Anxiety: Three
Compulsive Feeding and Fear of Moving
On the EDI Forums, a few have flagged with me the concern that the HDRM can very readily be misinterpreted, and are often applied such that they actually worsen anxiety rather than alleviate it.
The goal of applying the HDRM in a recovery process is to connect to hunger, not allow anxiety to interfere with hunger.
Whack-a-Mole
The brain must also be treated in a recovery process, and re-feeding and rest efforts alone are usually insufficient in helping a patient reach remission.
Anxiety interferes with hunger when you have an eating disorder. And as mentioned everywhere on this site, eating disorders are closely analogous to phobias, a kind of anxiety disorder. Anxiety states don’t just magically go “poof!” simply because you are now resting and refeeding.
When you tell someone with an active eating disorder that they just need to eat what they are hungry for, what happens? They eat very little. They are hungry but cannot connect to the hunger because the eating disorder fires up anxiety responses and it results in a drive to avoid food.
There are patients for whom the anxiety will manifest in a novel way once they begin to refeed. They will become locked in on whether they are eating enough and resting enough to realize a quick and straightforward remission.
Some of you with a predisposition to apply obsessive behaviours to alleviate anxiety, might find that these behaviours, and the accompanying compulsive thoughts, seem to worsen as you begin to refeed. Others might find they begin to drink more alcohol, or their weed habit increases (Self-Medicating). And of course, we all know that many attempting recovery can easily refeed but cannot give up the activity and exercise (ExerciseTwo).
That is why therapy is a non-negotiable component of applying the HDRM. You need to learn to identify the firing up of your anxiety response so you do not get caught out playing whack-a-mole with your anxiety rather than reaching your goal of remission from an eating disorder.
By learning how to identify the anxiety rising in you; learning how to apply adaptive responses to that anxiety; and then finding that those responses actually ease the anxiety rather than allow it to pop up somewhere else, you can put down your mallet altogether and get on with your fabulous in-remission life.
A Mole That Rarely Pops Up
In Bulimia. I mention three cases where patients developed a specific anxiety while attempting recovery:
“The facets of anxiety on eating enough food involved panic if food was not readily at hand; hoarding and stealing food and eating in secret; and some elements of using food consumption as an expression of individuality and separation from parents (rebellion). All three switched out their psychotherapeutic practitioners and subsequently all three recovered from the compulsiveness and drive to avoid any period of not eating.”
There have been three such cases of which I am aware. Some in recovery may lock onto needing to do the recovery process “perfectly.” Anxiety ratchets in that case around getting in food and remaining very still while doing so.
Here’s the most important tell that someone has careened from active restriction into this unusual compulsive feeding/resting cycle: they believe they can fast-track and short-circuit the recovery process. They hope to avoid pain, swelling, bloating, an overshoot of weight, and/or a protracted period of discomfort.
The key here is everything that they are doing is still based on avoidance.
Moving Around
Unless your medical team advises otherwise, no patient must remain bed-ridden while applying the HDRM. The guidelines incorporate a low average amount of non-exercise-based movement throughout the day.
You can walk the campus, or head to work, and manage some of your daily chores. Your hunger will communicate the necessity of upping your intake if you have had to be out and about a bit too much on any given day.
If you are spending your days in bed because you are in pain and exhausted, then obviously the body is telling you it needs rest. If you are spending your days in bed because you are afraid that if you don’t you will have recovery symptoms you don’t want, or you are going to get more swelling or fat, then that needs to be worked on together with a therapist.
Now I know full well, that the vast majority of those dealing with compulsive exercise as part of their eating disorder are going to likely interpret this post as a blessing to go forth and maintain their usual activity levels— “Hey, walking isn’t exercise, right?”
I am going to try to appeal to everyone’s inner sense of whether this post even applies to you or not.
If you use your activities and exercise as a way to alleviate the mounting anxiety, and/or they are used to rationalize the food intake, then this post is not for you.
If however, you are holed up in your house terrified to load the washing machine because you will have to eat another sandwich to make up for the energy depletion of that activity, then this post is for you.
Food Intake
Again, I’ll remind everyone that if your eating disorder still generally runs the anxiety show in your mind, then this next section can readily be applied to leverage a relapse. Be careful how you interpret this material and seek advice and input from your family, friends and health care professionals.
If you are not hungry for more than the minimum intake, then do not force it. Extreme hunger is not subtle and you will know when you need way more than the minimum. For most when extreme hunger hits, the anxiety goes through the roof: “Surely, I can’t be needing this amount of food?!” And there are posts on EDI dedicated to the challenges of hitting Extreme Hunger.
But what if you are not even hungry for the minimum guideline intake for your age/sex and height and you are eight or more months into the recovery process?
Then you apply a well-known technique found in many psychotherapeutic models: test your understanding and assumptions.
As someone with an eating disorder, the first line of inquiry when you are not hungry for even the minimum guideline for food intake, is to determine whether anxiety or stress might actually be jamming your natural hunger signals.
Alongside that inquiry, consider whether you are still dealing with a narrow list of foods and too many forbidden foods still off your regular food roster— meaning that the eating disorder is still running the show. Your lack of interest in eating to the minimum intake may be a signal that you need to broaden radically the types of food you are eating.
Then, if you have ruled out underlying stress, anxiety and/or a diet that is too narrow in scope and excitement, then you move on to test your actual hunger level. It might be that what you’re unhappy with is the tracking of the intake, and that you and your hunger are well-connected now to match the minimum intake easily.
As you know, moving to eating to your hunger cues and away from either counting calories or applying a meal plan is the final stage in the recovery process for most. But you can always test your ability to connect to your hunger cues at any point along the recovery road. I say this with the obvious warning label that testing your ability to eat fully to hunger cues has a high degree of risk for relapse.
When someone is energy balanced, their daily intake is an average that nets out where the HDRM intake guidelines sit. For energy balanced people some days are much higher, some days are right on the dot and other days are lower.
However, for most with a history of an eating disorder, under eating in any single day tends to trigger relapse. So you may be energy balanced, but you will have to apply more vigilance than someone with no history of an eating disorder.
So after eight months or so, test your assumption by eating to hunger cues for three to five days. Log all the food you eat in those days and at the end of the test phase, add up all the calories and average the intake out to arrive at your daily average.
If the daily average appears at the minimum intake guideline for your age/sex and height, then try another five-day test period in the same way. If you see no progressive restriction in your intake, then Huzzah! You can likely continue trusting your connection to your hunger is not getting hijacked by the eating disorder misidentifying food as a threat.
If you note that the eating disorder is rearing its ugly head as you attempt to eat using hunger cues alone, then you return to making sure you eat to the minimum intake every day yet again and keep working with your therapist or counsellor on your anxiety modulation.
Your Body Is Mighty Resilient
There is no way to ruin a recovery effort. Say it with me: “There is no way I can ruin my recovery effort.” You can always return from a relapse, and slips and slides are all part and parcel of a normal recovery effort.
You cannot prevent an overshoot of your optimal weight set point in recovery. Yes, that sucks, but the body has to manage its fat mass to fat free mass adjustments in its own way. Stop trying to mess with your fat organ— it only makes things worse.
An overshoot is not an automatic outcome for everyone in recovery, but if you are not working with a therapist to help you through accepting the process as it comes and wherever it takes you, then you are leaving yourself open to the dangers of both perfectionism and disappointment.
Respect your hunger. Respect the vagaries, and ups and downs of the process.
A perfect recovery process is not your goal.
And if you suspect that you have found yourself playing whack-a-mole with anxiety rather than progressing towards remission, then seek out some additional therapy or counselling service.
One final reminder: the input you receive from others who have been there is absolutely genuine and well meaning, but as confident or reassuring as it might appear, those responses are no substitute for working with professionals who have the benefit of meeting, questioning and examining you in person.
The same caution must be applied to the posts you find on this site as well. The information here is meant to be reviewed and discussed with those who have the benefit of actually advising you in relation to your specific situation and condition.
If you don’t like or trust your current roster of specialists, then fire them and hire a new bunch— but never treat anything on this entire site as a valid substitution for proper in-person professional advice.
