Terminal Uniqueness In Recovery

One of my favourite podcasts is Armchair Expert with Dax Shepard. What I like about Dax is that he is this fantastic mix of being incredibly compassionate, authentic and vulnerable, insanely smart and well-read, and hilariously comedic and funny. It all makes him a supremely talented interviewer. 

Dax talks a lot about his past struggles with alcohol and drugs and the sobriety he now has in a large part because of Alcoholics Anonymous (AA). 

One of the concepts from AA that he talks about, and that is relevant to eating disorder recovery, is terminal uniqueness.

Terminal Uniqueness 

Terminal uniqueness is the belief that the situation you are facing is unlike anything faced by other people. That all the treatments and approaches may work for others, but you are the exception or special case. That you’re unique.

And the reason for using the word “terminal” here is because this kind of belief in uniqueness can get people killed. This is true for both alcoholism and eating disorders.

In my practice, I have seen this a lot.

I’ve had a past client that felt unable to really start recovery because she felt like the amount that she ate and the way she exercised was like nothing she’d heard before. Every time she’s listened to a recovery story on a podcast or read a recovery account, the particulars of the case never matched closely enough to hers.

And so this meant that she couldn’t get started. Because what if different rules applied to her? What if she got everything she feared (namely weight gain) but with no upside?

I’ve had this happen to clients during the recovery journey because certain symptoms were going on longer than they expected or they believed they should.

For one client, water retention was a real issue. While this is often a problem that is associated more with the early stages of recovery, hers was continuing on. Many other issues were improving, but not the water retention. She was over a year into recovery and was having water retention that she’d only ever heard talked about for those at the start of recovery.

For another client, it’s disgust with eating. She has trouble eating because so many foods make her feel disgusted. Even while eating, something can suddenly turn from pleasant to unpleasant. This is then mixed with times of no appetite and times of extreme hunger. She’s never heard of anyone going through this and feels that this is something unique to her.

For another client, she had really low energy. If she did too much, she would be wiped and need to go back to bed. And “too much” could be as simple as taking a trip to the park with her kids or going to the grocery store. Her tolerance for anything mildly strenuous was non-existent. And this wasn’t at the start of recovery, this was still happening 18 months on.

I could easily come up with many other examples.

But the reality is that nearly all clients will have one thing like this. A symptom or facet that seems extreme or different to anything they have heard other people experiencing. Something that it feels like makes their situation unique from the masses.       

The Damage That This Kind Of Thought Creates

This kind of thinking isn’t benign and it can have huge ramifications. From my experience, it tends to then lead to two other equally damaging thoughts. 

The first is the thought that “I must be doing something wrong.” This is actually a thought that comes up a lot in recovery and largely is a by-product of the emotions that arise connected to making a change or even just the anticipation of making a change.

For example, in an eating disorder, most foods get registered as a threat by the nervous system. So, when looking at or thinking about consuming a burger or ice cream, this is synonymous with looking at or thinking about something scary. Say, being placed in a room full of snakes or scorpions.

This is an automatic response, where the body is hit by the feeling of fear. As humans, we are meaning-making machines. And so, when this feeling comes up, we ask ourselves (often unconsciously), “why am I feeling this way?” 

Considering the thoughts and beliefs that are already entrenched about food, weight, and exercise, and that so much of life is then seen through this lens, the natural conclusion is that I must be doing something wrong. 

So, when someone focuses on some symptom or facet that seems extreme or different and asks themselves “why is this happening” because this also elicits the same threat response in the nervous system, you reach the same conclusion of “I must be doing something wrong.”  

This thought then connects with the next damaging thought, which is “there must be another way to do recovery, I just haven’t found it yet.”

Typically, when I start work with clients, I am not the first person they have worked with. And not only am I not the first person they have worked with, but they have also usually tried many things on their own.

And very often there is one thing that connects all other attempts: trying to recover, with all the upside, but none of the downside.

They tried to recover, but doing so while still eating the same foods they currently do

They tried to recover, but without giving up any exercise

They tried to recover, but doing it in a slow manner so there is no weight gain

They tried to recover but worked with a practitioner who was all about supplements

Recovery attempts have been made based on the idea that they can get to a place of recovery, but where they are able to keep all the habits that they feel unable to change as well as avoid all the “negative” symptoms and body changes that occur in recovery.

And this idea of some magic way out with nothing but an upside is hard to shake. For most clients full surrender comes much later in recovery and before this occurs it is lots of ambivalence and an unsureness about whether they just haven’t searched hard enough for some other method. 

So, when there is a symptom that goes on longer or feels more extreme, then there is a feeling of fear and the thought of “I must be doing something wrong,” then it’s natural that this lingering belief of “there must be another way” crops up.

 You Are Not Your Thoughts

So what should you do if this is coming up for you? There are a handful of ideas that are helpful. 

The first is to remember that thoughts think themselves.

If you’ve ever done mediation, this idea is fairly instantly obvious. If you were to spend five minutes sitting still with the goal of not having a single thought come to mind, you wouldn’t be able to do it. Even the best meditators in the world, wouldn’t be able to do it.

And that’s because thoughts naturally arise and enter into your conscious mind. You are the witness of your thoughts; you are not the author. Which is something I talk about at length in this podcast on Free Will.

Just because you had a thought does not mean:

It is true

That you believe it

That it’s a value of yours  

That it’s important

That you have to obey it

That it’s a wise thought

That it is a legitimate threat

This is incredibly helpful to constantly remember all through life but especially while going through recovery. Because it’s too easy to have a thought that you get captured by it, believing that it is true and feeling that this thought says something about who you are or what you value.

A way of dealing with this is using the phrase “I’m noticing my mind is generating the thought that…” This can create some distance between you and the thought because the two of you are not the same.  

Another helpful thing can be to ask yourself “Is this a helpful thought?” And the word helpful here can be thought about through the lens of, “Is this bringing me closer towards recovery and helping me take action in service of this goal?” 

This can be quite a departure from many of us, where the goal is constantly to seek the truth. But just because you find the truth, doesn’t mean it necessarily serves your purpose of recovery.

It may indeed be true that you have never heard of anyone experiencing a particular symptom to the degree that you are. But the more important question is, does focusing on this truth help you in moving forward?

This is where the question of “is this a helpful thought” comes in. Because if it is helpful, keep thinking about it and have it help you make the changes you need to. And if it is not helpful, see it simply as another thought that your mind has thrown up into your consciousness and not something you need to become fused and fixated on.

[Note: Both of the above ideas come from Acceptance And Commitment Therapy (ACT) and I’ve taken them from the book The Happiness Trap by Russ Harris.]

The final idea I want to mention here is that the kinds of thoughts (and feelings) that naturally arise are determined by the state our body is in.

As I mentioned earlier, food can be a threat and this automatically takes us into a state of fear. The thoughts that then arise are connected to this state.

One of my favourite people on this topic is Deb Dana, who I spoke to in this podcast. While the common wisdom has been to think about thoughts leading to feelings, Dana says that it’s actually the opposite that is true. She has the saying that “story follows state.”

So alongside using the phrase “I’m noticing my mind is generating that thought that…” and asking the question “is this a helpful thought?” it’s also useful to ask to notice and ask yourself, “what state is my body in that it would generate a thought like this?” And to be able to answer that question, I suggest learning more about polyvagal theory as discussed in this episode or in Dana’s books here.

You Don’t Know What You Don’t Know

The statistics around eating disorder recovery are rather grim.

It’s estimated that only 10% of those who suffer from an eating disorder actually seek treatment. This is obviously an estimate because it’s an illness that is so often filled with shame, so the exact percentage is hard to know. But for an illness that is so devastating to so many facets of life, it’s a heartbreakingly small percentage that seeks treatment.  

But if we then look at the people who are either showing up in the eating disorder research or are talking about their experience online or in books, this is then the tiniest of a fraction of the people who experience the illness. And these are the people that you are referencing when you think “I’ve never heard anyone else experiencing this to the degree I am.” 

Just because a symptom feels unique or like no one else is dealing with it, doesn’t mean that this is true. It’s highly likely that many other people are dealing with it, they just haven’t come up in the recovery accounts or research that you’ve looked at. The probability is that this isn’t unique at all and is simply one of the normal but less common facets of recovery.

But even if you are the one and only person in the entirety of recovery that is experiencing this, let’s come back to something I mentioned at the start of this with terminal uniqueness and the word terminal.

You can see the statistics in full here and here, but eating disorders have a high mortality rate.

• Eating disorders have the second-highest mortality rate of all mental health disorders, surpassed only by opioid addiction
• Anorexia has an estimated mortality rate of around 10%
• Young people between the ages of 15 and 24 with anorexia have 10 times the risk of dying compared to their same-aged peers
• One study found that people with anorexia are 56 times more likely to commit suicide than people without an eating disorder

The terminal side of eating disorders is real, even though everyone thinks that this is something that will only happen to other people. And so even if a particular symptom is taking the longest to heal of any person on the planet, recovery is still worth it and you are still on the right path. Or if you haven’t even started, then doing so is unquestionably the right thing to do.

Getting Support

I’m a leading expert and advocate for full recovery. I’ve been working with clients for over 15 years and understand what needs to happen to recover.

I truly believe that you can reach a place where the eating disorder is a thing of the past and I want to help you get there. If you want to fully recover and drastically increase the quality of your life, I’d love to help.

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