Monday, October 24, 2016

Dear KJ: How Can I Overcome My Fear of Eating in Public?

Dear KJ: How do you get over your fear of eating in front of other people (at a restaurant or cafeteria, for example) after recovering from an eating disorder? (Originally posted HERE)
Image found HERE.
The experience of having—and recovering from—an eating disorder takes many forms, because many different kinds of people experience EDs. Many eating disorder sufferers experience crippling phobias and obsessive thoughts related to eating and body image. One phobia many people have heard of is having extreme fear of certain foods, or food groups. Another commonly known experience is one of obsessive counting, whether counting calories, carbs or minutes exercising.
Some less well-known fears, however, have to do with the social aspects of eating, which add an additional layer to an individual's struggles managing food or exercise-related symptoms. Eating is a social experience in most cultures, including in American culture. We see advertisements depicting big family meals as a time when people connect with each other at the end of the day. One of Normal Rockwell's most famous pieces features Thanksgiving dinner in this way. The common dating phrase "dinner and a movie" similarly links food with social connection, and pretty much every high school movie depicts the school cafeteria as a modern day Roman Forum! Suffice it to say, most of us associate eating with spending time with friends and family.
But eating socially can be a huge challenge for people who are suffering from or in recovery from eating disorders. Sometimes, this challenge is due to attempts to hide disordered eating habits from friends and family. Sometimes, those struggling eat in isolation not only to be secretive, but also to avoid scrutiny, critique or feeling freakish. It's also common for individuals with eating disorders to experience exaggerated feelings of being watched or judged while eating.
Once a pattern of eating in isolation has become a habit, the prospect of eating socially, or even of eating alone but in a public place, can trigger major anxiety, sometimes leading to panic attacks. Not everyone experiences this, but it's more common than most people think.
There are many well-researched approaches to overcoming fearful experiences. In extreme cases, such as when a person experiences panic attacks or if the social phobia begins to extend beyond just eating situations, it's almost always necessary to work with a therapist with special training on managing phobias. For cases that are less extreme but still distressing, here are some tips.  First, when in recovery from an eating disorder, your first priority must be to take care of your body, even if this sometimes means neglecting social experiences. If your body isn't properly nourished and rested, your brain can't work effectively. If your brain isn't working effectively, your efforts on the psychological side of recovery will be even more difficult.
So, if nourishing yourself properly means missing out on a slumber party or two, so what? However, this only makes sense if you are actually able to nourish yourself in less social contexts. And it can't go on forever. At some point, whether it takes days or weeks or months, it's important to rejoin the social world of eating.
There are two strategies I've used when facing a fear. The first one is to deliberately—and in all seriousness—ask yourself, "realistically, what's the absolute worst thing that could happen? How would I survive that?" (Note the choice of the word "realistically." That means you should avoid imagining scenarios of an asteroid falling on the restaurant, okay?)
Once you've answered this question to yourself, come up with a plan to survive it. Notice I did not say "come up with a plan to guarantee that this never happens!" Facing fears by avoiding them is what trapped in this situation in the first place. So let's try it: maybe your worst case scenario is that somebody comments on your eating in a way that is upsetting, whether it's a difficult relative or a nosy stranger. What would you do to survive it? Is there a phrase you could prepare in response, like "I know you think that commenting on my eating is helpful, but it isn't. Please give me some space." 
Afraid that could be too difficult or awkward? What if your plan was to burst into tears and run out of the room? That doesn't sound fun, but could you survive it? Think to yourself, "Well, if I burst into tears and run out of the room I will probably feel really embarrassed, but I will survive. I will not actually be in any real physical danger." When I describe this strategy, some of my friends find it incredibly useful and calming to be so specific and methodological in their planning, but others find that it increases their anxiety to imagine possible worst-case scenarios. Only use it if it works for you!
The second strategy I've used is to convince myself that I'm just conducting a tiny little experiment, just to see what happens. To do this, ask yourself to take a baby step but nothing more. Perhaps you hope to someday go to a pizza party with your friends, but everything about it terrifies you (the pizza! the chaos! people seeing me eat! food decisions! strangers! ack!). 
So, start really, really small, by just looking at the menu of a local pizza place and asking yourself what your favorite kind of pizza is. You don't have to go there. You don't have to order it. You don't have to eat it. You just have to take one small step toward these other things. If you can get through that first baby step, stop and observe the result of your experiment. Are you okay? Were you able to identify what kind of pizza you would like the most? Great! Now, the next step might be to go to the pizza place with no intention of eating there. Just walk by outside and look into a window. Still okay? Great. Next time you can go in, ask to see a menu (so you have something to say), and then turn around and leave.
The next step might be to go there with a very close friend or family member, but eat ahead of time, so all you have to do is sit in the pizza place while the other person has a slice. Or maybe the next step would be to go in by yourself to eat a slice of pizza on your own. Or maybe you'll ask for a slice of pizza "to go" and then eat it at home. Either way, the point here is to take very small steps without any expectation of doing more than that one step at any time. Then you take the next one, and then the next, and eventually you'll have "tested" each step of the way. This may sound excruciatingly slow or drawn out, but if it works, who cares, right?
You can do it!

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