Common misunderstandings and issues around what signifies "remission" from an eating disorder.

 
 

When can I start exercising again?

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The resumption of a regular period or returning to a pre-eating disorder weight in no way tells us that someone is energy balanced just yet. While they are great signs that things are moving in the right direction, remission is actually a lifelong practice and not an end-state.

You are liable to simply shift your eating disorder from to anorexia athletica if you reintroduce exercise. Please re-read Phases of Recovery from an Eating Disorder as well as Exercise II: Insidious Activity to understand why the resumption of exercise has tremendous pitfalls and problems for those with eating disorders.

Many with a history of an eating disorder will rationalize that exercise had "nothing to do with the eating disorder" and that it's not about "restriction," plus it's so health protective and is a necessary addition to longevity and health. The health protective benefits of regular exercise are largely cultural platitudes and the science doesn't really support the construct.

Another post on the topic: Exercise III: Athletes, the Picture of Health

 

When can I start eating to hunger cues again?

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Be careful on this one. Many attempt to eat to their hunger cues as soon as they have had three consecutive periods (women obviously) and often it is far too soon to trust hunger cues.

Your hunger cues are always accurate, but those with an eating disorder have what I call a "signal jamming" issue in their brain such that they are torn between responding to hunger and avoiding the perceived threat (namely eating). It takes a lot of non-restrictive practice before you can be sure your hunger cues are coming through to you loud and clear.

Here is how you know you are ready to attempt eating to your hunger cues:

  1. Your weight appears stable. (weighing yourself is not necessary to determine that).
  2. If you have dealt with amenorrhea during your restriction, then you have achieved 3 consecutive periods in a row.
  3. You are continuing to eat minimum amounts and it is comfortable to do so.
  4. Other lingering signs of repair seem complete (no longer cold, tired, achy, dealing with water retention, no brittle hair or nails etc.)
  5. You think you may need to start eating to hunger cues and are a bit anxious that you can trust those cues.

Note Item 5—if you are feeling extremely confident about eating to hunger cues then chances are you are a ways away from remission still.

[from Phases of Recovery from an Eating Disorder]

You should really be comfortable that you have covered off all 5 items on that list, not just item 2, before you attempt to eat to hunger cues.

When you think you might be ready, you log your food intake for 3 days while eating entirely to your hunger. After the 3 days, you tally up the calorie intake for each of those days. If you are averaging the minimum guideline amounts for your age, sex and height, then you can feel fairly confident that you will be able to use your hunger cues to stay in remission from that point forward.

 

I am weight restored by my period hasn't returned, is it ever coming back?

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Menstrual cycles feature prominently in recovery programs despite the fact that their presence or absence is a) irrelevant for males and post-menopausal women and b) has been removed from any Diagnostic and Statistical Manual of Mental Disorders classifications of eating disorders precisely because menstruation is a poor marker of health (although its absence signifies ill health; its presence doesn't signify health).

The second problem is that "weight restored" has no significance because weight restoration is only reflected when unrestricted eating is occurring all the time and weight has stabilized as a result. Usually "weight restored" for those with a history of eating disorders continues to involve food restriction and/or energy deficits through exertion relative to food intake (exercise and other compensatory behaviors).

The first line of resolution is to eat without restriction and seek out psychotherapeutic support to address anxiety for doing so and the second line of investigation would be to discuss the situation further with your medical doctor.