The Homeodynamic Recovery Method (HDRM) has been developed using both evidence-based and scientific data on recovery to provide the best opportunity for an adult to reach remission from an eating disorder. An eating disorder is a spectrum condition for which there is no cure. Facets of this condition are complex and include anorexia, cycles of restriction and reactive eating, bulimia, binge eating disorder, orthorexia, avoidant/restrictive food intake, anorexia athletica (also known as exercise bulimia) and several other behaviors that all reflect food-avoidant drives.
There is nothing about these guidelines that you will not find in any other inpatient setting where they apply scientific evidence in developing their recovery programs.
The Sturdy 3-Legged Stool for Remission
- Weight restoration (re-feeding)
- Repair of physical damage (resting)
- Developing new non-restrictive neural patterns in response to usual anxiety triggers (brain re-training)
An easier way to remember the method is as the three “R”s to remission: re-feeding, resting, and re-training.
It is best to develop your three-legged stool toward remission by attending to the above facets in order. However, you cannot sit on a two-legged stool, so the sooner you are consuming the minimum intake and resting, the sooner you will have enough energy for the brain to be able to handle the work you will undertake (with a suitable counselor or therapist) to develop the new non-restrictive neural patterns. Remember to involve your medical advisor before you begin upping calorie intake.
To support the first and second leg, these approaches will help:
- Eat the minimum intake for your height, age, weight and sex every single day. It’s a minimum intake and you are both encouraged and expected to eat more. Never restrict food intake.
- No weighing yourself or measuring yourself. Get forgiving stretchy clothing. Relapse is common if you watch the needle on the scale.
- No exercise. I address what is meant by this in more detail in the posts on Exercise.
In addition to these simple, yet hard to apply, necessities there is also a need to recognize that eating disorders are neurobiological conditions. You are not cured by restoring weight. The condition can be managed, unmanaged, or in remission; but it’s never cured.
To get to a robust and permanent remission, you have to incorporate, along with weight restoration and physical repair efforts, the fact that the anxiety you feel welling up when you eat unrestrictedly has to addressed as part of your treatment.
You have practiced maladaptive responses to that anxiety (dieting, exercising, clean eating, and so on)and it helps to have a guide and teacher to help you learn the adaptive techniques for responding to anxiety. Cognitive behavioral therapy, dialectical behavioral therapy, exposure/response prevention therapy (among other approaches)—are all suitable options to investigate with a counsellor or therapist of your choosing. Over time, it not only gets easier to automatically apply well-adapted responses, but you will find the underlying anxieties ease as well. Brain retraining is the third leg in recovery that makes your final remission sturdy and resilient.
HDRM Food Intake Guidelines
The Homeodynamic Recovery Method minimum intake guidelines are age-, height-, and sex-matched based on energy intake requirements for equivalent healthy controls. They are based on all the amassed hard data listed in Doubly-Labeled Water Method Trials. I have just stated that these intake levels are for energy-balanced individuals and when you have an eating disorder, you are energy depleted. The reason the minimum intakes are set to these levels is that it’s a reasonable way to get you started. In fact, the HDRM intake guidelines are set lower than many inpatient and residential treatment centers for those with eating disorders because you cannot restore an energy deficit in the body by merely eating as an energy-balanced person might do.
You therefore can expect to eat far more than HDRM minimum intake levels during your energy-restoration process towards reaching remission. You will find more information on what recovery looks like and why extreme hunger is a necessary part of reaching a robust remission in these posts:
The HDRM food intake guidelines are as follows:
You are a 25+ year-old female between 5’0” and 5’8” (152.4 to 173 cm): minimum 2500 kcal/day.
You are a 25+ year-old male between 5’4” and 6’0” (162.5 and 183 cm): minimum 3000 kcal/day.
You are an under 25-year-old female between 5’0” and 5’8” (152.4 to 173 cm): minimum 3000 kcal/day.
You are an under 25-year-old male between 5’4” and 6’0” (162.5 and 183 cm): minimum 3500 kcal/day.
Outside Height Range
If you are taller than the height guidelines listed above, then expect to add approximately 200 kcal/day to the minimum intake amounts listed for your shorter counterparts (age and sex matched).
If you are shorter than the height guidelines listed above, then you may eat 200 kcal/day less than the minimum intake listed for your taller age and sex matched counterparts; however, keep in mind that these are average intake guidelines for those without an eating disorder—you should find yourself wanting to eat far more than these intake guidelines during your recovery process as hyperphagia (extreme eating) will kick in to help you replenish the energy deficit in the body.
Outside Weight Range
The intake values are confirmed averages for those of average height and weight. The vast majority of the population is of average height and of average weight—almost all of us are sitting on or near that peak of the bell-shaped curve. The absolute peak is BMI 27ish, with the range in which approximately 70% of the population will reside between BMI 21 to 30. 1
Only 4% of the adult population is naturally meant to be between BMI 18.5 to 20.9. There is a steep slope up from the x-axis to the peak of the bell curve on the left-hand size and a shallow slope down from the peak of the curve to the x-axis on the right-hand side. Human beings cannot survive being exceedingly tall or exceedingly thin as well as they can survive being exceedingly short or exceedingly fat.
As it bears repeating: no body mass index above BMI 17 confirms either the presence of absence of an energy deficit. It may come as a shock to many, but weight is not a determining identifier for the presence of an eating disorder. No matter what Diagnostic and Statistical Manual for Mental Disorders (DSM-5) classification you wish to use, there is only one eating disorder spectrum and it denotes the misidentification of food as a threat within the threat identification system in the brain. There can be a more severe energy deficit present for a patient who is BMI 30 than one who is BMI 20. Whether you call it anorexia, binge eating disorder, bulimia, orthorexia, bigorexia, manorexia, diabulima, drunkorexia, anorexia athletica, avoidant/restrictive food intake disorder (etc.), it’s all one lone neurobiological condition. 2, 3, 4
1. Centers for Disease Control and Prevention. “National Health and Nutrition Examination Survey [NHANES] 2005-2006”, CDC.gov (data), November 2007, http://www.cdc.gov/nchs/nhanes/nhanes2005-2006/BMX_D.htm.
2. Gleaves, David H., Michael R. Lowe, Bradley A. Green, Michelle B. Cororve, and Tara L. Williams. “Do anorexia and bulimia nervosa occur on a continuum? A taxometric analysis.” Behavior Therapy 31, no. 2 (2000): 195-219.
3. Eddy, Kamryn T., Pamela K. Keel, David J. Dorer, Sherrie S. Delinsky, Debra L. Franko, and David B. Herzog. “Longitudinal comparison of anorexia nervosa subtypes.” International Journal of Eating Disorders 31, no. 2 (2002): 191-201.
4. Eddy, Kamryn T., David J. Dorer, Debra L. Franko, Kavita Tahilani, Heather Thompson-Brenner, and David B. Herzog. Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. American Journal of Psychiatry 165, no. 2 (2008): 245-250.