When I arrived in the hospital and began refeeding, I was actually full of joy and gratitude. After many months of oscillating between hope and despair, I saw the hospital as a chance to reset my brain, to erase the past year of mental discipline that had crippled my body and soul. Sitting in my hospital bed, properly full for the first time in months, I composed a list of all the foods I wanted to eat when I was discharged: cake, grilled cheese, spaghetti with meatballs, ice cream, donuts, french fries, and the list went on. I fantasized constantly about the new life I would claim, freed of the constant measuring, weighing, fidgeting, and other compulsions of anorexia.
Unfortunately, as soon as I got home, my vision of a perfect and beautiful recovery was quickly overshadowed by a craving for my old habits. Back in my house, with my measuring cups and my running shoes, I started to feel the pull of my old behaviors. On good days, when I felt happy and light, I could avoid such temptations, but as soon as I started feeling tense and stressed, I found myself stumbling back to anorexia.
At first, I couldn’t understand why stress launched me back into my eating disorder behaviors. If anorexia made me so miserable, why was I turning back towards it in times of distress? Rationally, it made no sense.
The problem, I learned, is that the anorexic brain is not rational. It is emotional, instinctive, and paradoxically self-destructive, right down to brain chemistry.
Anyone who has suffered from an eating disorder knows that eating disorder behaviors are not always calculated, conscious decisions. These behaviors are compulsions, meaning that they originate deep within the habit system of the brain, beneath our powers of conscious reasoning.
Most importantly, these compulsions actually reduce anxiety in the eating-disordered brain. While normal, healthy brains signal a stress response in the face of hunger, people with ED have a neurological quirk: in our brains, hunger itself relieves the stress response. In this way, eating disorders are actually a form of coping behavior for the stress of life. Those of us with eating disorders cling to these destructive habits because, on a neurobiological level, they do provide acute relief for anxiety and sadness, even though they lead to greater suffering in the long-term.
This is why recovery is so difficult: even when we have given up the conscious desire to be thin or lose weight, our brains still crave the anxiety-reducing effects of hunger. Nearly two-thirds of people with eating disorders have a comorbid anxiety disorder, making the neurobiological need for a coping mechanism even greater in people with ED.
When we are feeling good about life, recovery might seem simple, but when life gets difficult and worrisome, our old, insidious ED coping mechanism rears its ugly head and throws off our progress.
Recovery isn’t just about conscious motivation and weight gain; it’s also about targeting the pernicious habit of using an ED to cope with anxiety and stress. This is why cognitive-behavioral therapy (CBT) is a critical component of recovery: it teaches us how to take stressful, anxious, depressed thoughts and manage them without eating disorder behaviors.
It is also why we must surround ourselves with love and sources of pleasure whenever possible during recovery. In order to truly recover, we must find new ways to cope with anxiety. Worry and stress do not simply dissolve with conscious effort; all human beings need coping mechanisms for the difficult times in life. The key is to find new ways to cope and de-stress, through close relationships, mindfulness, art, nature, and other pleasures that are both anxiety-reducing and healthy for the mind and body.
Recovery is not easy, nor is it supposed to be. It has been months since I left the hospital, and I still struggle with eating-disorder behaviors on my hardest days. However, I am gradually learning to recognize stress as it arises and to cope in new ways: through journalling, music, television, and even a quick conversation with family.
In recovery, we must remember that our EDs, while completely destructive, do serve a purpose in the afflicted brain. We must focus on healing our brains alongside our bodies, so that even on the hardest, most stressful days, we can relieve our stress while still giving our bodies the energy and love they deserve.
