The Myth of Accountability

Accountability, in the general sense, means to be held responsible for your actions. It typically means that if you do not live up to goals, promises, or expectations there will be some sort of punishment.  Doesn’t sound very therapeutic, does it?

I frequently have discussion, both personally and professionally, about accountability. Clients find  that following a meal plan or not using behaviors is easier or more likely to happen at a higher level of care. That makes sense, right. There are nurses, nutritionists, techs, psychiatrists, therapists and other authority figures following you around all day, making sure you follow through.

What’s are the consequences if you don’t do what they say? Well, depending on how life threatening a behavior is, they can literally and physically force you to do something. They can kick you out of treatment. Or they can keep you in treatment. Or any number of other things. Usually, the simple presence of the authority figure is enough, but they do have their ways.

It certainly doesn’t sound appealing, but, it does mean that you have permission to eat. It does mean that someone else fights your eating disorder with you on a moment-by-moment basis. In many ways, it’s a relief.

Then, after all of this, something wonderful and terrible happens. You leave treatment. Suddenly, you’re back to being on your own and back in the same environment. You’re free…but so is your eating disorder. You’re free to do what you want but the eating disorder is free to do what it wants. It’s back to bossing your around and offering false relief.

Awesome…so what do you do now?

People often talk about having someone, be it a therapist or a family member or significant other, maintain accountability on an outpatient basis.”If I just had someone to keep me accountable, then I’d be able to do it.”

Unfortunately, this is a grand fallacy. It is a myth perpetuated by both well meaning individuals and the eating disorder alike. It seems to make sense at first.. “I’m accountable in an inpatient setting and can do it. So, if I was accountable out of the hospital, I could do it.”

Not how recovery works, unfortunately. The major problem is that the most someone else can do is know. They can know that you haven’t met your meal plan or know you have engaged in a behavior; But beyond that, what are they supposed to do? They cannot make you do anything, and any “punishment” runs the risk abusive or set up a counter productive power struggle. There is the added fact they they cannot monitor you forever. Accountability, in the traditional sense, does not produce the desired result of recovery.

Again, what do you do?

The real answer is to become “accountable” to yourself and use the support you have to help you fight the eating disorder. Instead of following a meal plan because you will get in trouble if you do not, you have to follow it because you want recovery.The people in your life, the therapist, significant other, family member are there to help you find why recovery is worth it, not shame you into it.

You can be accountable to yourself because there are very real consequences that you suffer when you continue to engage in eating disorder behaviors. Everything from heart problems to relationship difficulties. In all reality, the natural consequences hold us accountable.

There are also the positive aspects of recovery, those things that you can attain only if you live in recovery. Those things include improved relationships, fully experiencing emotions, loving yourself, being allowed to take care of yourself, relief from constant failure, and on and on. Being accountable to yourself also means being able to remember and be motivated by the positive things in life.

It’s certainly tough. Anyone who has recovered or has an eating disorder will tell you that we often do not know how to be motivated by good things. Shame and guilt have been there with us, for a very long time, and those are usually the things motivate us. It’s also tough because the eating disorder wants you to fail and has a lot of reasons why recovery isn’t worth it (All lies, btw.) There may even be people in your life who want you to keep the eating disorder.

Luckily, it’s worth it and there is support out there. Your therapist is there to help. Hopefully, your friends and family are there to help. And if they are not, there are communities out there who will help.

And most importantly, the reason to recover is reading this right now. You. You are the reason to recover. You  are the reason to follow a meal plan and use skills and stop using behaviors. You are worth it and you deserve it. Start believing that and you’ve started being accountable.


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