363: Unconditional Permission To Eat, Co-occuring Medical Conditions And Being Social In Recovery

Chris Sandel: Hey, everyone! Welcome to Episode 363 of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist and a coach and an eating disorder expert, and I help people to fully recover.

So today on the podcast, it’s another Q&A episode. I’ve still got a lot of questions that were asked when I requested for questions back in – maybe it was December time, January time, something like that. So I’m continuing to make my way through them.

As part of this episode, we’re going to be looking at being social in recovery; unconditional permission to eat in recovery; being in the recovery body and dealing with that; recovery support groups; co-occurring medical conditions; and much more.

Before I get started with that, I just want to say that I’m currently taking on new clients. I had put a pause on taking on new clients for a little while. I’ve just opened up a few more spots. Again, I don’t know how long it’s going to be before I put a pause on that again, but I’m just mentioning it now. If you are living with an eating disorder, if you want to reach a place of full recovery, even if that feels like this distant, far-off thing, I would love to help. I do believe that everyone can fully recover, and if you do the things that are required, you can get there. And I would love to be able to help you to do that.

So if this is what you want, you want support with this, then you can send me an email at info@seven-health.com and just put ‘support’ in the subject line, or you can send a message on Instagram. It’s @sevenhealthcompany, and just put ‘support’ in a DM and I can get over the details of what that can look like.

So let’s get on with today’s episode.

00:01:50

How to start socialising during recovery?

The first question comes from Anita, and the question is: “How to start socialising during recovery? I mean, I’m in a really underweight state after almost seven years, and I know I could feel loneliness, but I cannot find the balance in which I can focus on real recovery and also force myself to meet people.”

There isn’t a right way of doing this. What I would say is that social connection is really important and can support recovery, while forcing yourself to be constantly socialising before you’re in a place where you are physically and emotionally capable of doing that doesn’t necessarily help with recovery.

So what I would be suggesting is for you to reflect on yourself. Who are the people that you enjoy spending time with? And in what situations do you enjoy spending time with those people, and in what places do you enjoy spending time with people?

I think there can be this very narrow idea of socialising meaning going to parties or going to this busy restaurant. There can be these constraints in terms of what this actually means, and socialising could be “Someone comes round to my house or my flat and we have a cup of tea or we have some food and we just hang out together. Maybe we even sit on a couch and watch a movie together. I’m just getting what I need from a social connection standpoint. That could be having real deep, meaningful conversations, or it could be just having this other person there where we’re able to do some things together and I’m not feeling quite so lonely with this.”

So it’s really looking at what works well for you at this point. And as time goes on and you get into a better state, your window of tolerance can increase, so maybe you go from “Being with one person is all I can handle” to “Yeah, I can be with two or three people at once, but I still don’t want to do that in a noisy café. I want to do this in a quieter environment, whether that’s sitting in a park, whether that’s being in my own house.” But just looking at, what are the ways that you can bring in some of this social connection at this point?

Because other human beings – and it doesn’t even have to be human beings; it can be other mammals, so cats, dogs, horses, whatever – are really important for co-regulation and for supporting your nervous system.

There’s self-regulation and co-regulation. Self-regulation is the capacity and the ability to regulate oneself, and co-regulation is using someone else, either some other human or some other mammal, to be able to help support our nervous system to do that. What often happens when living with an eating disorder is one’s ability to actually self-regulate is very downgraded and can almost become impossible, so having someone there can be then really helpful with this in terms of the co-regulation.

And they don’t necessarily have to be doing anything big. It could be just them being there, you noticing the smile on their face, your nervous system is picking up cues of safety from that other person or that other mammal. So that’s why the social piece can be important if we’re looking at it just from a co-regulation piece.

The other part I would say – you mentioned this about the loneliness – is loneliness isn’t always just about the absence of people. Sometimes it’s the absence of being with yourself. You can be surrounded by people and still be profoundly lonely. I think a lot of what the work of recovery is about is finding one’s way back to themselves and really rebuilding that connection with yourself so that “I’m spending a bit more time with people, but actually, my loneliness is really abating because I’m finding how to spend time with myself and how to actually be with myself, and be with myself in a way that feels fun or enjoyable as opposed to when I’m with myself I’m so critical and I get lost in all of those thoughts, etc.”

So starting to look at, what are ways that you can be in your body? What are ways that you can start to support your emotions? What are your actual preferences, and how do you like to have humour in your life? Or what creative pursuits do you like? What are your wants and needs? I think this is a really important part of the loneliness piece.

And it also means the more you’re able to do this with yourself, when you’re then meeting other people, you’re in a better, more regulated state. So I would also look at this around, how can you start to come back to yourself, and figuring out the ways that you can support yourself but also the ways that you can be alone and not feel lonely, where “Actually, I can genuinely enjoy my own company and the way I spend my time.”

00:07:12

How to give yourself unconditional permission to eat?

The next question comes from Philippa and it says, “How to give yourself unconditional permission to eat?”

I think one of the biggest misconceptions is around unconditional permission and that it means “I will feel calm and comfortable eating and I will just have this blissful moment of like ‘it’s completely fine, you can have whatever you want, just go for it, it’s completely okay’.” That’s just not what unconditional permission is going to look like, especially in the beginning.

Unconditional permission in the beginning is going to be that “I’m stopping worrying about the fear or certainty or really understanding my hunger or all of these things, that I’ve figured those out and then I can start to eat properly.” It’s “Hey, I’m actually eating despite all of the noise and despite the uncertainty and despite feeling like I must be doing something wrong. I’m still allowing myself to eat.”

And in this way, unconditional permission and real permission is behavioural to start with. It’s not going to feel emotionally okay. It’s about the action-taking. I think of permission as being a verb. It’s “I’m starting to eat this meal and I’m starting to eat this snack and I’m having my three melas and my three snacks each day, and I’m including these fear foods, and I’m doing all of these things while at the same time emotionally, it’s really difficult for me to do it, and psychologically, I’m second-guessing if this is the right thing and there’s all these thoughts that are coming up. But I’m still behaviourally taking the action to do this.”

Because the more that you do that, the more that those things do then start to change. You start to then normalise, “Okay, it is actually helpful for me to be having three meals and three snacks a day and to be eating every couple of hours because that actually does help me. It used to be such a challenge to have breakfast and now it’s not a challenge to have breakfast.”

I know there can be a lot of talk around physical hunger and mental hunger and that if you’re eating and you’re not giving yourself full permission, you’re still not fully allowing your body to do it. And yes, I can agree with that at some level, but to start with, that’s how it’s going to be. You’re going to be eating while also telling yourself “Maybe I shouldn’t be doing this. Maybe this is the wrong option.”

I think of full permission as really being a journey to get to that place. You do get to the place where “I’m behaviourally doing this, mentally, emotionally, in all arenas, I’m onboard with me having this amount of food and me getting the satisfaction from this and me being able to really honour my hunger.” That’s the end goal. That’s not where you start. It really does start with the behaviour piece. So that is how you give yourself that permission, and then you continue to build on from there.

So rather than checking in with yourself emotionally and feeling like “Am I giving myself unconditional permission based on my emotional response to these things?”, I would be looking at this – “If someone was only watching my behaviours, so all they had was looking at how I’m actually eating, would that demonstrate that I’m giving myself permission?” Because that’s the more important thing, especially in the beginning – that you’re doing the action-taking with this.

00:11:12

How to deal with feeling uncomfortable in my own skin?

Then the next question comes from Barbara, and she says, “My biggest struggle is honouring my physical hunger and basic nourishment needs and feeling so wrong and uncomfortable in my own skin as my recovery body morphs into what it’s meant to be. My weight is ‘normal and appropriate’, yet I’m critical of it, uncomfortable, hyperaware of certain body parts, the intrusive thoughts, etc. I’m having this maybe 200 times a day. It’s literally torture.”

Thank you for the question, and I can understand and hear how hard this is for you. To be having those intrusive thoughts and to be having them at that level, yeah, that makes it really difficult.

I want to just say that actually what you’re describing is also very common. This is what happens so often in recovery. I think there can be, again, this expectation and this mis-expectation with the idea that “Once I become weight restored, I’ll automatically feel peaceful in my body.” It might be that you’re not at that place yet in terms of the weight restoration, so you’re working up to that place, but there can be this idea of “I just need to do the eating and the resting piece and then everything else will take care of itself.”

While I do believe that eating more and resting more can get you some of the way there, it doesn’t do everything for you. So there can be a huge amount of body distress that is going on, and there can be body image distress even when someone is weight restored because there’s going to be some time for your body, and more importantly your mind, to then catch up with “This is my new body and this is what I now look like.”

And also, for so many people, it’s not that they never had body image concerns prior to the eating disorder, like it was just this complete clean slate and then “I got the eating disorder and that was the only reason I’ve ever had concerns about my body.” For so many people, this part really does predate the eating disorder. So even though we get over the eating disorder in terms of doing the nutritional rehabilitation and the repair work, that doesn’t then take away all those things that happened beforehand.

And people can have a lot of complexities connected to this, whether this be around all the different types of trauma that has gone on in terms of families and what messaging one received growing up, depending on Mum and Dad and what their dieting histories were or what work they were doing or the kinds of messages that they were saying about how a body should look. So there’s all of this stuff that is then still there that needs to be worked on as part of recovery.

And yes, being in a more well-rested, well-nourished body can help this, and there can also be the distress of being in this larger body and “It feeling very alien to me and I’m just so much more sensitive to the sensory experiences of being in this body and the way that my clothes are feeling on me or the way my belly feels after I’ve had food and just that increase in intensity with it.”

Another thing I would say with this is just being careful not to misinterpret the frequency that you’re having these thoughts as meaning that they must be true or important. We are not the author of our thoughts. Our mind generates our thoughts, it comes into our conscious awareness, it feels like we’re the ones generating these thoughts. But even as I’m talking here, whatever is coming out, I don’t necessarily know. It just comes out.

So being able to be aware of the fact that “Just because I’m having this thought 200 times a day, doesn’t mean that it’s true. It doesn’t mean that it’s a value of mine. It doesn’t mean that I have to spend a lot of time focusing on it and trying to come up with a better argument against it.” It just means that your mind, because of the state that you’re in, because of how your body’s changed by going through this process, is currently throwing up a lot of thoughts connected to this.

What often happens and why it then becomes much more repeated is that you have these thoughts, and then there is some kind of action-taking connected to this, whether that is “I become very indecisive around ‘do I have this snack or not have this snack’, I start delaying some of my eating, I start skipping some of my eating. Sometimes I do some kind of compensatory behaviours connected to exercise or I start checking myself in the mirror or start taking photos of myself and starting to engage in scanning for cues of danger or flaws” or all of these kinds of things. If you’re then taking action on top of those thoughts, it starts to reinforce those.

So what I would be suggesting around this is, one, I want to normalise it that this is a really common thing, and two, starting to bring in other practices for when this is coming up so that you can remind yourself that “This is just a thought or this is just feeling” and creating that space so that that can be there and you’re not having to take action connected to it.

It could be doing things like Tara Brach’s rain meditation, I think is wonderful. You can get an emotions wheel and start to use that to be able to label it. So “Even though I’m turning this feeling inwards connected to my body, what actually is going on? What other emotions are coming up in this moment?” Because so often, when one is feeling this in their body, there can be other events that are starting to trigger this. There can be the recognition of “Oh, actually I’m quite lonely in this moment” or “I’m feeling behind my peers and where they are in their life” or whatever it may be, and it then gets translated into “It’s because my body is the issue.”

So being able to have different practices that allow you to have more of that observer role and to be able to build up that curiosity around it, but also that tolerance of having those thoughts or those feelings without then taking some eating disorder behaviour action that starts to reinforce it.

And then bigger picture, how can you start to build a life that can start to demonstrate to you that “This body isn’t getting in the way of me having a good quality life”? I think what can make this so much worse is that if you’re having this experience, you just pull back from everything, so you’re not having experiences with friends or you’re not having experiences in terms of furthering your career or going on holiday or whatever it may be. “All my life is now just about recovery and there’s not anything else going on except that” – that becomes a very dangerous place to be in because there’s nothing really to buffer that, and you do get into a place where there’s those constant thoughts because there’s nothing to hold your attention in some other ways.

So it would be starting to look at, “How do I create a life that starts to demonstrate to me that my body is not an issue?” And some of those things can feel easier to do, some of them can feel much more challenging to do. But this is if I’m thinking about this bigger picture, not just in the moments where you’re struggling, but bigger picture if you’re wanting to change this over the long haul, this would be the stuff that I’m suggesting you work on.

00:19:43

Should I not give in to cravings?

The next question comes from Fernanda, and she says, “How do we or should we psycho-educate our patients about habituation vs extinction burst when it comes to cravings and binges? This is where I’m coming from: when someone has a craving, if they give in, they can have a binge and reinforce the habit neural pathway, right? At the same time, the habituation to eating and some foods are a very important part of the work. What my guess is – they shouldn’t give in to the craving in order to put it in extinction, but they should be trying, outside of those craving moments, the habitual exposure techniques. Or is it right that we hear online ‘when a craving comes, feed it, eat what you want’ and this act would be responsible for the habituation? Would we be ignoring the habit reinforcement if we follow this line of thinking?”

Let me just say that in terms of the “Should I not give in to the craving in order to put it in extinction”, I do not believe that that is a helpful way of dealing with this, especially for someone who is early in recovery. I really think that there’s this mistake of treating all cravings and even all binges as being this ‘bad habit’ loop, and this ‘problem behaviour’.

Often, a binge is this predictable biological and psychological consequence of someone being in deprivation. A low-energy brain becomes hyper-focused on food and cravings intensify, and there is then more of a chance that you’re going to have either this loss of control moment, or you’re going to have moments and times where you’re eating a lot more food because of this.

I think it can be very easy to get into this way of thinking that cravings are bad. I’ve seen this so much online, like “If you’re craving chocolate, it really means that you need magnesium and zinc, so try having some nuts instead” or “If you’re craving this thing, what it really means is that you need broccoli.” It’s just this idea that we should never crave particular ‘bad’ foods, and if we are, we don’t really need them; we actually need something else.

I just don’t believe that to be true, and the more that someone tries to take that as a path, the worse it gets. The more that food, one, becomes put up on this pedestal, but two, it then becomes off limits. It feeds into the drive to have that food. So even if you escape it for that moment on that day, the next day, the next time, it is building and building.

So if someone is going through recovery, the thing that really ‘extinguishes’ those cravings – and more accurately, means that someone starts to return all foods to just being food again – is by not resisting them, not suppressing them, not trying to white-knuckle their way through that moment – by actually eating more.

What I’ve seen for lots of clients, especially clients who do have a history of binge eating disorder, is that in the beginning, as they start to eat more food and they eat more consistently, it can lead to more binges in the beginning. Because your body is finally saying, “Oh wow, there’s food available. This doesn’t happen very often”, so then the impulse is to have a binge and to eat more in those moments.

And part of that is your body is in a really depleted state, and it needs more energy coming in, so it’s making the most of this availability. But what happens is as this continues on and you eat more and you eat more consistently, you get to a place where that’s just not happening. So if we’re looking at the habituation vs extinction thing, the way that you extinguish binges is by giving yourself full permission to eat so that your body does trust you that there is going to be food tomorrow and next week and it doesn’t have to go down this road, and you’re then not getting into those energy-depleted states.

I think there can be this misconception “If I start eating all of these donuts and I start having all of this peanut butter and all of these foods, that’s going to become my norm all the time and it’s the only thing I’m ever going to eat”, and it’s just not what I see. Yeah, there can be a period where there’s a lot more of those things coming in, but at some point the novelty with all of these things disappears. And it’s not that you can’t still appreciate how good peanut butter tastes or how good pizza tastes or whatever it is, but you really right size that.

I’ve had clients who were eating jars of peanut butter every week and just get to the point of “For now, I do not want to see any more peanut butter. The novelty is just not there anymore. I’ve had my fill for a while. Yeah, I’ll come back to it, but man, it just does not hold the power over me that it used to have.” So that is the way that I would think about this.

And look, I’m conscious when I add this that the eating disorder can hear this in the wrong way, so I’ve been questioning whether to add this piece, but I don’t want to create this very binary, black-and-white idea with this. I want to add that there can be times where people are using food as a conditioned coping strategy in the absence of deprivation. That’s typically not what I’m seeing, especially in the early stages of recovery.

But if I’m thinking about this, there is a client that I’m currently working with where she has been eating a lot more and she has been eating a lot more consistently, and for quite a while there wasn’t any binges, and then there have been some that have come up more recently. The first one, it felt like “Okay, there could be some deprivation that has gone on here” and then more recently there was one that was like “Actually, it doesn’t feel like there’s deprivation that has happened here.” But what we’ve been able to identify is when there are moments of real heightened stress and that doesn’t get responded to adequately and it goes on and on, then at this point, her response is more to have a binge in those moments because that has been something that has conditioned over a long time.

So what we’re working on is, how can she start to pick up all those signs earlier on that ‘we’re going in this direction’? And part of that is I really want you to still consistently eat. I want you to have the foods that have previously been off-limits all of the time. I want you to have the foods that you previously were only eating during your binges. I want more of those into your day to day. So it’s not that there’s no food connection with this in terms of how we’re working on it, but there are other components that can come in.

But I think what happens, and why I’m hesitating to even have mentioned this, is most people instantly think “That’s where I’m at. This has got nothing to do with food. This is because I’m an emotional eater. This is just my coping mechanism”, and it’s actually being driven really by the state the body’s in, and there is this restriction that is still going on.

I think people can get to the place that I’m talking about here where it can be going on for other reasons outside of it, but let’s remove all the chance that that’s actually what’s going on first. I would say this client is more of a rarity than the norm. So starting to deal with all of those other things first and then we can come back to this piece later on.

00:28:21

Why does my child with an eating disorder treat me like rubbish?

The next question comes from Jojo, and she says, “Why does my eating disorder child treat me like rubbish when all you’re doing is trying to support them?”

I really understand how hard this is. I think I’ve commented at various points, having a child or having my child with an eating disorder – that is terrifying to be in that situation. For you to be doing your best to try and support them and what you receive back is not loving kindness for that support, I understand how hard that can be.

In terms of why they’re doing this, it makes complete sense why they’re doing this. The eating disorder experiences your support and everything you’re trying to do to help as a threat. So if you’re encouraging food, if you’re encouraging rest, if you’re encouraging weight gain, encouraging to be honest or flexible or whatever it is that you’re trying to do in terms of support, this is unintentionally challenging the eating disorder. The eating disorder creates a sense of safety. It creates a sense of control. It’s a way of numbing. It’s part of someone’s identity at some point. It’s this emotional protection. So you’re in essence trying to remove this thing that is meeting a lot of needs.

We can look at, it’s meeting them in a really bad way and it’s creating lots of collateral damage and lots of other problems, and that can be true – and at that point, it feels like “This is the best that I know” and it can feel very difficult to want to give that up. And the way that the body reacts is that “This is a threat, and that’s what I’m experiencing.”

And being able to remember that starvation changes the brain. That low energy availability increases rigidity, it makes there more emotional volatility. There can be this very black-and-white thinking, obsessionality, threat sensitivity – there are all these things that actually change within the brain, that change within the nervous system, on top of the fact that I don’t know how old your child is, but your child is not going to be at full emotional and cognitive capacity just from an age perspective.

And then if you add the eating disorder on top of that, it’s going to be even more of a factor in why they’re reacting the way that they are. They’re having this severely stressed nervous system all the time, and then, as loving and kind and supportive as you’re being, that’s being interpreted as a threat.

I would also add, there can be this mix where “On the one hand, I want to be really defensive about this and on the other hand, there is a huge amount of shame and fear and worry about the dependency with this. There can be brief, there can be loss. There can be all of these things that are going on, and those emotions can be really painful to feel. They can be very vulnerable to feel. So the way to be able to deal with that is through anger and blame and hostility and withdrawal because these are the protective mechanisms, because it feels safer to be at that level than to actually deal with everything else that is coming up within me.”

Paradoxically, the closer the relationship is and the more important the relationship is, the more emotionally reactive they are. In a sense, your child feels the safest to be big and explosive and say horrible things and to be defiant and all of this because of that closeness in that relationship.

With all of this, I truly understand that it is really hard, and being able to recognise “My child is being affected by this. Their nervous system is being affected by the state that they’re in, and that’s having an impact on the way that they’re behaving in this moment and the way they’re interacting with me.”

I said earlier, my biggest fear is having a child with an eating disorder, and I don’t have that, but I have a child who does have a lot of struggles around nervous system regulation and a lot of social anxiety and processing differences. So I have been on the receiving end of a lot of verbal abuse, a lot of physical abuse, a lot of explosions. And realising how difficult it is to navigate that – and the more I can be able to recognise, “This isn’t about me, and this is a person who is struggling in this moment, and what would actually help to support his nervous system in this moment?” as opposed to, in my worst moments, I get into the expectations piece and I get into how ‘kids are not meant to behave that way, you shouldn’t be able to do that, that’s so disrespectful’ or whatever it may be.

If I go to that place, it doesn’t end well. If I can stay at the place of like “Okay, this must be a real challenge, and how can I be that co-regulation in this moment?”, it goes better. It doesn’t always go the way that I would love it to go, and it can be exhausting with these things – and I also understand that the more I’m able to be compassionate with that experience, the better it goes.

And this doesn’t mean that you say “Okay, it’s fine then, you don’t have to have your snack” or “It’s fine, you don’t need to have your dinner.” It can be “Hey, I do need to hold this boundary. And I know this is really uncomfortable for you. I know it sucks that I’m asking you to do this. I know why you’re giving this torrent of abuse at me at this moment. And I’m still going to sit here with you while we finish this meal, because you need to finish it” – if you’re taking the family-based treatment option with this.

But you can do that from a place of kindness and compassion even if you’re getting this blowtorch of fire being thrown straight back at you. But again, I know this is very hard to deal with.

00:35:11

Why are recovery support groups so hard to find?

The next question is from Jessica. I will just shorten the question down a little bit. She said, “I’d love to hear an episode or your thoughts on the inaccessibility of recovery support groups. I have many friends in Alcoholics Anonymous and Narcotics Anonymous, and for them it’s a way of life and a cornerstone in their sobriety. I wish so badly there was a widely available group for those with eating disorders. I’m in the final 25% of recovery after 10 years of anorexia. I sometimes find myself in a funny no-man’s-land – not sick enough anymore to really feel comfortable in an online group of deeply ill people, but not fully well either. Young people need support desperately. I think you could speak well to this.”

I do totally understand this, and I also see how much especially services – I’m talking from the UK over here, services within the NHS – are there when you are at death’s door, you are in this absolute desperate need, and then once you get a little bit better, it’s like “You’re good. Go and do this thing on your own” and it just creates this revolving door where someone gets a little better and then they get left to their own devices and it just gets worse again. We need to focus not just on getting people out of those life-and-death situations, but how do we then really, truly transition it from someone who is still clearly living with an eating disorder to getting to a place of being fully recovered?

This is going to turn into a plug for the group that I’ve created and the group that I run. I didn’t create a group for eating disorders for a really long time. I had my own biases around this in that if you put people with eating disorders in a room together, it doesn’t end very well. People are sharing tricks, people are not wanting to recover, and that just rubs off on everyone else and it’s not a productive thing in recovery.

And I still believe that that is largely what’s going on in lots of places, and I also don’t believe that that is necessarily true. So I have created a group – and I’ve been running this now for the last three years – where it is people who want to fully recover, and they have put their hand up and said “I want to do this.” It’s not people who are being sent there by their parents who don’t want to recover and are just doing whatever they can to get out of it; it’s people who are saying, “Hey, I want to actually do this.”

And the focus isn’t just on how do we get you out of that really early stage of needing to do the nutritional rehabilitation and needing to take the pause on the exercise, etc., and after that you’re out on your own – it’s “Hey, I want to have people go through all the stages of recovery.” So as part of the group, yeah, there are people who are very much in the beginning stages of recovery, and there are people in the group who are many years into recovery and I would say are in a really strong spot in their recovery, and they’re working on all of the other aspects of recovery that aren’t just about nutritional rehabilitation and exercise and body image, but all of the ways that the eating disorder had got its tentacles into all aspects of life.

Especially if someone’s in their late thirties, mid-forties, early fifties. They’ve lived with an eating disorder for 20, 30 years. It has an impact. So being able to have a space where people are able to support one another, are able to share where they’re at honestly about what’s going on, to really feel this community in that.

I know I’m biased and I know I’m talking about something that I run, but hey, I think I’ve created a really good thing in the group, and we do have a really good mix of ages of people in there. We have a good mix of people in different stages of recovery. So what you’re describing isn’t a pipe dream. I do have something that does fit the bill of what you’re describing.

So if you, Jessica, or anyone else who’s listening is interested, there will be a link to this in the show notes. Or if you just send an email and put ‘group’ in the subject line, I can share the details about this. But yeah, I wholeheartedly agree with what you’re saying and I also have wanted to create this.

It’s the same in terms of the way that I work with people. I don’t want to just work with someone just for those beginning stages; I’m very happy to work with people on an ongoing basis, and I have many clients that I’ve been working with for a number of years because they want to keep going. They want to deal with all of the other bits.

You talked about there’s this final 25% that you need to do – that is the part that really, truly cements recovery. That’s the part that turns this from “I’m another 10 years on and I’m still in that quasi place” to “Yeah, I’ve really got over this and this is something that is truly in my past.”

So one, keep working towards that final 25% because I think it makes a massive difference in the trajectory of your life, and two, get in contact and I would love to have you be part of the group and continue to do that work in that environment.

00:41:10

I hate my eating disorder, but why can’t I change?

The next question is from Emily. “I’m currently going through the worst relapse after struggling with anorexia for six years. It’s never been this bad. It’s gotten to the point where I’m so miserable in this lifestyle and I’m losing everything around me, but for some reason I just can’t bring myself to change my habits. I hate them, but no matter what, I keep going back to them like I deserve to live this way. Do you have any advice on this?”

What you’re describing, unfortunately, is a very common thing, and it’s very common especially as eating disorders get more entrenched, and especially common as you have moments of being more in the depths of an eating disorder, where there is this feeling of “I want this to be gone but I keep returning to my behaviours.”

What I want to say with this is this doesn’t mean that you secretly love the illness, or that you’re choosing misery. The way that the brain and the nervous system work is that repetition creates powerful neural and behavioural and emotional and psychological conditioning, and these behaviours, even if you can recognise that they’re causing all of these problems in your life, at the same time, they are providing some sense of temporary relief. They are connected to your identity. There is some level of certainty, that you know “When I do this thing, this is what’s going to happen.” They do provide some sense of numbness when you need that to happen. There is some regulation that happens as part of it.

So it’s being able to recognise, “Hey, this thing that I really don’t want, it is actually doing something for me, and I do want to find another way of being able to cope and another way of being able to deal with the challenges of life.” But I think it can become this thing where it becomes very one-sided, like “I don’t want this thing, it’s doing absolutely nothing for me”, and I just don’t believe that’s true. I think what becomes a lot more helpful is starting to look at “What is it actually doing in my life? What needs is it meeting for me? What ways do I not know how to do this outside of the eating disorder?” That then becomes the more important thing.

I would also be cautious about the thought of ‘maybe I deserve this’. I think eating disorders are very quick to attach morality to suffering and your brain can then start interpreting the things that you’re doing as punishment and as deprivation and as isolation and self-destructive, and ‘this is virtuous’ or ‘this is deserved’ or ‘this is because you’re so bad that you deserve this kind of life’.

Those kinds of thoughts are just a symptom of the illness. It’s your mind making sense of what’s going on, and that being the supposedly logical argument that it comes up with. But it is not an objective truth, and it is not saying anything about your worth as a person. It’s just this is the kind of thought that comes to mind when you get into the depleted state that you’re in.

I would also add with this, there can be this feeling of “I need to wait until I really feel ready to then start to find my way out of this hole.” Like I say constantly, recovery starts with behaviour first. It doesn’t start with feeling confident or feeling you can do this; it starts with “I did these things, I’ve had a really tough day with all the regret and all the thoughts coming up, but actually I did start to do this new thing. I did start to have that breakfast again. I did bring in this snack. I started to have carbohydrates again”, whatever it may be. Those acts while your mind and nervous system are screaming at you, that’s the thing that starts to move the needle and have you go in a different direction.

The thing I would also add with everything you’re describing is if this is the worst relapse that you’ve had and it feels like you’re really losing everything around you and you’re white-knuckling it to get through the day but it’s not improving, stop trying to do this on your own. The eating disorder will always be very convincing. It will make you second-guess everything. It will be “I start the day with these very good intentions and then they completely fall by the wayside”, and that is just so much more likely to happen if you’re trying to do this on your own.

So if you are doing this on your own and you’re not getting support, I highly recommend that you reach out and get support with this, whether that’s through me, whether that’s through someone else. But don’t be trying to do this on your own. Have outside support to help you deal with this, because as so many people who recover realise, “This is the most difficult thing that I’ve ever done. I needed to have support to actually get myself through this. I just couldn’t do it on my own.”

So figuring out what is the right kind of support or accountability or treatment input or connection or whatever it is, but finding that. And I know that obviously there can be blocks depending on where you live, what is available because of financing, all of these things. But finding something that can help you through this as opposed to doing it on your own.

00:46:56

How to grieve diagnoses of co-occurring medical conditions?

The final question is – this was from Kenna – “I think it would be really neat to explore co-occurring medical conditions in eating disorder recovery, especially less commonly discussed ones like pancreatic insufficiency. A conversation about how to grieve medical diagnoses and work through feeling like your fault because of the eating disorder would be amazing. As someone who has a co-occurring medical condition, I often struggle to follow through on treatment for those medical conditions because I feel like I caused them from the eating disorder and my body should be fine now. I’ve wrestled with the heaviness of feeling like there’s not a light at the end of the tunnel with recovery because so many things / symptoms / diagnoses, even outside of the eating disorder, feel like they’ve been so set in stone for the trajectory of my life.”

This is actually something that needs more attention. I think there’s a lot of well-meaning recovery content that is “You do recovery and if you do all the rest and if you do all the eating, everything just recovers and you get back to this wonderful place of health, and it’s as if nothing ever happened and it’s all great.” And that’s just not true.

And it’s not true when we look outside of eating disorders. If we look at the general population, there are some people who are in very good health. Some of that’s down to behaviours; a lot of it’s just down to dumb luck, whether that be the genetics you were born into, the family you were born into, the socioeconomics you were born into, where in the world you were born. So much of what we chalk up to behaviours and us being in control of our health is not from that. A lot of it is just luck. Even if you’re keeping up behaviours. Yeah, you’re keeping up behaviours because you had this upbringing that meant that those were much more likely to happen, or because you had the disposable income to allow that to happen, or because you’re got the job that allows that to happen.

So it’s not that there is nothing in terms of the personal responsibility piece, but I think there’s often way too much of a leaning in that place. I just want to say that yes, you can weight restore, you can eat normally again, and your body doesn’t fully reset. And part of that could be because of things connected to you having an eating disorder for X amount of years or decades, and part of it could be no matter what you did, even if you didn’t have an eating disorder, you were going to end up in this place just because of that’s the trajectory your body was on based on genetics and all of these different things.

I think it can be really dangerous to get into “I caused this, so I don’t deserve help” or the “My body should be fixed by now because I’ve been doing this recovery stuff.” Shame is just a really terrible motivator. It’s not great for long-term care. It doesn’t help. So really recognising where shame is coming up and where there is this self-blame and being able to cut it off.

Especially if you can notice “When I get into that place, I neglect treatment, I ignore symptoms, I avoid appointments, I subtly punish myself” – this is then not actually helping you in terms of, if the end goal is “I do want to take care of my health and do that in a genuine way, not in a ‘being healthy’ eating disorder or diet culture way, but if I really do want to take care of myself, what are the things that would be most helpful for me?”

Constantly focusing on the fact that “I brought this upon myself, if I didn’t have an eating disorder, if I hadn’t made these choices, this wouldn’t be here” – I just don’t think that’s a useful line of thinking to spend your time ruminating on. And yes, thoughts think themselves, and those kinds of things can come up, and then being able to notice that “When that comes up, I’m going to do this technique or I’m going to do this thing so that I actually start to put my attention somewhere else because I recognise that that doesn’t really help me.”

I do want to add that what you’re describing is a really common thing for many clients that I work with, and I think there can be a feeling of like “This is really unfair. Not only have I had to live with an eating disorder, not only have I had to go through all of the difficulties that is recovery, I now do this and then at the end of this, I have this co-occurring condition that is still going on, or multiple co-occurring conditions that are still going on. That feels unfair.” I can even extend that out, “That’s not what I was promised” or “This is not what I thought was meant to happen as part of recovery.”

So just being able to recognise that this does happen for lots of people, and this happens for lots of people outside of having an eating disorder. There are many people in the population that live with a chronic illness or live with multiple chronic illnesses. As part of the diet culture that we live in, there is this idea that if everyone did all of the right things, we’re all going to be living to 100 and being in perfect health and we’re going to die in our sleep and have had the most wonderful century of our lives, and it’s just not true. And it’s especially not true given the world and the society that we live in at this point.

So yes, I would say that there is some work to be done around here for you. There could be some journalling, there could be some reflecting, there could be some deeper work with this. And recognising that it’s not a given that just because you went through recovery, you get this complete health reset at the end of it, that you’re in perfect health at the end. That is not the case for everyone, and I wouldn’t even say it’s the case for the majority of people, especially as people get older.

It could be one thing to assume that more if you’re very much in your early twenties – and even that, it’s not a given. But as you’re in your thirties and in your forties and your fifties, there’s much more of a likelihood that there are going to be other things that are going on. I just would avoid the thinking of “I created my own pancreatic insufficiency because of the things that I did.” I don’t agree with that. Even if it is connected to having an eating disorder, you didn’t choose to have an eating disorder; you didn’t get to pick your genetics so that when you ate in a certain way, it turned into an eating disorder compared to someone else who eats in that way and after a week thinks “Oh my God, this is terrible, I’m not going to keep doing this thing.”

So yeah, getting out of the blaming yourself and recognising when those thoughts come up that “This is unhelpful.” Even if you can’t get past the “This is true”, you can still recognise that “This is true and it doesn’t serve me to constantly keep focusing on this and thinking about this.”

00:54:43

Conclusion

So that is it for this week’s episode. As I said at the beginning, I’m taking on new clients, or at least for now. I don’t know when there’ll be the pause on that again, but yeah, if this episode has helped to demonstrate my knowledge, my compassion, my understanding of eating disorders, and you would like help with recovery, then please reach out.

You can send an email to info@seven-health.com and just put ‘support’ in the subject line, or you can send a message on Instagram to @sevenhealthcompany, and again, just put ‘support’ in the message and I can get the details over.

So that is it for this week’s episode. I will be back next week with another one. Until then, take care and I will see you soon!

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