Last week on the podcast I chatted with Betsy Brenner. She is the author of The Longest Match: Rallying To Defeat An Eating Disorder In Midlife. If you haven’t listened to the episode, I highly suggest checking it out.
When I reflected on the book and our conversation, several lessons came to mind concerning eating disorders and recovery. Below I have included the nine most salient of these lessons.
When Betsy was first diagnosed with anorexia, she was shocked. At the time she had a very stereotypical and narrow view of anorexia: that it was something that affected teenagers; that you have to be emaciated to have it.
Betsy’s view is actually a common one but it is not true. Eating disorders do not discriminate and occur in people of any age, size, weight, shape, sexuality, gender identity, cultural background or socioeconomic group.
This mistaken belief, of how an eating disorder “looks,” creates many issues.
It can affect how seriously someone is taken.
It can affect someone’s ability to receive adequate treatment.
It can even affect if someone believes they are “sick enough” and in need of help.
Thankfully for Betsy, despite her initial shock at the diagnosis, she quickly adjusted her thinking and started on the long road of recovery.
From as young as Betsy could remember, she suppressed her emotions. When her parents divorced, her mother pretended as if nothing had happened. If she wrote anything negative in her diary, she felt the need to follow it with something like “I love my life.”
Even when her parents passed away, she believed she needed to focus only on the good times, rather than the grief of the loss or the complicated relationships she had with each of them.
Eating disorders are a coping mechanism; they are a way of avoiding or distracting. And in Betsy’s case, it was a way to avoid feeling her emotions and to cope with feeling fallible and mortal when she wanted to be perfect.
This meant that a big part of recovery for Betsy, as it is for so many, was to learn how to feel her feelings. What did this look like?
Talking about her past and realising how this had affected her
Crying and not trying to suppress this release of emotions
Opening up and being vulnerable with family and friends
Discovering it’s ok to feel negative emotions, this isn’t anything to feel guilty about
Building resilience and learning that she will survive even when emotions arise
The more you can learn how to feel your feelings, the less need there is for an eating disorder. Because you’ve found an alternate way of coping.
Note: the practice of feeling your feelings is something I also covered in my recent conversation with Summer Innanen and Colleen Reichmann.
One way of conceptualising eating disorders is the biopsychosocial model. It considers the interaction of biological, psychological, and social factors that coalesce to contribute to the development of an eating disorder.
And while Betsy’s eating disorder was decades in the making and had many contributing factors, losing weight in her 40s was a big part of it.
This was from a psychological perspective, as she received praise for the weight loss and increased her fear of weight gain.
But it was also from a physiological perspective. As weight is lost, the eating disorder thoughts increase. So does the anxiety when making choices that go against the eating disorder’s wishes.
So while weight gain becomes an enormous fear, it is what is needed for recovery to take place.
Betsy’s dietician helped her to increase her energy intake, by eating more often and including more energy-dense foods. But she also got her to reduce her energy output, by reducing her exercise and putting limits on how much she could do.
These changes were all in service of weight restoration and the amelioration of symptoms that happens as a result of the weight increase.
Note: I have written more about the importance of recovery weight gain, which you can read here.
When Betsy was first diagnosed with anorexia, she had the option of going to an in-patient facility. But as a mother of three who worked and had a busy life, the in-patient route didn’t seem doable.
But even if she had, in-patient is only the start of the recovery journey. Betsy’s recovery took many years (which is true for many people who recover) and it’s not feasible, practical or even possible to spend this amount of time at an in-patient facility.
The reality is that for most people, recovery has to happen while life continues on. Yes, someone in their teen years or early twenties may be able to focus almost exclusively on recovery.
But typically, as people get older than this and they have a job, partner, children, elderly parents and many other parts of life that are mostly impossible to put a pause on.
Despite the challenges this presents, I actually believe that there is an upside to it too. Because you are learning to recover in the real world of life.
And considering eating disorders are a coping mechanism, it is giving you a regular opportunity to practice coping without the eating disorder behaviours whilst experiencing the slings and arrows of life.
Recovery is anything but a quick process, although I can see how people can be mistaken in believing otherwise.
The average length of stay at an in-patient facility for anorexia is less than 90 days (see studies here and here). It’s also common to read online or watch videos on YouTube with people talking about how they recovered in 6 months or 9 months.
But the person walking out of the in-patient facility after 90 days is far from fully recovered. And the same is true with online stories and videos.
Because recovery is more than just about nutritional rehabilitation, it’s about addressing all the factors that have gone into creating the eating disorder and as well as the factors that have been keeping continuing on.
The eating disorder has its tentacles in so many areas and recovery is about identifying and disentangling all of them.
In Betsy’s case, it took years for her to get to a better place. And even then, she relapsed, and then further strengthened her recovery. So, in total it was roughly 7 to 8 years.
Now, there is obviously a more acute phase at the start of recovery and then with time this changes. But I do think there is a misconception about just how long recovery takes and I’m glad that Betsy is giving some perspective on this.
Betsy was very good at taking care of and pleasing everyone else. In fact, it was when she developed asthma and couldn’t keep up with all the things she believed she should be able to do, that the eating disorder took hold.
This is actually rather common with clients that I see. Where they have a fear of laziness and taking a break. And even when this leads to the loss of their period or they receive a diagnosis of osteoporosis, they can still feel unable to stop.
Betsy mentioned during our conversation that self-care wasn’t in her vocabulary. Given her upbringing and the difficulty she had with expressing her feelings, this wasn’t a surprise. She’d been taught to simply soldier on no matter what was happening.
But self-care is crucial to health on all levels.
Maybe there can be a misunderstanding about what self-care actually means. As I talk about in this article, it’s not simply bubble baths and getting a massage. Real self-care is much bigger than and is about genuinely taking care of and supporting yourself.
It’s eating the food even when it feels scary
It’s resting because your body is tired, in pain or needs to repair
It’s saying no and setting boundaries with a friend or partner, even though it feels uncomfortable
It’s reaching out for support and admitting that you are struggling
It’s living by your values, even in moments when this feels like the more difficult choice
And as Betsy talked about in our conversation, these are all habits that she learned to do.
These days, there are lots of places to find recovery content. And this is wonderful as it allows you to learn and understand both the eating disorder and the recovery process.
But recovery isn’t about more knowledge, it’s what is done with that knowledge. Healing happens because of action taking and making choices that are pro-recovery.
And this is hugely important to recognise. Because many people know everything there is to know about recovery, nutritional rehabilitation, neural rewiring, and the Minnesota Starvation Experiment. But this knowledge doesn’t translate into action and so recovery doesn’t happen.
Thankfully Betsy had the support of a dietician and a therapist to help her with this.
As I talked about in the weight restoration section, they helped her to increase her food intake, start including fear foods and decrease her exercise and movement.
As I covered in the feeling your feelings section, they helped her get in touch with her feelings, see vulnerability as a strength rather than a weakness and become ok with feeling the full spectrum of emotions.
All through her journey, it wasn’t that she simply learned more information, it was that this translated into her behaving and acting differently.
Betsy began her recovery in 2011 and by the summer of 2017, she felt strong in her recovery.
She had been attending meetings with the Multi-Service Eating Disorder Association (MEDA) and saw they offered a “Hope and Inspiration” event. This was an event where someone who had recovered from an eating disorder could share their story and answer questions.
During the summer of 2017, she met with a clinician to discuss speaking at the “Hope and Inspiration” event, which she did in May 2018.
But despite Betsy’s strength in recovery, events in late 2018 led to a relapse in early 2019. And like most people who make it so far into recovery, this was an unintentional relapse.
Recovery is rarely linear and there will be ups and downs. Even when things feel strong, relapse can happen.
To quote Betsy “A set-back, whether physical or emotional, can be a gift of recovery in disguise. As long as lessons are learned with each twist and turn, recovery continues to get stronger”.
She learned that:
The final important lesson from Betsy’s journey is that recovery can happen at any age. I mentioned earlier how eating disorders are incorrectly associated with teenagers. The reality is that eating disorders can happen at any age and so can recovery.
Betsy recovered from an eating disorder in her 50s. She had decades of beliefs and behaviours that needed to be changed and overcome.
I recently published this post, sharing a testimonial from my client Julie. She is also in her 50s and had decades of unlearning to do on her path to recovery.
Yes, recovery in midlife and above can have unique challenges. But it is a population that I’m working with more and more and I truly believe that recovery is still every bit as possible.
As Betsy mentioned during the end of our conversation, getting support in recovery is vital. Recovery is one of the most difficult things you will do and you don’t need to do it alone.
Whether you’re just starting your recovery or you’ve been making progress but know you need more support, I’d love to help.
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.
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