Anorexia involves extreme disruptions in eating behaviours. It is difficult to watch a loved one suffer physically, emotionally, mentally, and spiritually, especially when the remedy appears quite simple. However, anorexia is more intricate than just unhealthy eating habits. At its core, there are self-critical beliefs and distorted attitudes about food, body image, and weight, in an attempt to manage emotional issues that are often debilitating in nature. These negative feelings and thoughts fuel the destructive behaviour in attempt to help the patient who is suffering cope. A person with anorexia uses food to manage emotional pain and restricts diet to feel a sense of control, safety and calm.
Recovering from anorexia can be a long process that requires professional intervention as well as love and support from family and friends. While you cannot force a person with anorexia to change, you can encourage and support them during their treatment and recovery process.
The Recovery Process
Recovery from anorexia is complex and individualized. The process is cyclic, meaning that the person can go through the cycle more than once. Sometimes, it may be necessary to revisit a specific stage before progressing to the next one. Supporting your loved one through each of the following steps will impact them positively.
Stage 1: Acknowledging the problem
Recovery starts when a person with anorexia accepts that they have a problem. Acceptance can be difficult, especially when they still have the subconscious belief that losing weight is critical to their confidence, success, and happiness. Even when they understand the flaws in their perceptions, it is still hard to stop old habits as well as admit that something needs to change.
Seeking help can be embarrassing. Your loved one may admit the problem but still, resist help. It is critical to carefully educate the person on how the condition will damage their life and health, and the benefits of change. To be helpful:
- Accept the severity of the disorder
- Be more aware of the symptoms
- Do not rationalize their disordered eating behaviour
- Share your concerns openly with them
Stage 2: Reaching out for support
Once the person accepts to seek help, they are taking steps in the right direction. When they open up to you, it means they trust you to support them without judgment or rejection. You must take steps to capitalize on that trust and help them feel safe.
- Timing and place: Choose the right place and time to discuss their disorder. Pick a time and a private, quiet place where they can speak out without feeling rushed and without interruptions.
- Patience: Starting the conversation may be difficult. The person may be unsure about what to say, and they will need your patience. Give them enough time to talk about how the disorder started, their thoughts, feelings, and behaviours, and how the condition has affected them.
- Responding: You will have your emotional reaction. You may feel sad, angry, confused, helpless, or shocked. You may not even have an appropriate response. Take time to process the information and ask specific questions without being judgmental or apportioning blame. Be mindful of the different emotions that come up over time, it’s important that you manage them effectively so that they don’t land on the person who is suffering.
- Offering support: You can:
- Identify your role and how best the person can involve you in their recovery (often support people lose sight of their role and take on the role of a counsellor, a nutritionist, doctor etc. It’s best to remember your role because that’s how you can really be the most helpful)
- Educate yourself about anorexia
- Be a good listener and check-in with them regularly about their feelings, but without being the food police.
- Explore your own beliefs and thoughts about food, appearance, shape, and weight
- Seek support for yourself from disorder support groups for friends and family
Stage 3: Getting treatment
Overcoming anorexia is more than desisting from unhealthy eating behaviors. It also involves learning new ways of dealing with emotional pain. The person learns to love and accept themselves and rediscover who they are beyond their body image, weight, and eating habits.
It is critical to identify the treatment modality or a combination of methods that will work best for your loved one. Treatment should address the destructive eating habits, symptoms, and the root cause of the problem. It should deal with emotional triggers and the challenges of coping with uncomfortable or painful emotions.
Treatment for anorexia involves several steps:
- Assembling the treatment team: Anorexia has severe medical, nutritional, and emotional consequences. Therefore, your loved one needs a clinical team to address all the aspects of the disorder.
- Addressing health problems: Anorexia endangers health. The person needs a comprehensive medical evaluation to identify any health issues. If they have a life-threatening problem, they may require hospitalization to keep them safe.
- Creating a long-term recovery plan: After determining and managing your loved one’s physical health, the treatment team will develop long-term treatment strategies that may include:
- Medical monitoring
- Nutritional counselling
- Group or individual therapy
- Family therapy
- Residential treatment
- Learning self-help strategies: Do not underestimate the role of the person in their recovery. Change and healing will be quicker when they understand the cause of their eating disorder and commit to change. Self-help strategies include:
- Learning healthier ways of coping with emotional pain
- Developing a balanced, healthy relationship with food
- Learning to accept, love and view yourself positively
While your loved one receives treatment, you can support them by:
- Following recommendations from the treatment team
- Removing triggers such as stress, scales and diet foods from their environment
- Being caring, warm, and appropriate with guidelines, rules, and boundaries
- Reinforcing progress without focusing on appearance, shape, or weight.
Stage 4: Maintaining health and preventing relapse
This stage commences after the person sustains healthy behavior for at least six months. However, recovery does not stop once they adopt healthier habits. They must stay healthy and prevent relapse by:
- Identifying triggers
- Keeping a journal to track their emotions, thoughts, and behaviors
- Developing solid support systems
- Sticking to the treatment plan
- Engaging in positive activities
- Maintaining a positive outlook and high self-esteem
Recovery as a process often involves setbacks. A brief lapse does not mean that your loved one has relapsed. You can help them maintain focus by:
- Applauding their efforts and successes
- Helping them to adapt to new experiences continuously
- Maintaining positive communication
- Redefining boundaries where necessary
- Being aware of possible relapse
Refeeding Syndrome
Refeeding is reintroducing food to the body after a period of starvation or malnourishment. Refeeding syndrome is a severe, potentially fatal reaction that occurs when the reinstitution of nutrients causes metabolic disturbances to a severely malnourished or starving body. The reintroduction of sugar or glucose causes a sudden imbalance of fluids and electrolytes that metabolize food in your body.
When you do not eat enough for long periods, your body quickly goes into starvation mode, you become malnourished, and you severely compromise your body’s capacity to process food. A starving body produces lower insulin levels, which suppresses the release of carbohydrates. With a carbohydrate deficiency, your body uses fat and protein reserves for energy. As your body adapts to starvation, electrolyte and vitamin levels diminish. When you reintroduce food, your body stops relying on protein and fat and its metabolism shifts abruptly. It responds to the glucose increase by producing more insulin, causing a deficiency in electrolytes.
While refeeding can take up to ten days, you may experience symptoms of refeeding syndrome in four days of commencing the refeeding process. It is impossible to determine who may develop the symptoms before initiating treatment because some at-risk persons do not suffer from the condition. Therefore, prevention is critical, and doctors can manage it if they detect the warning signs early.
Challenges Individuals Face During Refeeding
The major challenge in refeeding is the risk of developing refeeding syndrome. However, the patient’s physician can manage the symptoms if they occur. If there is no risk of refeeding syndrome, the treatment protocol will be faster and more aggressive. Their daily caloric intake may be as high as 3,000 to 5,000 calories to achieve a weight gain of up to two pounds a week.
This heavy calorie load comes with some challenges.
- Elevated body temperature: The body may convert the energy intake into heat, instead of using it solely to build tissue.
- An urge to exercise: Despite malnutrition, the patient may feel the need to burn the massive amounts of calories they are consuming. Monitoring is necessary because exercise is not medically advisable in the early stages of refeeding.
- Anxiety: An increase in calorie intake causes significant stress in anorexia patients. However, sufficient caloric intake is necessary for recovery, and therapy can help reduce your loved one’s anxiety.
- Resistance: Most anorexia patients resist eating more. Together with the treatment team, you can hold your loved one accountable for weight gain and meal plans. You can also challenge their mindset and encourage them to consume fear foods daily.
- Delayed gastric emptying: This condition contributes to bloating and early fullness. It makes eating physically uncomfortable and compromises the nourishment process. You can overcome it by feeding the patient frequently with nutrient-loaded snacks and meals that allow them to eat smaller portions but still achieve the necessary calorie intake.
Physical Weight Restoration is Not Recovery
Restoration of physical weight is an integral part of healing, but it is not the absolute indicator of wellness. Weight gain can produce adverse emotional and mental side effects. Anorexia alters how a person views their body and their food, and weight gain may produce discomfort even in recovery. Confronting and changing such thoughts is often tough.
In anorexia, learning and habits play a primary role in thoughts and behaviours. Recovery requires the acquisition of new patterns by practicing healthy eating behaviours. It is critical for the patient to work with a therapist to help them work through their emotions and develop healthier coping mechanisms. Practicing normal eating behaviours in varied settings without regressing into old habits is also vital for relapse prevention.
Takeaway
Recovery may be slow, and major life events or stresses can cause a relapse. However, restoring and maintaining physical, emotional, and psychological health is possible. With the right treatment, guidance, and support, your loved one can be free from destructive eating patterns, regain their strength, and enjoy life.
Dr. Natalie Mulligan
Dr. Natalie Mulligan graduated from the Canadian College of Naturopathic Medicine (CCNM). She completed her clinical internship at the Robert Schad Naturopathic Clinic with a focused interest in mental health. Prior to attending CCNM, she completed a Bachelor of Science degree at the University of Waterloo.