The Myth of Motivation in Adolescent Eating Disorder Recovery by Ashley Solomon, PsyD, CEDS
There’s an adage that’s often used when talking about individuals struggling with substance use issues or eating disorders that says, “To get better, they first have to hit rock bottom.” The idea is that in order to be helped, the person suffering has to reach the lowest point and, having lost everything, be willing to seek and accept help from others. Fortunately for the millions of individuals who suffer from eating disorders, this is not the truth. When it comes to adolescents with eating disorders, it’s in fact a misguided and dangerous falsehood. I’ve sat with many worried parents, desperate to do what is right for their adolescent child, who say, “I really want her to get help, but it’s just not the right time. She has to want to get better.” What many of these parents have yet to learn and understand, often as a result of the misinformation in our culture, is that eating disorders are insidious brain diseases. They are brain diseases that wreak havoc on a teenager’s ability to comprehend, reason, and make decisions, skills that are already often fragile in a young brain. Eating disorders starve the brain of essential nutrition. This occurs in all eating disorders and isn’t necessarily related to the victim’s body size or weight. The starved brain results in the individual withdrawing from others, becoming depressed or anxious, and becoming more rigid in their thinking patterns. They usually have very little awareness of how the illness is impacting them or those around them, a phenomenon that has a name: anosognosia. The person suffering may not see himself as suffering, but rather as “perfectly fine.” Unfortunately, “perfectly fine” is the farthest thing from the truth. While the brain is malnourished, it actually shrinks, compromising cognitive abilities and recall, in addition to numerous other physical effects, like loss of menstruation or bone density loss. In this context, in the brain of a malnourished teenager, we wouldn’t expect there to be a strong desire to get recover. It can be frustrating – infuriating even – for loved ones to observe, but this is part of the illness. Unfortunately, waiting for an adolescent with an eating disorder to want recovery before seeking help is like waiting for a toddler to want to leave the playhouse. It’s not likely to happen without some intervention by the people that love the child most. And just like that toddler, it’s likely that the ill adolescent is going to put up a strong fight to avoid getting help. Unfortunately, teenage parents are now contending with much larger, more verbal, and more connected kids than their toddler counterparts. But many of the same principles apply: “I am setting this limit because I love and care about you. I hear that you are frustrated/disappointed/angry, and I am establishing this boundary because I’m going to keep you safe and healthy.” The good news is that individuals who get help – whether they wanted the help or it was facilitated by loving caregivers – get better. Their brains restore function, their bodies get stronger, and their wonderful personalities return. And often once they have restored their healthy selves with the help of supportive adults, they can see more clearly the amazing world waiting for them in a life of recovery.