[DR. CRISTINA CASTAGNINI] Behind The Bite podcast is part of a network of podcasts that are good for the world. Check out podcasts like the Full of Shift podcast, After the First Marriage podcast and Eating Recovery Academy over at practiceofthepractice.com/network. . Welcome to Behind The Bite podcast. This podcast is about the real-life struggles women face with food, body image and weight. We're here to help you inspire and create better healthier lives. Welcome.. Well, hello everyone. Welcome to the show. So one of the main reasons why I started this podcast was so that I could spread awareness and accurate information out there about eating disorders. That being said, I want to spend some time discussing recovery, but in order to do that, I think it's important to understand what it is that a person with an eating disorder is recovering from. You may be asking why I am even asking that because it may sound like a simple question, but with eating disorders it really isn't, which is why I am bringing this up today. So say you have an illness like a cold, you have symptoms like a sore throat, runny nose, cough and fatigue. You would say you were fully recovered from the cold when all of those symptoms were gone. Now let's take an eating disorder. I cannot tell you how many times I hear from people that they believe that they or their loved one has recovered or no longer has their eating disorder because they are now eating their meal plan consistently and have stopped restricting or physically stable. Now I know that weight restored so often is also used as a determinant of recovery. However, I am going to personally state that I believe that weight does not indicate that someone is or is not recovered. Just like you cannot look at someone and know if they have an eaten disorder or not, even if you have one, you simply just can't look at someone based on their weight and know if they're recovered or not. I'm not going to go there with that one. Well, while these are all huge milestones being physically stable and eating their meal plan, they're huge milestones in someone's progress and treatment and I would never ever want to diminish that. They are also things that we can only objectively see from the outside. So because there is an unfortunate misunderstanding about eating disorders and what they really are then two, there's also an unfortunate misunderstanding about what recovery is as well. Eating disorders are not just about how someone eats or what they weigh. So in order for anyone to understand what recovery is, it's essential for us to understand that not eating, eating too much, exercising in secret, taking laxatives, and other behaviors observed in patients with eating disorders that relate to food and weight are just one piece of the picture for recovery. So those behaviors are what others see but for the person who has an eating disorder, they are experiencing so much more. What nobody else sees or are aware of are these larger issues that the person who has the eating disorder is struggling with. So while some of these things can be similar to those with eating disorders each person really has these unique struggles that are their own. So what is really hard for most people to understand, people that don't have eating disorders to understand is that the eating disorder is not the problem. It is a symptom of the problem. So the behaviors I just mentioned above like binging that are related to food and weight, they serve as a way to cope with their individual problem struggles and concerns. So you may be someone here listening who knows exactly what I'm talking about, or you may be someone listening who is a bit confused and wondering why treatment is not done once someone stops their eating disorder behaviors and they are no longer at risk for any physical complications. And I get it can be really difficult and confusing even for someone who has an eating disorder to understand at least initially. So I'll give an example. What I often hear in my practice from someone who comes in really early on to see me is something like this. They'll say, "Hey doc, I really need to stop eating nearly everything in my fridge and pantry at night once everyone is asleep. I don't know why I keep doing it, I hate it, I feel guilty. I keep telling myself I won't do it ever again, yet I do over and over and over and I've tried every diet and I've failed and I just need more willpower. I have none." Or I'll hear something like, "I have to fit in my exercise. I can't not do it. If I don't go, I feel guilty and believe me, I'll gain weight so fast if I let up even for a day. I set my alarm for 4:00 AM just to make sure I get it in before work." So most of the time someone who comes in saying one of these two things or something like this does not come in asking for help with an eating disorder. They might come in asking for help with stress from work or relationship issue or anxiety. So let's take the example of the first person I mentioned who came in wanting to stop eating at night. They truly believe that they are the problem. They are coming to me to ask for help having more willpower and to stop at failing. But what they do not yet realize is that they are binging or turning to food for a reason, that these binges serve a purpose to help them numb out from or cope with some painful emotions, thoughts, or problems that they would otherwise be focused on if they weren't engaging in that binge. So even if this person were to stop the binging behavior, they are not fully recovered. They still have to discover and treat these deeper issues as well because if they do not address these aspects beyond food and these behaviors with food treatment's going to fall short and relapse in engaging in these behaviors is likely. So we might be asking, okay, so what might some of these underlying deeper issues be? Could be low self-esteem, having a core belief that they're not good enough, difficulties with regulating their emotions, perfectionism, unaddressed history of past abuse, unmanaged anxiety or loneliness. I could go on. There's a number of things it could be. But even beyond that, there is so much more to recovery. I'm not saying any of this trying to deter anyone from seeking help by making it sound like recovery is this endless process that goes on and on and it's unattainable because that's simply not the case. But I'm not going to lie to you, recovery from an eating disorder is not a short-term treatment. It's usually a very intense and it can go on for months or even years. And everyone has a different experience in treatment because you know they have their eating disorder because of their own struggles, their own problems, and there's no cookie cutter approach to treating them. Okay, but all that being said, treatment can and does work and full recovery is possible. So what is recovery beyond, again, no longer engaging in the eating disorder behavior, no longer being at imminent risk for physical complications for such things as cardiac arrest, stroke, or even death, and like I just said, also identifying and working through deeper underlying struggles and problems that triggered the eating disorder behaviors. So if all of those things are met, well we still don't know the whole story of someone's mental state and any silent disorder thinking that they may be still experiencing. So sure, someone may be eating but they still may be struggling with eating disorder thoughts and beliefs about food and weight. For instance, they still may be labeling and categorizing foods and opting to avoid some foods and choosing others simply based on their fears about gaining weight. They may still be body checking by looking in reflective surfaces or comparing their body to those of others when they walk in a room. They may be struggling not to weigh themselves every day and ruminate about if they have or have not gained weight. Those are things you can't see. Those aren't on the surface. So intuitive eating and body compassion, they're no, they're not easy to achieve and they're not particularly for someone who has an eaten disorder. It can feel like it's eons a way to achieve these things because people may still experience body shame and have a huge amount of fear of gaining weight or continue to feel extreme hunger throughout the day. So these can be signs that they may still be a long way away from full recovery. Also, after living with an eating disorder for years, it can be really difficult to know who they are anymore. Oftentimes, their identity may have been wrapped up in their eating disorder itself. So perhaps they were known as the "healthy" one or the "fit" one, or someone who was the "fun" one who always hosted the Friday movie nights, they brought food and they binged on with the girls. So figuring out who they are without their eating disorder can evoke so many feelings. They can be sad, confused, feel shame, really any emotion. So figuring out who they are, their new identity without their eating disorder can be so hard and is also part of recovery. But there may also be difficulties experience with having to create a new normal without their eating disorder. So much of someone's life revolves around engaging in the eating disorder behaviors, rituals, and routines that once they no longer have their eating disorder, it can be really, it's a really big transition to finding new ways to spend their time or really once they have all that time, they have maybe guilt or anxiety that may arise from not engaging in their eating disorder behaviors such as all that intense exercise at the times that they would normally do them. So let's say that they exercise like three hours a day and now say they did it from like 3:00 PM to 6:00 PM, now it's three o'clock and they're feeling guilty because they're going, oh my gosh, this is what I used to do at three o'clock. Now what do I do? So maybe it can bring up some intense emotions or fears or guilt because this can be especially difficult for someone, especially if during their recovery, their body changed at all or they're eating foods that are really scary to them. This can really bring up a lot of thoughts, a lot of fears, a lot of feelings that they need to work through. Also during this time, during going through recovery, reaching recovery, people start to become aware of how their eating disorder affected their life and there are usually some really negative consequences that can be difficult not only to realize, but to accept and move on from. I'll be honest, the eating disorder usually takes a lot from people and there can be a lot of losses which can evoke all sorts of emotions like grief, anger, shame, depression. So what are some of these losses? They may be things like money, which they spend on binge food or expensive exercise equipment or programs. Some people lost their education because they failed too many classes from choosing to fit in exercise instead of going to class one too many times. Or the loss of memories from having missed too many family events, weddings, vacations, because they were afraid to go and not be able to eat the food that would be there and they had to follow their eating disorder what the eating disorder told them they could or couldn't eat. Having some self-compassion to move beyond these negative thoughts and emotions that could come up once all this starts to come to their realization and getting to a place of acceptance is really key to recovery. Also so often there are negative consequences to or losses of relationships when someone has an eating disorder. Someone with an eating disorder often isolates and shuts loved ones out and the other person doesn't know what's going on or they don't have any knowledge or understanding about why this is happening. Also to the person with an eating disorder may have been irritable and angry toward the loved ones or others when they approach them, which just contributes often to alienation and causing a lot of damage to relationships. So dealing with the loss of these relationships or spending time trying to mend them can also be an important part of achieving full recovery. I brought up a lot of things here and I hope you can see that recovery from an eating disorder is far beyond what someone eats and if they're physically stable. And again I know I will continue to have patients or have patients families cease treatment claiming, "Hey, they're fully recovered, I don't need help anymore, I got this," just because they stopped engaging the eating disorder behavior with food. I get it. I totally get it. It can feel like, wow, this is such a milestone. This was so hard. Everything feels so much better. Here's the thing, I caution anyone who sees this treatment at that time to really consider that just because the behavior stops doesn't mean the reason it started in the first place has been treated. Relapse is something you don't want to have happen. Again, I leave you with this, the eating disorder is not the problem. It is a symptom of the problem. This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical, or any other professional information. If you want a professional, you should find one.