Do you believe recovery just isn’t possible, at least, not for you?

Lessons from ICED 2013

I see 30-40 individuals suffering from anorexia, bulimia, binge eating disorder and disordered eating each week. Men and women, preteens through age 70+.  So short breaks and vacations are, of course, quite refreshing.

But last week’s Academy for Eating Disorders Conference, the International Conference on Eating Disorders (ICED) offered anything but relaxation.

Stimulating, inspiring, fascinating and hopeful—even these words do little justice to the conference presentations. I became pumped, and felt validated that the progress I see with my patients is not random. I was sparked by the incredible research demonstrating the progress in the understanding of eating disorders and their treatment. It only confirmed my belief that there’s reason for you, too, to know that recovery is possible.

Let me tell you about a session I was most excited about—Lisa Dawson, a PhD candidate’s research presentation entitled Recovery From Chronic Anorexia Nervosa: The Tipping Point for Change. You don’t have long-standing anorexia? Don’t stop reading. The lessons from this psychologist’s research are inspiring for all.

Dawson decided to select those individuals who recovered from anorexia—and I mean trulyrecovered—because by looking at this population we can figure out what elements are critical for recovery in anyone living with an eating disorder. They had to be free of anorexia for 7+ years, in an objectively normal weight range, and free of eating disorder behaviors. “You mean such people really exist?” you’re thinking? You bet. And she identified the common elements that contributed to their movement toward and their ultimate full recovery, based on extensive interviews with the participants. Here are some key points she identifies:

There are 4 stages to recovery, which individuals move through in one direction, and for differing amounts of time:

1. unready/unable to change
2. the tipping point of change
3. active pursuit of recovery
4. reflection and rehabilitation

In the first stage, people feel like they didn’t know why they were doing what they were doing (wrt ED behaviors) but felt they just couldn’t stop. They internalized the eating disorder and they perceived treatment as unhelpful. They felt misunderstood and lacked insight. In summary, recovery seemed impossible; they didn’t feel like anything they did made a difference for recovery, they had low motivation and had a sense of helplessness and hopelessness.

Over time, they realized that their eating disorder wasn’t helping them. Those who recovered also started to experience feeling understood. They were able to externalize the eating disorder and over time gained insight into their condition. They became more worn out by their eating disorder as well. Motivation increased. They started to feel that they had the power to change their situation, that they could impact their curse.

More value was placed on life outside their eating disorder. They learned skills to help them cope as they let go of their eating disorder behaviors.

Self-discovery, self-acceptance, and learning to love oneself were components of the maintenance stage.

It was a long, and slow process. But it happened.

So here’s an email I received this week from a patient of mine who, in spite of living with anorexia for more than 25 years, is now in recovery. The timing couldn't have been more fitting for this post:

"I've been continuing to do well with food.  I know I was upset at my last apt with life in general, but that did not affect my eating.  To date, I still have not purged or restricted or exercised.   Can you believe it? And... I don't want to forget to tell you so I'll share now, re: exercise...  I have been taking walks after dinner with either one of the girls or my husband or all (not every night, but several) and it didn't dawn on me til yesterday that I can go on these walks and I haven't:

• thought about how many calories I'm burning
• gone at fast pace to burn more calories
• obsessed over having to walk each and every night/same time/same pace/same path 

Instead, I:

• go on a walk if I feel like it
• enjoy whatever pace I seem to be going at, without thoughts of burning calories
• actually enjoy being present with the people I'm walking with!!! 

I do not fret if I can't make a walk.  I do not keep track of how many nights I've walked. I do not feel it's necessary if I've eaten a larger dinner. The obsession is not there!  Where did it go? I don't feel it, all I feel is the happiness that I'm going on a walk with a very loved family member where we can chat and talk and laugh. 

Huh? When did this happen?! Although it may not seem big, it really didn't hit me until yesterday that these walks are not the same walks as in the past. Not one bit. I am totally present and I completely enjoy them. And I continue to eat. Normally. I think I now know what normal is. At least, my normal. And I never, ever thought I would find "normal". And "normal" to me means:

I can eat when I'm hungry, know when I'm full, eat what I want in moderation... and because of this, I have not gained 30 lbs in 5 days as previously thought. I have gained weight.  I am working on accepting the feelings that accompany this. I think I'm in a better place to work on this. Nobody likes to gain weight, that's pretty much reality. But... I'm healthy.   

I put myself, my body, through hell. Can you imagine deliberately depriving your own body of nutrients it needs to stay alive? Can you imagine the destruction throwing up food causes? Or ingesting a plethora of pills to help further the weight loss process? How good is THAT for your body?! Oh my God, I sit and think how the hell am I still alive!!!  This has been going on for decades!  

I am at a really low point - sad, lost, confused, lost, angry, lost...  I feel like everything is out of control in my life.  Where did I turn for all those years to gain control over something when everything else felt so out of control? Ed. But what is happening now? Everything feels so out of control, yet the ONLY thing that feels IN control is my decision to eat well. Isn't this the complete opposite? What is going on here?  

So, the point of this email is to tell you that I have the strength to continue fighting this and I will succeed.  You are not going to see me relapse. Everything about this eating disorder is finally beginning to make sense. I have so much more to share but I'll save that for our next meeting. 

Lori, boy I can't begin to tell you how everything you've taught me is now landing in place and making sense and how in the world do I thank you for that?I was so, so sick.You saved my life.I still have work to do, I'm a work in progress, but slowly I'm regaining inner strength - which is just what I need to move forward. 

Thank you, thank you, thank you..."

I share this, with her permission, because while recovery is challenging, to say the least, it happens. And what I hear from her and from others confirms what Lisa Dawson shared in her study—that belief that you can recover, that change is in your hands, is essential for recovery. And that working with providers who get it and help you feel understood, and provide hope that full recovery is possible, can make all the difference.

Your thoughts?

Lessons About Eating Disorders

What I Learned at the AED Meeting

I’ve exceeded my 1 week limit between posts, but I’ve got a really good excuse—I’ve spent the past 4 days at the Academy of Eating Disorders (AED) Annual Conference. So I thought I’d share some personal and hopefully meaningful observations about eating, recovery, and miscellaneous thoughts:

• Day one, 4 hours of workshop, and what did they serve at the refreshment break? Coffee, tea and water. Period. And I wanted calories. Food. I was hungry. Half a day learning about a treatment for anorexia and I couldn’t find anything to eat! But it only got better from there—really.



One of several courses eaten at Barley Swine

• I spent a large percentage of my 24 hours each day doing 2 things—learning about eating disorders and planning and arranging to eat—where to go, whom to go with, and what to order, to name a few. And I must say, Austin Texas has some fabulous food! My top picks?  Barley Swine and La Condesa—simply divine!

• Another evening we were 8—two in recovery from anorexia with 3 RDs, 2 therapists and a mom/eating disorder advocate—all eating out together. Can you even imagine? From my perspective it was fabulous. How about a round of applause for those recovering, brave enough to endure such a dinner?
• People appeared better in person than they had on the web. No, I’m not speaking of their physical attributes. But in person, their energy and warmth radiated, adding a whole level of beauty that truly got missed on line. Thoughts were shared and clarified without misunderstanding—it sure helps when you have more than 140 characters to explain yourself!

• Two of the diners are bloggers that I had a somewhat rough start with in the virtual world. Carrie and I, as I recall it, had long ago debated the implications of viewing eating disorders through the lens of biology, much as a conference panel debated labeling eating disorders as brain disorders. While Laura helped shake up my thinking on Family Based Treatment, yet supported my perspective about the important role for dietitians, typically omitted from this therapy.

Carrie, Cate and I before dinner.
(We didn't look any different after dinner, though!)

• Conflict leads to learning and change. If we all stuck with our same ways of doing things we would never grow and develop. We would perhaps feel safe, but would truly stifle our potential, our recovery even.
• Cate and I met for the first time, in spite of feeling I have known her forever. We met through this blog and we have inspired each other to change as well. And you’ll soon hear details about our upcoming book!

Dessert shared with another RD

Meaningful messages from the AED meeting

Connection

Connection helps recovery. A family member, treatment provider, friend, an internet-mentor—even one strong connection can make a difference. And involving your partner shows great promise, based on the research by Cynthia Bulik, PhD and Donald Baucom, PhD. So if you haven’t begun to share with your significant other, or no one knows your struggle, perhaps it’s time to change that.

Hope

“You’re the first person who ever told me I can recover”, I’ve been told far too many times. It is unfortunate. Recovery happens(a bumper sticker, perhaps?), but it doesn’t occur passively. It certainly takes work, your hard work, and a great deal of time. And there are slips, which you must prepare yourself for. Because slips happen (ok, another bumper sticker?) I hope those of you outside the states get the reference to a US bumper sticker—Shit Happens—it would be much funnier if you did!

So if your provider tells you that you can’t recover, then it’s time to find a new provider.

Blame

Blame is useless. Your mother didn’t cause your eating disorder, nor did your ex-boyfriend. Sure, environment can play a role in the development of eating disorders (just as perhaps your genetic predisposition and your personality type may have contributed). But it is most ineffective to focus on “why did I get this condition” or to blame yourself asking “what’s wrong with me, why can’t I change?” We all want answers, but the truth is, what we really need are solutions. And blame is clearly an obstacle to getting there.

Eating disorders are serious

I liked Laura (Collins) Lester-Mensch’s suggestion that we refer to eating disorders as treatable brain disorders. Sounds so serious, no? Even a bit scary—and rightfully so. Eating disorders need to be taken seriously. One in 10 people die from their eating disorder. And delaying treatment only makes the challenge greater for recovery. While we don’t know whether the brain is involved from the start of the eating disorder or as a result of the eating disorder, here’s what remains—the brain is involved, and nourishing it aids in recovery of the disordered thoughts, mood changes and of course, the physical consequences. The brain is not static—it is flexible, plastic, and changeable.

Perhaps viewing eating disorders as treatable brain disorders will allow us to have hope, remove the blame, and inspire us to connect with others without shame to support recovery.

As always, I care to hear your thoughts and reactions to these posts.