Resolving an Eating Disorder: The 6 Stages of Change
“I’m thinking of going to a nutritionist to finally try to get my eating under control,” Debbie, age 16, says to her parents.
“What do you mean you’re thinking about it?” laughs her father. “You’re either doing it or not.”
Debbie feels ashamed by her father’s comment.
But if Mr. S. had known about the 6 Stages of Change, he would have said, “That’s a good first step. Let us know what we can do to help you move forward!”
Change is difficult for all of us, and it is comforting to learn that no one improves their eating struggles overnight. First we tend to think about our problem, then we deny it, dismiss it, decide we need help, make a plan of action, then get scared and back out of it, and then try again! Very often it is by this slow, deliberate process, change and healing can occur – not in a straight line but in weaving back and forth.
The Stages of Change model was developed in 1983 by psychologists Dr. James Prochaska and DiClemente as they researched how to help people stop smoking. Since then, this model has been used in the field of alcohol and drug addiction. Now let’s see how it can be applied to eating problems:
Precontemplation: In this stage, people may not recognize their eating behaviors are a problem, or they may be in denial or resistant to change. They might not see their eating disorder as having health or social consequences and are not ready to consider treatment.
Abby says her bulimia is not a problem. She thinks it’s a good way to lose weight and claims she can stop anytime she wants. “Don’t bother me,” she says to her sister who confronted her about throwing up.
Contemplation: In this second stage, people begin to acknowledge that their eating behaviors are causing them problems, and they start to think about the possibility of change. They weigh the pros and cons of improving their eating but may still have mixed feelings about moving forward.
Jody begins to realize how her restrictive eating may lead to anorexia. She is cold all the time, doesn’t have the energy of her friends, and her family has begun to express alarm at her weight loss. But Jody is afraid to tackle her problem because of anxiety about gaining weight.
Preparation: People begin to think about how they could make changes and start to develop a specific plan of action. They begin to take small steps forward to improving their eating behaviors and may seek out resources or support.
Debbie, whom we met before, realizes her night time bingeing is not something she’s able to control on her own. She is hopeful that a nutritionist can give her guidance and goes back again to her parents for their help to make the appointment.
Action: This stage involves actively making behavioral changes. People in this phase are engaged in strategies to alter their eating habits and tackle their disorder directly with clear plans.
David began therapy for his binge eating disorder. Together with his therapist, David is identifying his binge triggers and strategizing alternatives. He also discussed his grief over the death of his grandmother and how his wish to run away from this pain had led him to bingeing.
Maintenance: Clients enter the maintenance stage after adopting their new changes for at least six months. At this stage, the focus is on sustaining the changes made and preventing relapse. People have support systems in place to help cope with challenges that might trigger old behaviors.
Tova continues writing in her daily Food and Feelings journal. Marsha joined a new 12-step group, Eating Disorders Anonymous. Fred schedules monthly check-ins with his nutritionist and therapist.
Relapse: This stage was not part of the original model but has been added since relapse is a common occurrence where people return to their previous hurtful eating behaviors. The key to maintain recovery with your eating disorder is using relapse as an opportunity to learn what personal stresses make you vulnerable and what intervention strategies will get you back on track.
To help you navigate all these stages of change, reach out to the Mindful Eating Project. We will work with you to custom tailor an individual approach for your unique needs.
Schedule an initial assessment with The Mindful Eating Project. To start a confidential conversation about your eating, please contact us at (718)336-MEND.
The Mindful Eating Project is a division of The Safe Foundation.
Mary Anne Cohen, LCSW, BCD is Director of The New York Center for Eating Disorders and author of three books on the treatment of eating disorders including French Toast for Breakfast: Declaring Peace with Emotional Eating. www.EmotionalEating.Org.