288: What Does Full Recovery Mean?

Chris Sandel: Welcome to Episode 288 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/288.

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 clients to fully recover.

In the last solo episode I recorded, I mentioned that I was going away. I had two weeks in Fiji for my mum’s 70th birthday and then time in Hong Kong each way to break up the trip. We flew from Aberdeen to London, from London to Hong Kong, and then from Hong Kong to Fiji, so it was quite the journey to get there, but the trip and the holiday were amazing. Fiji is absolutely gorgeous, and I loved being in a resort for 13 days, as it gave me plenty of time to chill out and relax.

It was hot, especially in comparison to Scotland when we left. It was like 35 degrees Centigrade, so that’s like 95 Fahrenheit, with 90% humidity. So it was rather full-on to get used to after leaving Scotland, which I think had some snow or it was below freezing when we left. Many days while we were there, it would rain in the afternoon. It was Fiji’s wet season. This was actually a bit of a relief. It was a perfect excuse to hang out in the room and get out of the sun.

It was really lovely getting to see family. My sister and her husband I hadn’t seen since pre-Covid, so it had been a really long time. It was nice to hang out and to see the family, and it was also then nice to have time with just Ali and Ramsay. The first week was a family week and then the second week it was just the three of us hanging out, so that was great. There was a buffet every day, or multiple times a day, which I’m a big fan of. It was some good eating.

Hong Kong was really great too. I’ve been there many times before. I had an aunt and uncle who lived in Hong Kong for probably about 15 years, and I first went out there I think in ’98. The English handed it back to Hong Kong in ’97, so I went out just after that, and then any time I would fly between Australia and the UK, I would always stop off in Hong Kong because I would have relatives to see and a place to stay. I really have a soft spot for it. I think it’s a really great place. I love living in the countryside and having lots of space; despite the bustlingness of it, there’s something that I really like about it, and I think I could probably live there for some amount of time. I don’t think I would want to be there forever, but there’s something about the city that really draws me in.

Had some amazing food, some really epic dim sum at this Michelin star restaurant, even though it was like £25. Really incredible ramen. And then got in a lot of nice shopping, which is something I don’t get a chance to do much of these days. So all in all, it was a really great trip. And now I’m back and starting what I’m hoping to be a very big year.

Before I get started with this episode, I have one announcement that I want to make. Starting this week, I’m going to be hosting a free 3-part live training series. It’s called How to Fully Recover From an Eating Disorder. The first training is going to be this Thursday from when this is released, so that’s going to be Thursday, February 8th. I did a similar training to this back in September last year, and many people found the information incredible.

I want to just share a couple of the feedback or the emails that I received from people connected to the last training. One said, “I’ve had an eating disorder for almost three decades at this point and I found your information more helpful than an entire treatment stay.” Next one, “Thank you so much for caring enough to offer your time and energy to helping others.” Another one, “I wanted to thank you for providing this very, very helpful information and sharing your approach to reaching full recovery. I would like you to know that I would’ve paid for this training. That’s how valuable it was to me.”

Then the final one I want to share was “I want to thank you for taking the time to create these three trainings. They’re probably the most helpful 5-½ hours I’ve ever had in my recovery, and I’ve been at this nearly three decades. After many inpatient, residential, PHP, and IOP stays, this is invaluable information that is tangible, doable, and understandable. I’ve never met someone to have such an insight into eating disorders that hasn’t had one themselves. Thank you again. I really appreciate you.”

The training really resonated with people, and from the comments, you can see who valuable it was. If you would like to be part of it, you can go to the show notes, www.seven-health.com/288, and there you’ll be able to click and register for that training.

So, on to today’s show. It’s another solo episode. I have got plans to do more interviews with people this year. We’ve started to line some of them up, so there are going to be more guest interviews coming. It feels like an eternity since they’ve happened. But at this stage, it’s just another one of me chatting about a specific topic. Today’s show is all about full recovery, and what does full recovery mean?

00:05:36

Why am I an advocate of full recovery?

I want to just say I am a strident advocate of full recovery. I really don’t want to be focusing on any other way of doing recovery with people because I think there is a real downside to every other way of doing recovery. I don’t want people to be getting stuck in quasi-recovery or ‘recovered enough’. I don’t want people to be doing harm reduction.

The reason that I say this is because eating disorders, when they’re left in this unfinished way where you’re partially recovered or you’re doing things that are reducing it somewhat but not getting the full way there, it’s a very slippery slope. And it’s a slippery slope to things getting worse again. I really am an advocate of full recovery because this is how someone truly gets to a place where they can leave the eating disorder behind, and where they can get to a place where their life isn’t constantly on high alert for “Am I going to slip back into this thing?” You being able to not just physically get to a place, but you being able to develop skills that allow you to have a situation where the eating disorder really is gone for good.

That is what I constantly work on when I’m working with clients, with the programmes I run. That is what it is about.

00:07:00

What does full recovery mean?

Let’s look at what full recovery means. I want to say there is no formal definition of this. Within the DSM or within people working within eating disorders, there isn’t this agreed-upon definition of what full recovery means. Certain people have come up with different definitions, and one of them is Carolyn Costin. She was one of the first people to really be talking about full recovery, and she’s come up with a definition of what full recovery means. So let me share her definition of full recovery.

She says: “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.”

I like that definition by Carolyn, and I think it encapsulates what full recovery can mean. And I also think that it is in a lot of ways fairly narrow in its perspective – talking very much about exercise and food and body size and shape, which are very big components as part of an eating disorder, but I really think that eating disorders are so much deeper than just that and so much bigger than just that.

A couple of things that I would add in terms of this definition, I would say that full recovery is when the eating disorder no longer shows up in your life in any form. It’s not just about a form where I’m conscious about my size or my shape or I struggle to take time off from this exercise, but really all the different ways that eating disorders show up. From my perspective, I think of eating disorders as anxiety disorders. They are about avoidance, using eating disorder behaviours as a way of avoiding.

This can be avoiding lots of different things. It can be avoiding particular activities, it can be avoiding particular emotions, it can be avoiding particular thoughts. So really getting to a place that you’re not using eating disorder behaviours and it’s no longer showing up in any form in your life.

Really connected to what I just said there is it’s about prioritising action-taking over avoidance. You’re consistently taking action, even when it is uncomfortable. And obviously that is true while going through the process of eating disorder recovery, but I also think that it is true after recovery has occurred. It’s that you are prioritising the things that actually make your life better, even if those things may be uncomfortable, even if it is uncomfortable to have that particular conversation or even if it is uncomfortable to change the way that you do a particular thing or to leave a job or to leave a relationship or whatever it may be. But really prioritising taking action over avoidance.

Eating disorders are very much about scarcity and restriction – and when I say restriction, I don’t just mean in terms of food; I mean restriction in all senses – and really playing small. Full recovery is really the opposite of this. It’s about abundance. It’s about expansion. It’s about playing big. Full recovery really is about you showing up as your true, authentic self and not changing yourself because of the opinions of others.

Obviously, in Carolyn Costin’s definition, a lot of this focus is around body shape and body size and a number on the scale, but I think that not changing yourself to fit the opinion of others is not just about the size and shape of your body; it’s so many different aspects of who you are. One of the things that comes up for me is so much of the work that I do with clients, and one of the things that often they discover is that there is neurodivergence that is part of their picture, and this is often part of the reason why the eating disorder started in the first place.

But there are certain aspects and personality traits and behaviours connected to their neurodivergence that aren’t going away. They are part of who they are. And so much of what is being attempted is really the masking of these things. So showing up as your true, authentic self is really embracing who you are as opposed to trying to put on a performance and changing yourself to fit the opinion of others.

Those are some of the extra things that I would add in, and obviously this is a non-exhaustive list; this is just some ideas that I would add in.

00:12:03

Questions to help you find what full recovery means for you

I actually have a writing exercise that I’ll often recommend connected to this. The thing I also want to get across is because there is no definition of what full recovery is, you get to define what that means for you. You’re wanting to use the healthy part of yourself to make that definition, because I think it could be very easy for the eating disorder to keep you stuck in quasi-recovery and tell you that this is full recovery and this is as good as it gets. But really understanding and coming up with a true definition of what full recovery means for you.

Some of the ideas you can think about when coming up with this idea are part of the writing exercise that I recommend, so I’m going to just share a couple or some of the things from the writing exercise so that you can start to explore (1) where you’re at now and (2) what that would look like or how things would be different if you were at a place of full recovery.

1. What physical symptoms are you currently experiencing that demonstrate the eating disorder is still present? You can go through all the physical stuff that is going on that would indicate that you haven’t reached a place of full recovery, of full nutritional rehabilitation.

2. How will you know when you have fully recovered physically? Again, you are the one who gets to come up with this definition. And look, it’s going to be a little bit grey, especially if you’ve lived with an eating disorder for a really long time. You aren’t really aware of what the possibilities could be, and you don’t know how good things could be or how things could change. With many of the writing exercises I do with people, these things are living, breathing documents. These are things that get added to over time. So this is more of a reflection or a snapshot of where you’re at right now. So coming up with some ideas of how you’ll know when you’ve fully recovered physically. What are some of the things you have going on that will have disappeared?

3. What behaviours are you keeping up that demonstrate that the eating disorder is still present? Looking at the different rules that you have or the different things that you’re doing on a daily basis that would demonstrate that you’re not in a place of full recovery.

4. What actions are you unable to take that demonstrate that the eating disorder is still impacting on you? There can be things you’re keeping up on doing that demonstrate the eating disorder is there, but there are also things that you’re unable to do that would demonstrate the eating disorder is still there.

5. How will you spend your time when you’ve fully recovered that will demonstrate that this is the case? This will combine the two previous questions into you starting to imagine, what would that life look like? If you were to imagine that, what would you be seeing that you are doing or not doing that’s really demonstrating you’re at that place of full recovery.

6. What thoughts or fears demonstrate the eating disorder still affects your mind? How will your thoughts and fears change when you fully recover? The thing that I want to mention – and maybe I should’ve mentioned this at the start as we go through this – is we’re not looking for perfection with all of these things. The thing is, if I’m thinking about it from a physical standpoint, from a physical health standpoint, we all have different things that are inherent strengths or weaknesses. For many people, they have lots of issues that were going on well before the eating disorder started. Someone could’ve had a weak digestive system before the eating disorder started, and that was inherent to who they are and the way that they function.

It’s not that that can’t get much better, but I want people to be in touch with reality that everything is not going to be absolutely perfect. There can still be different ailments that are going on even though you are fully recovered. And the same thing in terms of the different thoughts and fears. It’s not that you’ll never, ever have a thought ever again about the size of your body or “I don’t like the way I look in this particular shirt” or “I’m having a bad body image day” or anything along those lines. It’s not that those things completely disappear. We live in the world that we do, we are also infallible humans who have our fears and worries. So I think there is a normal level of that that will naturally come up.

But one of the things I focus a lot on with this kind of work is recognising that you are not your thoughts. Thoughts think themselves; you become aware of those thoughts. And the same thing with different fears, different emotions, etc. It’s more about what happens when those things arise. And for someone who is in a place of full recovery, when they arise, they are dealt with pretty quickly. It doesn’t derail someone in the same ways that it does when they are still struggling with an eating disorder.

7. How about your emotions or emotional regulation? What of those are really demonstrating that the eating disorder still exists? And what will be different with your emotions and your experience and your ability to cope with them when you are fully recovered? Again, it’s not that you won’t ever experience uncomfortable or difficult emotions; it’s how you then handle those when they arise.

8. What other ways is the eating disorder affecting your current life? I talked earlier about the way that eating disorders make people stay small. It could be about staying in certain friendships or certain relationships or a certain job that is demonstrating, “Actually, I’m still in the eating disorder. This is an area where I need to speak up or I need to change something or I need to have more confidence”, whatever it may be.

9. What other indicators will you use to demonstrate that you are fully recovered? Obviously, I’ve touched on many different areas, but there could be lots of other things you can think about that “These are the things that are really demonstrating that I’m not fully recovered, and I know that I will be when these things are able to change.”

And then the final bit is coming up with your own definition of full recovery, and to write this out as a paragraph or a series of paragraphs so that you have something that you are aiming for, but you also have something in mind so that you really understand what full recovery means to you at this moment. And as I said, this is you taking a snapshot of where you are now and how you feel about this, and you can then come back and look at it again in three months or six months or a year’s time and say, “How do I feel about that definition of full recovery?”

00:19:04

Areas involved in full recovery from my perspective

Because really, when I think about full recovery – and I touched on this more generally, but if I’m breaking it down, full recovery for me is really recovery from a physical standpoint, so the nutritional rehabilitation of the body and all of the damage that has occurred because of the eating disorder. So it’s doing the things that allow the body to repair and to get back to a place of good nutritional standing, and as part of that process, that’s going to involve making changes to your energy balance.

That’s in terms of energy coming in and the kinds of foods you’re eating as part of recovery; it’s the movement that you’re doing and reducing and stopping that to help with recovery; it could be even the intensity of your job and how long you’re doing that for if you’re working many, many hours a day or you’re always on your feet or something along those lines. So it’s looking at, “What are the things that need to happen so that I can physically repair?”

It’s also then about mental repair and really creating this mental fortitude or psychological fortitude to be able to handle the challenges of life, but also to be able to handle the kinds of thoughts that your brain is naturally generating and how to deal with those.

The next is in terms of your emotional strength and emotional full recovery. Again, this is coming from a place of how you’re able to handle the emotions that come up. Are you able to create room for those as opposed to there being this resistance to them? Or if these uncomfortable emotions come up, “I have to do something to avoid them”?

Then the final piece is connected to connection. This is connection with other people, so having a good support network for your recovery, but also for after recovery, because we are social creatures. It’s really important to have relations with other people, and it doesn’t mean that you need to have this huge friends network, but you want to have people in your life that you can connect with and that you can socialise with and that you can get co-regulation from. It’s crucially important.

And then the connection with oneself. I think one of the biggest travesties with the eating disorder is it disconnects us from ourselves. Sometimes in the beginning, that’s what people are wanting to do. That’s the whole point of the eating disorder. But what it means when we become disconnected from ourselves is we are no longer living a life that is in alignment with our values. We are making choices that are about something else as opposed to what we truly value.

So coming back into contact with being able to be connected to ourselves, being able to do that so we’re not trying to avoid that or “that’s too uncomfortable”, but truly being able to be in connection with ourselves and our authentic selves.

Those are really the areas I think about when thinking about full recovery.

So that is it for this episode. It wasn’t going to be a long one, but I really wanted to start to explore the question of what full recovery means, because this is what I really believe people should be aiming for as part of recovery. I want people to be aiming for this for a number of reasons.

One I already talked about in that I think eating disorders are a slippery slope, and if you don’t get out of them, then it’s very easy for life to happen and you get sucked back into things getting a lot worse and you being really stuck.

But two, I want people to go for full recovery because I truly believe that they can get there, and I truly believe that when you are in an eating disorder, it has such an impact on your beliefs, on your perceptions, on your sense of self. It’s like a veil comes over your eyes and it changes your view of things.

So often, when people are being told “Let’s just do harm reduction” or someone’s saying “Hey, I want to do harm reduction,” I want to be the person who is saying, no, there is a lot more on offer for you. I don’t want you to be constrained by what the eating disorder or your current physical state is allowing you to believe is possible. That’s why I want to be such an advocate for full recovery, because I truly believe people can have a much better existence and a much better life and a much more fulfilling life than the eating disorder is letting them believe is true for them.

That is it for this episode. As I mentioned, I’m going to be doing a 3-part live training. It is starting this week. I would love to have you there and participating. I know from last time, lots of people commented on how lovely it was to get this sense of community while doing it, seeing other people ask questions, being able to ask questions yourself as part of these calls. I’m really looking forward to doing this. I’m really excited about it and I would love for you to be there.

So once again, if you go to www.seven-health.com/288, you can find the link there and register. And I will hopefully see you on Thursday. Until then, I will catch you soon.

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