Stages of Change

You have probably heard of the stages of change, a model that identifies the different stages individuals cycle through as they attempt to modify a negative behaviour. There are five 'steps', which are characterized by particular levels of readiness and certain ways of thinking and acting. The first is pre-contemplation, where the person does not recognize a problem or a need for change. The second is contemplation, where the person realizes there is a problem but is not yet prepared to make changes. The third stage is preparation, where the individual is preparing to take the necessary steps to get better. The fourth step is action - the person has implemented real changes for recovery. The final stage is maintenance, where the individual has made great progress and is trying to keep it going.

The interesting thing about these stages is that they are not linear - a person may start at the second or third stage, or they may reach the final stage and find themselves starting back at one all over again. Eating disorders (ED) are a great example of this. Many people with ED may be stuck in the pre-contemplation stage for a long time because they cannot see, or they may not be ready to admit that they are sick. This prolongs the illness and puts them at higher risk for complications.

I was one of the rare ED patients that always knew that there was a problem, but I wanted it to be kept on the 'down-low'. I did not want my parents or friends worrying about me or pressuring me. It took me a long time to realize that I was getting very sick and even at that point; I was scared to get help. I did, however, take some steps to help myself. I entered the contemplation and 'preparation' stages by seeking books about recovery and listening to professional speakers. Testing out treatment put me into the 'action' stage. When I returned home, continuing on this way to recovery and getting better helped me progress to the 'maintenance' stage.

Understandably, each step has its challenges. It is difficult to first admit that there is a problem, let alone to seek help. It is also difficult to stick with a plan in order to get better. Once you are better, it is even more challenging to maintain the progress and success that you have achieved. ED makes it even more stressful because he is so deceptive and knows exactly what to say to make me feel down about myself and my life. He attempts to sneak back into my life and tries to put me down the rabbit hole all over again. He is angry when I am in the action and maintenance stages because that decreases his power and importance in my life, so he will fight tooth and nail to get back into the picture.

The stages of change have been very useful in my journey to recovery. I am able to take a step back and analyze where I am at, what I am doing, where I am going, and what I need to do to get there. However, this takes a lot of practice and discipline. With time and effort, I have seen that people - the true friends in my life who sincerely care and wish to help - will not judge me because of my illness. They will strive to assist me whenever I need it, and they will be glad that I am reaching out for help. This makes it easier for me to work hard, to continue in the action stage and move towards the maintenance stage. Now, I am able to maintain my recovery by eating meals regularly, using coping skills to handle potential triggers and coaching myself through stressful situations.

It is not an easy path, and as mentioned before, it is not always a linear path. When a challenge occurs, it is important not to let that set you back. Rather than dwelling on that slip or relapse, focus on what you can learn from it. What happened, and why did ED win that battle? What can you do next time to help you cope? What has this experience taught you about your recovery? Asking myself these questions has helped me get to where I am today. By having a solid treatment plan and arming myself with tools to help me stay strong, I was able to overcome ED.

This is my message to you: full recovery IS possible – you just have to work hard for it. And even when you struggle, don’t lose hope. Instead, pick yourself back up and make today a better day, a day where ED is not invited.


Marina Abdel Malak is recovered from a seven-year battle with anorexia nervosa. She has recently completed her Bachelor of Science in Nursing and is the author of 'Recipe for Recovery: I Battled and Overcame an Eating Disorder, and you can too'. She is a NEDIC volunteer, and active advocate for eating disorder awareness, and mental and physical health. You can also follow her blog.