“You need to have a seat.”
A therapeutic assistant at the residential eating disorder treatment center where I was then a patient stood nearby, glaring at me.
I had been standing while talking on the phone with my mom, when the staff member interrupted. I was only allowed a few minutes for the call, so I decided it wasn’t worth the fight and sat down.
Standing wasn’t the only forbidden activity at the facility. Motion of any kind was so frowned upon that providers even coined a term for it: “excessive body movement.”
“Any kind of movement in [eating disorder] treatment—from fidgeting to formal exercise—is closely surveilled, monitored, structured, and overall limited,” says Stacie Fanelli, LCSW, of Revolutionary Eating Disorder Psychotherapy and Consulting.
As someone with anorexia recovery, I can attest to this: At all five treatment centers where I have been a patient, movement was forbidden.
During my first inpatient visit, an assistant sat in my room with me until I fell asleep, which I believe was meant to ensure that I didn’t exercise. At another treatment center, I once was sitting on the floor during a group therapy session, rocking back and forth. I didn’t even realize I was doing it; the motion just felt soothing. Almost immediately, a therapist rushed over, signaling for me to stop. It didn’t matter that I had been self-soothing—my coping skill wasn’t allowed.
“Even for those for whom over-exercise and under-fueling has been the primary behavior at play, how are they supposed to repair their relationship with [exercise] when we’re sending an abstinence-only message?” Fanelli says. “When my clients are told they have to drink a supplement when they’re ‘excessively standing’ or engaging in joyful movement like hanging upside down off a couch, they’re getting validation that movement is in fact a form of currency that you use to earn food, which is exactly what many eating disorders are telling them.”
For me, not being able to move during treatment only took away a key tool that I’ve used to heal.
Why eating disorder treatment centers restrict movement
What’s behind providers’ insistence on not allowing patients to move? Psychiatrist Wendy Oliver-Pyatt, MD, FAED, CEDS, founder of several eating disorder treatment centers, including Within Health, explains that for some patients, a period of rest may be needed if their body needs time to heal from disordered behaviors. Those with restrictive eating disorders may truly not be fueling their bodies enough to allow for anything strenuous. Some patients may also need time off from movement for psychological reasons, if they feel like they need to exercise to burn calories.
Fanelli adds that another major concern for centers is liability. Providers don’t want to be responsible for a patient passing out or injuring themselves, for instance, so they ban movement to reduce the chances of this happening.
But instead of being upfront about these fears, she says centers sometimes shift blame onto the patient. “Providers often couch their fears that come with the perceived physical fragility of all eating disorder clients in a catch-all ‘that’s your eating disorder talking’ accusation so that they don’t have to take accountability for what’s actually their own anxiety,” Fanelli says.
As a patient, I can’t help but feel like this kind of policy is created for providers’ own self-preservation. Rather than treating patients as individuals with different needs and choosing what’s best for each person at each step of their recovery, a blanket ban against movement seems to serve the center itself most of all.
The effects of not being allowed to move during recovery
Personally, having the choice to move my body completely removed from my coping skills toolbox left me feeling powerless. And it instilled an intense need to feel in control of my body—which ironically is the reason many patients wind up in treatment.
Compounding the frustration of not being able to move was a lack of any timeline for when I might be able to do so. “When the person has no indication of when they’re going to be able to move again or it’s contingent on their compliance with a protocol of some sort, that lack of agency can activate emotions that have nowhere to go,” Fanelli says.
I found that this rigidity around movement actually reinforced a harmful myth that many patients already believe: that food and exercise are directly correlated. Fanelli notes that patients who begin treatment with rigid rules about food can end up with a new set of rules, this time about movement. “It just becomes another control mechanism,” she says. “Is that really recovery?”
In contrast, when I’m not in treatment, joyful movement has been a key part of my recovery. Instead of restricting or purging away my anxious thoughts, I’ll go for a quick walk down the street, enjoying not only the benefits of stretching my legs, but also fresh air and nature.
A better way forward
It's a natural human impulse to desire some kind of physical activity. And I honestly believe that not being allowed to move my body the way it craved removed my autonomy in a way that was not only not helpful, but actually harmful.
Fortunately, not all eating disorder treatment centers follow this policy. There are some centers that actively embrace the benefits of movement through dance or movement therapy to help patients reconnect with their bodies. “We can get back to the basics of feeling safe in moving our body,” says Erica Hornthal, a dance therapist in Chicago. Hornthal says this process isn’t about body positivity and how the body looks, but focuses on how it feels to be in the body, something eating disorder survivors often struggle with.
“Allowing ourselves to take up space and notice how our body moves helps us reclaim ourselves on the road to recovery,” says Hornthal, who helps clients do this through practices like guided imagery, movement meditation, and creative techniques like mirroring (where the therapist will mirror the client’s movements to externalize what they’re feeling in their body). “It’s like rebuilding a friendship with someone who has hurt us, and working to repair that connection.”
Fanelli adds that yoga can also be a helpful transition exercise. Not only does the practice encourage a mindful connection to the body, it takes the focus off reaching numerical goals, which patients often struggle with in more intense workouts, like running or high-intensity interval training.
Dr. Oliver-Pyatt says the key is to create a “paradigm shift” so that patients see exercise as self-care instead of something they have to do to burn calories. “You want to do it not out of fear, but because you want to move your body,” Dr. Oliver-Pyatt says.
At Within Health, Dr. Oliver-Pyatt says patients begin to move gradually and with support of a provider. And if they’re not quite ready yet, providers will determine when to incorporate it into a patient’s recovery plan and let clients know that even if they can’t exercise at the moment, they will be able to eventually.
With any steps in the recovery process, I strongly believe—and Dr. Oliver-Pyatt agrees—that the client should be included in the process. “If you don’t have that relationship, they won’t share with you what’s actually going on,” she says. When it comes to movement, having someone listen to my concerns around not being able to move while in treatment would have been instrumental in learning to trust not only my body, but also my voice.
“Patients may not have ever learned how to trust their body, and that you can eat without compensatory activity,” Dr. Oliver-Pyatt says. “But if people don’t learn that while in treatment, they may never learn it all their life.”
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