Why Does Eating Disorder Recovery Feel So Hard? Why Things Can Feel Worse Before They Feel Better
If eating disorder recovery is supposed to help you feel better, why can treatment sometimes make you feel worse?
This is one of the most confusing parts of eating disorder recovery.
Someone may begin eating more consistently—and suddenly think about food more.
A teenager may begin restoring nutrition—and become increasingly distressed about their body.
Someone may stop purging, restricting, binge eating, or compulsively exercising—and discover that anxiety suddenly feels much harder to manage.
A child beginning eating disorder treatment may become more tearful, angry, fearful, or resistant around meals.
This can leave individuals and families wondering:
“Are we making things worse?”
Not necessarily.
Eating disorder treatment often asks a person to approach the exact foods, situations, emotions, and body experiences that the eating disorder has taught them to fear or avoid. Fear, anxiety, body dissatisfaction, loss-of-control fears, and emotion-regulation difficulties can all be important parts of eating disorder psychopathology (Butler et al., 2023; Félix et al., 2024).
Therefore, feeling uncomfortable during recovery does not automatically mean recovery is going badly.
Sometimes discomfort is part of learning to live without the eating disorder.
At the same time, significant deterioration should never simply be dismissed as “part of recovery.” Increasing medical instability, inability to maintain adequate nutrition, escalating eating disorder behaviors, severe depression, suicidality, or other major changes require prompt assessment by the treatment team.
Why Is Eating Disorder Recovery So Hard?
Eating disorders are not simply about food.
They are complex psychiatric illnesses involving biological, psychological, behavioral, interpersonal, and environmental factors. Eating disorders are also associated with significant medical and psychiatric morbidity, which is why effective treatment often requires attention to both physical and psychological recovery (Phillipou et al., 2025).
Over time, eating disorder behaviors may also become intertwined with how a person responds to distress.
Research has identified emotion-regulation difficulties across eating disorder presentations. In a systematic review involving more than 31,000 adolescents, Félix et al. (2024) found significant relationships between emotion-regulation difficulties and eating disorder psychopathology.
Eating disorder behaviors can therefore begin to serve functions beyond food itself.
For example:
Restriction may provide a temporary sense of predictability or control.
Binge eating may occur in response to emotional distress.
Purging may temporarily decrease anxiety after eating.
Compulsive exercise may reduce guilt or fears about weight gain.
Body checking may temporarily reassure someone about their appearance.
Food rituals and rules may create a sense of certainty.
Avoiding feared foods may immediately decrease anxiety.
These behaviors may provide short-term relief while strengthening the disorder over time.
That creates one of the central challenges of recovery:
Treatment asks someone to stop using behaviors that are harming them even when those behaviors may temporarily make them feel safer.
Can Eating Disorder Recovery Feel Worse Before It Feels Better?
Yes, it can—but it does not happen to everyone, and worsening symptoms should always be evaluated in context.
Imagine someone who is terrified of eating pizza.
Avoiding pizza provides immediate relief.
Every time the person avoids it, however, they lose an opportunity to discover that they can eat the food, tolerate the anxiety, and continue with their day.
Eventually, even thinking about eating pizza may create significant distress.
Recovery reverses that pattern.
Instead of avoiding the feared experience, treatment may involve gradually learning to approach it.
Research examining eating disorder fears has found that they extend beyond weight gain alone. Individuals may fear particular foods, changes in their body, judgment from other people, or losing control (Butler et al., 2023).
Exposure-based research provides additional insight into why confronting these fears can initially feel difficult. Levinson et al. (2020) found reductions in eating disorder symptoms and core fears over the course of an exposure intervention, while subsequent research has continued examining fear and body dissatisfaction as potential mechanisms of therapeutic change (Williams et al., 2024).
The goal is not to make someone anxious.
The goal is to help the person learn:
“I can experience this feeling without doing what my eating disorder tells me to do.”
Why Am I More Anxious During Eating Disorder Recovery?
Because recovery often involves doing things that directly contradict the eating disorder.
Treatment might require someone to:
Eat regularly even when the eating disorder says not to.
Eat foods categorized as “bad,” “unhealthy,” or “unsafe.”
Eat without knowing exact calories.
Allow someone else to prepare a meal.
Tolerate fullness.
Reduce body checking.
Stop weighing themselves.
Reduce or stop compulsive exercise.
Resist purging after eating.
Interrupt binge-restrict cycles.
Eat at restaurants.
Participate in social events involving food.
Allow their body to change.
Challenge rigid routines.
Stop seeking reassurance about weight or appearance.
These behaviors can produce anxiety precisely because they challenge the rules that have maintained the disorder.
Eating disorder fears commonly involve food, weight or shape, judgment, and loss of control (Butler et al., 2023).
Anxiety during recovery therefore does not necessarily mean:
“This is dangerous.”
Sometimes it means:
“This is unfamiliar, and my eating disorder does not like it.”
Why Do Eating Disorder Thoughts Get Louder During Recovery?
One of the most frustrating experiences in recovery is doing everything “right” behaviorally while feeling worse mentally.
Someone might begin eating more consistently and suddenly experience thoughts such as:
“You're eating too much.”
“You need to compensate for that.”
“Your body is changing.”
“You're losing control.”
“Skip the next meal.”
“You shouldn't have eaten that.”
“You need to exercise.”
An important recovery principle is:
Having an eating disorder thought is not the same as acting on it.
Psychological recovery often requires changing the relationship with these thoughts—not necessarily making every thought disappear immediately.
Treatment can help someone notice an eating disorder thought, tolerate the discomfort it produces, and choose a different behavior.
Over time, repeated recovery-oriented choices can weaken the relationship between an intrusive thought and the eating disorder behavior that previously followed it.
Why Does Body Image Sometimes Get Worse During Eating Disorder Recovery?
Body image recovery does not always happen at the same speed as behavioral or nutritional recovery.
Someone may begin eating more consistently before they become comfortable with the possibility of body change.
A person may stop restricting while still experiencing intense body dissatisfaction.
Someone may reach important physical recovery milestones while still struggling psychologically.
Research increasingly emphasizes that recovery from anorexia nervosa cannot be conceptualized exclusively in terms of weight. Psychological symptoms and broader functioning also matter (Phillipou et al., 2025).
Body image distress may also be maintained by behaviors such as:
Mirror checking
Pinching or measuring the body
Repeated weighing
Comparing one's body with other people's bodies
Checking whether clothing fits differently
Photographing the body for comparison
Asking others for reassurance
Avoiding certain clothes
Avoiding photographs
Avoiding social situations because of appearance
Recovery may therefore require changing not only how someone thinks about their body, but also what they do when they feel uncomfortable in their body.
The ultimate goal does not have to be:
“I love every part of my body every day.”
A more meaningful goal may be:
“My body no longer determines whether I participate in my life.”
Why Is My Child More Upset After Starting Eating Disorder Treatment?
Parents frequently ask this question.
Before treatment, a child might appear relatively calm while:
Restricting food
Avoiding feared foods
Exercising excessively
Eating only certain “safe” foods
Following rigid food rules
Avoiding restaurants
Skipping snacks
Controlling how food is prepared
Then treatment begins interrupting those behaviors.
Suddenly parents may see:
Crying
Anger
Panic
Negotiating
Reassurance seeking
Refusal
Irritability
Statements such as “you're making me fat”
Claims that treatment is making everything worse
For parents, this can be extremely difficult.
It can feel counterintuitive to continue encouraging recovery-oriented behavior when your child is clearly distressed.
However, family involvement is one of the most extensively studied approaches for adolescents with anorexia nervosa.
A 2024 systematic review and meta-analysis of 18 randomized controlled trials found that eating-disorder-focused family therapy produced greater weight gain by the end of treatment than individual psychotherapy among adolescents with anorexia nervosa (Austin et al., 2024).
Randomized trials have also demonstrated the importance of family-based approaches and parental involvement in adolescent anorexia nervosa treatment (Agras et al., 2014; Le Grange et al., 2016; Lock et al., 2023).
Parents can therefore become an important part of the recovery team.
Your child's distress deserves compassion.
But compassion does not always mean removing the recovery expectation.
Sometimes it means communicating:
“I believe you that this feels incredibly hard. And I am going to help you through it rather than let the eating disorder decide what happens next.”
Does Feeling Worse Mean Eating Disorder Treatment Isn't Working?
Not necessarily.
Emotional comfort is only one measure of how treatment is progressing.
Someone may be making meaningful progress while still experiencing significant anxiety.
Progress might look like:
Completing meals despite eating disorder thoughts.
Eating previously feared foods.
Decreasing restriction.
Reducing binge eating or purging.
Decreasing compulsive exercise.
Allowing parents to provide greater meal support.
Reducing body checking.
Becoming more flexible with food.
Eating socially again.
Returning to previously avoided activities.
Recognizing eating disorder thoughts without immediately following them.
Asking for support rather than engaging in an eating disorder behavior.
This is one reason specialized treatment matters.
The clinician must distinguish between productive therapeutic discomfort and clinical deterioration requiring a change in treatment or level of care.
Is Eating Disorder Recovery Linear?
No. Eating disorder recovery is rarely a perfectly straight progression from “sick” to “recovered.”
Large-scale outcome research demonstrates substantial variability in the course of eating disorders.
A major systematic review and meta-analysis involving 415 studies and more than 88,000 participants found that recovery continued to occur across longer follow-up periods, demonstrating that meaningful recovery can happen over time (Solmi et al., 2024).
Relapse can also occur.
Research examining relapse after treatment for anorexia nervosa demonstrates the importance of continued follow-up and relapse-prevention work after acute improvement (Walsh et al., 2021). A separate meta-analysis found that relapse risk is associated with multiple factors, including eating disorder severity, psychiatric comorbidity, treatment response, and motivation for change (Sala et al., 2023).
A difficult week therefore does not erase months of recovery.
Instead of asking:
“Am I completely recovered yet?”
Try asking:
“Am I becoming increasingly able to choose what matters to me instead of what the eating disorder demands?”
How Long Does Eating Disorder Recovery Take?
There is no universal timeline.
Recovery can differ according to:
Diagnosis
Age
Duration of illness
Medical status
Eating disorder severity
Co-occurring mental health conditions
Family support
Treatment approach
Response to treatment
Access to specialized care
Physical, behavioral, and psychological recovery may also happen at different rates.
Someone may become medically safer before eating disorder thoughts substantially decrease.
Someone may stop purging while continuing to experience significant body dissatisfaction.
A teenager may restore nutrition while still needing considerable meal support.
Long-term outcome research is particularly important here. Solmi et al. (2024) found that recovery rates increased with longer follow-up, reinforcing an important message:
Recovery can take time, and continuing to struggle does not mean recovery is impossible.
What Helps When Eating Disorder Recovery Feels Impossible?
1. Focus on the Next Recovery-Oriented Decision
Thinking about months or years of recovery can feel overwhelming.
Sometimes the more useful question is:
“What does recovery require from me at this meal?”
2. Expect Some Anxiety When Challenging the Eating Disorder
Anxiety is not automatically evidence that something is wrong.
Fear can emerge precisely because someone is confronting something the eating disorder has taught them to avoid (Butler et al., 2023).
3. Stop Waiting to “Feel Ready”
Recovery-oriented behavior may need to happen before confidence arrives.
You may not feel ready to eat the feared food.
You may not feel ready to stop weighing yourself.
You may not feel ready to decrease exercise.
Treatment can help you practice doing difficult things without waiting for the eating disorder to give you permission.
4. Look at Behavior, Not Just Feelings
Ask:
“What am I able to do today that the eating disorder prevented me from doing before?”
That may provide a more useful measure of progress.
5. Use Specialized Eating Disorder Treatment
Eating disorders are complex psychiatric illnesses. Treatment needs vary according to diagnosis, age, medical status, severity, and other individual factors.
Evidence supports several psychological interventions. Family-focused treatments have substantial evidence for adolescent anorexia nervosa, while cognitive-behavioral approaches have evidence across several eating disorder presentations (Austin et al., 2024; Monteleone et al., 2022).
A systematic review of CBT delivered in routine eating disorder clinical practice also found substantial improvements in eating disorder psychopathology, although the authors noted limitations in the quality of the available studies (Öst et al., 2023).
Eating Disorder Treatment at Ezer Psychotherapy
At Ezer Psychotherapy, eating disorder treatment focuses on helping children, adolescents, young adults, and families address both the behaviors and psychological processes that keep an eating disorder going.
Treatment may address concerns including:
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
ARFID
Other Specified Feeding or Eating Disorder (OSFED)
Restrictive eating
Binge eating and purging
Compulsive exercise
Food anxiety and food avoidance
Fear of weight gain
Body image concerns
Rigid food rules
Perfectionism
Eating disorder thoughts and urges
Depending on the individual and family, treatment may incorporate evidence-based approaches such as Family-Based Treatment (FBT) and cognitive-behavioral approaches to eating disorders.
For children and adolescents, parents can be an important part of treatment.
Parents may learn how to:
Support adequate and consistent nutrition.
Respond to eating disorder behaviors effectively.
Reduce accommodation of the eating disorder.
Manage difficult meals.
Set appropriate recovery expectations.
Separate their child from the eating disorder.
Increase confidence in responding to eating disorder behaviors.
Family involvement does not mean that parents caused the eating disorder.
Instead, family-based approaches recognize that parents and caregivers can become powerful resources in helping a young person recover.
Recovery Can Feel Hard and Still Be Moving in the Right Direction
There can be a particularly difficult stage of eating disorder recovery when the eating disorder is no longer getting everything it wants—but living without the eating disorder does not feel comfortable yet.
You may think:
“I felt better before recovery.”
But there is an important difference between feeling temporarily safer because you are obeying the eating disorder and developing the ability to feel safe without obeying it.
Recovery is not necessarily never feeling anxious around food again.
It is increasingly being able to eat even when anxiety appears.
Recovery is not necessarily never having a negative body image thought.
It is reaching a point where that thought no longer determines whether you eat dinner, attend school, go swimming, see your friends, or participate in your life.
Recovery is not never experiencing an eating disorder urge.
It is developing the ability to experience the urge and choose something different.
Those choices matter.
And repeated over time, they can create a life in which the eating disorder occupies increasingly less space.
Frequently Asked Questions About Eating Disorder Recovery
Is it normal to struggle more when starting eating disorder recovery?
Some people experience increased anxiety or distress when they begin challenging eating disorder behaviors. This may happen because treatment requires approaching previously avoided foods, situations, emotions, or body experiences. However, significant deterioration should be discussed with the treatment team rather than automatically attributed to recovery.
Why am I more emotional during eating disorder recovery?
Eating disorders are associated with emotion-regulation difficulties, and eating disorder behaviors may sometimes function as ways of responding to distress (Félix et al., 2024). When those behaviors are interrupted, emotions may initially feel harder to manage.
Why do I miss my eating disorder?
An eating disorder can become familiar, predictable, and connected with a person's sense of safety or control. Missing aspects of it does not mean you do not want recovery. Ambivalence can be part of the recovery process.
Can I be recovering if I still have eating disorder thoughts?
Yes. Psychological recovery does not necessarily require every eating disorder thought to disappear before behavioral change occurs. An important treatment goal is learning that thoughts and urges do not have to dictate behavior.
Can parents help their child recover from an eating disorder?
Yes. Family-focused interventions have substantial research support, particularly for children and adolescents with anorexia nervosa (Austin et al., 2024; Lock et al., 2023).
What should I do if eating disorder recovery actually seems to be making me worse?
Tell your treatment team. Increasing medical symptoms, inability to maintain adequate nutrition, escalating restriction, bingeing or purging, rapidly worsening psychiatric symptoms, or suicidal thoughts should not simply be accepted as “normal recovery discomfort.” Treatment intensity or level of care may need to be reassessed.
Looking for Eating Disorder Therapy?
If you or your child is struggling with an eating disorder, restrictive eating, binge eating, purging, food anxiety, compulsive exercise, or body image concerns, specialized treatment can help.
Ezer Psychotherapy provides specialized eating disorder therapy for children, adolescents, young adults, and families.
Learn more about eating disorder treatment and getting started here on this website and click below to book your session today!
References
Agras, W. S., Lock, J., Brandt, H., Bryson, S. W., Dodge, E., Halmi, K. A., Jo, B., Johnson, C., Kaye, W., Wilfley, D., & Woodside, B. (2014). Comparison of 2 family therapies for adolescent anorexia nervosa: A randomized parallel trial. JAMA Psychiatry, 71(11), 1279–1286.
Austin, A., et al. (2024). Efficacy of eating disorder focused family therapy for adolescents with anorexia nervosa: A systematic review and meta-analysis. International Journal of Eating Disorders.
Butler, R. M., et al. (2023). An examination of eating disorder fears in imaginal exposure scripts. Journal of Affective Disorders.
Félix, S., et al. (2024). Emotion regulation as a transdiagnostic construct across the spectrum of disordered eating in adolescents: A systematic review. Journal of Affective Disorders.
Le Grange, D., Hughes, E. K., Court, A., Yeo, M., Crosby, R. D., & Sawyer, S. M. (2016). Randomized clinical trial of parent-focused treatment and family-based treatment for adolescent anorexia nervosa. Journal of the American Academy of Child & Adolescent Psychiatry, 55(8), 683–692.
Levinson, C. A., et al. (2020). Eating disorder symptoms and core eating disorder fears decrease during online imaginal exposure therapy for eating disorders. Journal of Affective Disorders.
Lock, J., et al. (2023). Who responds to an adaptive intervention for adolescents with anorexia nervosa being treated with family-based treatment? Outcomes from a randomized clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry.
Monteleone, A. M., et al. (2022). Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses. Neuroscience & Biobehavioral Reviews.
Öst, L.-G., et al. (2023). Cognitive behavior therapy for adult eating disorders in routine clinical care: A systematic review and meta-analysis. International Journal of Eating Disorders.
Phillipou, A., et al. (2025). Anorexia nervosa—Facts, frustrations, and the future. JAMA Psychiatry.
Sala, M., et al. (2023). Predictors of relapse in eating disorders: A meta-analysis. Journal of Psychiatric Research.
Solmi, M., et al. (2024). Outcomes in people with eating disorders: A transdiagnostic and disorder-specific systematic review, meta-analysis and multivariable meta-regression analysis. World Psychiatry.
Walsh, B. T., et al. (2021). Time course of relapse following acute treatment for anorexia nervosa. American Journal of Psychiatry.
Williams, B. M., et al. (2024). State mechanisms of change in eating disorder symptoms and fears during an online imaginal exposure treatment for eating disorders. Journal of Affective Disorders.
This article is for educational purposes and is not a substitute for individualized medical, nutritional, or mental health care. Eating disorders can cause serious medical and psychiatric complications. Acute medical symptoms, suicidality, or other immediate safety concerns require urgent evaluation.
