Normalizing Fear Foods in Eating Disorder Recovery
Embarking on eating disorder recovery involves far more than simply nourishing the body. It also means confronting fears, challenging food rules, and gradually rebuilding a more peaceful relationship with food. One important part of this process is learning to integrate and normalize fear foods. Though this can feel incredibly daunting, it is a powerful step toward greater freedom, flexibility, and healing in recovery.
Before someone is ready to begin normalizing fear foods, there are several foundational stages of nutrition in eating disorder recovery that need to be established first.
Foundational Stages of Recovery Nutrition
1. Establishing a Regular Pattern of Eating:
When we first begin the nutrition work in eating disorder recovery, our goal is physical stabilization and establishing a regular pattern of eating. This is the foundation upon which recovery is built.
This may look like:
Gently increasing the individual’s nutrition, starting from where they are currently at. Everyone is different here. Each person is consuming a different amount of food, has different safe and fear foods, unique food rules and rituals, and their own eating disorder symptoms. We do this gradually to support safe refeeding.
Building up to regular meals and snacks at consistent intervals throughout the day. For example, three meals and three snacks spaced in a way that ensures the person in recovery is never going too long without nourishment.
Gradually introducing more foods, food groups and diversity of foods.
Working on consuming a balanced plate inclusive of enough carbs, fats and protein sources at each meal.
Ensuring energy rich snack choices.
Working on consistency with all of the above.
2. Symptom Interruption:
We also work on interrupting eating disorder symptoms in the early stages of recovery. By symptoms, I mean urges to binge, purge, restrict, use laxatives, chew and spit, overexercise, and engage in other eating disorder behaviours.
Symptom interruption may look like:
Supervision after meals: having a structure and plan in place for family or clinician supervision for a duration of time after meals and snacks to ensure there is no purging.
Learning how to “urge surf” when the urge to purge, exercise, take laxatives, exercise, or restrict comes up.
Learning how to build a toolbox of alternate activities to utilize when urges to engage in eating disorder symptoms arise.
Learning how to get ahead of the urge by beginning to identify your triggers. Triggers can include certain people (family members, friends, or a partner), places (home, school, teams, or work), social situations (such as parties, lunchtime at school, camp, or work), social media, bullying, specific emotions (anger, sadness, guilt, shame, feeling unworthy or “not enough”), life events, seasons, holidays, travel, conversations, and past trauma.
3. Family Education and Support:
Integrating family into nutrition for eating disorder recovery is integral to ones’ recovery success.
We are working with the family on the following:
Education on what a balanced plate looks like and what food groups and components need to always be included.
Introducing the food philosophies of addition nutrition and an all foods fit approach.
Working with the family to plan weekly meals and snacks and help choose what to shop for.
Teaching you how to navigate meal times, and how not to negotiate with the eating disorder.
Teaching you what to look for at meal times to ensure that there is no space for eating disorder behaviors. As well as what to do and how to navigate it when you notice these behaviors showing up.
Teaching you how to support your loved one after the meal.
Normalizing Fear Foods
In time, once a strong foundation for eating disorder recovery has been established, we are ready to begin the work of normalizing fear foods. This foundation includes refeeding, physical stabilization, establishing a regular pattern of eating, consistently showing up to full plates and all meals and snacks, interrupting and reducing eating disorder symptoms, and integrating family education and support.
It is important to note that this foundational work does not stop. Recovery is not a series of isolated stages, but rather an overlapping process in which each phase continues to be supported and integrated throughout the journey.
What is Fear Food Normalization?
Food normalization in eating disorder recovery is the stage in which we begin to integrate fear foods and fearful food situations. These are foods or situations that feel especially triggering to the individual in recovery and may still lead to eating disorder behaviours, or increased urges to engage in those behaviours, when encountered.
Some examples include:
Foods the person has labeled as “bad,” as well as certain eating situations they find especially challenging. This may include packaged foods, fast foods, sweets and treats, specific food groups, larger portions, restaurant meals, eating out, social eating, holidays, travel, or meals prepared by others.
Amounts of food that feel more scary. For example, someone in eating disorder recovery may feel comfortable eating one slice of pizza, but experience strong urges to purge or restrict if they were to eat two or three slices. Or they may feel okay eating meals prepared at home in familiar portions, while restaurant meals and restaurant-sized portions feel extremely scary and triggering.
Having a hierarchy of foods, such as being OK with sprouted grain bread only, but feeling very triggered if served white bread. Or being OK with a homemade sandwich, but not yet able to eat a sandwich out at a restaurant or cafe without having urges to engage in the eating disorder.
Having rules around certain foods or food situations. For example, someone may avoid appetizers, only allow themselves to drink water (restricting beverages such as soda, juice, or milk), or believe they cannot have an evening snack if they have already had dessert with dinner.
Why is Fear Food Normalization Important in Recovery?
We cannot recover only part of the way. By the time we are ready to begin normalizing and integrating fear foods, the individual in recovery has already come a long way. They are more physically stable, often more weight stable, experiencing fewer physical symptoms, and may have improved laboratory markers. They are showing up to meals and snacks more consistently and are often beginning to re-engage in life outside of the eating disorder, including school, social activities, and family life.
However, at this point, they still have a lot of boundaries and restrictions created by the eating disorder:
For example:
They may feel uncomfortable eating out with friends and choose to not eat when out of the house or eat much less than is required of them to continue to stay physically well.
They may not have flexibility with their food choices yet. For example, perhaps they feel comfortable ordering only one specific item at a local coffee shop or restaurant, and that option is unavailable. Someone without an eating disorder would typically be able to pivot and choose something else based on what is available. For someone with an eating disorder, this situation can feel extremely distressing and may lead to a significant emotional reaction or an inability to make an alternative choice.
They struggle to participate in eating that is special, celebratory, or out of the ordinary rhythm or routine. This might include birthday cake, holiday meals and desserts, Easter chocolates, a special restaurant meal, or foods encountered while traveling, such as unfamiliar cuisines or meals eaten on airplanes and at airports.
They may still have a list of foods they are avoiding for a variety of reasons and, despite significant progress with their nutrition and the foods they have already reintroduced, there is still active restriction.
We need to be able to normalize all aspects of food and eating, or there will continue to be many moments and spaces where the eating disorder still resides. Without fear food normalization, someone may do well in a very specific and familiar environment — for example, at home with predictable, home-cooked meals that feel safe and controlled — but remain highly triggered and vulnerable to eating disorder symptoms in many other situations, such as unexpected changes in plans, travel, celebrations, restaurants, or social settings.
What Does the Normalization Process Look Like?
This process looks different for everyone, as no two individuals or eating disorders are exactly alike. Which fear foods and eating situations we work on, and how we approach them, depends entirely on where the fear, triggers, and discomfort are arising for the individual in recovery.
That said, the first step is identifying which foods and food situations need to be normalized.
Once we have a working list (which is always evolving), we begin with an item that feels more manageable than some of the others. We never start with the most difficult food or situation.
From there, we determine what the normalization process will look like and how to implement it in the safest and most supported way possible.
Let’s look at a few examples.
Names and identifying details have been changed to protect privacy.
Beth’s Normalization Journey:
Beth struggled with binge eating disorder and exercise bulimia. She followed a vegan diet, but always binged on dairy products and knew that if she was able to integrate more animal foods into her diet, she would feel more balanced, full and satisfied and have less urges to binge.
We made a list of foods that she felt fearful of, restricted, binged on, and felt the need to “get rid of” if consumed. And then we ranked them from easiest to most difficult.
She picked an easier one to start: yogurt. It was very frightening for her but she also knew her body craved it and was able to easily see how it could be part of balanced diet. She added it to either her breakfast or dessert each day for a few weeks and over time, it simply became a food that she could integrate as needed into her diet. It became normalized and “no big deal”. We also safety planned accordingly, ensuring there was no space for any eating disorder symptoms around these meals and that she was eating them with safe people (her family in this circumstance) and at the most safe times of day for her.
Over many months, we worked through her fear foods list, integrating and normalizing foods like cheese, chocolate, ice cream and more. Some foods she integrated in the house, some she went out to eat, and some she ate with people who were important to include in her recovery journey.
She worked on foods that felt scary and triggering, ate at places that she would normally only buy binge foods at, and we safety planned her day to ensure she could not over-exercise after these meals.
Jade’s Normalization Journey:
Jade recovered from Anorexia Nervosa. She had a lot of food rules around what was healthy and what was not, and what foods were allowed or not. She felt fearful of eating foods containing sugar, baked goods, fats, foods containing gluten, and more.
Again, we made a list together when she was ready. Actually, the really cool thing here was that Jade already had made a list by herself of all the foods she missed and wanted to eat one day. It was tucked away in her journal and when I told her what we would be working on together, she chose to share it with me. I am still smiling from ear to ear as I write this, because that is exactly the kind of self ownership required to be well.
Each week we integrated something new to normalize. As always, we started with some of the “easier” ones (in quotations because of course they are all quite difficult!) and moved to more challenging ones in readiness.
Some weeks Jade was baking (from the many recipes she would save for herself but felt too fearful of), and used these baked goods for some of her snacks that week. Some weeks she was going to get drinks and snacks at coffee shops. Some weeks she was asking her family to cook dinners that she used to like but has avoided for a long time.
And as her eating disorder was one of restriction, the work here was always to be able to show up to her regular meals and snacks AND the foods she was working on normalizing.
There was no space for restriction or compensation in this process and as such, what Jade was able to learn was that “nothing crazy happened”. She ate the scariest foods that her eating disorder would never have allowed her to eat, and all the crazy and terrible things her eating disorder said would happen, didn’t!
That is the power of fear food normalization. Once someone has these affirming experiences again and again, the fear foods gradually lose their power. In recovery, they are able to choose what to eat and when without the eating disorder having a say. That is food freedom.
