National Eating Disorders Association

Although it may start that way for some, anorexia is not “a diet gone too far.” No consciously chosen diet would take you to the point of organ failure. In reality, an eating disorder is so much more than that — it’s your brain detecting a stressor (real or perceived) and focusing on escaping from that stressor. In the process, it deprioritizes all non-essential biological mechanisms to focus on escape, including slowing digestion (reducing appetite in the process) so it can increase absorption of sugars from the digestive tract and give your muscles energy to run away. In neuroscience, they say, “those that wire together fire together,” so for those with a genetic predisposition with persistent stress, the brain learns if you feel stressed you eat less. Eating less becomes wired with the stress response and so if you eat more, you become stressed. Eating less then makes your brain more anxious as the brain enters “famine mode” and the threat becomes hunger. The lack of food increases your anxiety and decreases your mood (you need food to feel joy) making you depressed, and you become stressed and anxious by the very essential thing keeping you alive, food. Food becomes the stressor. It isn’t a diet gone too far, it’s not a choice, it’s not you not liking food, instead it’s your brain wiring stress and food together and evoking anxiety around eating and food. However, with the right treatment for the anxiety, the right re-nutrition to help nourish the brain and leave famine mode, you can re-wire your brain, find peace, and learn to get palatable joy from food again. Anorexia is not a choice or identity, but a temporary brain illness, completely and sustainably recoverable with the right treatment. Anorexia Is Not a Choice, but Recovery Can Be Although getting anorexia is not a choice, recovery can be. Our brains are neuroplastic. They are forever wiring and rewiring so that with decreased threat, lots of nutritious food to help improve mood and leave famine mode, sleep and sustained practice, we can rewire the stimuli and response mechanism and relearn how to remove the “food is threat” response. We have to face our food fears and become desensitized to them. However, the longer the stress and behavior (eating less) become wired together, the harder they are to unwire. This is why early intervention is so critical. Those with a larger amygdala, the emotional reasoning part of the brain, are more susceptible to anxiety and thus to eating disorders. The emotional part of the brain is affected by oestrogen (one of the reasons women are more susceptible to eating disorders than men) as oestrogen plays a role in serotonin (the happiness chemical) levels and mental well-being. Over-exercising can reduce oestrogen, which could be part of why anorexia is very prominent in athletes (as part of athletes triad). Too high (intense happiness) and too low serotonin (depression) levels and fluctuations in serotonin increase anxiety and thus increase the chance of someone developing an eating disorder. Healthy eating includes foods high in tryptophan (the serotonin precursor) which is why “orthorexia” or “extreme healthy eating” can lead to improved mood — but then anxiety if in excess. When I talk about anxiety, I don’t mean that some people are weaker than others. Not at all. In fact, one theory states that people with a predisposition to anxiety are more evolved than those who are not. This is because of the flight or fight response. According to Charles Darwin and his “Origin of Species,” the “evolutionary aim” of a species is to prevent species extinction. To do this, a species must survive against natural disasters, predators, extreme environments, and outcompete other members of the species for shelter, space, food, and a compatible mate and produce fertile offspring. The “flight or fight” mechanism helps organisms to survive. This is a biological mechanism from our evolutionary ancestors which helps us to detect a threat to survival and run, defend or hide from a threat. This occurs via increasing adrenaline and cortisol which effects the body in the following ways: it dilates pupils, increases our heart rate, decreases digestion (and appetite so you feel fuller) and reproduction (including oestrogen and testosterone production) and moves the blood to the muscles to combine with glucose from our diet in respiration and give us the energy to run away from the predator. Therefore, those caveman ancestors with a higher predisposition for anxiety — “the premeditation or anticipation of stressor” — were more likely to detect the predator first and survive based upon the principles of “survival of the fittest.” Whether environmental (from their lives) or from within (for example, putting yourself under a lot of pressure to succeed), this anxiety is not weakness, but a biological advantage. It actually can be the sign of a more evolved brain, of greater intelligence, of being more likely to recognize a threat and of having a greater chance of evolutionary survival. But, it also puts you at higher risk of eating disorders and other mental illnesses linked to anxiety. How we respond to stress depends on our genetics. Whether we get a decreased or increased appetite in response to stress depends upon our genetics. This is why stress plays a role in anorexia and in over-eating. For those with a genetic predisposition to anorexia, stress makes you full. People who are more likely to get anxiety include those with stressful upbringings or jobs, those under a lot of pressure from others or themselves (including “Type A personality” highly ambitious people) or financial pressure, those with a lot of time with technology, limited sleep and limited access to outdoor spaces and nature in cities, those alone (as relationships, family, friends, and community increase oxytocin which reduces anxiety), women (due to the role of oestrogen on anxiety levels), “emotional people” whose genetics result in larger amygdala’s (which also evokes more creativity, greater memory and thus intelligence, greater empathy, and compassion) and those with much indecision or uncertainty in their lives (one of the reasons eating disorder levels rose during the pandemic). In cognitive behavioral therapy, the idea is that a thought (including an anxious thought), leads to a feeling that leads to a behavior. Thought> feeling>behavior. When it comes to anxiety and eating disorders, there are two main focal points: Frontal Lobe: Controlling emotions, impulse control, judgment, behavior, memory, thought processing. Limbic System (including amygdala and hippocampus): Emotions and stress (real or perceived), memory, and thought processing. Anxiety, via the “flight or fight reflex,” can steal your appetite and stop you feeling hungry, but also gives your muscles fuel, so you feel hyper. With a reduced appetite, you naturally eat less. With increased energy you do more. Over time, your brain wires stimulus and response together, so if you eat less when you’re chronically worried, if you eat more, you get stressed. Food becomes the stressor. You don’t “not like” food. You don’t “choose to not eat” — but your brain makes eating stressful and gives you anxious energy, reducing sleep and increasing activity. This is why anorexia is so hard to fight and is why lapses and relapses are common in periods of stress or anxiety, such as life changes or if the threat or stressor is not removed. If the stressors from before are not changed, relapse risk is high. To prevent relapse, patients must mine the thought and feelings and environments that trigger their behavior and try and avoid them or develop coping mechanisms to them. They must learn ways to move their brains from “flight and fight” to “rest and digest” and feel calm and hunger and at ease with food again. Brain re-wiring takes practice and reinforcement as new neural pathways are weaker, less strong than old ones (which is why habits are so hard to get rid of). Recovery takes incentives for practice (support, goals, reasons to recover, knowledge of repercussions if you don’t recover), and sustained practice and maintenance of new brain pathways. It means facing your fear foods (often in anorexia, high calorie, fat, or carbohydrate foods associated with weight gain, another anxiety-producing fear in anorexia). Sleep, good nutrition, and the removal of stressor all help reinforce memory (in the brain hippocampus and frontal lobe) and neuroplasticity, reducing anxiety. They also stimulate BDGF (brain-derived growth factor) which plays a role in the formation of new neural pathways. Relapse prevention is about maintaining a constant external environment so you can maintain a constant internal environment. It is doing what you can to mitigate changes and remain constant and reinforce those new brain pathways. Finding Order in Disorder With an Eating Disorder Initially in anorexia, it is not about food. It is a maladaptive coping mechanism for dealing with thoughts, feelings, and environments. Our brains use control over food as a way of “calming the chaos” in our lives. To find order in the disorder with an eating disorder. You can’t “choose” this, it’s a nervous system response out of voluntary control. To fight it, you must “re-wire” your brain, which is incredibly difficult, but I, as living evidence of this, can confirm it’s not impossible. In recovery, I have learned tools to manage my “old brain” and how it responds to stimulus and think more rationally and logically. In between the emotional and logical brain is the wise brain. I have neuroplastically developed my “new brain” neocortex and, with CBT and mindfulness, have learned to interrupt the mechanism that links feelings and unhelpful behaviors and enter this “rest and digest” brain mode. I am consciously aware of how my emotions (how I feel) impact and skew my decisions, interpretations of life events, how I respond to situations with my behavior, and have learned to always question how I am feeling and ensure I am basing decisions on evidence and logic, rather than solely emotion. I have learned that when tired, with too high or low blood sugar, too much or too little social stimuli, hungry, ill, and on my period, I am less able to control my emotions and so use healthy coping mechanisms like sleep, yoga, rest, classical and jazz music, hot baths, walks in nature, and socializing to disrupt anxious thoughts, stop unhealthy behaviors, and switch my brain from the “sympathetic” stress response to the “parasympathetic” relaxation response. I know that deep breathing and yoga is a great quick way of switching one “flight and fight” brain mechanism to the next “rest and digest.” I know my triggers and know how to disarm them! With this I have hijacked the mechanisms that link the food and feelings and, as long as I stick to what works for me (which with food, is three relaxed meals and three snacks and activity for leisure), I can live a full and wonderful life. I now get no angst around and can happily confess I love food. I am a rabid flavor machine, using cooking as creative expression, trying it all and using meals (my famous potato pie especially) as a way of bringing together my wonderful “good eggs,” the people I care about. Unlike when I was anorexic, I now eat and enjoy what I cook. I am at peace with food again and if a hideously average person like me can do this, so can you. Sustained health maintained recovery from anorexia and other eating disorders is possible for everyone. If I can do it, so can you. See more from Laura on her site.

Holidays like Christmas and New Year’s Eve can be tough for eating disorder survivors. I consider myself “in recovery,” but that doesn’t necessarily mean it is easy. I was first diagnosed in 2014 and have off and on dealt with eating disorders since that time. I have written in another article my main coping skills that help me stay in eating disorder recovery. These same tips apply—and more (it is also important to note that these tips apply outside of the holiday season)! 1. Naming Your Eating Disorder Naming my eating disorder has helped me separate myself from it. I am not “anorexic” or “bulimic” but rather I have struggled with eating disorders. I am not my illness, but rather I am overcoming it every single day. I find it helpful to write letters to “Ed” (and his friends like “Oscar” and “Derrick”—my obsessive-compulsive disorder (OCD) and depression!) in order to get my feelings and urges out without acting upon them. 2. Imagery and Visualizations I recently started therapy with a new therapist who has suggested that I get into imagery and visualizations as a means of coping with trauma and subsequent self-harm and eating disorder urges. What exactly do I mean by this? I have created a “safe space” that only I can enter in my mind. This does take a bit of effort in terms of imagination, so I know this might not be for everyone, but so far it is helping me. My safe space is elaborate, filled with dogs and books and things that bring me comfort. The walls are colorful and there is a pool—and more! However, if you were to create a safe space, it could look completely different. It doesn’t even have to be a room; it could be another planet! Now each time I get triggered into wanting to engage in my eating disorder or self-harm, I bring myself to this imagery within my mind. 3. Positive Affirmations I have a word document in which I am, as also requested by my therapist, writing three things I like about myself daily. Some examples: I am creative. I am brave. I am kind. I am a dedicated dog parent. I am intelligent. I am open-minded. It is very effective to remind myself that I have worth, and so I do not deserve to struggle with an eating disorder. I deserve to cope in healthy ways. As do you! 4. Staying Off the Scale Enough said! This is easier said than done of course, but it certainly remains true for me that staying off the scale is beneficial to my overall mood and well-being. I have a doctor tracking my weight for health reasons, but I request to not see the number. 5. Writing Your List of Reasons for Staying in Recovery I have so many reasons to be in recovery, as do you! This includes wanting to experience a happy and healthy future, realizing that I deserve wellness, and my desire to be an advocate to others who are struggling with similar challenges! 6. Having a Support Network/Accountability This can include family, friends and/or a dietician and therapist. Having a person or group of people in your corner is essential I’ve found. And if you’re feeling isolated and currently can’t be in therapy, then I suggest starting here with The Mighty, where you may be able to connect with others who have similar struggles with disordered eating, mental health and chronic illnesses. 7. Holiday Activities That Are Not Triggering Can you think of at least one fun and safe activity that you’d like to do this holiday season? Perhaps you can build a snowman or do an arts and craft activity related to the season. Or maybe you’ll decide to go to a winter festival or zoo lights (when the zoo puts up holiday lights at night). If you have relatives visiting from out of town, perhaps you can go to a museum together. Lastly, if you’re a fan of the holiday classics, there are plenty of movies to watch! If you’re reading this, most likely you struggle(d) with an eating disorder or are close to someone who does/has. I hope that you have a happy winter and also accept that it’s OK to have down moments too; what’s most important is what you do to manage those hard moments. I believe in you, just as I am working on believing in me!

Today, I want to celebrate how far I’ve come in my eating disorder recovery. I also want to help anyone else who currently struggles with disordered eating, of all kinds, to know that recovery is most certainly possible. I have been in recovery off and on since 2014, when I was first hospitalized for anorexia nervosa , (binge-purging type) for 10 days on an eating disorders unit. Since then, I have been trying my best to eat in a balanced way, with the help of therapists, nutritionists, psychiatrists, self-help reading, and lots and lots of writing. I have since been to two residential treatments, primarily for other disorders like borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD), but naturally my eating issues were always addressed. This included not only anorexia , but also bulimia nervosa, exercise addiction, compulsive overeating and the ambiguous label of eating disorder not otherwise specified (EDNOS). Here are 10 ways I stay in recovery today: 1. Radical acceptance. This might sound contradictory, but I radically accept my relapses, rather than shame myself for them. I try to prevent them from happening; however, by accepting them, I get through them quicker. 2. Trauma work. See my essay on trauma recovery. I know that eating disorders are often deep-rooted in trauma , and so working through it in therapy has helped me abstain from my eating disorder. 3. Treating other comorbid conditions with medication and therapies. Eating disorders often exist with other conditions such as personality disorders , PTSD, anxiety disorders, obsessive-compulsive disorder ( OCD ), depression , sensory processing disorder, substance use disorders , etc. 4. I allow myself to grieve the loss of my eating disorder , as if it were a person. My eating disorder was my best friend, my companion, but also an abusive bully, and so it is important to give yourself the space to grieve that. 5. Sensory issues. I use fidget toys to keep my hands and mind busy when I have urges to engage in eating disorder behaviors, as well as other forms of self-harm. I also have heavy weighted blanket that calms me. 6. Using DBT and CBT skills. These skills have really helped me cope when I have urges or miss my eating disorder . Dialectical behavior therapy (DBT) was great for the coping skills, while cognitive behavior therapy (CBT) helped me reshape my distorted thoughts. 7. I write. I write and I write and I write. I journal, I creative write, I make poems. It keeps me grounded. 8. Exercise in moderation. I only recommend this with the permission of your treatment team first. I engage in going on daily walks, which I consider a light exercise, and it really helps me feel calmer and more emotionally regulated. I do not exercise for weight purposes, but rather just to help my mood and concentration. It also really helps, even if you cannot exercise, to be outside. Nature is soothing to my soul. 9. Create art. I paint, I draw, I create. I get those anxieties and inner hyperactivity out onto a canvas or paper. 10. I read. I read about others’ recoveries as well as fiction novels that take me to a different world. I read nonfiction to better understand myself or my brain, and I read poetry to find a sense of inner peace. I love to read. If books aren’t your thing, I recommend giving poetry a try or a graphic, art-based novel. Thank you for reading. I hope that these tips can help someone, anyone, out there living with an eating disorder . I feel as though I am doing well today, but I am prepared for the hard moments, as this is a disease that will likely try to re-enter my life for many years. I often view eating disorders through the addiction model. To go along with reading, I am also trying to connect with my spiritual side through support groups like Eating Disorders Anonymous, something that isn’t for everyone, but just very well could be the next thing to help you. I also want to point out that at no point in this article have I mentioned weight. Why? Because weight is not the most important thing! Don’t get me wrong — it’s important to be at a medically healthy weight. However, I want to make it clear that eating disorders can affect people of all genders, shapes and sizes. Please comment below if you have any other suggestions for coping and staying in recovery.

When I was 10 years old, and the 1990s turned into the 2000s, I remember thinking to myself: “2020 is so far away, I’ll probably be dead by then.” A part of my subconscious knew I would barely make it to 2020, if at all. But here I am, in 2020, with a beating heart. I’m almost 30 years old, but I’ve been through the wringer. How did this happen so fast? I now know what my parents mean when they say “time flies.” Making it to 2020, for some, might seem like not a big deal, but for me, this is a huge accomplishment. Here’s why. I’ve been struggling with a severe eating disorder ( anorexia nervosa , binge/purge type) since 2010. Before that, I was a professional athlete and I was addicted to exercise to the point where I trained so much that I had to have two very invasive leg surgeries within six months of each other. Over the past 10 years, I have been to 11 treatment centers for various amounts of time (between three months and a year at a time). Before I came to the ACUTE Center for Eating Disorders  in Denver, Colorado, on January 13, 2020, I was knocking on death’s door. I was a very low weight at 5 feet 4 inches, I was unintentionally vomiting multiple times a day, I was binging and purging multiple times a night while dissociated (and I’d only realize what I had done the next morning by the stacks of dirty dishes and the dried puke all over my bathroom walls). I was fainting multiple times a day, my potassium was severely low (putting my heart at risk for a heart attack), I could barely walk without falling, I had to stop at every step when I went up the stairs to catch my breath and bring my heart rate down, and my bones had become very brittle. My service dog was constantly alerting to tachycardia, bradycardia and electrolyte imbalances. I should have died. But I wasn’t ready to leave this earthly world yet. I still had fight left inside this frail body that my eating disorder has tried to destroy. I came to ACUTE Center for Eating Disorders full of fear. I have had terrible experiences at treatment centers in the past, so I had no idea what to expect. When I got here, my eating disorder told me I was not sick enough to be here, and it compared my body with other patient’s bodies when we passed in the hallway, which only fueled the thoughts of not being worthy of this care. I’m not the thinnest patient here. I’m not the sickest, but I do deserve this care, and ACUTE saved my life that was vanishing fast. Upon admission, I met with the founder of ACUTE and he gave me a book he wrote about eating disorders. I met with a medical doctor, a psychiatrist, a dietician, a social worker, a psychologist, a physical therapist and an occupational therapist. I also met the certified nursing assistant (CNA) who would be in my room with me until shift change, when I’d meet a new CNA who would be with me until the next shift change the next morning. I had 24-hour one-on-one care. I also met with the nurse attending to me, and the head nurse. Everyone was incredibly kind and compassionate. I kept waiting for the next shoe to drop, and for me to be blamed for my symptoms… but that never happened. I continued to vomit unintentionally for the first week, and each time I threw up I was treated with compassion and care, rather than blame and punishment. In past treatment, I was isolated in a room because the treatment center thought it would make me stop vomiting. It didn’t stop the vomiting because it’s unintentional, and therefore, not in my control. I was worried that ACUTE would blame me for the vomiting. But instead, they worked with me. They tailored treatment to meet my needs. They observed me for two days while I puked constantly any time I ate or drank anything. Then, they prescribed a few different medications until we found one that helped. I went from puking many times a day to just once a day, and they used my feeding tube for nutrition so I was still getting all my caloric needs met. I was not punished for the times I threw up. I was treated with compassion. I was given a basin so I wouldn’t get sick on the floor or bed. A basin might seem like an obvious solution, but at other treatment centers I have been denied basins and made to puke on the floor and then clean it up. However, this was not the case at ACUTE. The one time I did puke on the floor, the CNA cleaned it up like it was nothing. I was on a heart monitor, IV saline, IV potassium and a feeding tube for the first week. I’m on week two now at the time of writing, and I am off the IV completely. I’m still on the tube feed 80% but trying small bits of food at each snack. The dietician here started really slowly with oral intake, which is also different from other treatment centers who typically force oral food way too soon and too fast. I have not eaten or drunk anything since before August 2019, and I haven’t been able to keep anything down since May 2019. By week two at ACUTE, I already can keep down one quarter of a muffin, one half of a pancake, and four ounces of juice. I never thought I’d get off this feeding tube. I never thought I’d be able to eat or drink ever again. ACUTE is the first place I have felt truly listened to, believed, cared for and treated with complete respect. I have friends who have been to ACUTE and they swear by this medical facility. ACUTE saved my life, and it has saved so many of my friends’ lives too. I still have a long way to go. I still have to reintroduce more oral food slowly, I still have to weight restore and I still have to get off the feeding tube. All of this will take many months — possibly a year, according to my outpatient dietician and doctor. And, I will continue this hard work at the Eating Recovery Center in Denver once I am medically stable here at ACUTE. I will always cherish this experience and take the tools I’ve learned while here at ACUTE. Special thanks to Dr. Mehler, world-famous eating disorder specialist, and founder of ACUTE, for creating a safe place for very ill patients with eating disorders to get the help we deserve.

Despite some major advances culturally, socially and medically, eating disorders are still commonly misunderstood. On top of that, it’s not easy for many with eating disorders to communicate or describe what is and isn’t helpful as they’re trying to navigate the complexity of their illness. Supporting someone with an eating disorder doesn’t just mean driving them to doctor’s appointments and worrying about what they’re eating. Support also means being an ambassador by squashing misconceptions. If you’re looking for ways to help others understand or simply wanting to gain more insight yourself, here are some myths that need to be debunked: Myth #1: All eating disorder patients look sick. This is a major and very dangerous misconception that’s not only perpetuated socially, but also medically. Someone with an eating disorder can get so good at hiding their disordered behaviors that doctors and dentists can miss certain warning signs. This was the case for me — I got the courage to ask for help after about seven years of serious symptoms. Additionally, not all eating disorders cause extreme changes in weight. People with anorexia or binge eating disorder might exhibit quick and dramatic weight gain or loss, but many eating disorder patients are diagnosed with OSFED, or Other Specified Feeding or Eating Disorder. This diagnosis includes a wide range of behaviors that don’t necessarily fit into the rigid diagnostic criteria for anorexia or bulimia. In fact, a person may be maintaining their weight but doing so through detrimental compensatory behaviors such as purging or excessive exercise. Myth #2: The most serious eating disorder is anorexia. Anorexia is not automatically any more serious than other conditions. Bulimia and other purging behaviors can cause extreme electrolyte imbalances, esophageal tears, anemia, hair loss, slow heart rates and other serious side effects. Over-exercisers can sustain serious injuries, especially if they don’t allow themselves to rest, even when they’re hurt. And of course, many eating disorder patients often suffer from depression, anxiety and other mental health issues. Eating disorder patients are often at a higher risk for self-harm and suicidal ideation, as well as death by suicide. Myth #3: Eating disorder symptoms stay the same through diagnosis and treatment. Many people with eating disorders experience fluctuations in their behaviors. After months or years of starvation, a person may experience extreme hunger, leading to a period of uncontrollable binging. Similarly, someone who originally restricted caloric intake may begin eating again but begin purging to compensate. Eating disorders are crafty and malleable conditions. The urge to lose or maintain weight can make self-sabotage extremely attractive, even when the patient wants to recover. Myth #4: If you want to lose weight, you can go on an “eating disorder” diet for a while and then stop. For most people, extreme calorie restriction, over-exercise or purging is not sustainable. People with eating disorders often don’t have issues with self-control. Eating disorder behaviors are compulsory. Much like obsessive compulsive disorder (OCD), an eating disorder can cause an irrational and uncontrollable urge to participate in certain rituals, compulsions and behaviors. Extensive therapy and medical intervention may help patients face their fears, address medical needs, and build new skills to combat those compulsions. In short, eating disorders are not diets. They’re serious, devastating illnesses that aren’t often stopped or started at will. Myth #5: Eating disorders always go away once you’re “better.” Recovery from an eating disorder is possible. Weight may be restored, fears may be reduced and tools may be acquired that can help combat disordered thoughts. But these practices of recovery tend to be a continuous journey; recovery doesn’t happen over night. Myth #6: Eating disorders are so serious that only professionals can help. Someone with an eating disorder may benefit from guidance from reliable psychiatrists, therapists and/or nutritionists. But that doesn’t mean that friends and family are unable to support someone through treatment and recovery. In my opinion, questions are helpful and very welcome: “Do you have known triggers that I can help you avoid?” “Do you need a bathroom buddy?” “Will you be able to enjoy this event or holiday if we make adjustments to make you more comfortable?” “How are you feeling right now?” And remember: if you’re supporting someone through treatment or recovery, any slip ups on their part are not a poor reflection on you. Relapses are common. The journey to wellness is not linear. Your job isn’t to take pride or responsibility in the their recovery. Your job is to be available, to provide unconditional love and to let them know they are not alone in this battle.

When you develop an eating disorder (ED) at a young age, things are often different. From the way you interact with those around you, to the thoughts in your head. I developed anorexia before I was 12. And there is a hard truth that many people — with and without ED — ignore. The longing for sickness. The desire to be ill again. The familiarity of the disorder. Every day is a new reason to restrict, a new compulsion to binge or purge. Whether you’re at day one of recovery, or year eight. The desire might still appear. There will be days where, after years of doing good and committing to self-care and self-love, you want to go back. Because an eating disorder is home when you feel like the world is crashing and burning around you. It’s safe in that upside down world of not feeling. Ive always compared it to Wonderland, it looks amazing at first, but the deeper you go, the more twisted it is, and eventually you’ll have to climb back up the rabbit hole. Eventually, the Wonderland can turn into a nightmare. But even nightmares, when left unfinished, leave a desire to fall back into them. There’s going to be a day where you might have to look yourself in the mirror, perhaps even multiple days, and tell yourself the hard truths. The ones no one talks about. The ones we all like to ignore. “I want to die” might ring in your head — the darkest parts of you will come to the surface. The parts that still do not want to feel anything. Tell them to go away. Leave you alone. Tell yourself it’s hard and you don’t want to do it. And do it anyway. Get better. Eat something. Cry over calories and numbers but get up and do it anyway. These are the hard truths: Recovery isn’t easy. Life is hard. Things aren’t fair. You won’t always want to do this. Being strong all the time sucks. The hardest truth is this: You have to anyway. If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237 . If you or someone you know needs help, visit our suicide prevention resources page. If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 , the Trevor Project at 1-866-488-7386 or reach the Crisis Text Line by texting “START” to 741741. We want to hear your story. Become a Mighty contributor here . Getty image via Archv

Many eating disorder treatment programs emphasize the sentiment that “food is medicine.” “Nutrition will restore weight that needs to be restored.” “Nutrition will fix medical complications.” “Nutrition will help to maintain your set point theory weight.” “Nutrition will help your mood disorders and obsessive thoughts to decrease.” “Eating is the best way to fight the eating disorder.” Even putting up quotes like, “The best way to fight the eating disorder is to pick up the fork and rebel.” I find these quotes to be inspiring, choice-based, and recovery minded. I am an advocate for quotes like these to be put up in treatment programs, recovering individual’s rooms, houses, etc. But, what happens when a chronic illness or a complication of the eating disorder makes it so that the individual cannot take their “medicine?” When they can’t eat? I was diagnosed with gastrointestinal dysmotility (gastroparesis) after years of restricting, purging, and abusing laxatives. It is a common and can be life-threatening complication of eating disorders. It causes symptoms like nausea, vomiting, severe gastroesophageal reflux disease, regurgitation, bloating, water retention, constipation, diarrhea, early fullness, and so much more. It is hell to live with, and, for many, certain types of foods, eating too frequently, eating certain groups of food, eating a high volume of food, or even eating at all, can cause vomiting, extreme pain, or extreme nausea. People with dysmotility or gastroparesis have delayed gastric emptying, meaning it takes them hours to days longer to digest a meal than it would for the average person due to a partially (or in some cases, completely) paralyzed digestive track. How do people who have both an eating disorder and dysmotility balance eating disorder recovery? At my medically sickest, I could not keep anything down. I wanted to eat more than anything, I wanted to leave the hospital, mentally I wanted to fight off my anorexia, but I couldn’t because of my dysmotility. I would be plagued with bloating after every meal, vomiting occasionally, not going to the bathroom for weeks, and pain so intense I would not leave the bed. Most eating disorder programs are not equipped to treat people with gastrointestinal illnesses or chronic illnesses, even though they are common complications of eating disorders. I wonder how we could shift from medical and behavioral stabilization to improvement of quality of life? I have thought about the idea of treating both gastroparesis and eating disorders together, in the same treatment program. What if we were able to treat both diseases at the same time? How many people would be able to get the treatment they needed and not fall through the cracks of the system? Since getting to a place where in eating disorder recovery where we do not have fear foods and we are able to intuitively eat is often the goal, where do people with gastroparesis fit in? Many people with gastroparesis do not get hunger cues, and cannot eat certain foods. My article is just one voice. For many, eating disorder recovery is truly about learning to intuitively eat again. But, for me, as someone who struggles with dysmotility, it is not. For me, recovery is about being able to sit with food inside of me, cope with the physical sensations and pain, and work through the waves and guilt. For me, recovery is about physically keeping food down. Of course, there is so much more to recovery for me than just those few ideas. But, my idea of recovery looks different than many treatment programs for eating disorders ideas of recovery look like. I wish we could start the discussion about treating gastrointestinal issues like gastroparesis that coexist with eating disorders. We want to hear your story. Become a Mighty contributor here . Thinkstock Image By: JNemchinova

Editor’s note: If you live with an eating disorder, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “NEDA” to 741-741. To the friends who left me because of my anorexia, You left me in my worst point of weakness, when I was tired of fighting and knocking on death’s door. I admit for so long I was angry at you. I went through the stages of grief. I was angry, then I was confused, then I was sad and then I wanted you back. You were a part of my life, a part of my growth as a person, and then you left me. However, I do not hold any resentment against you. Instead I have begun to realize I am thankful for what you did. You made me realize how much I needed recovery. You became something I lost and from the pain it brought I finally realized I didn’t want to continue losing the things I loved. When I entered into recovery, our separation made me realize the importance of finding myself in recovery, with you I was held back as a member in a group and not an individual. When our separation had passed a few months time, I realized I didn’t want to be friends with you any longer. It wasn’t that you weren’t astoundingly beautiful friends to me — you were. The memories we made I will cherish forever. However, I can’t live my life with people like you in my life. It was too hard for you and I understand that. I knew how hard it was for me and in recovery I have seen how hard it is to watch the people you love self-destruct. But if you can’t see me at my worst, then you can’t see me at my best. My best will take a long time to get to, it’s a process I am currently working on every minute of my existence. I couldn’t have been able to recover without your decisions, they shaped me to be stronger and with that strength, I found myself again. Sincerely, the friend you left because of her anorexia If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237. We want to hear your story. Become a Mighty contributor here . Thinkstock photo via Rively