Ambivalence in Anorexia Recovery: Understanding Resistance to Treatment

Many individuals with anorexia nervosa experience ambivalence toward treatment—feeling both a desire to recover and a deep fear of letting go of their disorder. This internal conflict makes treatment challenging, as patients may resist interventions even when they are medically at risk.

Why Do Patients with Anorexia Feel Ambivalent About Treatment?

Common Reasons for Resistance to Recovery:

·         Fear of Weight Gain & Loss of Control

o   Many individuals equate thinness with identity, worth, or safety

o   Weight restoration feels like losing control, leading to anxiety and distress

·         Denial or Minimization of the Disorder

o   “I’m not sick enough to need help.”

o   Some patients don’t perceive the seriousness of their condition due to body dysmorphia

·         Anorexia as a Coping Mechanism

o   Restricting food may feel like the only way to manage stress, anxiety, or emotions

o   Giving up restrictive behaviors can feel like losing a sense of safety or control

·         Fear of Losing an "Identity" Built Around the Disorder

o   “Who am I without my eating disorder?”

o   Some individuals feel that anorexia defines their self-worth or sense of purpose

·         Lack of Motivation for Recovery

o   Low energy, malnutrition, and depression can make it hard to find motivation to recover

o   The brain may not function optimally due to starvation-induced cognitive impairment

·         Pressure From External Sources

o   Patients may resist treatment if they feel forced into recovery by parents, doctors, or therapists

o   Rebellion or secrecy can emerge if they feel treatment is being imposed on them

·         Ambivalence is not stubbornness or refusal to get better—it’s part of the disorder itself.

How Ambivalence Affects Treatment and Recovery

Ambivalence Can Lead To:

·         Avoidance of Treatment

Canceling appointments, refusing to engage in therapy

·         Resistance to Weight Restoration

o   Hiding food, lying about eating, or excessive exercise

·         Emotional Shutdown

o   Feeling disconnected, angry, or unwilling to engage in recovery work

·         Relapse & Backsliding

o   Engaging in old behaviors out of fear or discomfort

·         Recovery cannot be forced, but motivation can be nurtured through therapy, compassionate conversations, and small steps toward progress.

 How to Support Someone Who Is Ambivalent About Recovery

·         Validate Their Fears Without Reinforcing the Disorder

o   Instead of: “You need to just eat—it’s not that hard.”

§  Say: “I know this is incredibly hard for you, and I want to support you.”

o   Instead of: “You should want to get better.”

§  Say: “It’s okay if you have mixed feelings about recovery. Let’s talk about what feels scary.”

Focus on Non-Weight-Related Benefits of Recovery

Many patients resist weight gain but may be motivated by other improvements:

·         More energy for school, sports, and hobbies

·         Better focus and mood stability

·         Less time obsessing over food & numbers

·         Stronger relationships with friends and family

·         Use questions to spark reflection:

o   “What has anorexia taken away from you?”

o   “What do you want your life to look like beyond the eating disorder?”

Use Motivational Interviewing (MI) Techniques

This therapy approach helps patients explore their own reasons for recovery rather than feeling pressured.

·         Examples of Motivational Interviewing Questions:

o   "On a scale of 1-10, how ready are you for recovery?"

o   "What would need to happen for you to move up one step?"

o   "What would life look like if your eating disorder was gone?"

·         Key Takeaway: Encouraging small, personal goals (rather than focusing only on weight gain) can help increase motivation over time.

 Involve the Patient in Their Treatment Plan

·         Offer choices where possible

o   Meal planning, therapy types, coping strategies

·         Encourage gradual changes instead of expecting instant compliance

·         Emphasize recovery as a process, not a punishment

·         Patients feel more engaged when they have some control over their own recovery

 Treatment Approaches That Help With Ambivalence

·         Best Therapeutic Approaches for Ambivalent Patients:

o   Cognitive Behavioral Therapy (CBT-E)

§  Challenges distorted thoughts about food and weight

o   Dialectical Behavior Therapy (DBT)

§  Helps with emotional regulation and distress tolerance

o   Family-Based Treatment (FBT)

§  Parents take an active role in meal support and encouragement

o   Motivational Enhancement Therapy (MET)

§  Addresses ambivalence and builds internal motivation

o   Exposure Therapy

§  Slowly reduces food-related fears and anxiety

o   For severe cases, inpatient or residential treatment may be necessary if physical health is at risk

o   Recovery takes time, patience, and multiple therapy approaches

 Encouraging Long-Term Recovery & Preventing Relapse

·         Focus on the Whole Person, Not Just Weight

o   Identity, relationships, and future goals

·         Celebrate Non-Scale Victories

o   Trying new foods, social meals, improved mood

·         Allow Space for Struggles

o   Ambivalence and setbacks are part of recovery

·         Encourage Self-Compassion

o   Recovery is a journey, not a test of strength

·         Model a Healthy Relationship with Food

o   Avoid diet talk, body shaming, or labeling foods as “good” or “bad.”

·         Ambivalence does not mean a patient doesn’t want to recover

o   It means they are scared, uncertain, and still attached to their disorder. With compassionate support, therapy, and patience, many individuals with anorexia can and do fully recover.

Disclaimer: This information is intended for educational purposes and should not replace professional medical advice. If you or someone you know is in crisis or needs immediate help, please contact a healthcare professional or crisis intervention service immediately.