292: The Asymmetry Of Eating Disorders

Chris Sandel: Welcome to Episode 292 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at www.seven-health.com/292.

Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist and a coach, and I help people to fully recover.

It’s been a few weeks since I put out a new episode, and there’s a few reasons for that. The first was I’ve been getting started with the Fundamentals of Full Recovery programme. We’re getting lots of new members in there and starting to do the live calls as part of that, and that just takes up a lot of time at this early stage. So that’s where my focus has been going. I’ve spent quite a lot of time doing the live trainings and putting the effort in there, and now we’re getting underway with the programme.

If you want to get on the waitlist and be notified about the next time I open up slots for this, you can go to the show notes (again, www.seven-health.com/292), and there’s a link there so that you can sign up and be on the waitlist and be the first notified when we open doors for that again.

The second reason why there hasn’t been the podcast in the last few weeks was we actually moved house, so it has been a very busy time. Obviously, I had the live launch, but behind the scenes we were then having to move house, and we actually got a call – it was while we were away; we were in Hong Kong, and we got a call saying the owners of the previous house we were living in are now wanting to sell, so we were given our notice. This was a bit of a shock. We didn’t expect that to be happening, so we had to come back and then start to find a new place.

And this truthfully all fell on Ali. She was the one who was dealing with all of this, and she has found us a really lovely new place to move and did it very, very quickly. From when we received that initial call until we moved, I think it was five weeks. We’re about 15 minutes down the road from where we were before, in a really lovely spot. It’s down a long country track. It’s very nice and secluded; we’re surrounded by forest. It’s a really lovely new, modern house. I’ve got a separate office. We actually rented two places, and the second place is next door, and it’s what would be called a granny flat over here, like a separate building with a kitchen and a little bedroom. I’ve converted it into my office.

So it’s a really lovely place, and I think in the end, once we are over all of the exhaustion from moving, we’re going to be really happy here. With this place, there’s no urgency in terms of having to move again. The owners are very happy for us to stay as long as we want. So yeah, it’s been a lot, and I think we’re going to be really glad that it has happened.

And then the third reason why it’s taken a while to put a podcast out – I was intending to put one out last week, but I actually lost my voice. I lost my voice en route to a friend’s 40th birthday party, so I had to whisper and have this very husky voice for the entirety of that weekend, and then it’s just taken a while for my voice to properly come back. So it didn’t sound very good to be able to record a podcast. I had to actually cancel a guest interview with someone just because it didn’t feel like I had the right kind of voice to be recording a podcast.

That is now all better, I am all better, so we’re back into the swing of things with the podcast. And I’ve actually got some guest interviews that are now lined up. I’m recording one next week, one the following week. The plan is to get back into the routine where I’m alternating between guest interviews and solo episodes. When I originally started the podcast – I think it was eight years ago – that was what I used to do, and I actually think it’s a really nice format to alternate between the two, so that’s the plan going forward, and I’ve got a few interviews lined up already and I’m going to get some more booked in.

So that brings you up to speed. Today, what I’m going to be covering is – it’s a solo episode, and what I want to look at is the asymmetry with eating disorders. I’m going to go through a number of different examples of how this shows up.

What I want to say from the outset is not all of these are going to apply to you. Some of them may, some of them won’t. But these are things I’ve seen come up again and again with clients, with people commenting, just understanding eating disorders. I really want to point this out because I think there is this asymmetry with eating disorders, and I think it’s helpful to start to notice this. In the same way it’s helpful to notice different cognitive distortions and know what the different cognitive distortions are, I think the same is true with this, so that when it comes up and when you experience it, you’re able to recognise, “Huh, okay, I can see that there is this lopsidedness or this asymmetry with eating disorders.”

00:05:22

Asymmetry in making changes

The first one that I want to mention is the asymmetry in terms of making changes. If there is an eating disorder change, a change that serves the eating disorder – and that could be something like you’re eating less food, or a particular meal or snack disappears, or you push your eating back later in the day, or there is some change in terms of your movement, so you’re now moving more, you’re walking for a longer amount of time or you’ve added in another exercise routine – anything that is pro the eating disorder very quickly gets normalised.

So you make this change and then the next day, there’s already this feeling of “Well, that was what happened yesterday, so that now is the new normal. If I removed breakfast or if I’ve added half an hour to my walk, that now is the new norm because that happened yesterday.” It can be really just one day of doing this and the change gets embedded, or it could be one or two days, but it’s generally a pretty small amount of time for this thought to come up that “This is what I now need to do.”

If we’re then looking in the opposite direction, it’s not that quick. If you’re then starting to make pro recovery changes – so you’re adding in a snack or you’re adding in a meal or you’re increasing the size of a meal or you’re reducing your exercise – any kind of pro recovery change, it’s not that you do it for a day or you do it for two days and then instantly this feels like the new normal. It takes more time than that.

Depending on what the change is will depend on how long it takes. I typically think that it’s not often as long as people think it’s going to be. Often within 5 or 10 repetitions of doing something, it starts to feel – not normal in the way that it does with an eating disorder change, but it starts to become a lot easier and feel like it’s not as challenging as it was when you first started. But I think it’s useful to recognise that there is this asymmetry here with making changes because I think so often, it can be feeling like “I’m putting in all of this effort. I feel like I just want a break. I want a break a day or a break for a couple of days, and then I’ll be back at it and it’ll get much easier again.”

And unfortunately, when you have that break and you say, “I’m not going to do this thing for a couple of days”, that instantly then becomes that new normal. So what felt like it was going to be a break now means that it’s even harder to do that thing than it was. So really, with recovery, there should be this recognition of this and a real focus on “I need to really make sure that I’m continuing to be spiralling up and making positive changes because it’s much easier when I’m in that momentum of the spiral up versus when I’m starting to spiral down and having to then stop that and go back in the other direction.”

So that is the first asymmetry I want to mention.

00:08:36

Asymmetry in eating or exercising with other people

The next one – and this comes up a lot with clients and a lot in terms of comments that I see, and this is connected to eating with other people. There can be this feeling that “I’m not able to eat if other people aren’t eating. If I’m eating and no-one else is, that is just such a difficult thing to do or that feels so wrong or there’s so much shame or so much guilt connected to it.”

But at the same time, when someone else is eating, there isn’t the same feeling of like “Oh, I must do what that other person is doing.” So I must do what that other person is doing if they’re doing something that is supporting my eating disorder, but it doesn’t work the same way. For example, I’ve had many conversations with clients where they’ll say, “I went out to dinner at a restaurant. There was a part of me that really wanted to order dessert, but my partner didn’t order dessert, so I felt that I couldn’t have that dessert.” And then there’ll be other conversations where they say, “My partner did order dessert, but I didn’t have any dessert.” It’s like, you said that you couldn’t do it because your partner didn’t do it, and yet when they did do it, you were unable to do it.

So again, recognising this asymmetry there where there’s an excuse of “I couldn’t possibly have done it because the other person I was with wasn’t doing it”, but yet the same principle doesn’t apply when the person does do it.

This is true also with exercise. Again, I’ve had this conversation many times with clients, where “I find it really hard to not exercise because my partner is exercising or a friend is exercising, or I saw someone outside who was going for a run or going for a walk. It’s so hard for me not to do that. It feels unfair that I’m being asked to not exercise when this other person in my life is able to exercise.”

And then I’ve had the same conversation with someone where they’re saying, “My partner was unwell and they took a week off of their exercise.” I ask, “So did you also take a week off of exercise?” They’re like, “No, of course not.” So again, there is this asymmetry here, where just because the partner or someone else took time off exercise, didn’t give them permission to do the same. It didn’t mean that they had to do the same. But when someone is exercising, there is this feeling of “I’m compelled to do it. I couldn’t possibly not do it.”

00:11:12

Asymmetry in response to comments

Another one here in terms of the asymmetry is where someone makes a comment. This could be a comment connected to dieting, it could be a comment connected to exercise, it could be a comment connected to that person’s own body concerns. That one comment can have someone really spiralling. It’s normally because that comment – there’s in a sense confirmation bias. This comment matches up to the kinds of thoughts that the eating disorder has, so this creates this huge impact on someone.

So “I feel that it’s unfair or it’s really hard to continue to eat the way that I need to eat as part of recovery when this other person made a comment about the fact that they’re doing this thing with dieting.” The reason or where I see this asymmetry is that there is this one comment that someone makes that can send someone really spiralling. And yet someone can listen to podcast after podcast after podcast about all the importance of pro recovery changes, about how much better life could be, about the different things that can help them to be able to make those changes, and yet all of that doesn’t go in. All of that gets put to the side or “that’s for other people” or it just doesn’t land in the same way as this other comment does.

So you can, in a sense, have 10, 20, 100 positive, helpful, pro recovery comments, and they don’t do very much. And then you have one comment that is unhelpful connected to dieting or exercise or body image or whatever it may be, and that’s the one that gets latched onto. That’s the one that gets ruminated on and talked about, and “This is so unfair that people are making these kinds of comments.” And yet when there’s 100 of the other type of comment, it doesn’t have that same impact.

I think this is really important to recognise connected to comments because there are people who are going to make comments. Given the world that we live in, there are going to be people who are dieting. There are going to be people who are exercising, and exercising compulsively. There are going to be all of these things that are going on, and recognising that just because that’s what someone else is doing or someone else’s reality, doesn’t mean that’s what you have to do – despite the fact that your brain might generate comments or thoughts to the contrary.

00:13:51

Asymmetry around fullness + hunger

The next one is connected to fullness and hunger. There can be this feeling when we’re thinking about fullness that fullness has to be absolutely respected. That “If I’m feeling full, that is gospel. I cannot challenge that. If I’m feeling full, it means that I’m full. It’s got nothing to do with the fact that I’m bloated or the fact that there could be anxiety that’s having an impact on this physical sensation. If there is that feeling there, then I’m not allowed to have any more food or I’m not allowed to challenge that.”

The opposite is “Hunger is more of a suggestion. I can be hungry and then leave it another hour or another two hours, or I can be hungry and feel like it’s not hunger enough. There needs to be more intensity to this hunger sensation for me to truly listen to it. I have to be having much more extreme sensations for me to fully listen to this feeling of hunger.” So there is this asymmetry here where fullness really means one thing and it is very black and white, whereas hunger, there’s many, many shades of grey.

Because of what happens when you put off hunger – and I’ve talked about this on other podcasts – hunger really is fairly nebulous in terms of its sensations. It can be often pretty difficult to pin down what hunger is when you are finding or trying to find all the reasons why this truly isn’t hunger. This becomes even more of a problem when you really push it and push it and push it so that when you experience hunger after not eating for a really long time or while you’re in this really energy-depleted state, it’s very obvious. It becomes very, very obvious at that point, and then every other subtle sensation is just ‘not hunger’.

From an outsider looking in, there can be many symptoms that someone is dealing with, and dealing with almost constantly, where I’m like, “These are all sensations of hunger and indicators of hunger” and yet someone is unable to recognise those as hunger symptoms. They’re like, “Well, I have headaches all the time” or “Yeah, I am irritable, but that’s just how it is” or “I always have trouble concentrating” or whatever it may be. These symptoms are very clearly connected to being in this low-energy state, and the hunger that is there just doesn’t get responded to. But any feeling of fullness or any sensation that someone associates with fullness, it’s like “This means I need to stop eating instantly.”

00:16:49

Asymmetry in worrying about health consequences

The next one is worrying about health consequences connected to things like taking a break from exercise or eating supposedly ‘unhealthy’ foods. “I’m worried about the health consequences of eating this particular food” or “What will happen to my health if I’m not moving every day or moving in the way that I’ve been currently doing it?” There’s this real concern about “If I take a break from these things or change these things, I worry about the health consequences.”

And this is obviously, with so many things connected to eating disorders from my perspective, you come up with a story. And this is true of all humans. When we explain why we do things, or why we think a certain way, we have a reason for why that is so. It doesn’t really actually matter whether those reasons are true or not; this is just the story we’re telling ourselves, and it doesn’t actually feel like a story. It feels like this is fact.

For someone, their concerns are connected to the health consequences, and what is often happening with people in this situation is they’re worrying about the health consequences of making these changes, and yet at the same time, they’re in a really terrible state of health at the moment. There’s osteoporosis or osteopenia. There’s lots of digestive issues. They can have blood results where there’s very high liver enzymes.

There can be lots of indicators that the current state of health is very poor, and this can be physical indicators, but it can also be mental health indicators. “I can see how much this is having an impact on my capacity to tolerate change or my capacity to deal with the stresses of everyday life. I’m having real mental health issues or I’m having real emotional health issues.” At the current stage, there’s all of these health complications that are there, and yet because that’s what’s currently going on and that’s, in a sense, the status quo, those things get put to the side. Those things are just like “Well, that’s the way that it is.”

So there is this, in a sense, like “I’m not worrying about those things anywhere near to the degree that I’m worrying about what could potentially happen if I make these changes that are pro recovery. The way that I’m thinking about them is connected to all of the potential negative health implications of doing this.”

Again, this comes up a lot with clients, and where there is real obvious issues in terms of their health currently, that just doesn’t get the real focus that it needs to. It’s all the focus on the fear of the potential health consequences of making a change.

I think this connects on to another aspect, which is there’s this huge fear of change – and fear of change in many different ways – and yet there is this small fear of the status quo and a small fear of what is going on. And when I say small, it’s not that someone can’t recognise that there are lots of problems that are going on and that there can’t be genuine concerns about this. When I say small, I’m talking about it in relative terms. Compared to the fear that comes up connected to thinking about change or starting to actually make changes and the fear that comes up connected to that, there is a huge asymmetry there. Actually, the worry about what’s happening day to day pales in comparison to worrying about “what may happen if I start to make a change?”

00:20:40

Asymmetry in one’s value system

The next area where there is this asymmetry is this hyper-concern or worry about what people may be thinking or what people may potentially say if that person begins to recover. It’s not so much the worry of what people are thinking or might say at this point; it’s “When I start to recover, what will happen there?”

Where the asymmetry lies with this, often, is that then someone will choose to stay in a life where they are the one that is suffering. There’s this asymmetry in terms of the value system of “I value the supposed opinion of other people very, very highly, and yet I value the quality of my own life and existence pretty low.” As I said, there is this asymmetry between these things. Rather than really looking at the quality of one’s life and saying, “This is not how I want to be living. This is so compromised. I’m not able to do the things that I really enjoy. I’m not able to do the things that prior to the eating disorder, I really valued.

And yet when the thought of making changes is thought about or actually starts to take action on, there is then this real worry about what people will say or what people will potentially be thinking. As I said, there is this “I would prefer to stay in this place than deal with the potential that someone could say something or be thinking something.”

00:22:29

Asymmetry in rules or standards for living

The next one where there is this asymmetry – and this, again, comes up a lot with clients – is having these rules or these standards that when we have a conversation about this, many clients – I would say most clients – don’t believe that others should be living in this way. So when I say, “Would you be suggesting what you’re doing to a loved one or a partner or a friend?”, there is a “Hell no.” There is a “I would not be suggesting this to someone else. I don’t think that this is a good template or blueprint for how someone should be living their life. I don’t believe that other people should be not eating fat” or whatever it may be, whatever rule someone has around food. It can be very obvious to them that this is not something they would believe is true or should be followed by other people.

And yet for them, this is true. For them, this should be a rule. This, again, is where there’s this clear asymmetry where “This isn’t something that someone else should ever have to abide by, and I disagree with recommending this to anyone else, and yet I believe that this is what I deserve or this is what is true and should be true for me.” Again, I think it’s really important to recognise that difference. And from my perspective, it actually doesn’t make sense that this shouldn’t be true for anyone else and yet it should be true for you.

00:24:12

Asymmetry in concern about restriction vs binges

The final one that I want to mention is when I’m thinking about restriction versus the concern about binges or eating too much. If someone is restricting their intake, there’s not typically a concern about this. If they’re not getting obvious hunger signals, if they’re able to keep up restriction, they will keep doing this as long as they’re able to, even if there are certain things that start to occur. Even if someone starts to lose their period, even if someone has got a diagnosis of osteoporosis, even if there are obvious things connected to restriction, if someone’s able to keep this up, it doesn’t feel like a concern for them.

It then becomes a huge concern when things start to go the other way, where “Now I feel like I’m having these binges” or “Now I’ve started to eat more and I recognise just how hungry I am. I’m eating more than I was before, and yet my hunger is so much higher than it was before.” And that then becomes a concern. So there’s a concern that “I’m eating too much or I will eat too much” or “These binges are bad”, and yet there isn’t the same concern about “Actually, restricting is really damaging and is causing lots of problems.”

Even if someone can intellectually understand “Restriction is not good or is having some kind of impact on my health”, there isn’t that same worry of “Wow, I really shouldn’t be doing this. I really shouldn’t be keeping this up. It’s causing a problem.” The concern is much more “I don’t want to turn into a binge eater. I don’t want to trade this for some other eating disorder.”

When I think about eating disorders, all eating disorders are the same. All eating disorders are connected to the fact that the body is in a low-energy state, that restriction is going on. That restriction can be physical restriction, it can be impending physical restriction, it can be mental restriction. (I’ve done a whole podcast on restriction. I will put it in the show notes, so if anyone wants to listen to that one, they can.)

So the thing where people are concerned that “I’m going to turn into a binge eater” and that that’s a bad thing, like there’s this hierarchy of eating disorders where “If I’m restricting, that’s a good eating disorder, but if I’m not restricting, that’s a bad eating disorder” – I totally disagree with all of that kind of logic. And I would also say that yes, if you have not been eating enough and you’ve been restricting – often people will say, “But I have been eating enough” when they truly haven’t and their body has not been getting what it needs – if you have been doing that, when there is more energy that becomes available because you do start eating more food and you are giving your body some more, it will use that opportunity to think, “Great, there’s more available. Let’s actually get out of the energy debt that we’re in. Let’s actually get more energy in so we can truly repair and heal.”

That’s why there is this uptick in eating, and people can categorise it as binges. It can also be probably more helpful to categorise it as recovery eating or repair eating or recovery feasting or some other more either neutral or positive way of framing this. But it makes complete sense that your body is going to want and need more food, so I don’t think of this as turning into a binge eater because binge eating, when it is going on, is happening because it’s connected to restriction.

So if you’ve been restricting and then you start eating more, yeah, there’s going to be possibly a period where you have binges or where you have more food coming in or you have that extreme hunger that occurs, and then once that goes on long enough and the body is getting what it needs and is able to get out of that energy debt and there’s not the restriction going on, then that naturally stops of its own accord. It’s not that someone’s going to ‘turn into a binge eater’; it’s that there’s a period where the body needs more energy, and then there’s a period where the energy that it needs is only what it needs for today. It’s not dealing with all this debt that has accrued.

00:28:52

Closing thoughts

So those are the different asymmetries that I wanted to mention. There are going to be others that I have missed. I just jotted down some notes before turning on this microphone, so yeah, there’s going to be others I missed. I think it’s just really helpful to be aware of all of these things.

Really, the point of this episode is to make you aware, if you’re not aware at this point, of how illogical eating disorders are, and the illogical nature of them and the kinds of thoughts and beliefs that they generate. I’m wanting, as part of this episode and why I want to do it, that when those thoughts do arise, hopefully you can then start to recognise how lopsided they are, or the asymmetry that is connected to them, because this is so common with all of the eating disorder thoughts. There is this insidious nature with them. It does change the way you perceive things, where it’s not so obvious that there is this asymmetry here.

So that has been the point of this episode, and I hope it’s been useful for you. That is it. That’s all I have to say on the topic. I will catch you again next week for another episode, and so I will see you soon.

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