Friday, February 5, 2016

So you think you're recovered from an eating disorder? Take this quiz to find out.

1) Recovery is about weight gain. Period.

The simple answer? 
It just might not be going the way you planned. 
False. Now don't let your eating disorder get all excited, saying "See! I told you so!"

Weight restoration is surely a must for those who have fallen from their usual weight or in the case of kids, their weight for age and BMI curves. That is, their expected pattern of gain based on their age and their weight history. For kids, falling off their usual growth curve suggests a problem. It shouldn't be praised or rewarded, but evaluated. (Pediatricians, did you read that?!) But if someone's weight was high due to unhealthy behaviors such as binging, emotional overeating, or general disregard for satiety, and weight dropped with improved eating and coping, weight gain is likely unnecessary.

Simply reaching a healthy range based on the charts also isn't enough. Perhaps your restrictive eating and suppressed weight began as a young teen, and you've lived for years with eating disordered behaviors. Did you rely on cigarette smoking or other substances? Was your appetite suppressed by ADHD meds? As you recover, weight gain may be essential regardless of what the BMI charts say. Focusing on the weight is misguided!

Your weight may be technically in the normal range, but your behaviors may indicate a problem. You know, like restricting, binging, purging, laxative abuse, compulsive exercise.

Weight is just one component of eating disorder recovery.

2) If I get a period (and I'm not a guy) then my body is healthy.


Surely losing your period when you're of age and sex to be getting a period is cause for concern. But getting your period is not evidence that all is well and you have recovered. You may get what seems like a period when you're on the pill, or start to get periods back without all the hormones being back to normal. Or maybe like one adult patient I used to see, in spite of her struggle with anorexia, she managed to conceive and deliver 5 children, never missing a cycle. Similarly, weight may be restored to the appropriate place, but it may take several months for menses to resume. For guys, low testosterone level is a more silent red flag that things are amiss; is resolves with adequate eating.

3) If I can take in enough calories, then I've recovered.


Can you eat foods you used to enjoy?
Sure, you will need enough calories to get your body bad to normal function--with a healthy heart rate and blood pressure, without major drops in pressure when you go from lying down to sitting or standing; with normal body temperature and energy level; with better sleep and mood. But full recovery means eating a range of foods and nutrients. It requires eating enough carbohydrates and fats-- not just protein. Recovery, true recovery, demands you include foods that seem scary, foods that you used to love, so that you aren't controlled by them. Like eating some pizza or an ice cream if the spirit moves you.  It means eating bread that may be whole wheat, or white, sourdough or french, without relying on ‘sandwich roundsor high fiber, low calorie flatbreads, or “Ezekiel” bread. If you’re truly recovered you can eat foods even if you can't justify them for their nutritional value, even if you don't think of them as "good for you".

4) I've stopped using laxatives, vomiting, and I'm eating better. I'm healthy now that I'm exercising every single day. So surely I'm recovered.

False. Replacing one behavior with another-- in this case, having to exercise to allow yourself to eat-- is also not healthy. Be careful that you aren't just swapping one behavior with another-- even a 'socially acceptable' behavior like exercise. If you feel you can't eat if you don't exercise you have work to do!

Ok. So I am doing fine with all that. But I need to be the one preparing the food. I'm still recovered, right?

I know. This is a scary idea. I will
settle for nourishing you
with words.
Not quite. Full recovery includes some flexibility and acceptance of what you can't control.
It means eating meals out without having to look up the calories before hand, and without having to modify the entire meal according to ED (that said, being vocal about your preferences doesn't have to be disordered. While Sally didn’t have an eating disorder in "When Harry Met Sally" this scene is worth viewing for some comic relief. Recovery is being able to eat a meal without watching the food be prepared, fearing the secret addition of ‘toxic’ ingredients.

Recovery acknowledges that people you know diet or overexercise or are losing weight, and it is what it is. (see husband triggering) And that you stay the course with eating and avoiding behaviors because it simply has to be; because you can be a great dieter-- but it didn't serve you very well being in that place before. And because you simply deserve to feel better.

Not as far along as you hoped? 

Then move your frustration to action. If you've just started on this path, hooray for improving your intake and taking steps toward recovery! Perhaps you're finding other ways to cope, so you're freeing yourself from unhealthy disordered behavior. Maybe reading this post helps you realize that more recovery pieces are in place than when you started. Progress! The point of this piece is to raise your awareness to help you keep going and reach fuller recovery. And to shake up some denial that stands in your way.
Yes, there's hope. See some of the links below.

Any changes to your thinking or eating you still need to make? Perhaps the post below will help to motivate.

Please share your thoughts!

And thanks for reading.


  1. Seems kind of dismal ��

  2. It gets SO MUCH better but I don't know, after 67 years, if I can ever REALLY have a completely healthy relationship to food and exercise. it is almost as if very deep grooves have been worn into my brain. But SO MUCH better and not so obsessive now.

  3. Hmm, guess I have a lot further to go. As I sit here and think about how I need to get up and go running on the beach, even though it's freezing out, windy and cloudy (I'm on vacation in FL so it should be warm) because if I don't do it now, I won't want to do it later, IF the sun comes out...but I have to do it. I'm afraid to gain weight. Afraid to eat more calories. Want to shave off anything part of my body that I don't like. Hmm, guess I have a lot more work to do.

  4. I was just considering my recovery in these terms today. I think I'm about as far from being a foodie as possible. I like food okay, but I don't get a whole lot of enjoyment out of it. I don't look forward to meals and getting hungry- I'd just assume eat soylent or something (doesn't that sound like it's from a Margret Atwood novel?). But my husband would shake his head and my kids... I don't think that would be good for them to see. I think men are given more freedom to dislike eating than women. Men who feel like me are quirky. Women like me are not over their eating disorders. I think I am over my eating disorder,though. I eat. I feel like not liking food is actually kind of healthy compared to the cravings for cake I used to have. But I'm not over the body dysmorphia and that is connected to food when I feel like I am too big. But they aren't the same thing. I can eat when I'm hungry. But it really is just fuel to me, like medicine. Which, by the way, is what they told me to think when I was recovering. I guess it worked! If someone could teach me how to see my physical self differently, then the food stuff wouldn't be an issue.

  5. I'm so grateful for your endless dedication to making patients see how far they've come and also how far they have to go. Being content is a dangerous place in recovery. I know for years I've struggled w/ not wanting full weight restoration, which is all you wanted. I argued with you till I was blue in the face but in the end you were right because my recovery was completely halted and I stayed stuck in this battle to keep my weight at the lowest possible weight and "recover". You were always right. Sometimes the ED gets so far into our heads that we just need to radically accept that it is what it is and listen to our providers. Acknowledge it's scary and take a leap of faith.

    I also believe that once you stop the behaviors this whole new world of emotions come. It's like that whack-a-mole that you describe. Stop taking diet pills, laxatives and diuretics, stop exercising and then you start to feel emotions and your body image and mindset get so much worse. But it's so important to keep in mind that it's temporary. All of this is temporary and things need to get worse to get better. I appreciate you always pointing us in this direction and reminding us that as far as we have come we still have a lot more to go. Recovery is always work. Thank you for your wise words of wisdom!