Thoughts about Recovery during the Holiday Season

This season is meant to be one of joy and celebration, and for many there are moments that match the hopes with true sentiment. Even so, a time of year with so much riding on it can lead to disappointment or disagreement, argument or worse. It's a time of year when people come together and families or groups cope with a host of mixed, often intense feelings. 

For people in recovery from an eating disorder, this season brings a mixture of regret about the past and time lost and also hope for change in the future. Often surpassing the celebratory moments can be the extra pressure on recovery to somehow take a giant leap forward or even magically leave the struggle of the eating disorder thoughts and behaviors behind. 

Clearly, the nature of recovery is neither kind nor forgiving. Progress comes from hard and steady work. Changing ingrained thoughts and patterns around food, a necessary component of survival, involves refashioning behaviors deeply imprinted in our most basic brain function. It's almost like learning how to walk again when every ounce of your body wants to sit forever. No holiday or new year will speed the process. 

What this time can bring is the peace to find steady ground around those people closest to us. The antidote to an eating disorder is not strict rules or tough love but about connection, meaning and forgiving love. The way to find peace from an unrelenting eating disorder is to create a foundation of true connection and bonds. Those pillars limit the space for an eating disorder in one's life. 

Although there may be a desire to push people away, the real benefit comes from knowing people are on your side. Feeling as if there are people supporting the cause can galvanize recovery and strengthen the sense of a healthy future more than anything else.

Why Compulsory Eating Disorder Treatment Almost Always Backfires

A topic I have visited several times in this blog is forced treatment of adults with eating disorders. I have seen patients taken to treatment against their will improve their medical health many times, but rarely if ever does this approach lead to psychological and emotional wellness and recovery. 

It feels incomprehensible for families to watch a loved one suffer, become ill or even come close to death from any illness, let alone an eating disorder. And watching this process is excruciating. There is a point when severe medical compromise leads a family to take their loved one to the ER for emergency care in order to avoid permanent damage or death, and that step is as valid for an eating disorder patient as for anyone. 

However, compulsory residential treatment for months is another consideration. At this juncture, forcing someone into treatment involves confining them against their will and forcing them to eat and follow rules they never agreed to. The result is such a loss of autonomy and enormous fear of doing things that feel impossible and indeed traumatizing. From the patient's point of view, enforced eating doesn't feel kind or compassionate in any way but instead incomprehensibly cruel. 

This is hard for people with little knowledge of eating disorders to understand. Eating for most people is as simple as breathing and sleeping. It is one of the basic daily tasks we must do to survive. Even for people who ruminate about what to eat, they must eat. For people with eating disorders though, nothing could be more terrifying. 

But forcing people to eat is not the crux of eating disorder recovery. Successful treatment entails regular eating and health to be sure, but love and compassion combined with the growth of the individual outside the pervasive and punitive eating disorder thoughts create true health. 

The circumstances necessary for treatment must be voluntary. A patient needs to realize the need for help while also recognizes the limitations the eating disorder imposes on daily life. From that point of view, there is a purpose to the scary step of starting treatment. There is a reason to seek out extraordinary circumstances and to start down the path to creating a full and healthy life.

Overexercise, an Undertreated Part of Eating Disorders

Exercise is a relatively new concept in health. Only in recent decades, as a significant number of jobs have become sedentary, has the medical world realized the detriment of the lack of exercise to health. 

The health news media spread the word about the need for exercise and helped create a new part of the virtuous life. The well-rounded, healthy individual must incorporate exercise into any daily regimen, so the message goes. 

Although the concept has merit, the individual's well-being, in today's age, is always secondary to the power of the marketplace and money. Accordingly, business interests now dominate the exercise world, exploiting a medical recommendation into a guilt-inducing profit machine.

From over-priced gyms to exercise classes to communities proselytizing a new way of life, smart individuals created companies to manipulate people to spend money on exercise and to translate the modern need for an idealized version of health into monetary gain. 

For people with eating disorders, the effect of a powerful exercise industry is more nefarious. Since exercise remains an unquestioned positive in today's society, there is still no room for the message about overexercise. The gyms and classes have no way to manage the person who spends seven hours per day in the gym or goes to four, five or six classes per day. 

The medical effects of overexercise are cardiovascular problems, chronic dehydration, muscle breakdown and even kidney failure. Even for those whose symptoms aren't as severe, exercise dominates one's life and leaves no room for any other personal growth or relationships. 

The first step towards addressing overexercise is to call it a problem. Exercise is necessary for our bodies to function, but that can mean walking each day as much as going to a gym or class. The idea is that our bodies are not made to sit exclusively. Moreover, the human body needs food to function every day, no matter the amount of exercise. The industry has coopted the concept of calorie burning to mean one deserves food only after burning energy. Separating food from exercise is a crucial part of discounting eating disorder myths. 

Limiting exercise to a certain number of times per week and amount of time per day is also a way to recognize the potential detriment of overexercise. Without a way to acknowledge excess, the pervasive message that exercise is always good will triumph. 

Taking these initial steps will also open the eyes to the eating disorder community that exercise must play as large a role in the eating disorder symptomatology as starving, purging or laxative use. When we as clinicians take overexercise seriously and devise treatment aimed directly at these symptoms, people seeking treatment will hear the message much more clearly.

It's Time to Treat Eating Disorders as Both Psychological and Physical Diseases

What makes eating disorders unique in the scope of psychiatric illness is the fundamental medical nature of treatment. As such, the complete approach to recovery needs to include a medical sensibility as well as psychological one. 

However, artificially separating the psychological and physical tends to limit the effectiveness of care. The best plan must incorporate and weave together these two parts of eating disorder for truly comprehensive care. 

The clinical world tracks eating disorder providers into specialities: food, therapy and medical. Each provider is a crucial member of the treatment team but usually focuses their specific treatment on only one component of recovery. However, the individual's experience is a cohesive one, and separating out the different aspects of an eating disorder doesn't reflect the reality of having one. 

This problem begs for creativity on the part of the treatment team, something always called for in eating disorder treatment. The wisest clinicians have gleaned enough knowledge and experience to know that blending information from other parts of recovery, even when it's not one's specialty, makes for more complete care and an increased chance for recovery. 

For the therapist, this means referring regularly to the medical complications from an eating disorder and heeding the severity of the illness. For the physician, respecting the power of the eating disorder thought process rather than implying recovery is the same as willpower. For the nutritionist, recognizing food and nutrition education isn't really the cornerstone to treating someone with an eating disorder: the treatment is really food therapy. 

Each clinician may have a specialty; however, the team overall must focus on the psychological and physical components of an eating disorder as well. Each appointment is a way to call into question the dominant eating disorder thoughts and point out the fallacy of continuing the symptoms. A cohesive approach of each member of the team can acknowledge the realities of recovery and help the patient recognize how physical and psychological impairment limits their lives.