The Restrictive Eating Disorder Spectrum

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restrictive eating disordersBy Gwyneth Olwyn

Definition

A restrictive eating disorder is best described as the misidentification in the brain of food as a threat. It is a chronic condition and has no cure. However, a successful recovery effort can result in a complete and permanent remission. It is currently defined as mental illness within the Diagnostic and Statistical Manual of Mental Illness (DSM) and psychiatrists are the only health care professionals tasked with the clinical diagnosis that will be accepted by either private or national health insurance providers.

Classification

The DSM splits out the restrictive eating disorder spectrum into three main classifications: anorexia nervosa, bulimia and avoidant/restrictive food intake disorder [DSM-V].

Binge eating disorder (not a restrictive eating disorder) has been added to the fifth edition of the DSM. I will have much to say on that topic in future. But for now, BED and NES (night eating syndrome) are not considered standalone eating disorders by expert researchers in the field and they are not neurobiologically related to restrictive eating disorders [AJ Stunkard, TA Wadden [eds], 2004].

While there was a push to pursue a transdiagnostic approach it did not materialize in the DSM-V. Transdiagnosis recognizes the fact that those with restrictive eating disorders can shift from one symptom to another or express several symptoms at once and that these symptoms can also change over time as well.

A transdiagnostic classification (merging all facets of restrictive eating disorder behaviors) would have accurately reflected the clinical evidence that anorexia and bulimia are not two distinct conditions and that several additional restrictive facets are all part of the same neurobiological condition as well [DH Gleaves, 2000; KT Eddy et. al., 2002 and 2008].

eating disordersSymptomatology
“…extreme dietary restraint and restriction, binge eating, self-induced vomiting and the misuse of laxatives, driven exercising, body checking and avoidance, and the over-evaluation of control over eating, shape and weight.”[CG Fairburn, K Bohn, 2005]

The terminology I prefer to use for symptomatology is as follows:

  • Avoiding food intake
  • Avoiding food intake and experiencing reactive eating sessions in response to starvation*
  • Abuse of laxatives, diuretics and purging to try to redress a reactive eating session
  • Using exercise to alleviate anxiety associated with eating
  • Applying rigid adherence to eating ‘healthy’ or ‘clean’ to alleviate anxiety associated with eating

* “binge eating” is a term I will not use because these sessions never occur in the absence of overall caloric deficiency for those with restrictive eating disorders.

Causes

A restrictive eating disorder is an inherited neurobiological condition [K Nunn et. al. 2011; CM Bulik et. al., 2006; M Strober et. al., 2000].

The genetic markers are not fully identified, but the condition usually lies dormant and is triggered by a myriad sociocultural and environmental factor(s) [B Devlin et al., 2002; WH Kaye et. al. 2000; T Wade et al., 1998; P Slade, 2011].

The condition is present in all human populations and even exists in some animals  [JL Treasure et. al., 1995; LEA Symons et al., 1981]. In fact, in sheep anorexia is caused by a parasite. Restrictive eating disorders are thought to have persisted within our gene pool because it had survival advantage [P Slade, 2011; S Guisinger; 2003].

Eating_DisorderActivation
One of the unfortunate aspects of activating an eating disorder (ED) is that restriction of energy intake has changed some functions in your body in ways that do not occur for non-ED people. So I’ll first explain a bit about the shifts that happen when ED-genetic mutations are activated with starvation.

When a non-ED and ED person both starve/diet their leptin levels plummet in their systems. Leptin is a gating hormone that manages metabolism, appetite, bone and blood formation, and reproductive hormone function. When we are at a healthy weight and taking in adequate energy, our leptin levels are at an optimal level. When they plummet, two things happen: the metabolism is suppressed and appetite increases. By the way, these are normal survival reactions and they are not resolved by trying to circumvent them while still trying to restrict intake.

For the ED person, starvation activates genes that shift the normal function of neurotransmitters in the brain. It is these neurotransmitters that are implicated in generating the anxious and compulsive thoughts, feelings and behaviors surrounding food and sometimes also body image and weight gain [WH Kaye et. al., 2005; F Fumeron et. al., 2001].

A non-ED person will say she feels irritated, fatigued, hungry and moody when dieting. The low leptin levels are creating unpleasant moods and extreme hunger to signal to the brain that it is time to go find more food/energy to eat.

An ED person will say she is not hungry. Although experts dispute whether she actually does feel hunger or not, it is clear she feels calmer, energized and dissociated from negative feelings (emotionally blunted) as a result of suppressing her hunger [S. Guisinger, 2003; M. Duclos et al., 2012]. The ED-skewed neurotransmitters are perhaps able to override what the leptin levels should be triggering: unpleasant moods and the desire to eat more.

One third of all people who diet end up on the restrictive eating disorder spectrum. [J Jones et. al., 2001; CM Shisslak, M Crago, 1995]. While not all of them develop clinical cases, they all experience lifelong anxieties and compulsions around food (if left untreated).

A sub-clinical case can worsen, at any point, due to life stressors (anything from a cold to a break-up). Patients can express multiple facets of the same spectrum at once or shift from one facet to another over time (anorexia, restrict/reactive eating cycles, bulimia, orthorexia (extreme focus on healthy foods) and anorexia athletica (over-exercise)).

Evidence-based Treatment

Most people don’t know or are unaware that treatments for restrictive eating disorders are largely not evidence-based.

Evidence-based treatment means that there have been clinical trials where the treatment in question is measured against a control group and other researchers have duplicated the results. Ideally, the treatment has also been measured over a long period of time to ensure the outcomes are not short-lived as well.

There is only one treatment protocol out there that fits that definition today: Maudsley Family-Based Treatment. It has controlled and duplicated trials as well as published and confirmed 5-year remission rates.

Two other protocols, Kartini (a family-based approach) and Mandometer (a technology-based approach), have self-published data but no independent corroboration of their findings as yet.

Problematically, Maudsley is specifically designed for child and adolescent sufferers of restrictive eating disorders. And its design is usually difficult to translate into the adult sufferer’s environment.

MinnieMaud Treatment

The MinnieMaud is the set of guidelines for recovery that are published on the Your Eatopia site. There have been no controlled trials or independent corroboration and therefore MinnieMaud cannot be identified as evidence-based treatment at this point. However, the guidelines are based on clinical trial data from Maudsley and the Minnesota Starvation Experiment, among other trial results, rather than merely empirical observation or practitioner philosophy.

The MinnieMaud guidelines include the following key facets:

  1. Unrestricted eating with minimum intakes that are set to reflect actual average consumption of non-restricting equivalents. [I Need How Many Calories?!!  references embedded in that post]
  2. No workouts or exercise. [C Zunker et. al., 2011; S Bratland-Sanda et. al., 2010]
  3. No weighing or taking measurements of self*.

*Numerous inpatient environments resort to “blind weigh-ins” so that they can monitor the patient’s progress while ensuring the patient isn’t triggered to relapse by knowing his or her weight (standing on the scale backwards). But the larger issue of why we must know our weight is overlooked in this approach. Weighing oneself is counterproductive to accepting that optimal weight set points are maintained without cognitive interference.

The Telltale Dozen

How do you identify a restrictive eating disorder? Because it is a neurobiological condition, it is the mindset you are forced to adopt towards food that is most telling. Please note that your current weight or body mass index is meaningless in the identification of the presence of a restrictive eating disorder.

  1. Family and friends have shifted from congratulating you on your weight loss and/or your healthier choices to making either careful or even blunt comments that you look too thin, sick, or generally don’t seem to eat enough.
  2. You are cold when others are not. You’ve started wearing sweaters when others are in short-sleeves. Sometimes you feel light-headed, dizzy. Other times you feel foggy-headed – like you are listening to others through cotton wool.
  3. You are tired and find your mind wanders. You struggle to focus in class or at work. You cannot remember things that others remember easily.
  4. You are prone to crying spells and/or explosive bouts of anger (more so than what might be usual). You alternate between wanting to be alone, snapping at family and then finding you are clingy and needy, seeking reassurance from loved ones.
  5. Not only do you find it hard to concentrate, but also you find you are absolutely consumed with thoughts of food. When you will eat. What you will eat. What you won’t eat.
  6. Facing social circumstances that involve food creates panic: family celebrations, lunches with friends at school, holiday times…in the days leading up to such events you feel extremely anxious and spend a lot of time trying to figure out how to avoid it altogether.
  7. The number of rules you assign to when and how you will eat keeps getting longer. You have become ritualistic to the point where any deviance causes massive anxiety (the wrong plate, the fork in the wrong place…).
  8. You have longer and longer lists of forbidden foods that you will not touch.
  9. If you indulge in any food that you consider unacceptable, you are wracked with shame, self-hatred, loathing and usually ‘punish’ yourself for the transgression (exercising to exhaustion, skipping yet another meal)
  10. As a woman, your regular menstrual cycle is irregular or has disappeared completely. Whether you are a woman or man you notice your skin appears dull and dry. Your hair and nails are brittle and perhaps your hair loss seems more pronounced than usual (clumps in the bathtub trains or on your brush).
  11. You find yourself promising yourself and others more and more that “tomorrow” will be different. But it isn’t.
  12. You lie to loved ones about what you ate that day, or about how much you actually exercised and make excuses for why you cannot eat now. If they are friends, you often fabricate food allergies, intolerances or other reasons why you cannot have the particular item being offered.

If the Telltale Dozen seem to ring true, then your next step is to determine whether these behaviors are impinging on your quality of life. If you feel you are missing out and are suffering, then it is time to seriously consider a recovery effort.

GwynOlwynGwyneth Olwyn is the owner of Your Eatopia, a website cataloguing Olwyn’s four year investigation into the science-based information on restrained eating disorders and recovery from them. She is a patient advocate and a member of The Alliance of Professional Health Advocates. Read her posts at 180D HERE.

30 Comments

  1. this article was enlightening.

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  2. I love seeing Gwyn post here, thank you!

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  3. great to see Gwyn posting here! :)

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    • totally!! :D

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  4. Fabulous post Gwyn! I agree wholeheartedly. Looking forward to visiting your site :)

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  5. GREAT to see Gwyneth posting here! This woman’s work is saving my life–and sanity. Thank you Matt for making her a contributor.

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  6. Thank you Gwyn. I have never thought that I had an eating disorder, even though I was very conscious of my body as a teen and I go through phases where I just don’t feel like eating much, even though I enjoy food very much. Other people think that I am too thin, but that is because I am a petite build. After reading this article, I am now certain that I do not suffer from an ED.

    I think that applying the principles that your blog advocates for an ED person may not be appropriate for a non ED person who may have some symptoms in common with an ED person for different reasons, something that is not always clarified on this blog.

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    • I politely disagree. The principles of the website are simply
      · Eat enough for your age, height, gender and activity level. Eat what you want , when you want and don’t deny your hunger
      · No exercise. This means exercise for its own sake. It does not mean no movement.
      · Don’t weigh yourself. Because nobody needs to know that.
      I know many, many people who live by the above principles, and who don’t have EDs. They have never heard of YourEatopia, know nothing about MinnieMaud.
      They are just listening to their bodies and living normal lives.
      So everyone can benefit from these principles.
      And actually there are many people who started following the above guidelines who don’t have EDs but who were hypothyroid, had fibromyalgia symptoms, have yo-yo dieted, who had other symptoms similar to ED sufferers, and their symptoms have improved. This is because they were restricting without realising it, or because they were on a diet. I’m not talking about autoimmune conditions such as Hashimoto’s, obviously. But a lot of the other symptoms are caused by sub-clinical starvation.
      And the following the principles does not cause harm. Because the body will not gain weight from following them unless it needs to, in the long term.

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      • “I think that applying the principles that your blog advocates for an ED person may not be appropriate for a non ED person who may have some symptoms in common with an ED person for different reasons, something that is not always clarified on this blog.” Pink

        I completely agree with Melissa, Pink. The guidelines are the normal amounts of calories that non-ED/non-dieting/non-restricting people eat. Pink, I think it would benefit you to re-read the post, and/or go over to YE to read the other numerous posts that discusses all of this. It’s clear by what you wrote that you still don’t quite get what she’s saying.

        I’m one of a number of non-ED individuals recovering from years of dieting, and the damage that caused my body, using the MM guidelines. The eating aspect of the MM guidelines applies to everyone living with non-ED restriction (dieting, including orthorexic behavior), not just those with EDs.

        I never would have thought that MM recovery was for me because I don’t have an ED (that’s a mistake that many make), but once I went over to YE and began reading, I began to realize that the guidelines apply to anyone because they are based on average non-ED/non-dieting/non-restricting eating. This is precisely the reason why I created my blog; to help non-ED individuals recognize that the MM guidelines ARE for them as well. I am forever grateful for Gwyneth and the MM guidelines, which finally got me on the road to true recovery.

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  7. Its cool to see Gwyn writing here, I really like her work. However I agree with Pink that some of her advice can easily be misinterpreted by people who are not starving, but maybe used to in the past and mistakenly attribute some current problem to underfeeding, particularly when coupled with reading the forums where people are indiscriminately encouraged to keep overfeeding no matter what their situation. Something that is not emphasized (for obvious reasons since its geared towards recovering anorexics) in Gwyneths writings is that for a person that is not starving, forced prolonged overfeeding can have equally negative health consequences as underfeeding, and give rise to similar mental symptoms such as anxiety, depression and loss of sex drive.

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    • The thing is though, “forced prolonged overfeeding” is very difficult for anyone who is energy-balanced, i.e. not recovering from an ED or a period of dieting/under-eating. Sure, everyone can eat beyond fullness at times – holidays, for example – but to do it consistently over a “prolonged” period would get increasingly difficult, painful and uncomfortable.

      The other issue to mention is that the minimum guidelines YE recommends aren’t extortionate amounts of food at all – they are averages based on the amounts non-restricting adults eat, and certainly not “overfeeding” amounts. I think Gwyneth’s writing makes that perfectly clear, so there’s really no need to make any warnings about the guidelines.

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      • The minimum guidelines are fine, but if you have read all her material and particularly the attitude prevailing on the forums you know it goes quite a bit further than that.

        And it is by no means impossible for even non-eating disordered people to forcibly overfeed themselves to the point where it will have negative consequences, as shown by numerous overfeeding studies (ie Ethan Sims prison study, or Fredrik Nyström with college students more recently) where normal-weight and non-eating disordered subjects were nonetheless able to stuff themselves with more than twice their normal intake for months, and felt progressively worse both physically and mentally as they did so.

        But I suspect people with eating disorders are probably more susceptible than others of taking overfeeding too far since they have a genetic inclination to let their cognitive anxieties override instinctual appetite signals. In this case, the fear of interrupting or slowing down their recovery process by accidentally underfeeding will completely override instinctive satiety signals to the point where many are eating to the point of gagging, day in and day out for months, and probably gaining far more weight and health problems than is necessary for their recovery.

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        • I have indeed read all the material on YE – in fact, Gwyneth does address the issue of force-feeding in a recent blog post (the one entitled “Force Feeding and Fear of Movement…”). I can’t say I’ve ever seen the guidance on YE going further than the basic guidelines for refeeding – the minimum amounts, the importance of responding to hunger, and beyond that, the need to work with medical professionals, to take steps to tackle the anxiety, and to trust one’s instincts (and one’s body).

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          • Gwyn makes it very clear the difference between “force feeding” and responding to hunger, and that includes extreme hunger. The only reason I got better was because I responded to my extreme hunger, however many calories it was, and did not follow it up with any form of restriction or exercise. Slowly my appetitive became that of an energy balanced person, and I have not experienced extreme hunger in many months. The MM guidelines were heaven sent.

        • “…reading the forums where people are indiscriminately encouraged to keep overfeeding no matter what their situation.”

          “… taking overfeeding too far since they have a genetic inclination to let their cognitive anxieties override instinctual appetite signals.”

          Collden, one thing you need to be aware of when you’re reading all of these so-called encouragements to keep “overfeeding”, is that a lot of people who have dieted/have ED have messed up appetite/hunger cues. They are being encouraged to eat their calorie minimum despite not *feeling* hungry because they can’t rely on their hunger cues. This is one more symptom/negative side effect of restriction that they are working on normalizing by eating normal amounts of food regardless of how they *feel*. I had to “force feed” myself to eat normal amounts of food for a long time until my appetite/hunger cues normalized, and they did. A person cannot rely on their hunger cues when they are not working properly. My appetite/hunger cues finally woke up and normalized, and now I eat normally; I don’t need to “force feed” myself. The “force feeding” that you seem to be referring to is not without reason.

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  8. Thanks, Gwyneth. Thank you so much. You don’t know, but you saved my life last year, as I was in a very bad place. I was even able to restore my menstrual cycle after a long, long time. I have “relapsed” a bit lately, due to many (new) life stressors, but knowing what I know now, the perspective is entirely different and I know what I need to do (and what I’ll do) ASAP. I think the MM basic principles can apply to everyone, ED sufferers, weight cyclers, chronic dieters, and whatnot – everyone who wants to restore their health after restriction of ANY kind. However, more often than not people who have an ED (especially not a full-blown, “typical” one) are convinced they don’t have it. But… feed yourself appropriately, rest, and don’t weigh yourself: who would think these things don’t apply to them, except people with some kind of disordered relationship with food/weight/body image?

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  9. The MM guidelines at YE do NOT recommend “overfeeding.” They recommended eating enough for your height and acitivity level. Once you start to eat enough, you may become temporarily very hungry, because your body is able to recognize that it needs the calories. This teaches you to eat like a normal person – when you’re hungry and without restriction. The guideline for no exercise is there to allow your body the time to really recover from starvation, and because many people restrict via exercise. It is not an all-encompassing statement that requires you to be sendentary forever.

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  10. Man you’re killing me.

    Gwyn’s site and work is about eating disorders. The primary focus of 180D is the role of a suppressed metabolic rate in the etiology of disease. Disordered eating just happens to be one of the most surefire ways of achieving a reduced metabolic rate, which is why there is so much overlap between Gwyn and I. Regardless of whether a person has an eating disorder or not, restricts their diet or not, a reduced metabolic rate is a reduced metabolic rate, and the “treatments” for that reduced metabolic rate are usually the same.

    No matter what a person’s history or issues are, metabolically-stimulating interventions are metabolically stimulating. Only a handful of people that I’ve worked with have had to resort to thyroid medication or other assistance to restore metabolic rate.

    I do not recommend “overfeeding” anymore either. I recommend eating to fullness of palatable, easy-to-digest foods. If that doesn’t work to supply necessary calories (some just don’t have an appetite for the amount of calories they need to stimulate metabolism), then they monitor calorie intake and shoot for set calorie targets (track and pack?).

    One also doesn’t have to be underweight to suffer from all the same problems, because it is the loss of bodyfat itself and the low calorie intake and/or dietary restriction (regardless of weight) that can trigger every one of those symptoms. My girlfriend had a severe eating disorder when I met her, but no one accused her of having an eating disorder because she looked “normal.” She would check yes to 2-12 of the dozen items Gwyn lists.

    And the physical manifestations were all there as well, from hair all over the shower and cracked fingernails to constipation, dry skin, and the growth of “peach fuzz” and beyond. And of course, being freezing cold all the time in Florida’s 90+ degree heat.

    Her case aside, this scenario is popping up everywhere in our society from disordered eating, and from other factors. That’s why this site covers a variety of topics pertaining to metabolic rate, from the fatty acid profiles of breast milk to the thyroid-suppressive impact of stress, excessive physical activity, overhydration, and beyond.

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    • I do not doubt what you have writen, nor that others have been helped by your approach. I have learnt a lot, in particular about stress and I am very glad that you went to the trouble to explain how its short term effects can be mistaken for well being.

      I was unknowingly eating in the most stressful way on the road with few carbs. I was extremely underweight and had heaps of stress from other things going on at the same time. Despite this, I had none of the symptoms you mention except for constipation, which was caused by something else and at the very end dry skin, but I get that molting effect in late winter anyway. I was still running around in a skivvy on minus 5 degree C mornings.

      What I am saying is that everyone is different and your approach simply may not have an effect on some people here. Personally, I thrive under a more structured eating schedule (which doesn’t mean rigid or dogmatic) and I do not carry extra fat happily or healthily. I feel so much better for having shrunk a size by not eating between meals (required for medication) and my temperature and other markers haven’t changed at all. The amount of fluid I take doesn’t seem to have any effect either, so I drink as much water/tea/coffee/fruit juice as I feel like.

      I also notice that some people report that they do not experience their weight settling, but uncontrolled gain. I have seen evidence (sorry couldn’t find it) that there are genetic factors that mean that a certain percentage of people are set up for this and that the percentage is greater for non white races. If there are genetic mutations for ED, then it is very likely that there are other mutations for weight gain.

      Reply
      • You say you have no symptoms besides dry skin and constipation, which you claim are not caused by undereating. That may well be the case. But, even if you are naturally slim and don’t have an eating disorder, your body might still be suffering. For example, osteoporosis often goes unnoticed as there is no pain involved early on and being of a low weight is a risk factor for it.

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  11. “Most people don’t know or are unaware that treatments for restrictive eating disorders are largely not evidence-based.”

    ^^Sadly this is just so true. I have been through so many status quo treatments for anorexia and spent so much money to have outdated advice which was never proven in the first place thrown at me. No less than a dozen different rounds in treatment programs never provided me with the simple guideline to eat what I wanted when I wanted; it was ALWAYS a structured mealplan according to a formula as if my body, mind, and life worked like a calculator. And here I am, still quite unwell a decade later.

    Reply
  12. Awesome post! Thanks, Gwyn, you have helped me so much in recovering from my eating disorder! It’s good to see you on 180degrees!!

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  13. In a nutshell: RRARF = SCIENCE! :-)

    Reply
  14. I’m currenty battling the restrictive eating disorder, where I restrict my daiy calorie intake to 1,500 calories, and eat the same foods every day, as that’s what I feel ‘comfortable’ eating. I weigh myself every day when I get up, because I feel compelled to do it, and has become a daily ritual. On some days when I’m not happy with my weight, I eat even less than 1,500 calories for that day.

    My dietary restrictions started 2 1/2 years go, with trying to control my epileptic seizures, which at the time were out of control (I was having up to 10 a day), and no doctors could help me, and couldn’t give me any answers except to put me on more medication. I got angry, and decided I was going to seek natural treatment by myself. I bought a book which was written by an epilepsy sufferer on how to treat epilepsy naturally, where I discovered alot of food preservatives/additives/chemicals, can trigger seizures for epilepsy sufferers.

    Sooo, I removed all processed food from my diet, and ate only ‘clean’ and ‘healthy’ food. My seizures stopped almost immediately, and were non-existent for about 9 months, so I thought I had found the answer to my epilepsy woes. However, after 9 months, it stopped working, and my seizures started to reoccur, with the frequency gradually increasing over time.

    I lost 15kg during that time, and that was without spending hours exercising every day. I became carohydrate phobic, convinced that that they will make me fat. I have issues with my body shape/size, even though when I say I’m fat, people look at me like I’ve got 2 heads. Whenever I watch people eat, it’s emotionally painful for me, as I sit there looking at what they’re eating, with thoughts of all the additives/preservatives that’s in the food they’re eating.

    Anyway, to cut a life story short, I have sufferred bulimia in the past, so I already had the ED predisposition prior to this. Though this time around I have not done any purging.

    I’m currently getting eating disorder counselling, so hope all goes well, though it’s alot of hard work psychologically.

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  15. This is very interesting. I didn’t know ED had no cure. I didn’t know they were inherited… I thought I’d just learned my mother’s orthorexia, not inherited it. That kinda sucks, but then it doesn’t because thanks to this site (180DH) I overcame it.

    For what it’s worth, what has helped me the most are these ideas:

    -Every food has something harmful. Even eating harms the body. Not eating is worse. So just eat what your body needs.
    -There are no good or bad foods.
    -Diet is just ONE factor to consider when it comes to being healthy.
    -Stressing over food is more harmful than eating something “unhealthy”.
    -Nobody really understands the body, but evolution helps us know what we need with cravings and hunger and thirst.
    -Our bodies are stronger than we think.
    -People who eat healthy and exercise also get sick.
    -We’ll all die anyway.

    I know most don’t sound very compassionate, but that’s what helped me:

    Now I enjoy food for the first time in my life and it’s amazing.
    Now I don’t have cravings. At all.
    Before, I spent like 8 hours a day reading about nutrition, now I visit only this site once a week.

    Sometimes I relapse. But then I remind myself the aforementioned ideas and read some Fat Acceptance or HAES literature and everything starts to get better again.

    Best wishes for everyone out there battling with an ED.

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  16. In my experience the ED is definitely incurable. It will just never, ever be the same as before, no matter how successfully managed. Memories of an ED-less existence seem like a far away dream, barely imaginable. Something fundamental changes deep within you.

    It’s like trying to un-learn how to ride a bike.

    Reply
    • I actually don’t fully agree with this. I spent 11 years in firm remission, where my ED was just a memory. I hardly ever thought about it. It was something that happened in my past, I acknowledged it, and moved on with my life.

      Granted, I did relapse, and recovery has been much harder this go around. But, I do believe the future will eventually be much brighter, and I have new tools in my bag so as hopefully not to relapse in the future. More understanding, knowing what to look out for, etc. I think the time spent in my ED, and my difficult recovery will be something that has impacted my life, but I also think it will eventually become a memory, something that I will remember, but not give much thought, just like before. If not, I hate to think of what the future holds…it doesn’t look so promising or bright to look at it any other way.

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  17. This was good information. I would never have thought ED was inherited, Learning something new every day.

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  18. Good information. I would have never though that ED was inherited. Learning something new every day. To those struggling with ED recovery – best of luck!

    Reply

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