Anorexia Recovery

Your eating disorder voice tells you that you’ll never be happy until you lose more weight. Or that your world will fall apart if you gain weight. It tells you that your worth is in your weight.

But the reality is very different. True happiness and freedom is about acceptance and living a full life and this is only possible with recovery.

The road to recovery from anorexia starts with admitting you have a problem. This is tough, because an eating disorder is so successful at convincing you that you don’t really have a problem. 

But despite these eating disorder thoughts, there is a healthy part of you. One that sees all the problems that this is causing and how much of life has fallen by the wayside.

Ambivalence is at the heart of all change and this is the case with anorexia recovery. You can fear recovery and long for it at the same time.

I’m glad you are here and reading this article because it shows that you are thinking about recovery and that’s an important first step.

I want to cover what recovery looks like and the many aspects that can be part of the recovery journey.

I also want to explain what anorexia is and the symptoms connected with it. Because it’s a disease that we have a stereotypical view of that doesn’t match the reality for the majority of sufferers.

But before I go any further let me just state that I believe full recovery is possible. I’ve helped many people get there (here and here are a couple of examples). So however daunting or scary it may feel, there is life on the other side.

What is anorexia? 

Anorexia nervosa (typically shortened to just anorexia) is a mental illness that is characterised by a preoccupation with restricting food and fear connected to weight.

 Anorexia is diagnosed using the DSM-5, which is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. To receive a diagnosis of anorexia nervosa you need to meet the following criteria:

1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

2. Intense fear of gaining weight or becoming fat, even though underweight.

3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Now there are different subtypes of anorexia and it’s important to mention this. Because while we have a stereotypical view of what anorexia “looks like” or what someone’s eating behaviours will be, it can be different from these narrow ideas.

Restricting type

This is the subtype that is most stereotypical of anorexia. Where someone consistently restricts without engaging in “binge eating”. [For more information on binge eating, check out this article].

Binge/Purge type

This subtype is where someone has regular instances of bingeing and/or purging. Purging could include vomiting, laxatives, diuretics, enemas or, more commonly, compensatory exercise and fasting. These behaviours are used to deal with the “extra” calories consumed.

Atypical type

This final subtype is where someone meets the criteria for anorexia, except they aren’t living with what is considered a “low body weight”. 

You can have anorexia at a “higher” body weight

I want to linger on this final subtype, the atypical type, because it really points towards a bigger problem we have as a society. While we have a bias about what anorexia or malnutrition looks like, the vast majority of people with eating disorders don’t “look like” they have one.

Just because someone isn’t in a small or emaciated body, doesn’t mean they aren’t suffering. Anorexia affects people of all shapes and sizes and someone shouldn’t have to reach some specific size before we deem them as worthy of needing treatment.

It’s abhorrent that thoughts and behaviours considered a disease for someone in one body size, are considered a great plan or solution for someone in a different body size. This is something I’ve covered in more detail here.  

It’s also important to note that, even if you don’t meet the official diagnosis, you can still be struggling.

Rather than eating disorders being a binary issue, where you either have one or you don’t, it’s more like a continuum.

There will be many people who don’t meet the criteria for a diagnosable eating disorder, but this doesn’t mean they are in the clear. Disordered eating is a term that is used as a catch-all to describe issues with food outside of an official eating disorder diagnosis.

Because of this, I think it’s easier to look at the multitude of symptoms and behaviours that are associated with anorexia, restriction and malnutrition, rather than the criteria in the DSM-5. Have a look through this list and see how many are true for you.

Symptoms

Physical symptoms (that you’ll notice)

• Feeling cold and increased sensitivity to the cold, with the need to wear more layers. This can lead to pain and the symptoms of Raynaud’s disease
• Numbness and tingling in your hands, feet, and other extremities
• Poor sleep with difficulty falling asleep, staying asleep, increased nightmares, night sweats and restlessness
• Increased digestive upset – gas, bloating, constipation, abdominal pain, loose stools, undigested food in stools, acid reflux, and delayed stomach emptying
• Decreased pulse, heart palpitations and irregular heartbeat
• Low blood pressure, leading to the occurrence of dizziness and feeling faint (especially when getting up or with exercise). Can even lead to blackouts
• Hypoglycaemia or low blood sugar. This can also lead to dizziness and feeling faint, as well as nausea. In extreme circumstances, it is deadly
• Decreased metabolic rate
• Decreased libido, often with periods becoming irregular or stopping altogether in women and lack of erections or erectile dysfunction in men
• Vaginal atrophy leading to pain with sex and vaginal itchiness or dryness
• Brittle hair, nails, and skin and where these grow and repair more slowly
• Poor dental and gum health
• Increased craving for salt
• Increased desire for hot beverages, especially caffeinated drinks
• Increased frequency and urgency of urination
• Muscle cramps and pain (which counter-intuitively can be worse with rest or with the cessation of exercise, at least in the short term)
• Oedema or swelling. Can happen all over, but commonly in the ankles, feet, legs, arms, under the chin, cheeks and around the eyes
• Decreased training performance or ability to exercise (although with something like walking, this can be overridden). Often in the beginning, even as the body is being undernourished, exercise performance increases. But as time goes on this stops
• Cuts are slow to heal, bruising occurs more often and takes longer to heal
• Increased incidence of bone fractures or injuries
• Elevated carotene in the blood, which can lead to a yellowing of the skin
• Immune system changes – for some this means many recurrent infections, for others, this means never getting sick
• Anaemia or lower amounts of red blood cells (these are the ones that carry around oxygen). This can lead to lower energy, but in restriction can feel like you are tired and wired
• Shortness of breath
• Difficulty swallowing
• Lanugo, which is fine hair that develops over the body
• Increased pain threshold – you become more numb to physical body signals

Physical Symptoms (you won’t directly notice)

• Reduction in heart size
• Brain atrophy
• Bone density reduction
• Reduction in the actual size and capacity of the bladder

Mental/Emotional Symptoms

• Increased neuroses like depression, anxiety, hypochondria, hysteria. Can lead to suicidal ideation
• Increased irritability and impatience
• Increased paranoia and defensiveness
• Inflexibility in your thinking
• Increased food thoughts and preoccupation, especially around calories, fat grams, carbohydrates, “eating healthy”. This can obsessive and also anxiety-provoking
• Hyper awareness of food and movement – noticing what other people are eating, triggered by comments of others doing exercise or dieting
• Fear of eating too much and of calorically dense or supposedly “unhealthy” food
• Fear of weight gain and feeling “fat”
• Regret and guilt because of eating
• Eating becomes highly emotional – whether that means incredibly difficult and challenging as well as eating being so prized and defended and the highlight of the day
• Dreams about food
• Fear of stillness and stopping moving
• Difficulty focusing and concentrating (although in the beginning, the opposite can be true)
• Loss of ambition
• Feeling more alone and shut off, which in reality can also be the case where you are isolating yourself more often or all the time
• Indecisiveness – with food choices but with decisions in general
• Obsession with weight and body checking
• Sensitivity to noise and crowds. Many clients are already Highly Sensitive People (HSPs) and this makes things even worse
• The dulling of senses and emotions, feeling numb
• Increased incidence of dissociation, often as a coping mechanism to deal with exercise or the difficulties of life
• Body dysmorphia and seeing your body differently from how it is in reality

Behavioural Symptoms

• Increased length of mealtimes, eating more slowly, eating foods in a specific order or other rituals around eating i.e. using the specific cutlery or plates, eating at an exact time
• Chewing and spitting out food. Or regular use of chewing gum or low-calorie sweets
• Avoiding eating in front of others
• Cooking food for others without eating yourself
• A focus on trying to take care of everyone else instead of yourself
• Increased interest in preparing food, reading recipes, buying cookbooks and watching food-based TV programmes
• A rigid and excessive exercise routine that causes distress when you try to change it
• Increased walking, housework, standing, fidgeting, and pacing. Favouring occupations that allow for movement 
• Withdrawal from friends and activities that used to be of interest
• Reluctance to participate in activities where the body will be viewed by others i.e. swimming. This is true even if someone’s body meets up to society’s standards and they supposedly have “nothing to hide”
• Possessiveness and hoarding – cookbooks, recipes, keeping the fridge completely stocked with safe foods but also hoarding non-food items like plastic bags, magazines, cleaning items, etc
• Kleptomania, which is the urge to steal. This can be food items but can be non-food stuff
• Eating food out of the bins or food that has been thrown away
• Compulsive spending or being extremely frugal. These are at opposite ends of the spectrum but both can occur 
• Prone to form strong habitual habits
• Increased OCD or OCD-like behaviour
• Increased ability to lie, particularly in connection with food. This isn’t always the case but if someone isn’t ready to give up the disorder, this can definitely be the case.

So rather than asking if you meet the DSM-5 criteria for anorexia, think about your own experience. How many of the above symptoms or behaviours are occurring for you?

Feeling like you’re not “sick enough”

One common feature of eating disorders, like anorexia, is the belief that you’re not sick enough to need help or treatment. That even if you look at the above list of issues and realise that many are occurring for you, that instead, you focus on how there are others that you aren’t experiencing.

It seems like there is always someone you can think of who is thinner or sicker, which proves you don’t need help.

But asking “am I sick enough” is the wrong question. Ask yourself, “would I like things to be better than they are now?” If the answer to this question is yes, then you should seek help. This is something I cover in more detail here.

What does recovery look like?

Everyone’s recovery from anorexia looks different. But despite this uniqueness, there are a number of components that are the same.

Nutritional rehabilitation 

The vast majority of symptoms connected to anorexia are due to malnutrition.

When the body is getting insufficient energy compared to what it needs, symptoms occur. No organs or body systems are spared from this. 

And because one of the areas that is affected is your brain, many of your thoughts and beliefs are changed. Unfortunately, while this is occurring, it can be hard to grasp. 

It can feel like “this is just me” or “this is what I truly believe or want”. But once out the other side, it’s amazing how these beliefs and thoughts have changed. Where you can finally see how much they were being driven by insufficient energy.

The goal of nutritional rehabilitation is to get the body out of the deprived state it’s in and provide it with the resources it needs to repair. 

This means not just meeting your energy demands for today, but also paying off all of the energy debt that has accrued. Because there is damage that occurs from being malnourished for an extended amount of time.

An analogy I often use is to think of your body as a house that is in need of repair. It’s not going to be a quick fix, but if the body is given the resources and the time, it truly can heal. 

A real-life example of this process is the Minnesota Starvation Experiment, which you can find out more about here. 

Brain and neural rewiring 

As I mentioned earlier, malnutrition affects all parts of the body and the brain is no exception.

Brain matter actually shrinks. These physical changes then lead to changes in personality, beliefs, thoughts and behaviours.

To reverse these changes, increased energy intake needs to occur. The extra energy facilitates recovery.

But in addition to energy intake, there needs to be a learning of new habits and patterns of behaviour at the brain level. Also known as neural rewiring.

There’s an oft used phrase that “cells that fire together, wire together”. What this means is that the more you do something, the more it becomes ingrained.

And this is definitely the case with anorexia. The more you have acted on behaviours connected to eating patterns and rituals, or exercise and movement regimes, the more these have become normalised.

Change is difficult. As humans, we like to do what is familiar. But the more we can make a change and then be consistent, the more this becomes the new norm. Not immediately, but with time. 

Challenging foods and food rules

One of the biggest areas that needs neural rewiring is connected to food.

Anorexia changes how food is seen. It’s seen as a threat and, much like when we see a snake or a spider, sets off the body’s stress response. Eating becomes a terrifying experience, where you want to find the foods you label as safe to minimise the discomfort.

The same is true with other rituals, like eating foods in a certain order or always using the same bowl or cutlery. These OCD-like behaviours are a way of trying to soothe the uncomfortableness of mealtimes.

Recovery is therefore about rewiring the body’s response to food. Teaching it that what it currently fears and leads to a stress response, is actually safe and nothing to be afraid of. And this is done by challenging fear foods and food rules. 

Self-Compassion

Recovery from anorexia is challenging and messy. The body responds in ways you’d like it not to. One of the biggest antidotes to this discomfort is self-compassion.

Dr. Kristen Neff is a pioneer in the field of self-compassion research and has studied it more than anyone else. She defines self-compassion as having three main characteristics.

1. Self-Kindness instead of Self-Judgement – recognising that we are imperfect, will make mistakes and go through difficult experiences. And that in these moments, we need to treat ourselves with kindness
2. Common Humanity instead of Isolation – recognising that suffering is part of being human and is a shared experience, not something that is only happening to you
3. Mindfulness instead of Over-Identification – recognising how our thoughts and feelings actually are, so they are not suppressed nor exaggerated

Self-compassion is important for human well-being, and this is particularly true in the recovery of anorexia. As covered in this podcast, self-compassion is actually correlated with recovery and how compassionate someone is can be a predictor for the likely success of recovery.

The good news is that self-compassion is a learned skill and even if it’s foreign or the antithesis of what you are used to, this can change. Which makes self-compassion an important pillar for recovery.

Body Image

One of the main features of anorexia and part of the diagnostic criteria in the DSM-5 is an intense fear of gaining weight. And this fear is there irrespective of someone’s actual weight. No matter how low weight goes, this fear never abates (in fact, it often gets stronger).

Now a big part of this fear is connected to malnutrition and how the eating disorder affects someone’s thoughts and perceptions.

And this is seen in those who never had fears or concerns about their weight before developing anorexia. But once the disease takes hold, then the panic about weight gain ensues. Tabitha Farrar is the perfect example of this, as we discuss in this conversation.

But for most suffers, body image and weight concerns were a problem before the anorexia. With the eating disorder significantly intensifying them.   

This means a big part of recovery is dealing with body image and the beliefs that you have about fatness and thinness. Some of this will naturally change as part of nutritional rehabilitation. But much will come about by exploring these beliefs and challenging them through various behaviours and practices.

A lot of body image work is to do with self-worth, self-acceptance and discovering your values and purpose. And this has nothing to do with “loving your body”. 

This kind of work is crucial to recovery and it’s why it’s such a big part of what I focus on with clients.  

Exercise and Movement 

Because weight concerns are at the heart of anorexia, anything that can reduce weight can become a tool to help accomplish this goal. This is why exercise compulsion is so common in anorexia.

This can take many forms. HIIT classes, boot camps, spinning, yoga, running, walking or cycling. It can include triathlons, rock climbing or marathons. Or weight training and bodybuilding or physique competitions.   

Despite how exercise is often talked about, it isn’t always a positive thing for our health. To benefit from exercise the body needs adequate calories, rest and repair.

 Our relationship to it is equally important and there’s a difference between genuine enjoyment compared to compulsion or needing to exercise to change your body or make up for the food you ate.

Recovery from anorexia means a change to exercise habits and your relationship to exercise. The goal, at least in the short term, being to support nutritional rehabilitation and allowing the body to repair.   

What Is This Doing For Me?

People keep up behaviours that are serving them in some way. Irrespective of how much pain or damage a behaviour may cause, if it is being kept up, there is some positive intent behind it. 

I’m a big believer that people keep their “problems” for a reason. And in a sense, they aren’t actually problems but are a solution. Now, this doesn’t mean that it is the best solution, but at least at this time, it’s the best solution you’ve come up with.

So, the goal with recovery is to understand what anorexia is doing for you. What benefits is it providing? What needs is it meeting?

Some example answers are:

It allows me to deal with anxiety and makes me numb

It calms the loop of critical thoughts in my mind

It helps me forget about the trauma I’ve experienced and makes my life small and manageable

It helps me to feel worthy and that I have value

I’m a perfectionist and it helps me feel I’m doing things right 

With these responses, we can then ask two questions:

1. What are other, more constructive ways that this need can be met?
2. What would have to change so that this current need is no longer so important?

 Recovery isn’t about chastising and blaming yourself for your thoughts or behaviours. It’s about understanding the situation so you can get to a place where these thoughts and behaviours are no longer needed.

By answering the above questions, you can figure out alternative ways to support yourself. Finding healthier ways to cope with the stresses of life.

Full Recovery Is Possible

Everyone’s recovery journey is different and some of the above areas are going to be more prominent for you than others.

But one thing I firmly believe in is that full recovery is possible. So, what does full recovery mean? To borrow a definition from Carolyn Costin, an eating disorder therapist:

“Full recovery is when you can accept your natural body size and shape and no longer have a self-destructive or unnatural relationship with food or exercise. Food and weight take a proper perspective in your life and what you weigh is not more important than who you are, in fact, actual numbers are of little or no importance at all. You will not compromise your health or betray your soul to look a certain way, wear a certain size or reach a certain number on a scale.”

This is the place I truly believe you can reach and clearly outlines the goal for recovery. The greatest risk of relapse is up to 18 months after recovery, so it’s typically 2 years post-recovery, when you’ve been living in the way the above quote states, that full recovery can be reached.

Outside of relapse, the other issue many face is getting stuck in quasi recovery. Quasi recovery is where symptoms and behaviours have improved, but haven’t gone away. You are still stuck, just in a prison cell that affords you some extra benefits compared to when things were at their worst.

This is actually a common place clients find themselves in when they contact me. 

So the goal of recovery is full recovery. Where symptoms and behaviours aren’t just a bit better but have completely changed. And where this isn’t just a temporary change but a lifelong one. 

Getting Recovery Support

Recovery is challenging and isn’t a quick fix. Getting support is an important step as part of this process.

It can feel scary or embarrassing to seek help for an eating disorder, which is why it’s crucial to get help that is supportive and non-judgemental.

You don’t have to pretend you’re fine when you really aren’t. You also don’t have to hide what’s going on for fear that you’ll be lectured. 

I’m a leading expert and advocate for full recovery. I’ve been working with clients for over 15 years and understand what needs to happen to recover.

I truly believe that you can reach a place where the eating disorder is a thing of the past and I want to help you get there. If you want to fully recover and drastically increase the quality of your life, I’d love to help.

Want to get a FREE online course created specifically for those wanting full recovery? Discover the first 5 steps to take in your eating disorder recovery. This course shows you how to take action and the exact step-by-step process. To get instant access, click the button below.

I truly hope that you’ve found this article helpful. I wish you all the best with your recovery.