368: The Forgotten Phase of Eating Disorder Recovery

Chris Sandel: 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 an eating disorder expert, and I help people to fully recover.

Before we get started with today’s episode, I just want to say that I’m currently taking on new clients. If you are living with an eating disorder and you want to reach a place of full recovery, then I would love to help. I know the idea of full recovery can feel like this distant, far-off thing or it just happens for some people, but I truly believe that if you do the things that are required as part of recovery, you will reach a place of full recovery.

So if you want help to get to this place, then please reach out. You can send an email to info@seven-health.com or you can send a message on Instagram @sevenhealthcompany and just send a DM, and you can put ‘support’ or ‘coaching’ in the subject line or in the message, and then I can get the details over to you.

00:00:57

What is the forgotten phase of eating disorder recovery?

So let’s get on with today’s show. Today, I’m going to title this one ‘The Forgotten Phase of Eating Disorder Recovery’. What I see happening a lot is that nutritional rehabilitation and the earlier stage of recovery receives a huge amount of attention, and rightfully so. It is so important for the repair of the body to restore cognitive capacity, to reduce so many of the symptoms that are caused by malnutrition as part of the eating disorder. So it makes sense that there’s a large focus that is placed here.

But I think what happens is this can be mistaken for the whole of recovery, and recovery doesn’t just end because you’re now eating more or you’ve gained some weight or you feel that your body has done the physical weight restoration piece. In many ways, this is just setting the foundation for actually starting the next phase. And the next phase is learning how to cope, building relationships, how to inhabit your new body, how to return to movement, how to navigate the messiness of life without relying on an eating disorder.

I think that this phase is less visible; often by this stage, people aren’t thinking you still have an eating disorder. People are probably thinking you’ve moved on and that this is something that’s in your past. It can be a lot harder to measure. It’s not the same as in some of the early stages, and I’ll go through this in more detail in a moment. And often people receive a lot less support during this phase.

So I think that’s a reason why I want to talk about it today. I think it also takes considerably longer than the early phase. The nutritional rehabilitation phase can take lots of different lengths of time depending on how people do it and how aggressively they attack that or how slowly they’re doing this and how long the eating disorder has been going on, and for many different factors or many different reasons.

But I do believe that if someone is doing the nutritional rehabilitation phase in earnest, that’s a lot quicker than this next phase that I’m going to talk about, and this next phase is the thing that really cements the recovery. It’s not that the first phase isn’t important; it actually really is. It’s just this is the thing that really, truly means that you learn how to live a life without an eating disorder.

00:03:31

A common scenario after nutritional rehabilitation

I want to just go through a scenario, and maybe this fits you, maybe it doesn’t. Maybe you’re wanting to get to this phase but you haven’t quite got there. But I want you to imagine that you’ve reached this place of recovery where you’re eating considerably more, you’ve challenged many of the fear foods, you’ve gained weight and feel that weight restoration has happened or it’s getting there. Your physical health has improved. You’re getting a lot less symptoms than before. A lot of symptoms have disappeared. You’ve reduced or stopped exercise and you’ve stopped the most obvious eating disorder behaviours. Other people are telling you how much better you seem.

And I don’t just mean this – and I think this often happens very early in recovery when someone puts on a bit of weight and they can receive those comments of “Oh, you’re looking so much better”, but where people are able to say “Hey, it’s been lovely to actually have this dinner with you and to recognise how much more relaxed you are and how much more present you are.” So there has been more than just an aesthetic shift; there’s been a shift in terms of how someone actually is in their body and how they are in relationships and in connection and all of those things.

You could be in this place, and these things have all occurred, and yet you don’t feel that you’re actually recovered. This can be going on and yet you’re still thinking about food quite a lot, or you’re still thinking about your body quite a lot, or you’re still struggling with body image quite a lot. You could still struggle to know how to deal with stress without restriction or without exercise. Sometimes you do well on that, sometimes you’re not doing so well on that.

There’s maybe some rules that are still hanging about. There’s still things that you haven’t quite been able to do just yet. There’s a lot of things you have been able to do, but there’s other things that are still hanging around. You’re still trying to bring exercise back in, and maybe you’re doing this but you’re discovering it’s feeling quite complicated and it’s not been as smooth as you may have hoped.

Or maybe life is just still feeling more small or more rigid or more organised in a not-so-helpful way around avoiding discomfort. So there’s been a lot of improvements, but there’s still a lot of this going on.

You could be even further than this point. I think there’s people who are at that point that I just discussed, but I think there’s a further point where someone can feel like “Hey, food is no longer dominating my thoughts. I feel pretty good in terms of accepting my body. Yes, I have days where I have wobbles, but in the whole scheme of things, it’s not preventing me from doing anything in my life, and I’m in a phase of being able to accept, at least through an action-taking perspective. I’m wearing these clothes, I’m doing these things. I can eat really flexibly, I can eat spontaneously, I can eat with lots of different people in lots of different settings. I’m not having compulsions to compensate or anything like that.”

It just feels in a lot of ways like the eating disorder is no longer interfering with your life, and yet even though that has occurred, you’re still trying to figure out how to live without the eating disorder, without the structure or the identity or the protection that it provided. You can look around and still notice that “While the eating disorder is not a huge part in terms of my sense of worth, I’m looking towards work or achievement or ‘productivity’ for that sense of worth. I still struggle with people-pleasing and feel really bad about disappointing people and that feels so uncomfortable for me to do. I really struggle to recognise and be able to communicate my needs in the way that I would like to be able to do. I find it difficult to set boundaries or to say no. I just really hate conflict and I try and avoid it at all costs, and I’m not very good with vulnerability or with asking for support.”

Or “I recognise that I’m still having lots of trauma responses.” There could be things that predate the eating disorder or happened during the eating disorder, but “I can notice that my nervous system is still dealing with this stuff.”

Maybe there’s neurodivergence that either you knew about for a long time or you discovered through recovery, and you’re still figuring out how to live in a way that supports you with that going on, and in a way that supports you now that you don’t have the eating disorder, which has been that one way of being able to cope.

There can still be these feelings of guilt when there is rest or not being ‘productive’. And not to the degree that it was in the eating disorder, but there’s still this underlying belief around that or some struggles connected to that.

These things can still be going on even though in a lot of ways the eating disorder is just not there anymore. And this is a lot what I mean by this forgotten phase of recovery. The earlier situation that I talked about, this can be the start of this, but you can be in this place that I’ve just described now and I still think that there is stuff to do in terms of your recovery.

This phase isn’t just about eliminating the final eating disorder thoughts; it’s really about discovering who you are and how you want to live and how to really navigate the ordinary difficulties of being a human being without the eating disorder. Nutritional rehabilitation helps you move out of this survival mode that people have been in for such a long time, and then this is really learning how to live while you’re out of that survival mode.

When I think about this phase, it’s especially important when the eating disorder has gone on for a long time. Like if I’m thinking about someone who, for example, at age 21 developed their eating disorder and by age 23 they were already doing recovery, it’s not a very long time. And I want to be clear here; I know those couple of years can feel like dark nights of the soul and can be very, very difficult, but by age 21, you’ve already discovered a lot of who you are and the things that you like, and there’s only been a couple of those years where the eating disorder has been having an impact, so once you’re recovering, you’re in a lot of ways going back to where things were before.

And I’m simplifying things here. It might not be quite that straight forward. But there’s a difference between that scenario that I just went through versus “I developed my eating disorder at age 14 and I’m now 36, or I’m now 48, and I’m starting to do recovery.” We’re now talking about multiple decades where the eating disorder was really having an impact on behaviours, on the kinds of choices that you made in your life, on relationships, on the kind of job that you did take or didn’t take, and it’s had such a big impact.

This phase is going to be much more important, it’s going to be a lot longer, because there’s so much discovery that’s going to be happening. There’s so much time where you missed out on being able to discover a coping skill or discover that “Actually, I really like this thing” or “I don’t actually like this thing.” The eating disorder has had such an impact on your preferences, on what you will have tried out or not tried out, etc.

This is why this phase can be so important, and especially because I so often work with people where the eating disorder has been going on for multiple decades. This is going to be a big chunk of the recovery process.

00:11:31

Nutritional rehabilitation is still the foundation

I want to make it really clear that nutritional rehabilitation is still the foundation. I don’t want it to feel like this episode and what I’m going through is minimising that or saying you can just jump over that or it’s not actually that important. It is absolutely important, and without that first phase, you don’t get on to any of these other bits. Without the adequate and consistent nutrition that is needed to come in, your brain is going to remain really rigid and obsessive and your nervous system is still going to react to certain things as if they are a threat.

Your emotional regulation is going to be a lot harder. Even though the eating disorder is better at numbing things, your capacity to actually feel and experience the full range of emotions is going to be completely minimised. Food and body and exercise and all these kinds of thoughts are going to be much more amplified, and they’re going to be amplified from a biological/physiological standpoint because of the nutritional state that the body’s in. You’re going to be more likely to have heightened anxiety or depression or worries and neuroses, and the way that the mind is affected when you’re in this state, you’re going to have less capacity to do the psychological work.

And it’s not that you can’t do some of that, but your capacity to withstand and to deal with the challenges is just so diminished when you’re in this state.

I think one of the bigger pieces with this, especially if the eating disorder has gone on for a long time, especially if it developed when you’re in your teenage years, is you can really mistake so many of the symptoms of malnutrition and the eating disorder for being “This is just my personality” or “This is just deeper emotional problems that are going on” as opposed to recognising “This is the state that I’m in, and once I move out of that state, it’s amazing how many things correct on themselves.”

And it’s not that it does everything. There’s still work to be done, as I’m talking about with this next phase. But it’s amazing how much someone’s state and the thoughts and feelings and beliefs and perceptions and all those things that naturally arise within all of us, how they’re affected by being in this depleted state.

You can do all the journalling in the world, you can do all the thinking in the world, you can have all the therapy in the world, but none of those things are going to change the state that you’re in unless you do the eating and the rest and the things that are required as part of the nutritional rehabilitation.

So I just want to be really clear that I’m not saying you should skip over that because this other phase is the longer and more important part of recovery. This first phase really needs to happen. The nutritional rehabilitation is the thing that gives you the capacity to do the next phase of work.

00:14:42

And nutritional rehabilitation isn’t the only thing

I want to also be clear that the nutritional rehabilitation isn’t the only thing, because I think often this is what people can start to believe. I think part of that is because nutritional rehabilitation and this early phase gets so much more attention, and I think there’s some understandable reasons why this is. Someone can be really medically unstable, so it’s really urgent that they’re getting the care and they’re getting the energy coming in and the changes, because there can be life and death situations, or there can be symptoms that are really having a massive impact on the quality of someone’s life. So yeah, it makes sense to really keep this at the forefront and talk about this and focus on it.

the goals in this stage are much more visible and concrete. It’s much easier to be saying, “We need to be changing these things with the meals. I wasn’t doing this with snacks before, but I am now doing this thing with snack. I wasn’t eating this food, and now I’ve brought it in. I wasn’t having this break in terms of my exercise and now I am. My weight was at this level and now it’s at this level. I was having this symptom in terms of I was waking up five times a night to pee or I was cold all the time” or whatever it may be, and now that has stopped or that has reduced.

It can be a lot easier to measure improvement or it can be a lot easier to plan out goals because there are these very specific, tangible things, and it can be easier to notice progress in terms of certain things changing. And it’s not that it’s very black and white, because so often in recovery, as you’re making changes, this thing’s getting a little better but this thing’s getting a little worse. So “Yes, I’m noticing I’ve got a little more energy, but man, my digestion has got worse” or “I was sleeping better and now that’s got worse.”

So it’s really understanding when certain things get better or worse, that’s actually still taking you in the right direction. There can be times where clients have this thing that’s apparently improving, and it’s like, “No, that’s actually not happening for the right reasons.” And there can be times where things are apparently getting worse and it’s like, “That’s what should happen. I’m expecting that to happen, so keep doing what you’re doing.”

This phase, one, can just feel more urgent, so it gets more attention, but two, it’s just easier to measure, so there can be this idea of “I just need to eat more, I just need to gain weight and become medically stable, and then I’m recovered.” And I just don’t think that that is true. Yes, that’s a really good starting point to be in a better, stable place, but that’s not full recovery.

If you have thought “That’s the place I need to get to. I’ve gained some weight, I’m feeling better now, I believe the weight restoration has happened – I should be recovered by now”, that’s a false finish line. There is more work to be done from there.

00:17:55

Learning coping skills in all phases of recovery

What I would also add is I don’t think this is binary, where you’re just doing the nutritional rehabilitation in that phase and then afterwards it’s learning all the coping skills. You’re learning coping skills, or I think you should be learning coping skills, as you’re going through recovery in that first phase, because that is a lot of what I focus on with clients: it’s not just you need to white-knuckle yourself through this phase; it’s learning ways to deal with thoughts and feelings and emotions and sensations and this specific situation and scenario and how to deal with it.

But I think what the difference is, when you’re in the earlier stages of recovery, much more of the focus is on “We’re doing this so that we can get the food in, and we’re doing this so that we can rest.”

You’re learning coping skills so you can manage the anxiety before and after a meal. You’re doing coping skills so you can learn to sit with the fullness and the digestive discomfort, or to respond differently to body thoughts as they come up, or to learn how to ask for support and ask for help. Using tools to resist the urge to compensate or to purge. To be able to rest even though it feels really uncomfortable to do so. To be able to tolerate the uncertainty around weight gain and around food, and to be able to experience distress and not have to do anything to immediately change it. You can use coping skills, but that’s not reaching for the eating disorder.

These are coping skills that you’re learning through this phase; it’s just that they’re being directed a lot more towards recovery and the actions required for recovery. And again, it’s not just that, because there will be times when there’s something going on with the kids or there’s something going on with the partner or you’re having this challenge with work. So you’ll still be using it in those scenarios, but so much of the focus is in that stage of doing the goals that are required to do nutritional rehabilitation. So that’s where that focus is.

As time goes on, you’re then looking at using these skills in a much broader set of circumstances. This is true as well because as you go forward with recovery, you’re opening up your life a lot more. Often in the first phase of recovery and nutritional rehabilitation, a lot of the time people aren’t doing a huge amount of things. There is a lot more of life being smaller and “I’m just doing the things that are required for recovery.”

But as time goes on and your life is opening up more and more, there are going to be things that become less predictable, and there’s going to be more spontaneity and there’s going to be more challenges that then come up. It’s then not just, can you use this skill to help you be able to have a meal?

It’s, can you use these skills when work becomes really overwhelming? When someone criticises you or rejects you? When you have to disappoint someone by setting a boundary or having a difficult conversation? When your child is distressed or is going through a challenging thing at school and you’re struggling to understand how to actually deal with that situation? When there’s relationship uncertainty? When you’re noticing “I’m feeling lonely or bored or directionless”?

This is something that comes up a lot as people get further along. In the beginning, often so many of the feelings around emotions and sensations and everything that comes up just gets channelled into it’s about body image, it’s about weight gain, it’s about the eating disorder stuff. And as time goes on, you start to recognise that “Even if my mind may go there for a moment, I can take a step back and ask myself, what else is going on? What’s really happening here? What emotion is actually happening here?”

Often, it’s the recognition of “Oh yeah, I am feeling quite lonely” or “I am feeling quite bored” or “I am feeling rather directionless” or “I’m feeling quite hurt about this thing that happened.” So being able to then adequately respond to what’s actually going on and what’s actually coming up as opposed to just this very blunt instrument of an idea of “It’s all about body image.”

Being able to use these skills when your body does change, or “We’ve now moved from being in the wintertime or now being in the summertime and I’m now dealing with the fact that all of the clothes from last summer aren’t fitting anymore, and I’m now having to deal with that process and the grief that may come up connected to that.”

So just being able to start to use the tools that you learnt specifically for recovery and starting to then use them in the wider life. Rather than the question being “How do I get through this meal without using the eating disorder behaviours?”, it’s “How do I navigate this difficult moment without trying to control everything, without returning to the eating disorder?”

00:23:27

Constructive coping skills don’t work immediately

The thing with this is the constructive coping practices, even though they’re ‘constructive’, don’t immediately make things better. If I look at something like setting a boundary, it will likely initially lead to some uncomfortableness with it. Maybe there’s some guilt that comes up. Maybe there’s some shame that comes up. Maybe there are these difficult emotions that come up because “I did this thing” and it doesn’t mean that you shouldn’t have done that thing. It just means that this is what happens when you start to make these kinds of choices or take these kinds of actions.

Like having an honest conversation with someone, in the long run, you can feel very good about that. But in the moment and shortly after the moment, it can feel really difficult. It can feel like “Oh God, that was so hard to do. Did I say the right thing? What are they going to be thinking about this?” So recognising that these practices are not going to feel as good as the eating disorder and as good as the restriction or the exercise or whatever tools or behaviours you’re using from the eating disorder.

It’s, again, about doing this enough so you start to recognise (1) “I can tolerate the discomfort and the challenge of doing this other way of coping” and (2) you start to realise that it’s worth it. “The discomfort that I feel now is worth so much more than all of the collateral damage that living with the eating disorder was creating for me.”

This just takes time to be able to get to that point, and the reality is you’re not going to respond skilfully in every moment. There will be times where you do overwork or you do people-please or you do avoid a difficult conversation or fall back into an old pattern, and that’s part and parcel of being a human. It’s part of going through the recovery process, and it’s often then noticing that “Oh, I avoided that thing, or that thing started to happen again, and what do I do about this now?”

This is where I think recovery is truly cemented. It’s where “There was that little slip-up or I didn’t do that as well as I would’ve liked” and then being able to respond accordingly, and not in a way where you’re belittling yourself, but (1) being able to have compassion and (2) then being able to take the necessary action to course-correct when you notice that’s gone on.

I want to just go through now a couple more specific examples in a little more detail, because these are some of the things that I see coming up throughout this phase. It’s not the only things, but it’s some of the things that happen I would say for a lot of people, so I think it’s worth going through.

00:26:14

Finding worth outside the eating disorder

One area is worth and achievement and productivity. I think for a lot of people – and again, the longer the eating disorder goes on, the more the eating disorder or facets of the eating disorder or things that happen because of keeping up behaviours can provide a sense of worth.

It can be feeling like “I’m disciplined” or “I’m in control” or “I’m doing something difficult” or “I’m doing something that most people would be envious of.” Especially as more and more of life falls by the wayside the longer someone’s in an eating disorder, it can become like “This is the only thing that I’m good at doing.” So when the eating disorder then starts to disappear, you may look elsewhere for that feeling, look elsewhere to get your sense of worth. That could come from work or parenting or recovery itself. It could come from constant productivity. Really trying to find, “Where is my worth from?”

What I would say with this is recovery gives you the opportunity to discover that “I don’t have to actually prove my worth. I don’t have to constantly justify my existence.” You don’t get there immediately, and there’s nothing wrong with saying “Oh, I feel good about my work” or “I had this experience with the kids today and I really feel good about how I was as a parent, and I can reflect on where I was a year ago and how I would’ve handled that very differently.”

I’m not against being able to recognise “I feel proud about this thing”, but there’s a difference between that and “If I mess up in my work, then I’ve got nothing. Then I’m worthless. So I have to hold on to this thing”, with parenting or whatever it may be. So really being able to discover, “My worth is inherent. There can be things that I want to prioritise and I’m good at or feel proud of, but this doesn’t dictate my worth, in the same way as with the eating disorder, what I ate or what I weighed or how long I was able to do exercise for can dictate my worth, and I want to move away from all those things.”

00:28:34

Moving away from people-pleasing + learning to set boundaries

The next piece is people-pleasing and boundaries. For a lot of people, the eating disorder can develop as a way of suppressing one’s needs. I think this is very common, especially because, one, a lot of people that I work with are Highly Sensitive, so there is so much more of this feeling of everyone around them and noticing everything in the room, so there’s this real heightened awareness of all of this stuff, and “I just didn’t know how to handle it, and I found the eating disorder and that was a way of being able to numb that or suppress that.”

Maybe you grew up in a family where your sensitivity wasn’t particularly liked, it wasn’t championed, it was something that you were made to be feel badly about, so “Hey, it makes sense that I want to hide this thing away.” So you can learn that “I need to keep other people happy, I need to avoid being difficult, I need to take responsibility for everyone’s emotions, I need to agree with people rather than risk conflict, I need to hide my anger or sadness or disappointment or whatever emotions I was taught we shouldn’t feel, or that those are not good emotions to have. I need to prioritise what other people want. I need to be low maintenance and I need to be self-sufficient.”

This isn’t just about sensitivity. I know I started this section talking about being Highly Sensitive. This can be connected to the family that someone grows up in and how your parents are and how they raise you and talk to you. Not just parents but your wider family, or the school that you went to, or your peer group – how those interactions can then have an impact on your thoughts and beliefs around what it’s like to show emotions or what it’s like to disappoint someone or to stand up for what I believe in.

So the eating disorder can really sweep in and become “my way of being able to negotiate with that and manage that.” Then as the eating disorder recedes into the background and falls away, it’s learning the skills to deal with your needs much more directly.

This is often a very challenging piece, and this is one of those things where it can take time, especially if someone has a trauma history or especially if someone is neurodivergent. There can be lots of complicating factors connected to this.

But really, it’s by going through the process and learning to say no without producing some elaborate justification. It’s okay just to say “No, I’m sorry, I just can’t do that today.”

Allowing someone to feel disappointed without swooping in and having to make sure that they’re all okay.

Being able to ask for help without reaching a crisis point. I think this is a really important one because often what happens is “It’s only when I reach this crisis point that I ask for help.” It could be that “That’s the only point I’m allowed to ask for help.” I’ve had many conversations with people where it feels like “My eating disorder has to get so bad, and I have to end up in a hospital or I have to have this thing happen, and then that can prove that I’m worthy of now asking for help, or people can see that I’m really doing the eating disorder and I’m not just faking it.”

So being able to recognise, “I don’t have to have everything completely unravel before I reach out for help. I can just notice things aren’t going as well as I would like right now or I’m struggling a little bit with this thing and I’m going to get some support for this.” Asking for help and support isn’t a bad thing. It’s actually a really useful thing to do, and it doesn’t need to get to this crisis mode before you do that.

Being able to recognise that resentment can be a sign that you need to set a boundary. “I’m noticing I’m feeling this resentment come up. I need to have a conversation with someone about this. And maybe I’m wrong; maybe my resentment, when we have this conversation, I can recognise that I’m viewing and framing this in a way that actually does need to change.” But rather than just feeling that resentment and not saying anything, it’s “I’m feeling that resentment and I want to verbalise that” and just saying “Hey, I want to let you know this is what I’m starting to notice.” So being able to say what you’re actually thinking.

It can be also being able to remain present during a disagreement, and part of this can be that your nervous system has got into a better place, so you’re able to be in this disagreement and this uncomfortableness without that feeling really unsafe and you getting into this shutdown mode or this freeze mode, but being able to have a disagreement and to be present and be okay that that’s happening.

And just understanding that being kind doesn’t mean keeping everyone happy. There are going to be times where you can be kind, but people are still going to be disappointed, or people are still not going to be happy with what you’ve done, and that’s okay, and that’s part of being able to set a boundary and understanding “where are my responsibilities and where are your responsibilities, and my goal isn’t to keep you happy all of the time.”

The goal with this, if I’m thinking about this from a people-pleasing boundaries perspective, it’s not to become selfish, it’s not to become indifferent to other people; it’s learning that “connection can mean, and should mean, that I need to be connected to myself too, and I need to understand what’s important for me as opposed to just putting everyone else first and I’m the last in line.”

00:34:46

Dealing with body acceptance + grief

The next piece is then body acceptance and grief of recovery. I think what can sometimes happen is that there can be the putting off of this. And maybe part of that is there can be a lot of narrative around weight overshoot, and “I’m going to put on this weight, but then it’s going to come down and I’m going to finish up in my new recovered body.” Sometimes there can be the weight gain that’s going on, and there’s the “I’ll deal with this later on. Maybe I don’t even need to deal with this. This is just my recovery body. It’s going to change later on.”

And then you reach a point where there’s a recognition of “Actually, there isn’t a later on. This is how it is, and this is the body that I’m going to be in post-recovery because this is where my body wants to be.” There can be a lot of grief that’s connected to that.

You can be grieving the fact that there was this body that you believed you could maintain, and you’re no longer living it. There could’ve been a lot of identity that was connected to thinness or fitness or feeling that your body showed that you were disciplined. There could’ve been certain clothes that you fit and that you liked being able to wear. There could’ve been compliments or approval that you received much more than you’re receiving now. There could be the fantasy that a particular body would make you more worthy or would make you more safe. And sometimes that’s not just a fantasy; sometimes that can actually be the case.

There can be also the grief of the years that were lost as part of the eating disorder and recognising, “Wow, this started when I was 15 and I’ve blinked and I’m now 35 or 42, and my God, all that time that has gone by as part of this.” Especially if you’re reflecting on “And I missed out on doing this thing and this thing, or I’ve ended up doing this job and I recognise I would’ve never done this if it wasn’t for the eating disorder interfering with this.” So there can be a lot of grief of how my life has been shaped because of living in the eating disorder or the lost opportunities with relationships, etc.

The body acceptance piece with this – it’s not just about loving your body. It’s grappling with and dealing with all of the different aspects that have happened as part of recovery. If I’m looking at what’s important as part of this phase, it’s allowing your body to exist without constantly trying to correct it. It’s removing or reducing the checking and the comparison and the reassurance checking, and just being realistic that there will be times where some of that comes up, and I think that’s very natural as a human being to have moments of that. But there’s a difference between having moments of that occasionally or in a very specific situation versus this being a very ongoing thing.

It can be wearing clothes that now fit your current body. I think for some people, there can be this phase in recovery where “I’m just not prioritising clothes right now. I just want to get through this. I actually feel quite uncomfortable so often in my body, so what I’m prioritising often is just comfort. I don’t really care what it looks like. I’m wearing activewear or a tracksuit top and tracksuit bottoms because that’s what is comfortable.”

It can then get to a phase where “You know what? I don’t want to keep dressing like that. I actually do want to start dressing in a way that does feel more in style with who I want to be and how I want to show up, and I’m more excited about clothes” and starting to wear things that really fit your body, whatever you want that style to be.

It’s participating in life even if there is discomfort. It’s not that there’s never going to be these things. It could be “Going to that thing does make me feel a little uncomfortable, but I’m still going to do it.”

It can be separating body feelings from body facts. There can be a lot of feelings that come up about your body; that doesn’t necessarily mean that those things are true.

And just recognising that “I’m not going to continue to live my life in a way where I’m prioritising changing the shape or the appearance of my body over the fact that I want to have relationships, I want to go out, I want to be able to do these things, and I don’t want my life to be reduced back to the eating disorder and trying to control my body.” Really understanding that you don’t have to wait until you love your body before you’re allowed to live your life, and that actually, the thing that allows you in a lot of ways to move forward with the body acceptance piece is “I’m doing more and more things, and I’m starting to recognise that (1) I can do so many more things in my life, and (2) when there are things that are challenging, I can cope with that disappointment or I can cope with that heartache or I can cope with those things that didn’t go to plan or may still be difficult.”

00:40:25

Bringing exercise back in

The next one is bringing exercise back in. This is something that I think can be a really difficult phase for people, and as part of recovery, when people are going through nutritional rehabilitation, I’m typically of the opinion that people need to be taking a rest. For how long and all the details connected to that are connected to what someone’s relationship with exercise has been like through their eating disorder and how central it has been to the eating disorder, how long it’s gone on, how depleted they are, all of these things. But as a general rule, my take is that it’s useful to be having a break, and it just depends on how long that break is for.

I think what can start to happen is that you get to a place where you do have more energy, you have gained some weight, maybe you do start exercising again, and you then think “This proves that I’m recovered.” I think there is a big difference between being physically able to exercise versus you actually have a helpful relationship with exercise and you’re very much in the driver’s seat in terms of being able to choose and it not be compulsive.

So just because “I can do this and I feel good doing it”, doesn’t mean that everything is in a good spot. I think what can often happen is that people can feel relatively stable while exercise is absent, because there wasn’t the trigger; it was very binary, it was very much “I know I’m not doing this thing, so I’m not having to make decisions very much. I’ve removed this thing.”

But when you’re bringing it back in, it can start to bring up a lot of thoughts. It can be “Maybe I should be doing a little more. Does that session count? I didn’t sweat as much as I usually do, or the instructor didn’t make it as hard a season, or I thought it was going to be a different type of yoga than this one; this didn’t really feel like it was to the degree I imagined it was going to be. I had something come up and I missed yesterday’s session and I’m now panicked about how do I bring that one back in.”

There can be thoughts around food and food becoming more difficult because “I’m now exercising and maybe I should be healthier. Maybe I shouldn’t be having so many carbohydrates. Maybe I should be bringing in a lot more vegetables. If I’m going to be exercising, I really need to focus once again on healthy eating. Now I’ve started doing this, I really don’t want to lose my fitness. I had such a time where I put things on hold, and we need to get back to it.”

So there can be these thoughts that start to come up, and it feels like “Wow, before I was doing this, I wasn’t having all of these thoughts, but now this is here, these are coming up again.” And this can be really tricky because there can be this feeling of “But I want to bring exercise back in. This was something that was important as part of my life, and I don’t think it was just about the eating disorder.” So being able to navigate this.

I’ve done a whole separate podcast on this in terms of how to deal with exercise in recovery and taking a break and bringing it back in, so I’m not going to go over this in any great detail, because my recommendation is to check out that podcast. I’ll link to it in the show notes.

But I think there can be some questions that you can be asking yourself, either before you start or once you’ve started, just to be assessing your readiness of “Should I be continuing with the exercise I’ve started to bring back in or again reduce it or put a pause on it? Or am I ready to start doing this?”

Can I miss a session without compensating?

Can I reduce the duration or the intensity? Am I able to say, “I know I’ve been doing a walk for this distance or a run for this distance; today I’m going to do half of that or I’m going to do a quarter of that”? Am I able to do that?

Am I able to eat adequately before and afterwards?

Can I increase my food without then thinking I also must increase my movement? “I’ve had a bigger day of eating, so I’ve got to have a bigger day of moving.”

Can I respond to tiredness or illness or injury or poor sleep and recognise if those things are going on, I’m not actually doing any movement or exercise today?

Can I choose movement that is based on joy and fun rather than numbers?

Can I do it in a very social way, where I’m hanging out with people and it’s about the social connection as opposed to “I need to go off and do it on my own”?

Can I cope with the fact that I’m now starting to do movement and my body isn’t changing in some specific way? Maybe there was this hope in the back of your mind that “When I start doing this, this is when some of that weight will start to come off” or “That’s when my body will start to change again” and that’s not happening; what is that doing for you? Is that making you think “I need to up the exercise” and starting to think in that way? Or are you able to say “It is what it is right now. This could be how it is for now, it could be how it is forever, but I’m not going to start to do things to manipulate that”?

Is the exercise and the movement I’m doing starting to expand my life? Or am I noticing I’m starting to organise my life around it again and it’s starting to contract things, and I’m now not going out to that dinner or not meeting up with that friend or whatever it is because I need to make sure I get my workouts in?

I think some of those questions are useful to ask beforehand or to ask while you’re doing exercise, because as I talk about in the exercise podcast, when I’m bringing it back in with clients, it’s not a quick process. We’re not trying to rush through it. We’re trying to create a completely different relationship with exercise.

What often happens is it is a little bit of two steps forward, one step back, where “I am starting to do it more, and I’m noticing body image getting worse or I’m noticing it’s been a little bit harder to eat or my appetite regulation’s not been as great, so we need to pull back.” And being able to do that. “Okay, I’m disappointed because I want to do this, but I also know that this is the best thing for my recovery and I’m actually able to do it.”

00:47:13

Learning to be in relationships without the eating disorder

The next one is learning how to be in relationships without the eating disorder. I think the eating disorder, again, when it’s been going on for a long time, it really affects how you are as a partner, as a parent, as a child, as a friend, in terms of your family.

As I talked about earlier, depending on those situations, it can often be a thing to cope with various situations, to avoid conflict or suppress needs or withdraw when you’re overwhelmed or create distance from intimacy or to cope with criticism or to feel in control around unpredictable people or to avoid social situations or to numb the demands of the parenting or the caregiving or whatever it may be.

The eating disorder can be having an impact on how you show up in relationships, and not all of those things are – I mean, there can be some collateral damage created from them, but it makes sense. Very much when I’m working with people, I believe people keep their problems for a reason. So it’s understanding, what needs is it meeting for you in this moment? If it’s helping you to avoid conflict, what do we need to work on to be able to help with that? It could be, how do we have this difficult conversation, or how do we recognise that in that situation, that person is someone who is better being avoided at this point? It’s not a healthy relationship, you’ve tried to set boundaries in the past, it hasn’t worked; the healthiest thing you can do is to step back.

So being able to look at this in terms of what needs are being met by the eating disorder or were being met by the eating disorder and what now needs to come in so that there’s a different way of being able to handle this. In a lot of ways, this connects to something I talked about earlier in terms of our needs and being able to express our needs and what we actually need in a certain situation. So saying what you need or being able to remain present during a conflict, etc., that I talked about earlier on.

00:49:29

Discovering who you are + expanding your life

The next section is just discovering who you are and expanding your life, because so much of the eating disorder – again, as it goes on longer and longer, it just constrains one’s life, and so many of those things that someone may have been interested in growing up just fall by the wayside. It shifts how you spend your time or what you think is important or who you think you are.

So recovery, especially as you’re getting out of that nutritional depleted state and you’re in a better place, it’s then about discovering, what do you actually enjoy doing? What do you value? What kinds of relationships do you want to be in? What do you actually believe? Not what the eating disorder has been telling you for years, but what do you actually believe? What do you want your days to contain in them? How do you want to spend your time during your days?

What matters when appearance and achievement aren’t the central thing? What are the other things in life that become important to you? What do you want to do if you’re not just trying to be ‘good’ all the time, if you’re not trying to keep up this particular appearance that you’ve had for a long time? What now becomes important?

This can be about rediscovering interests, developing friendships, it could be about travelling, being creative and noticing that the creativity is an outlet that is good for your emotional regulation, but “It’s also this thing that I really wanted to do but my dad was critical of it” or “It just wasn’t something that the family thought of as anything that is meaningful, and I was pushed in this other direction.”

That could mean also returning to education or changing jobs. It’s not that someone has to rush into any of these things, but starting to recognise, “This just doesn’t feel in alignment with who I am or what’s important to me anymore.”

It could be exploring spirituality or religion or moving away from those things, if that was part of your eating disorder and you’re coming to the realisation of “I don’t know if that really is me.”

It could be spending more time as a partner, as parent, as a child, depending on the relationships with your parents, and all of these things. Again, “How do I want to spend my time?” Because often you have missed out on spending that time in the way that you would’ve liked. What are the things you like playing or having fun with?

There’s just all of these different questions about your life that are then explored. And the thing with this is that identity is built through experimentation. It’s built through trying things out, finding that some things fit and that some things don’t, recognising that it’s okay to change your mind, it’s okay to disappoint people. It’s recognising that “Oh, I actually really do like this thing. It’s just been suppressed.”

So really learning through trial and error. This, again, is why this phase can be such a long one, because there are lots of different aspects that I just went through there that, with time, you’re going to get a chance to try out and notice what you notice by doing that.

And with the idea as well that this doesn’t become some other life hack or “I’ve got to find compulsive productivity” or anything along those lines. It’s like, let this thing naturally evolve. Yes, there can be intentions around trying this thing out or that thing out, but this isn’t just then “some other project that I have to really get right.”

I would also add it’s normal to have ordinary evenings, to have boredom, to have rest days, to have days or months or stretches of time where nothing particularly impressive happens. That’s also okay, too.

00:53:45

You need support in this phase too

I want to just add as well that this phase often doesn’t receive the support that the early phase does, and I think that it really should. I get why it doesn’t often receive the support that it does; in the early phase, someone can be in the immediate medical danger, so that’s why there’s much more of a focus.

In this later phase, people can assume you’re doing better, so there’s just not the focus there. Professional support may be reduced or removed, especially if you’re having certain things covered by insurance. It can be you’re now medically stable or you’re now in a place that thing is withdrawn from you. Family members are like, “We’ve moved on. She’s doing better. We don’t have to put that focus there anymore.” So there can be this feeling of “You’re good now.” Even though for you, you can realise that there’s so much that needs to be done, it’s just not as visible in the same way.

I think this can create a real problem where you start to think, “Oh, I should be done by now. Everyone else has moved on. Everyone else is telling me I look so much better and I’m doing so much better, and yet that’s not how I feel. I can still feel ashamed about my body, or I can feel ashamed about where my life is at compared to other people or where I’d imagined it would be, or I’m still struggling with this thing and I’m still trying to navigate my way in these relationships and I just feel so raw trying to do that compared to what I perceive my peers are doing.”

So recognising that this is still a really important phase of recovery where I truly believe people should still be getting support. I work with clients during this phase. I want to keep working with people during this phase. And some of that is I’m still working with people one on one during this phase, or sometimes people are saying “I want to stay in the group programme so I’m getting that kind of support; I don’t need quite as high touch in doing the one-on-ones, but being in the recovery community and doing the group calls is actually really supportive.”

But I just want to make it really clear that this phase is still important to get support and to navigate through, because there can still be lots of questions. There can still be lots of unsureness. There can still be wanting to figure that out and it being helpful to have someone to support with that.

In closing with this, nutritional rehabilitation – super important. It is the foundation on which all of this is built. But this is really, I think, the forgotten phase of recovery. This is the part where people are like, “Oh, just go out into the world and figure it out yourself. You’re in a good spot now.” And I just don’t believe that to be true.

So if you’re finding yourself in a place where you feel like “I’m eating so much better, I’ve gained weight, I feel like I’ve reduced all of the obvious eating disorder behaviours; I expect to be fully recovered by now based on everything I hear online, but I’m not” – I want you to be able to get support. I want you to be able to get help with this.

This is still part of recovery. I know this can be a little messier in terms of part of this is just being a human, and we go through this – I’m not recovering from an eating disorder, but there’s lots of stuff as an adult that I’m working on, whether that’s doing stuff connected to parenting or doing stuff connected to being better at feeling my emotions or whatever it may be. There are still personal development things I work on or relationship stuff I work on.

So I think in some senses, it can get a little blurrier, like “Is this recovery work or is this just being a human?” And in some senses it doesn’t really matter. I don’t really care about the label. What I’m more caring about is, hey, this is something that could be really useful for someone to still be continuing to get support on with it.

So that is it for this episode. As I said at the top, I’m currently taking on new clients. If you’re wanting support in your recovery, whether you are at the very early nutritional rehabilitation stage or you’re, like I’ve gone through a lot in here, at this further stage and you’re feeling like “I still would like support with this”, then please reach out. You can send an email to info@seven-health.com or you can send a DM to @sevenhealthcompany on Instagram. So get in contact and I would love to help.

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

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