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I am blessed to work with many brilliant clinicians and authors at Eating Recovery Center. Dr. Catherine Ruscitti is one. Below, please find an excerpt from her newly released book, The Anorexia Recovery Skills Workbook. I only wish she’d have written this book about 20 years ago. I needed it then! But, here it is now, for you. Thanks, Dr. Ruscitti, for sharing your wisdom and inspiration with us. (I look forward to seeing you and your incredible co-author, Dr. Rebecca Wagner, in Houston at ERC next week!)

For a chance to win a signed book, please see the information at the bottom of this post, following the book excerpt. 

Building Motivation to Get Better

Anorexia Recovery Skills Workbook Cover
Win this book! See details below.

There are two types of motivation that influence how we behave: extrinsic motivation and intrinsic motivation.

Extrinsic motivation comes from external sources outside of yourself (like attending psychotherapy appointments to avoid late-fee charges), while intrinsic motivation comes from internal resources within yourself (attending psychotherapy appointments because you want to get better).

Because anorexia tends to be egosyntonic, fostering intrinsic motivation is often extremely difficult.

Hence, it is typically easier to be successful in recovery in intensive treatment settings than in outpatient settings or with no treatment. Intensive treatment settings establish various types of external motivators that help you take positive steps toward recovery (for example, gaining privileges if you complete meals, or adding nutritional supplements to your meal plan if you do not complete meals). However, once you step down to less structured levels of treatment, the amount of extrinsic motivation tends to decrease and the consequences and rewards of your behaviors are not as immediate.

Having both external and internal motivators is important in recovery and in life. The more sources of motivation you have, the more likely you are to continue in a healthy, recovery-oriented direction. Because intrinsic motivation is not always stable— as there will inevitably be days when you want to give up— it is important to create and identify external sources of motivation for yourself. However, relying solely on external motivators can be detrimental to your recovery in the long term, as the value you place on them is likely to dissipate gradually over time. Intrinsic motivation is long lasting and will foster a stronger and more stable recovery journey. Therefore, rather than relying on extrinsic motivation as a crutch, use it to help foster intrinsic motivation. Sometimes you will need to go through the motions in recovery (for example, by following your treatment team’s recommendations regardless of your feelings toward its members). At those times, external motivators (such as not wanting to disappoint others, avoiding a higher level of care, or getting or remaining medically stable) will serve you well. They will help you to avoid a lapse or relapse and prevent you from falling so far backward physically that your mental health and well-being are compromised.

But eventually you will need to make choices that move you toward recovery for you, because you want it and because you are ready to live in accordance with your values. Having intrinsic motivation does not mean you are ready or able to do recovery alone; it means quite the opposite: that you are ready to do whatever it takes, including using the help offered to you and the level of support that will best assist you at this time, to make steps toward recovery without the need of external rewards or consequences to motivate you. Some examples of intrinsic motivators for recovery include your values that you identified in the previous chapter, a desire to live a more vital life than you live when you are engaged in your eating disorder, and goals you have for yourself that may be possible to achieve only with recovery (such as to finish school, pursue your dream job, have a stable relationship, go on an adventure.)

Now that we have discussed the differences between and importance of both extrinsic and intrinsic motivation, take some time to write yourself a letter on your motivation and reasons to recover.

Why do you want recovery? What keeps you motivated to recover?

Be sure to include a list of both your external and internal motivators. This list may need to be reviewed time to time both as a reminder and in order to keep it updated and relevant to you. While you can complete this exercise at any time in your recovery, it would be best to write your letter when you are feeling particularly motivated. Keep this letter handy and read it when you are struggling with motivation or having urges to act on eating disordered behaviors. Feel free to add to it or rewrite it at any time, as your life may change and provide you with more or different reasons to stay motivated.


Win a Signed Book! To enter to win a signed copy, please post a comment below, sharing one reason you are motivated to recover. Why do you want recovery? What keeps you motivated to recover? One winner will be selected from all who comment.