“How do you get past the in-between stage of having regained some weight but probably not enough, of not being sure whether it’s enough, of finding it awful enough already and not believing you can bear any more, of knowing this isn’t being well again but fearing going any further? Partial recovery is such a common outcome in anorexia – anecdotally, at least, it seems the norm – that many people assume it’s the best possible outcome. I see this as an unnecessarily pessimistic way of thinking about the possibilities for life after anorexia. My life now is not remission; it’s health. Indeed, I think I’m now less susceptible to relapse than many women around me are to disordered eating.”
There is a ton of recovery writing out there that is completely warped and unhealthy, so I avoid most of it. A Hunger Artist blog (quoted above & throughout) on Psychology Today is a different story. Written by fully-recovered ex-anorexic Emily T. Troscianko, Ph.D., it is one of the smartest, no-bullshit sources for anyone struggling with an eating disorder or slogging through recovery. She focuses on cold, hard, often-painful facts over fiction…the eating disordered person’s preferred mode. Here are some of those, which most people outside of this world do not know:
– One obvious though often neglected truth is that a minimally healthy BMI is usually an inadequate basis for full recovery from a severely underweight state (i.e. a BMI of 17.5 or below). This is something you need to bear in mind when you find yourself wondering whether you really need to regain more weight; if you’re just within the 20-25 ‘healthy range’ BMI, but many anorexic symptoms still seem to be in place, the answer is probably going to be to regain more weight. The fact that that’s the last thing you want to do is also a sign that you probably ought to!
– There is usually a temporary ‘overshoot’ phenomenon: if recovery from a malnourished state is allowed to proceed naturally (i.e. without any negative impact of restricting behaviors) then bodyweight increases beyond the level at which it was stable before weight loss, but gradually drops back again to pre-starvation levels within a year.
– There is absolutely no way you will ever recover fully if you decide on an arbitrary (for your body) BMI and, once you reach it, start restricting again to make sure you stay there. Dieting is incompatible with recovery from anorexia, both physically and psychologically. This should be trivially obvious, but with all your anorexic instincts screaming at you not to lose control and let yourself get fat and ugly, it can be easy to forget.
– Your metabolism won’t normalize until you reach your natural bodyweight. This means that, when you get there (building in the overshoot factor), your metabolic rate will be ramped up to normal levels again, which will mean that you will be able to keep eating the same amount as was supporting weight gain and not keep gaining forever. Your bodyweight will stabilize without restriction – but only if you let your weight increase to where it’s meant to be.
When I had my reading in November and read a long piece about being hospitalized, I vowed to myself that I was done writing about my eating issues for a while. It was a nice way of lying to myself that writing about my eating disorder was no longer necessary, even though as I stood in front of that crowd I was surely still (and still am) underweight. No, not where I once was, but definitely not at optimal health, either. I had just returned from a trip to Chicago where I was perpetually on the verge of melting down because suddenly running felt hard and I was terrified of the weight I was going to gain as a result. But this attitude has become my normal, and with my still-sick mind, it didn’t set off red flags. “People don’t think I look sick anymore, and so I am not,” continues to be a constant, faulty notion of mine.
“One of anorexia’s most fundamental characteristics seems to be the combination of a high degree of insight and the complete inability to act on it. This is one of the main things that allow the illness to continue long after it’s been recognized, diagnosed, and accepted as destructive. The paralysis as regards action comes from the many physiological and psychological effects of starvation that act in concert to make weight gain seem impossible, from the shrunk stomach to the rigidly obsessive thought patterns, from the diminished self-esteem to the slowed metabolism. Even objectively positive things like the return of your period or your breasts, signs of life and fertility returning, can induce panic because they seem to signal a loss of control, when in fact they denote the opposite: a brave and powerful wresting back of control from anorexia.”
I could follow that ‘vow’ I made and not write about it, retreating and trying to do it all in private, but there’s something to be said for announcing this and having that much more accountability. I can already assure you I will long to go back on this announcement and plan a hundred times.
I’ve been clinging desperately to uber thinness for years now, never allowing myself to reach full recovery. The outside world may no longer recognize it but my poor health is a fact: I have not had more than 2 periods in about three years—and those were light and abnormal. My body is not functioning at its full capacity because I stopped my recovery halfway—I didn’t keep going, and in fact even in my strongest moments I was still consumed by thoughts of food and weight. I have lost sight of who I was when those were not my top priorities, and yet I constantly long for her. I wake up every morning and dream of changes to be made that will bring a little more life back into my eyes, but continue to follow old, unhealthy patterns. I tell myself comfortable lies—that because I am in a much better place than I was when hospitalized, I am totally better. That because I eat three meals a day plus snacks, I am better. Ignoring the reality that I pretty much live off of cereal and salads, because they are safe, and anything remotely like indulgence requires serious gym time to “atone.” I have written about this before, outlining how a person can still be very ill despite the way they look. But my own words elude me—I get scared quickly and turn back. Back to a life that I’m once again taking a hard look at, as I wonder…what exactly am I clinging to? Well, here’s an overview:
Every day of my life revolves around meal times and not in some normal food-appreciative way, but one grounded in guidelines and avoidance. Where will I eat today that will not cause me to gain more weight? How will I make up for anything seemingly excessive? How can I schedule my day to make sure that my priorities, exercise and very restrictive eating, are accommodated?
Exercise, which I do enjoy, becomes more like a chore. An intense, dreary chore centered on keeping me in line rather than freeing my mind. I am always, always, always exhausted afterwards and need to lie down—often shivering uncontrollably because the food I live off of is simply not enough to sustain my energy output.
I am depressed. So depressed. And unmotivated, lacking direction—qualities that are not normally attributed to me. My creativity is in the gutter.
My relationships with men are frigid and I feel like a paper cutout in bed. My libido does not exist—I avoid sex like the plague. If I spend the night with them, I dart out early in the mornings because I am hungry and I often have a gym to get to. There is no time for intimacy. I literally had a better sex life in high school.
I am not a good role model for my sisters. I can never fully enjoy family meals because I’m so stuck in my own sick head, over-thinking each bite. I am not fun to eat with in general. It’s always about doing the least damage possible, rather than getting the most enjoyment out of a meal. If I drink, I get drunk and tired so fast, wanting to be in bed almost immediately.
Sometimes when I drift off to sleep I wonder if I’ll ever actually be able to have children. Not if I continue this way. I wake up in the middle of the night often, usually hungry. I’m constantly needing to lie down during the day as a result.
I let everything trigger me and confirm my anorexic thoughts. A depressed friend loses loads of weight and I decide that means I should stay this way. A friend’s grandmother tells me I’m “at the perfect weight” (probably because I was blatantly ill last time she saw me) and I assume that means I should definitely not gain any more—because, clearly Jessica, she’s an expert. I read stupid blogs that feature overtly ill women and convince myself that that’s the ideal way to live.
But I am not living…I’m barely getting by. I’m still pretty fucking lost in this disease. Sure, it’s not my worst point, and sure, not all will see it—but that shouldn’t matter, it is undeniably TRUE.
Please believe me when I tell you that my life at this low end of thin has not been dreamy at all. Whatever fleeting satisfactions I get from it are a poor replacement for the more fulfilling life I’m sure I could be living. I don’t feel good about myself at the end of the day, or good about my life. Yes, I am terrified of gaining more weight and returning to anything close to where I used to be, but I’m also terrified of staying in this place. I’ve tried this half-assed thing long enough and, as everyone tried to tell me, it has not paid off. So what’s there to do? Really working towards full recovery again seems like the only option. As Troscianko writes…
“Your years of illness mean that you simply can’t think and act in relation to diet and weight and shape in the mildly disordered way that other people can ‘get away with’, if you want to be anything approaching healthy. This might seem a negative – now you can’t diet and control your weight as others do, because it’ll keep you ill – but actually it’s a massive positive: calorie-restricted dieting doesn’t work, and just because other people usually just don’t get ‘quite bad enough’ to have to confront the reality of what constant dieting and body-dissatisfaction is doing to them mentally and physically, that doesn’t mean they’re happy or enviable. You can see through that now, and choose to do better.
What kept me going was…I knew that there were no unanswered questions for me about anorexia any more: it had given me all the answers it could, and there was nothing left that I didn’t know about how life (and death) would be if I kept starving. And gradually I realized that I wanted now to get all the answers about getting better. I didn’t want to stop halfway and be forever wondering what might have happened if I hadn’t. I wanted to do this thing properly.”