Getting Help
The process of recovery is long and hard, sometimes taking years of intensive treatment and close monitoring to make significant progress and work through strategies to prevent relapse.
Asking for help
Asking for help from an ED is very scary and difficult because of the enormous feelings of shame and embarrassment. EDs can go on for years before the individual is ready to begin the process of recovery. By then, serious physical damage may already have been done. People with bulimia are more apt to reach out for help than those with anorexia.
Why does getting better feel so bad?
Although living with an ED is not pleasant, it is familiar. Life after recovery and the process of recovery itself can seem frightening. As progress is made, the individual is forced to deal with difficult feelings and situations in a whole new way. Before, she could rely on the ED. Now, she is in unfamiliar territory. It seems easier to deal with the familiar struggles of an ED than the distress of unfamiliar negative feelings.
Building confidence
It is very discouraging when, despite serious efforts to recover, ED behaviors continue. There is no such thing as a "perfect" recovery. It takes time, patience, and compassion. One slip does not mean that you have failed or that you aren't capable of recovering. Each success, however small it may be, makes the next one easier. Each success builds confidence in your ability to handle the next attempt.
Sustaining factors
Sustaining factors are those that help maintain eating disordered behaviors, such as...
- Pain relief - Sufferers may continue restricting or purging because of the high or euphoric feelings that result.
- Decreased appetite - Zinc deficiency, delayed gastric emptying and/or increased cholecystokinin (CCK) production can lead to a decrease in appetite, which promotes restrictive eating.
- Compliments & praise - When weight is lost, the sufferer may receive compliments about her new figure or envy from others over her self-control, which serve as reinforcements for the behaviors and also allows her to deny that they are problematic.
- Negative comments - Attention from others about weight gain, appearance, and/or food behaviors can lower self-esteem and lead to disordered behaviors.
- The binge/purge cycle - Restrictive eating usually leads to binging and/or purging, which are perceived as a failure and loss of control. Her already low self-esteem is further reduced and she feels she must be punished, or make up, for the ‘bad’ behavior. This leads to restrictive eating and the cycle continues.
- Isolation - In order to avoid eating, it is common for eating disordered individuals to isolate themselves and withdraw from social activities, which leaves them alone with their eating disorder and facilitates behaviors.
- Hypoglycemia - The drop in blood glucose following purging can set the person up for another binge.
- Dieting - Limiting calories and types of foods eaten can trigger a binge.
- Reduced basal metabolism - Weight can be gained while on a reduced calorie diet. This leads the individual to believe that they don't need to eat as much as other people do. Why eat more when my body needs so little?
- Reduced cholecystokinin (CCK) production - People with BN release less CCK than normal. Because of this, they will experience less satisfaction after eating a normal sized meal, making them more likely to overeat. Thinking about how much they have consumed, even though they may not feel full, can initiate purging.
Relapse
Relapses are very common in the process of recovery... you can pretty much expect them to occur. There are numerous reasons for why this happens but the one I have found to be the most challenging is re-establishing an identity. When one is living in the world of their ED, the illness consumes their cognitions, behaviors, and life in general. The individual doesn't know who they are exactly. It can feel like "I am my ED and nothing else." In recovery, they must learn to be themselves again. How scary it must be to not know who you are! This can make them feel empty inside and in need of comfort. It can be tempting then to revert back to habits that at least provided a sense of identity, comfort and acceptance, despite the horror of it.
I'll say it again - forcing patients into any kind of treatment is detrimental. So, if they stop coming to nutrition counseling, don't force it but do try to maintain contact and encourage them to come back ASAP. The sooner they get back on track, the better their chance of lasting progress.
As a dietitian, you need to prepare for the possibility of relapse. If a client enters a phase where progress stops or even regresses, don't give up. Realize that with help from you and their psychotherapist, they will likely get through it. It is nearly impossible to recover on one's own. They need your support and patience. No matter what, don't give up on them!
It is debatable whether or not complete recovery (psychological and behavioral) is possible. However, a high percentage of people are able to eventually adopt healthy eating practices.
I'll say it again - forcing patients into any kind of treatment is detrimental. So, if they stop coming to nutrition counseling, don't force it but do try to maintain contact and encourage them to come back ASAP. The sooner they get back on track, the better their chance of lasting progress.
As a dietitian, you need to prepare for the possibility of relapse. If a client enters a phase where progress stops or even regresses, don't give up. Realize that with help from you and their psychotherapist, they will likely get through it. It is nearly impossible to recover on one's own. They need your support and patience. No matter what, don't give up on them!
It is debatable whether or not complete recovery (psychological and behavioral) is possible. However, a high percentage of people are able to eventually adopt healthy eating practices.
Warning signs of relapse
- Skipping meals
- Feeling hopeless
- Wanting to isolate oneself
- Daily weighing
- Increase in any addictive behavior (food-related behaviors, exercise, alcohol, drugs, etc.)
- Thoughts of suicide
- Increase in obsessive thinking about food and weight
- Feeling "too fat"
- Counting calories, fat grams, etc.
- Looking in the mirror often
- Marked increase or decrease in sleep
- Increase in binging, purging, restricting, or use of laxatives, diuretics or diet pills
- Increase or decrease in weight by more than 5 lbs.
- Decreased appetite or ability to eat
- Being dishonest about symptoms with support network
- Wearing only loose fitting clothes
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