Common Questions 2024 Update
For the first seven years that this site was in existence there were forums and I was available via email. I no longer offer these services however the questions I received back in the day have not changed as these are common to anyone attempting a recovery effort. Unfortunately I rarely write succinctly but I will be rebuilding the vlogs in the next year to support those who find reading tiring and who find my written material too long to navigate.
In the meantime, this is an entry that was first compiled January 2013 and subsequently updated with a few new items as well:
I encourage you to engage your loved-ones in the recovery process. If you find posts on this site overwhelming, then your loved ones can read them on your behalf and give you the point form highlights to help you keep moving forward.
Seems People Love or Hate HDRM
I’ve searched around and there are those who say HDRM is dangerous and harmful and others who have successfully recovered using it. I don’t know what to believe. What do you have to say?
I am not here to make you believe anything either way. I am afraid it is entirely up to you.
All chronic conditions have no cures and we are all relegated to suppressing symptoms and pursuing a hoped for period of remission that is ideally long lasting. HDRM is a science-based protocol in line with Family Based Treatment. Family Based Treatment has a success rate of about 30%. HDRM is assuredly in that range, and perhaps a bit higher because it gets those who have previously failed on other science-based protocols and no other method focuses on unrestricted eating for life. But here’s what that means: success is hard to achieve with any approach available today, including HDRM.
You may regret your decision to choose DBT, ERP, FBT, CBTe, IFT, ICAT, RCT, EFT or ACT– all science-based treatment protocols used for eating disorders today. You may even be harmed by any of these protocols. No intervention for any chronic illness is without risk.
However, untreated eating disorders have the highest morbidity and mortality of any of the mental disorders listed in the DSM. I am not advising you to choose HDRM, but I am assuredly advising you that you not leave your eating disorder completely untreated.
If HDRM seems appealing to you, don’t rely on this site or what you find out on it online generally— talk it over with your in-person healthcare professionals and your trusted closest family and friends. You may be ground down, finding it hard to think and feeling very insecure, but you are still you. So use your instinct and own your final decision.
Can I Do This on My Own
I have been in inpatient treatment centres several times and I hated it. Each time I come out I attend the group sessions for a bit and then I drop out. I am back likely needing to go in again as my partner is getting worried about how I am doing lately. I came across HDRM and I’m wondering if I can get healthy without having to go into hospital yet again.
All chronic conditions (an eating disorder is a chronic condition) will have acute flares. And anyone with any chronic condition dreads needing emergent hospital care, usually for good reason. Chronic conditions, whether they are assigned as mental health disorders or not, have no place in the current medical industrial complex entirely designed for crises that are readily resolved. If you have appendicitis, you want to be in an emergency department! If you have a lupus or Ehlers-Danlos crisis, then how well you are treated and whether the flare is successfully resolved or not in an emergent medical setting is much more of a coin toss. Sadly, there are no chronic condition specialty hospitals.
Even eating disorder inpatient clinics and hospitals are modelled on a medical industrial system of fixing things and cures. As an eating disorder cannot be cured, the place marker for “done” is to get the weight stabilized and the biomarkers looking okay and then to free the bed up for the next person in line (and there are more patients than beds everywhere).
The upshot is that only you can make the decision to go and get acute medical care. But while HDRM can be used in inpatient and outpatient settings, true medical stabilization can only happen in the flawed hospitals we have today. And with an eating disorder, medical destabilization is serious and intervention should not be delayed.
If the motivation for applying HDRM is to avoid an inpatient stay, then it may not be the right protocol and right time for you to embark on a recovery effort. If, however, you want to get off the cycle of periodic inpatient stays when things deteriorate, then now might be the time to discuss HDRM with your medical advisers, family and/or partner.
Can I Go Low and Slow Instead
The minimum calorie guidelines for HDRM seem way too high and they scare me. I am maintaining my weight on [redacted amount] of calories right now and I don’t notice any symptoms or health concerns. I do think about food constantly and I have a bit of trouble sleeping, but otherwise I am fine. Surely, I don’t need 3000 calories a day?
Many on the eating disorder spectrum have no idea that the mere thought of food is hunger (an energy deficit in your body) for those who are not on the spectrum. Essentially the non-eating disordered world never thinks about food unless they have accidentally gotten caught up in things. As soon as the thought of food pops into their heads, they are off to eat. For more on this, check out Experience of Hunger.
As a reminder, the calorie guidelines assigned in HDRM are not for those with energy deficits, but what energy-balanced people actually eat. If you have been ignoring thoughts of food, and not eating as soon as thoughts of food occur, then you have created an energy deficit in your body and that means you will need additional energy beyond the minimum intakes.
While going low and slow has been a common approach in many inpatient settings, usually on the now debunked belief that refeeding syndrome (a deadly side effect of refeeding after a period of starvation) could be avoided if food intake was slowly notched up, it also makes for less intense patient experiences, easing the load for the healthcare professionals. Unfortunately, what is easier to manage for the administration of an inpatient environment is not necessarily in the best interests of the patient getting to remission. Refeeding syndrome is a very real risk whether you up calories slowly or not and it is not correlated with whether you are at an objectively low weight or not either. So always have the ability to seek medical attention very quickly if you show signs of refeeding syndrome.
HDRM defines eating disorders as the misidentification of food as a threat — a phobia. When you have a phobia, you avoid the stimulus because it generates a fight/flight/freeze meltdown. Phobias are not resolved by continuing to avoid the stimulus. As such, slowly reintroducing food as a way to try to lower the fight/flight reaction reinforces the phobia and not the recovery.
There are many EDI papers that can be found under the heading Brain Retraining on how to navigate approaching and eating the food to help get you to a point where you keep approaching and eating rather than delaying and avoiding.
Still Wanting Ultra-Processed Foods
I am currently about 7 weeks into recovery and am still craving snack foods only! I have been eating around 20 granola bars (each one containing about 160-200 cals) and 2 big boxes of cookies everyday on top of my 3 main meals. I'm just wondering if it is normal to still be eating so much snacks since i hear that people on the forums start craving "real" food a lot sooner? and I still feel bloated all the time with a huge belly which is so uncomfortable, may i know when this will get better?
You will hear lots of things about others in recovery that will generate anxiety that you are somehow not trending as you should.
Quoting myself from Phases of Recovery:
“Do not read the Phases of Recovery as though you are reading a recipe or following scientific steps that will realize unequivocal and successful results. Think of it as “individual mileage may vary”.
Do not panic if you find some symptoms are not present, or seem to appear, disappear and re-appear. Your entire recovery process may take you into full remission in as little as 3 months or as long as 24 months or even 48 months. Three months is very, very rare and 18 months is the median time to remission, so be prepared to be patient.”
I sympathize with the impatience that everyone experiences through the recovery process, but try to remain realistic about how long the body really needs to repair all the damage.
When you are unsure about where you are in your process of recovery, then always re-read: Phases of Recovery from an Eating Disorder.
Food Fears Part One: Food, Family and Fear and Food Is the Foundation can help you reinforce the fact that you need a lot of energy to re-balance the huge energy deficit you have in your body. A preference for ultra-processed foods is explained in Food Fears and Food is the Foundation provides the clinical data for why the minimum intakes are set as they are.
Amenorrhea and Oligomenorrhea (absent or irregular periods)
I have a question regarding my irregular period. It stopped in September, and I haven't gotten it since then. I'm really worried about what that entails. Perhaps this is a stupid question, but does that mean I'm infertile? Do I really have to eat 3000 calories a day to start menstruating again? I've also heard that once you stop menstruating, you can bleed for two months when you start again. I don't know what i've done to myself and it scares me. I just want to be healthy again, but I don't know how. If you have time, could you please respond to some of these questions? I would truly appreciate it.
Not a stupid question at all. 3000 calories is a bare minimum for those women under age 25 and under 5’8” in height who has never had an eating disorder. You will eat more than 3000 through some portions of the recovery process and that is to be encouraged and normal.
You have created such an energy deficit in your body that, at the moment, it has decided that you cannot survive a pregnancy (nor likely could the developing baby) and so it has shut down the process of a regular menstrual cycle to try to keep you alive by redirecting energy that would go to that cycle for immediate issues like keeping your heart beating.
Your period, and your fertility, will return when you rebalance the energy your body needs. And to do that you have to stop exercising, rest and eat a lot. Nothing about the damage caused by an eating disorder is irreversible thankfully.
It is a serious thing when you stop menstruating and you should talk to your parents/loved ones and to your doctor so you can be monitored as you begin to refeed and rebalance the energy in your body. Don’t attempt to do this alone as there may be other physical issues beyond amenorrhea (lack of a regular period) that need to be monitored carefully as you restore your weight and health.
Is This Me?
I say all this assuming that I have an eating disorder. Thus far in recovery I've been eating between 2500-3000 calories a day with some days being more like 5000. Yet this hasn't been very difficult for me so I'm wondering if what i'm experiencing is merely gluttony rather than an actual ED recovery situation [emphasis mine]. I also only seem to get extra calories through 'junk' food which I'm not really craving I just know I CAN eat it due to how small I am.
…details omitted…
My mum was worried and we fought about it a lot but I was sure I was being healthy and didn't have anorexia or anything similar. I knew I wasn't and had never been fat so I assumed I was fine. I started university earlier this year and was catered for, but my fear of gaining the 'Freshman 15' led me to under eat. When I finally managed to weigh myself again I was only [severely underweight]. Throughout this time I've been 5'6' and 17-18 years old.
Does this put me in the ED spectrum? Should I really be eating 3000 calories a day?[emphasis mine] I also have lost my period but I've no idea when I lost it due to being on the contraceptive pill for some time.
One of my all-time top questions is “Am I just a gluttonous pig?”
The answer is “No.”
Next in line is “Do the guidelines apply to me?”
The answer is “Yes and No." They actually apply to all people who have never had an eating disorder, so in that sense they are ubiquitous. However, when you have an eating disorder history, then in fact you will need more than those minimum intake guidelines to reverse damage and return to an energy-balanaced state.
3000 calories is an average intake for a non-ED woman under the age of 25 and under 5’8”. Read that one again. That is what an energy-balanced young female eats.
If you are energy deficient, which you will be when you restrict your intake below 3000 and/or up your energy outputs with formal activity and exercise, then 3000 calories is an absolute bare minimum intake during a recovery process where you are attempting to restore your energy balance. Restoring energy balance includes both weight restoration and physical repair and will not occur if you treat the minimum guideline as a maximum. Your body will let you know it’s ready for all the additional energy with extreme hunger. You can read about that here: Extreme Hunger One and Two.
If any family or friends have ever expressed concern regarding your restrictive behaviouurs, take it very seriously indeed.
Read the Telltale Dozen and Phases of Recovery.
When Can I Exercise Again?
I Know i emailed you a few days ago about not getting my period back yet but I just got it today! Thank you so much for your site, I am so happy! But I would just like to know now if I can resume exercise? I that generally it is recommended to wait until I have 3 consecutive periods but my I am at my pre-ED weight already and it has been quite stable despite eating 3000-4000+cals. I have been recovering for 7+ weeks and have been hungry since the beginning. Nowadays I still eat whenever I am hungry and it naturally takes me to 3000+. does this mean I can stop counting calories now? Can I resume exercise if I am confident that I will not have anorexia athletica because even during my anorexia I was always lazy to exercise, but the past few days I have been feeling like increasing my physical activity (other than walking).
Unless you are over the age of 25 and you also experienced your bout of restriction after the age of 25, then your pre-ED weight is irrelevant.
The resumption of a regular period in no way tells us that you are weight restored or energy balanced just yet. It’s a great sign that things are moving in the right direction. Periods work one way only: their absence confirms things are amiss, but their presence doesn’t confirm everything is great.
And finally, resumption of exercise tends to shift your eating disorder from anorexia to anorexia athletica. Just because you were not applying exercise to modulate the anxiety around food intake up to now does not mean you are immune from doing so in future. Please read Phases of Recovery and specifically search for the sub-headings: No Exercise, Honeymoon, Menstruation and Knowing When You Can Trust Your Hunger Cues.
