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What Does Eating Disorder Recovery Mean?

By January 7, 2013

I was diagnosed with anorexia when I was 17. I’m 23 now. I’ve gained back the weight and am at a healthy weight now. I used to struggle with chewing and spitting for four years, but about one month ago, I stopped doing it and am still fighting to keep clean from doing it. However, I don’t eat as much as I probably should – I take in less than 1000 calories, but I’m not sure exactly because I don’t keep track (too triggering). But I’m pretty sure I take in around 700 calories or so a day. I don’t eat three meals a day, and most of the food I eat is non-carb (carbs are “forbidden” foods for me, which I know is not right – I eat them, but in small amounts). I also exercise everyday for about 60 to 80 minutes. Despite all this, I’m not underweight. I don’t look anorexic anymore. I still feel like garbage if I feel I’ve gained a little or if I eat too much (which in actuality is not that much). Sometimes I feel like I seriously binged, but then step back and realize I only ate like 3 chips, and for some reason it constitutes a binge for me. But I don’t completely starve the whole day – eating completely nothing – like I used to. I even eat some sweets sometimes, although in small amounts. I don’t see a therapist or nutritionist. Do you think I still have the eating disorder? Also, do I have to eat thousands of calories to be considered recovery?? What does recovery mean? Does it mean to love yourself and accept your body? Because I will never be like that. The most I can do is to maintain the healthy weight despite my hatred towards it. Also, I used to have strong palpitations. Ever since I stopped chewing and spitting and eating a little more regularly, the palpitations have eased up. But I still get them time to time. Is this something I should be concerned about? My old therapist wanted me to get a bone density test to see if I have osteopenia, but my dad said no (he’s in denial about the whole thing) and doesn’t want me to get one. He says even if I did have it, there’s nothing to be done because osteoporosis is irreversible (he’s a bone doctor). Is this something that I still need to check out? Thank you so much for taking the time to read this novel of an e-mail. I really do appreciate it.

Dear M,

Your patterns sound to me like you still are suffering from your eating disorder. Patterns of eating disorders change over time, but you are restricting, exercising more than is safe based on your nutritional intake, you have serious body image issues, and have a lot of rules regarding what you can or can’t eat. This is an eating disorder. The palpitations can be from many things. It could be related to anxiety. It could be from too much exercise without the fuel going in to support that exercise. The bone mineral density assessment is a good idea. Anytime you have had anorexia, your bone health is at risk. You are at an age where you still have time to rebuild bone density, but getting a baseline will be good information.

I would encourage you to see a doctor on your own. At your age, it is appropriate for you to take over your own health care, even though your dad is a doctor. Being a parent and a doctor, I know it is not good to try and treat my own children.

I wish you the best!

Brenda K. Woods, MD, FAAFP

Hi M.!

Given all that you said, I would strongly suggest that you begin at least weekly therapy, if you are not already going. Eating disorders are not black and white issues, like cancer. People either have cancer or they don’t. Eating disorders are on a continuum ranging from very healthy ideas about food, eating practices and body acceptance on one end to unhealthy ideas about food, problematic eating behaviors and poor body image on the other end. Based upon what you have said, it sounds like you are very much on the ED side of this continuum. Although I think you probably would be diagnosed with an ED (it is hard to say without knowing more), the diagnosis is mostly irrelevant because you do have very strong ongoing ED issues that are negatively and severely impacting several areas of your life – and you need help to move to the healthy side of the continuum.

You also need to see a registered dietitian and have him or her evaluate your current eating plan. With certain styles of eating – for example, restricting – you would be setting yourself up for problems like chewing and spitting. You have to understand that your body is constantly seeking balance or equilibrium. When your eating is erratic or inadequate, hunger and satiety get messed up. You will experience these chemical responses as drives – for food in general and/or specific types of foods (sugar, candy, etc.).

These food-related drives often are accompanied by strong emotions because food tends to be associated with nurturance, social activities, etc. The stronger the drive and the resulting emotions, the more control they have over how you think and what you do. That’s one reason why people with an ED have body image distortions and distortions about how much they are eating.

When you were a child, emotions determined what was real for you. If you felt angry, the whole world was bad. If you felt happy, the whole world was good. When a parent says NO to a child about something, the child feels angry and sad. The anger and sadness control the child’s thoughts about what is happening as she tells mom, “You don’t love me.” Her feelings also control her behaviors as she throws a tantrum. In this case, the child makes a permanent decision about life and her relationship with mom based upon the emotion she is feeling right now. She does not take into account the past time when things were good, nor does she take into account the future when many good things might happen. All she knows is right now she is hurt and angry, which means “mom doesn’t love me.”

As the child’s brain grows and through a multitude of learning experiences she has growing up, she can understand the difference between momentary emotions – “I am angry and hurt” – versus permanent conditions “Mom hates me.” Her rational cognitive mind is able to put the emotion in perspective so that it no longer controls her conclusions (mom hates me) and her actions (tantrum). However, all of us are subject to being controlled by our emotions when they get strong enough.

When you are hurting, hungry, tired, etc. the emotions gain more and more control over you and begin to shape your beliefs about your life and reality. Let me show you this from your email:

“Sometimes I FEEL like I seriously binged, but then step back and REALIZE I only ate like 3 chips…”

If I can paraphrase what you said: “Emotionally I feel like I binged, but I step back and rationally I understand I only ate 3 chips.”

You have two contradictory pieces of information coming into your mind: one from your emotions (I binged) and one from your rational thinking (I only ate 3 chips). These sources of information will battle within you. As your emotional state intensifies, it will win – and you will (at least for a while) see it as a binge, even thought it is far from a binge.

The same thing happens with body image. Your painful and wounded emotions tell you “I am fat and disgusting,” but when you look at it logically – for example with math – you can see that you are not fat. When the emotions intensify, they win and you will fall into the eating disordered view of your body – and that will control what you do in terms of food, etc.

The problem is, the more you engage in unhealthy eating patterns, the more feelings will distort your sense of reality concerning eating and body image. This becomes a vicious cycle:

Unhealthy eating –> Distorted feeling-based ED thoughts and perceptions –> Unhealthy eating.

Working with Registered Dietitians, I have learned a lot about food intake. It is not just a matter of calories, but the proper distribution of proteins, carbs and fat throughout the day that helps keep the chemicals in you stable and control hunger, emotions, etc. A good RD can help you with this. FYI, anyone can say s/he is a nutritionist, but only someone who has a college degree, completed internship hours and passed a national registration exam can refer to him/herself as a registered dietitian – so be careful in choosing one.

Reading your e-mail makes me believe that you may have obsessive compulsive disorder (OCD) or at least strong tendencies, although I cannot tell without a full assessment. With OCD, people have intrusive thoughts, images or urges that are very disturbing. Compulsions are things people do to deal with the distress of these thoughts, images or emotions. In order to keep themselves safe from their fears, people with OCD develop rigid rules that they are compelled to follow. Failure to follow the rules results in overwhelming distress that is very painful. Looking at your e-mail, “forbidden food” is a prime example of an OCD rule. Exercise may also be compulsive to deal with the anxiety and guilt of violating the rule of not eating (or not eating too much). In this case, my guess is that you HAVE to run, to ward off the bad feelings. Even if you don’t technically have OCD you CLEARLY have obsessive compulsive issues in the ED that are controlling you.

First recognize this for what it is: Obsessions and Compulsions – caused by a combination of genetic issues and your past environment.

With OC problems, people overestimate the danger in various situations (e.g., touching a doorknob due to germs). So they avoid doorknobs (and other scary things that might have germs) and/or wash all the time. Therefore, the two primary ways that people deal with phobic anxiety is to avoid what they are afraid of and/or escape it. With the germ phobic OCD person, it is avoid “dirty” objects and escape germs (wash). With an ED, people avoid dangerous food (only eating safe foods), which is called restricting; and/or they escape dangerous food by compensating for exposure to it – for example, by purging, exercising, or spitting.

The treatment for OC problems – whether they are related to germs, checking over and over to see if a stove was turned off, or whether the obsessions and compulsions are about food and weight gain – is something called exposure with response prevention. I cannot fully describe this here, but it involves exposing yourself to the things you are phobically afraid of AND not escaping by practicing some compulsion. For example: exposing yourself to fear food, and not exercising in response to that.

Here are some good books to learn more about OCD, if this aspect seems to fit for you.

When Once is not Enough: Help for Obsessive Compulsives. Gail Steketee and Kerrin White (older book may be out of print, but it is excellent and you should be able to get it through places such as Amazon.com),

Brain Lock: Free Yourself from Obsessive Compulsive Behavior. Jeffrey Schwartz.

Also, see the article “Finding Treatment” at this site.

I hope this helps – God bless you and please get into therapy if you are not currently going.

David Wall, PhD