A: This is a great question, Maxine, one with no simple yes or no answer. Here are some things to consider:

• People get better at different rates and in different ways. Some peoples’ ED symptoms get better fairly early in treatment, though they still need to work on underlying issues to prevent relapse. Other peoples’ symptoms get better a little at a time as they progress in treatment. Still others may need to work for a long time on underlying issues before their ED symptoms really begin to subside.

• If your symptoms are not improving and you are suffering unacceptable medical risk as a result, you may need to look at a higher level of treatment, such an intensive outpatient program or residential care.

• You may benefit from adding one or more additional treatments to your psychotherapy, such as nutritional counseling, medication, group therapy, art or music therapy, yoga, meditation or the like.

• There may be ways you can use your current therapy more effectively. You may not understand exactly what is expected of you inside or outside of treatment, and thus may not be getting the full benefit. (If you think this might be true of you, you may wish to check out my chapter, “Making Good Use of the Approach You Choose,” in Eating Disorders for Dummies.)

• In some situations a change of therapist may be appropriate. Perhaps your therapist isn’t experienced with treating eating disorders. Or maybe you have reached an impasse with each other in terms of mutual expectations.

You should certainly talk over your concerns with your therapist and discuss any of the issues above that seem relevant for you. Sometimes feeling stuck is just a temporary lull before changes begin to show up. But you don’t want to ignore stuckness. It’s a sign that something needs to be different.

Above all, please, please don’t decide you can’t be helped! Eating disorder treatment is complicated and takes a long time—longer than a year—for most people.

A: Yes and no, Marci. Depends on who’s defining “addiction.” Often when people say “addiction” they are implicitly including the physical changes that occur in the brain when a substance is used over time. These include physicals cravings, physical dependence and tolerance. Physical dependence means you will experience withdrawal symptoms when you quit using the substance. Tolerance means over time it takes increasing amounts of the substance to produce the same effect. None of these physical effects have been proven to apply when it comes to food.

On the other hand, there’s plenty of overlap between the use of food and the use of drugs or alcohol when it comes to addiction as psychological dependence. In each instance a person is relying on a substance to manage distressing emotions and experiences. The substance becomes paired in the brain with the relief that goes with avoiding painful feelings. It therefore becomes highly valued and sought after, and the “addicted” person will feel great anxiety if blocked from using it. Feeling out of control, being preoccupied with the addictive substance, and continued over–use despite the personal suffering it causes are other ways compulsive overeating or bingeing can feel similar to drug or alcohol addiction .

Answer: Your desire for your boyfriend’s help is completely understandable—and doomed to failure, even if you get him to cooperate. Whenever a person tries to get external policing for internal impulses, the impulses always win in the end. Impulses to binge, or engage in other compulsive behaviors, are driven by what we call threat energy. Something triggers a threat to your sense of equilibrium or basic well–being and your mind goes into the automatic behavior of bingeing to protect you from it. “It” could be feeling hurt, bad about yourself, helpless, empty, frightened or any of the binge triggers you’re discovering in recovery. This will pit your boyfriend’s efforts against a very basic internal instinct to protect yourself from painful or even overwhelming emotion. Learning to manage binge behavior remains an “inside job.” (For an account of a particularly spectacular and tragic failure of an attempt at external policing for internal impulses, check out Wired: Short Life and Fast Times of John Belushi. The beloved SNL star actually hired a bodyguard to control his drug addiction, yet still died of an overdose.)

So does this mean there’s no role for your boyfriend in your recovery? Absolutely not! Depending on your needs and wishes, your boyfriend can be an invaluable support. He can acknowledge and validate your struggles, applaud your successes, cheer you on, learn to respect recovery–enhancing boundaries (for instance, not commenting on your weight or your food or exercise choices), and remind you of your worth and lovability when you can’t believe in them yourself. This kind of support can mean the world during the long haul process of eating disorder recovery.

Question: If I know how much my symptoms of bingeing or purging are hurting me and how horrible I’m going to feel afterward, why do I keep relapsing?

Answer: In this inaugural month of “Ideas and Inspirations for Recovery,” I’ll get the ball rolling with this question which comes up repeatedly in my practice.

I’m always so glad to have a chance to respond to this question because it allows me to address the critical issue of shame in relation eating disorder symptoms.

The simplest answer to the question is that none of us does anything self–destructive, discouraging or shame–inducing unless it feels (unconsciously) like things would be worse if we didn’t. Another way to say the same thing is that symptoms have a purpose, a positive intention. They develop to help us handle life experience that would otherwise be overwhelming. For instance, bingeing may distract and soothe in the face of painful emotion, purging may feel like a way to restore order when bingeing has gone out of control, or restricting may serve as a way to assuage fears about growing up too quickly. (These are just a few examples of the purposes eating disorder symptoms may serve.)

The payoff for searching to discover the purpose or intention behind your symptoms is that it opens the door to finding new and healthier ways to accomplish the same thing. For instance, you may learn to meditate, focus on your breathing, journal or engage in other quieting practices to cope with painful emotions. Or, you may find that a commitment to learning from slips and returning immediately to healthy eating patterns can work much better than purging to restore a sense of control after bingeing. In yet another example, you might discover it’s more helpful to reach out for support and learn to go at your own pace than to fall back on restricting when you’re facing uncertainty about a new stage of development.

Eating disorder symptoms serve as vivid signposts to issues we need to resolve, skills we need to acquire or experiences that feel like too much. If you take the time to see beyond your symptom to the problem it’s highlighting, you can greatly enhance your recovery process.