Understanding and Incorporating “The Three Difficulties” in Eating Disorder Treatment
Recovery from an eating disorder is not just about eating differently — it’s about relating to suffering differently.
In the self-compassion and mindfulness world, “The Three Difficulties” is a framework introduced by meditation teacher Tara Brach, rooted in Buddhist psychology and supported by trauma-informed care.
These difficulties show up over and over again in eating disorder treatment. But when they’re brought into the light, they can become powerful gateways to healing.
What Are “The Three Difficulties”?
Recognizing when we’re suffering
Meeting that suffering with compassion
Letting go of old patterns of protection that no longer serve us
Let’s explore how each of these shows up in eating disorder recovery — and how we can gently support clients in working with them.
1. Recognizing Suffering
“This is hard.”
Many individuals with eating disorders are numb to their emotional pain — or have been conditioned to believe that suffering must be minimized, ignored, or controlled.
They may say:
“I’m fine.”
“It’s not that bad.”
“Other people have it worse.”
“I’m just being dramatic.”
But under the surface, there may be:
Anxiety
Shame
Grief
Body fear
Loneliness
Emotional overwhelm
In therapy, we help clients learn to notice and name their suffering — in the body, in their thoughts, and in their lived experience.
Practice: “Can you pause for a moment and ask: ‘What am I really feeling right now?’”
2. Responding With Compassion
“This hurts — and I deserve kindness.”
Once suffering is recognized, the next step is to respond with care, not criticism.
This is where many clients struggle — especially those who’ve internalized the belief that:
They are weak for having needs
They must be “in control” to be worthy
They must punish themselves to be safe
In eating disorders, self-criticism often drives the behaviors:
“You don’t deserve to eat.”
“You messed up — restrict tomorrow.”
“If you don’t work out, you’re a failure.”
Compassion invites a different voice:
“You’re hurting, and you need care — not punishment.”
In treatment, we model and teach this through:
Self-compassion practices
Parts work (“What part of you is feeling scared right now?”)
Somatic tools (hand over heart, grounding, breath)
Relational support and attunement
Practice: “Can I offer myself the same kindness I would give a friend right now?”
3. Letting Go of Old Strategies That No Longer Serve
“I don’t need to protect myself in the old way.”
Eating disorders are not about vanity or control. They are protective strategies — brilliant, adaptive tools that once helped the individual survive overwhelming emotion, trauma, or chaos.
Letting go of restriction, bingeing, purging, or rigid rituals can feel terrifying — because those behaviors were the way the person coped with unbearable distress.
Letting go isn’t about force — it’s about replacing those behaviors with new, safe, compassionate ones.
“You don’t have to control food to feel okay.”
“You don’t need to punish your body to be safe.”
“There’s another way — and we’ll find it together.”
In therapy, this stage may involve:
Grief for the loss of the old coping identity
Deep fear around newness or flexibility
Replacing behaviors with connection, expression, and care
Practice: “What am I protecting myself from — and is there another way to feel safe?”
Why This Matters in ED Treatment
Eating disorder recovery isn’t just behavioral. It’s relational. Emotional. Somatic. And spiritual, in the sense of reconnecting with the self.
The Three Difficulties framework:
Helps clients make meaning of relapse and struggle
Reduces shame
Builds emotional regulation and distress tolerance
Fosters true compassion — which is one of the most powerful antidotes to disordered eating
Final Thought
Recovery isn’t linear. But when clients learn to:
Recognize their suffering
Respond with kindness
Release what no longer protects them
…they begin to walk a path that’s rooted not in fear — but in freedom.
“This is a moment of suffering.
Suffering is part of being human.
May I be kind to myself in this moment.”
