There is a common misconception with regards to eating disorders that in anorexia nervosa, a healthy body means a healthy mind. Even among professionals whilst an inpatient I was met with ignorant comments along the lines of, “once you are no longer malnourished, your negative thoughts will automatically transfer into positive ones”, blaming my depression and my self hatred entirely on my small frame. Entering recovery, I believed that as my weight gain increased, the extra nutrients pumped into my body would in turn allow the chemicals in my brain to rebalance and thus my mental illness would be cured. Did my path of recovery turn out this way? Definitely not. Instead, all these comments provided me with was a sense of false security, bearing nothing but disappointment when my negative thoughts were transferred into thoughts only significantly more negative, instigating a vicious spiral of decline.
In reality, I found being near to weight restoration significantly more emotionally challenging than I did being at a critically low weight and I know that this is not an uncommon experience. The result of this was quite a severe relapse before even having been discharged from inpatient, 10kg (22lb) up from my admission weight. Up until this point I had complied fully to my meal plan, accepted every single increase posed by my dietitian, challenged every fear food thrown at me; I had given it my all until I’d reached a point in my journey so painstakingly difficult that I just couldn’t physically cope with any more. My compliance reversed. Not only did I refuse meals once at the table, I began refusing to enter the dining room at all. I lost all motivation to try. I had given up entirely. I spent my hospital days at this stage curled into a bean bag for the entire duration of the day, begging the nursing team to provide me with the maximum amounts of PRN medication in order to force my body to sleep the hours away. Sleep was the only time that the pain of weight restoration was even briefly minimized.
But why? What is it about weight restoration in recovery from anorexia nervosa that causes a worsening mental state, so contrary to the promises made by mental health clinicians when encouraged to enter recovery?
Personally, I found that whilst on home leave and being in the presence of people I hadn’t seen for extensive periods of time, the weight gain I had experienced was always a key pointer for conversation. Always expressed in a supportive manner, comments regarding friends’ pride over how much weight I had gained and thus how well I must be doing were instead used by my eating disorder to criticise myself. Looking physically healthier, others believed that this must mean that I was becoming mentally healthier too. If people around you think you are in a better place away from your mental illness, they tend not to tiptoe around you so much; instead of weight and food being a forbidden topic when you were critically underweight, now, it’s assumed you’re more comfortable with this conversation when actually my eating disorder was screaming louder and louder with every passing comment; I must be too fat to have an eating disorder now, I was clearly never ill enough, I’ve gained too much weight, people won’t continue to offer me help and support anymore because if I’m physically healthy this means I’m not allowed to struggle. It was a revolving cycle of my eating disorder telling me I had to lose the weight again switching to the part of me deep down which desperately wanted to recover, believing that the necessary support would be withdrawn.
On a medical side, weight gain in anorexia nervosa often leads to a change in diagnosis. This is because even in 2017, criterion for diagnosis still includes being below a certain BMI. Thus for myself and many other recovering anorexics, once weight restoration has passed this boundary professionals decide that you no longer meet the correct criteria and diagnosis is changed to “eating disorder not otherwise specified (EDNOS)”, regardless of any change in thought processes. You no longer tick all the boxes and thus cue anorexic thoughts being sent into overdrive. Not good enough, not sick enough, not thin enough. Not even unwell enough to meet a recognised diagnosis anymore, because let’s face it, who even knows what EDNOS is anyway? In a disorder that for so many is centered around a desire for perfection, there is nothing that has ever made me feel more of a failed anorexic than when my diagnosis got changed. Don’t get me wrong, although I now understand that EDNOS is a serious diagnosis worthy of treatment to the same extent as any other eating disorder, accounting for up to 50% of all eating disorder diagnoses, it is still secretly a relief for my own to have been reverted back to anorexia nervosa. It’s not acceptable that a label should have the power to invalidate your struggles, but unfortunately it will continue to do so until EDNOS is more publicly accepted and understood.
At the start of this post, I briefly mentioned the incorrect hope that “as my weight gain increased, the extra nutrients pumped into my body would in turn allow the chemicals in my brain to rebalance and thus my mental illness would be cured”. However, not all of this sentence was untrue. The extra nutrients in my body did allow the chemicals in my brain to re-balance, but the initial consequences of this were much more negative than I was prepared for. At the depths of anorexia nervosa and at a critically low weight, your body learns to survive on so little fuel that it shuts off any non-essential bodily functions, so that the minimal amount of energy it still possesses can be used most efficiently to enable you to survive. For me, at my lowest weight, this included the absence of an ability to feel emotional pain. My body became too weak and too tired to feel anything at all; the only emotion my brain had the stamina to produce was that of numbness. All of the heartache that had directly let to the manifest of my eating disorder had been periodically erased; a brief moment of relief for my previously overworked brain. However, as the chemicals did begin to re-balance and my body was finally treated to the nutrition it so desperately yearned for, following the initial life-saving weight gain, with this nourishment then came an excess of energy which my body and brain were no longer familiar with. Enough energy for my brain to direct into learning how to feel things again. This brought a new found sensitivity to emotions, experiencing them more intensely than I had ever felt before; unfortunately, had the whirlwind of emotions that struck me been love, affection and a new zest for life, I could’ve viewed this sensitivity with value. But instead as my cognitive cycles were simultaneously sent into overdrive, with an ability to think about the endless numbers of calories that were being pumped into me came an ability to fall out of love with my consequently expanding body even further, bearing emotions of self loathing, despair and hopelessness. There therefore became a negative relationship between my weight and mental state, my mentality deteriorating further with every ounce I gained.
As I hope I have accurately depicted, weight gain alone is not the magic cure to a restrictive eating disorder. But the most important lesson to be learned from all of this is that body acceptance does eventually come. It just takes patience.
If you are in the depths of an eating disorder, waiting for that one spark of inspiration to make the terrifying jump into learning to nourish your body again, I am not prepared to lie to you in telling you that gaining weight will solve all of your insecurities. It just won’t. It will get worse before it gets better. But what I can promise you most is that the eventual “better” really is worth fighting for. Gaining to my current weight has been one hell of a journey where on many days it would’ve been far easier to give up than to fight, but I am so glad that I have continued to fight. Recovery is a strenuous choice you must continue to make every single day, but I now stand in a position I would never have achieved had I given into the overpowering thoughts to lose the weight I had battled the dreaded fear of eating six times a day just to gain.
With therapy, support from those around you and most importantly, persistence, your mental health will eventually catch up to your physical health. Your new found sensitivity to emotions will allow you to feel love for your family brighter than you feel the warm glow of the sun on a midsummer’s day. This love for others and for the world around you will be transformed into a love for yourself as you begin to feel more comfortable with your new body. It’s no surprise that at first you will feel uncomfortable, housed in a body you do not recognise, but after weeks, or months of waking up each day, the familiarity will return. Four years into weight restoration and I have fallen in love with every crevice of my body. I have learned to love the softness of my stomach and bum, and appreciate the cushioning as I lay in bed each night, no longer woken every hour by the discomfort of my bones pressing into every mindnumbingly painful spring of my mattress. I love my legs and the strength they have built with every bite I have ever taken. I am thankful that they allow me to run and to dance, and I will continue to be thankful for them far into the future when they enable me to walk down the aisle on my wedding day.
It has taken a long and strenuous battle with my mind but finally, I have fallen in love with my body irrespective of my weight.
Love and hugs,
Shann x x x