Tackling Difficult Decisions Head On

If you’ve ever experienced an eating disorder, then chances are that at some point you felt uncertain about working towards recovery. On the one hand, thoughts of food, weight, or body shape dominate your life, you may feel isolated from family and friends, and you may be dealing with any number of negative effects on your physical health. On the other hand, eating disordered behaviors may help mask or manage painful emotions, and the familiarity of routine in the eating disorder may feel comforting or just automatic.

What happens when conflicting motivations swirl around in your head? Maybe you feel overwhelmed and confused. Likely, you feel stuck. Unsure what to do next, many people may feel like they have one foot in recovery and one foot in the eating disorder, making it a real challenge to move on in life. How do you get unstuck? One way to help organize and clarify all of the pros and cons tangled together in your brain is to use a technique called a Decision Analysis.

The steps to a Decision Analysis are fairly simple.

  • Identify the decision you feel unsure about. What are the two sides of the coin? You can go big picture or small picture here. Big picture, for example, would be trying to figure out whether or not you’d like to commit to working towards recovery from an eating disorder or not. Small picture would be using this technique to make day-to-day decisions like trying a new food, improving portion size, or reaching out to friends and family when you need help.
  • Evaluate the pros and cons of the two choices. Specifically, if you make Choice A (e.g., working towards recovery) what are advantages and disadvantages to that choice in the short-term, and what are the consequences down the road? Get as detailed as possible. The power is in the specifics. If you think your health will improve in recovery, in what ways? What physical symptoms will you no longer experience (e.g., dizziness, chest pains, constipation, swelling, etc.)? What will you be able to do that you can’t do currently (e.g., go on a trip, return to school next semester)? How will your relationships be impacted? What will your school and career options be? How much will you be able to live in line with your values following one path or another? Have a deeply honest conversation with yourself and record your thoughts in a list using the figure below as a template.
  • Notice what parts of the chart are harder to fill out than others and think about why that is. Upon completing the chart, does one choice clearly win out over the other? If so, great! You can start making clear plans to work towards making that choice a reality.

  • But if not, then an additional helpful piece to a Decision Analysis is to identify what your most compelling reasons are to make Choice A or Choice B (written in green text in the figure). For example, perhaps the ability to lead a truly fulfilling life, doing work that feels purposeful is most compelling to you.

Next, identify what the most difficult part about making Choice A or Choice B would be (written in red text in the figure). For example, if you work towards recovery, you may be uncertain of how you will cope with difficult emotional experiences and this may feel particularly daunting. At this point, what choice feels most compelling and what challenge would you be most willing to take on? If the choice is now clear, or at least clearer, you can start figuring out exactly how to take on the challenges you’ve identified.

Let’s say that you most fear being without a way to manage difficult emotions, yet you know that they are unavoidable (because, of course, we cannot avoid experiencing feelings like anxiety and sadness). Well in this case, your next step would be to start problem-solving ways to address this concern. Maybe you test out coping strategies like journaling, practicing mindfulness, listening to mood-incongruent music, or taking other ‘opposite action’ and see which works best for you, and in what context. If you have a treatment team, you can enlist their help and guidance.

Decision Analysis is not (unfortunately!) magical, but it does tend to be clarifying and organizing. It may well be that you end this process without a clear decision in mind—that’s okay. This exercise can be useful in identifying your motivations and difficulties in a concrete way that serves as a good jumping off point. It’s also an active way to grapple with your choices, to take charge rather than avoid or put your eating disorder in charge.

Most change, after all, is incremental. And this means that the decision to analyze your decisions is itself a sign that you – not your eating disorder – are in the driver’s seat.

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