampen the pleasure of, the enjoyment of that by making it really hard and making it, making myself feel like I was gonna faint the entire time because I was too weak, and yeah just, yeah being self-disciplined and I kind of feel, believe quite strongly that people don’t really deserve to have like, I felt that people just didn’t deserve to have any pleasure in their life. Like why? Why would you? Like why should you? You have to earn stuff and if you haven’t done anything to earn eating nice food, then why should you?

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Restricting used to be a form of punishment for James. He used to love the feeling of hunger pains.

Age at interview 21

Gender Male

Age at diagnosis 20

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I loved that sort of feeling of pain I got from it. I’d feel like justified to do it because I, I guess it was, I guess it’s sort of that OCD behaviour coming back but in a different sort of way. And I’m guessing that’s, it really went together with the fact that you know when I wasn’t eating it was coming out in these sort of strange sorts of habits and…

But then but with me that’s, that’s how I’d always, I’d always feel justified to punish myself because I never felt like I would deserved anything like, because as I said I have like confidence issues and stuff like that, and it felt right to punish myself because I felt worthless and I felt like, because I felt worthless I should be doing this. And I shouldn’t feel, I should feel pain you know, I like, I enjoyed that feeling of like hunger pangs and stuff like that because it would really, it would hurt. You know? it’s a different sort of hurt feeling that you would get, but it was a, it was a, it was a hurtful feeling that I could control, you know.

it’s you know, there’s no coming down from this. You can constantly feel like this, you know, you can stop but you’ve got, you’ve got the power to stop it if you want to, but you can keep going if you, if you dare to go that far. And I always wanted to push it that little bit further.

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People could also feel the need to make up for the times when they thought they had overeaten. They could restrict their food intake further, do exercise or household work, purge or cause themselves pain, for example by sleeping on the floor instead of the bed.
Talking therapies were often useful in helping young people break the negative cycle of self-punishment. They found more positive outlets for their anger or frustration but also, over time, were able to address the underlying reasons behind the negative emotions and let go of them.

Dealing with emotions

‘My reaction to that unhappiness of feeling really dissimilar to all of these people around me was to kind of hold back and eat bean salad and go to the gym loads. And so I got into a very punishing cycle of working really hard, obsessively and exercising obsessively. And feeling like I didn’t have the right to have any fun.’ -Elizabeth

Restricting food, or bingeing and purging could also be a way of dealing with emotions; feeling upset, guilty, anxious, lonely or embarrassed. Particularly people with bulimia nervosa often described, bingeing and/or purging as a release of negative emotions. Bingeing and purging was described as a continuing cycle of emotions where people would overeat if feeling upset, then make themselves sick to stop the feelings of guilt that came from overeating. Weight loss or ‘being skinny’ could also be associated with being happy and successful. Jasmin said she’d never liked herself and she thought that she could ‘fix’ this by losing weight.
People with bulimia nervosa often described their illness as ‘dirty’ and ‘disgusting’. Emily said bingeing made her feel ‘greedy and overindulgent’ and people could feel that purging would help undo those feelings. Charlotte said she used to ‘stuff food’ to numb the feelings of anxiety. For Jasmin, bingeing could help ‘cover up’ negative feelings. Craig said that rather than express his emotions, like anger or sadness, he tended keep them inside and restrict his food intake.

Jasmin used to feel that eating would take away any feelings of upset.

Age at interview 19

Gender Female

Age at diagnosis 17

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I’d usually be alone, and that’s always been a, like a trigger for me, if I’m, if I was ever home alone and I had, didn’t really have any plans or anything that would be when it was more likely to happen. It would just be, again not something that I was really aware of until going into recovery and thinking about it, if I was really upset or something, food took away those feelings. I know I’ve got a diagram that we drew together which I still have of sort of a picture of a person and then there’s all the bad things I’ve got a kind of like in the bottom of the stomach sort of thing of, because of whatever’s happened, whatever’s made me upset, and then eating kind of covers those up, if that makes sense yeah?

Yeah it does yeah.

And it would just be like while I was eating that would kind of take away all those feelings. But then obviously after I finished eating those feelings are still there plus the feelings towards food, so I’d just feel a hundred times worse, and purging would, would get rid of that.

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Emily describes the cycle of bingeing and purging and the emotions that kept the cycle going.

Age at interview 21

Gender Female

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It would be like a mental tally in my mind what I’d eaten throughout the day, and if say for instance I had something that I class as bad like a chocolate bar or something, then, and I didn’t make myself sick, then that would kind of weigh on my mind for the rest of the time and I’d go through the rest of the day feeling really rubbish about myself and thinking

And sometimes it’ll be a case of like Oh well I’ve had a rubbish day now anyway like going to, it’s, I’ve done really badly I might as well eat whatever I want because it’s not so then I’d eat a lot of really bad things for me, and then it would be inevitable that I’d make myself sick anyway. So it was kind of, like it would get worse like that. But if, yeah, so it was a constant weighing on your mind that you’d eaten something bad and if, knowing that if you’re, if I made myself sick then I wouldn’t have that weighing on my mind. It was like it never happened, so I got to kind of enjoy eating whatever it was but I now don’t even have to have the bad consequences of it. So it was, it’s like in a warped kind of way I made it into a kind of a win win situation in my head. Like I didn’t see anything wrong with it, I kind of thought it was you know a good thing to be doing, or not a good thing but it made sense to be doing and.

Yeah like immediately beforehand it would just be like I couldn’t think of anything else but like I knew I just had to do it, there was, it was like I had no choice, so I just felt so like fat and disgusting and like just un it was just unbearable and like yeah unbearably kind of greedy, and like overindulgent and things. So I’d be like well if I make myself sick then it won’t like, I won’t feel like this anymore, I’ll, I’ll have the opportunity of getting skinnier and you know it won’t happen again. I won’t do something that stupid, like eat that much again. That was like, I’ll just get this, get this one out of the way and then I’ll start again, I won’t do this again.

And then I’d make myself sick and then I’d like, it would immediately be off my mind, like immediately like a relief, like I wouldn’t, I didn’t have all this fatty horrible food inside me and I wasn’t like, okay I’d messed up and not eaten the right things and I, like I’d done wrong by eating lots of really bad fatty things, but at least I didn’t have to kind of pay the consequences for it. And I didn’t have to yeah I didn’t have to have all these extra calories inside me, they were now forgotten about, they were out of the way. They weren’t in me anymore so I can now go on and, and like build and have it, and just eat good things for now and it would be better, and I’d be skinny and life would be brilliant.

But yeah, so after the feeling, like relief and like it was out of the way and it would, things would get better, like inevitably if you eat something else bad or that you class as bad you know that last time you felt so much better after making yourself sick and you felt like you didn’t have to worry about it. So you eat something and then the worry’s there again.

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Working towards recovery

'You can be extremely ill and you can come through it and it can be fine. Because if I can do it, really anybody can...

Obsessions and rituals around eating

This section includes people describing their experiences of obsessive behaviours and rituals at the time when they were ill. Some people might find reading about...