Saturday, December 17, 2011

Brain-Body Disconnect

It's amazing how variable my perceptions of myself can be. Some days, I realize that my stomach is empty and achy, my jeans are baggy, my head hurts, and I consider the possibility that I might be on the thin side of average. Other days, the rolls of fat on my gut and thighs jiggle and my double chin sags and everything seems squishy and disgusting. Compared to my high school years, I feel MUCH fatter now...but I know for a fact that my weight is lower. Compared to a year ago, I feel physically similar and my clothes seem to fit the same, but "mentally" I feel fatter because I'm eating more and exercising less...and my weight is higher. So obviously, something's off.

This week, both J and R harped on the lag time between bodily recovery and brain recovery - how you can restore weight, improve bone density, and undo all the physical damage while continuing to feel like a miserable, anxious, fearful ball of nerves throughout the entire process, and after. Lovely. If only I could reverse the process, this would be so much easier.

R keeps telling me that it takes achieving 90% of ideal body weight to significantly reduce the physical symptoms of malnutrition, but up to about 97%  of IBW to break free of the food/counting obsessions, fat-phobia, and body distortion. The tricky part being, of course, that determining IBW is far from an exact science, so who's to say when you've reached 80%, 90%, or 97%? What if I make it to 95% - would just a couple more pounds transform my entire mindset? How will I know? I don't want to be gaining forever.

The idea that adequate weight gain heals the brain makes sense to me, but it's hard to believe. I hit my highest recovery weight last spring (in a healthy range and I got a period, although I was still below the goal set by my first treatment team) but I was no less obsessive or anxious about food, still counted calories compulsively, exercised too much and for the wrong reasons, and experienced the most intense body hatred of my life. Plus, I was isolated, depressed, and crying multiple times a day for weeks and weeks.

I've explained to R that I'm afraid of gaining the weight back and returning to that same awful place. Although he is understanding, his proposed solution is always the same: get to a healthy weight - MY healthy weight - and stay there.


  1. I totatlly get how it's scary...but R is right. All the research supports that. So does anecdotal evidence from my own recovery process and anecdotal evidence that i hear about from others. It's not like you'l gain weight and instantly stop obsessing... but if you get to your healthy weight and stay there.. over the course of a year (sometimes sooner depending on the person), you will notice the mental benefits. R really is right. It's awesome that he's not letting you settle for anything less than full recovery, and it's awesome that he's so current and up to date.

  2. Thanks Laura, R definitely stays on top of the latest research and stuff, but I always find the "real life" proof more convincing! I also have to keep reminding myself that this is a looong slow process, and that I can't expect radical overnight changes.

  3. I totally understand this entry. Most of the research seems to suggest that a BMI of 19 or 20 is sort of "magic" in helping to heal the cognitive effects of the disorder. Of course, even this is dependent on the person, as my "healthy" BMI (where I am able to finally see through the ED fog) is closer to 21. (Imagine my dismay.)

    Unfortunately, R is right -- getting to YOUR healthy weight (which may or may not be your IBW as set by a team or a BMI chart) is crucial. The times I have been doing really well in recovery and really able to challenge the ED thoughts have been the times when I have been at my set point, where my body naturally wants to settle. It's a painful, torturous process to get there -- but healing the body is definitely the first key to healing the thoughts.

  4. Yeah, and MY healthy weight is a BMI of between 21 and 22. That's not just a place where I get my period and don't live meal-to-snack-to-meal, it's also a pace when, once I have held it there for long enough, I am less anxious, my calorie counting decreases, my body image is better, etc. And, no one sees me as fat at that BMI.

  5. Hi Jess - sometimes I wish I could snap my fingers and be at that magical "set point" and have all my anxieties disappear, just to avoid the process of gaining and finding where my body wants to be, especially if it's at a higher weight than I'd like.

    Laura - those are seriously some of my biggest ultimate recovery goals: someday being less anxious and not counting calories!

  6. Kaylee, I totally know what you mean about wanting to snap your fingers and be at that magical setpoint. I used to tell my T and RD that I would rather go to the store and buy X pounds and then just have it on me versus having to be conscious during the gaining process.

    And discontinuing calorie counting actually is possible. That was the biggest part of my ED... I was an obsessive cal counter (as are you, I assume)... it did take time and work and if you want to know more about how I stopped counting, just ask and I'll tell you. But, it is possible. I can't believe I actually don't count cals anymore...

  7. Kaylee - YES! I totally understand the feeling of just wanting the weight gain process done, my body to be "settled," so that I can then work through the feelings about being at that weight with a clearer mind. It is torturous to gain and to be conscious of the process and feel every ounce and pound as if it is foreign.

  8. Body image in recovery can be SO wacky. Hang in there, though, it *can* get better, just as other commenters have said. I found that every time I hit a new weight milestone (not with every pound gained, but reaching the top of an arbitrary range in my mind), I really had to just grit my teeth and give myself a couplefew weeks of a grace period to adjust. At first your body really can just feel foreign and uncomfortable. I always thought it felt like wearing someone else's clothes, that I didn't like and just wanted to take off. But I also found that if I could tough it out and not relapse during that grace period, I actually ended up liking my body *better* than I did at the lower weight. It can happen, I promise! And tons of neuropsych stuff shows that anxiety will be worse the more severe your symptoms and lower your weight, so that alone is worth the experiment of restoring yourself, right?

    I don't know if I've recommended this book to you before or not, but 'The Body Has a Mind of Its Own' offers some really great insight into this issue. It's not about EDs specifically, but does discuss how there is often a time lag or disconnect between how we feel physically in our bodies and how our minds perceive that we looks/feels in the context of weight loss and gain.

  9. I don't mean to imply you are wacky, just reread the first sentence of my comment and wasn't sure how it would be taken. I just mean body image can be so inconsistent with reality and even with our subjective perceptions from day to day. Disclaimer concluded.

  10. Haha thanks, Cammy, I didn't take it the wrong way at all. That book is definitely going on my winter break reading list!

  11. I read this book "Locker Room Diaries" which is about research one woman dad in her health club locker room watching women's responses to their own bodies. I liked it a lot and actually got my mom to read it.
    My pastor also encourages me to "maintain my focus" and think of the extremes and decide if I could deal with them.
    For example: "If you gained X amount of weight, what would really happen? If you did this, would what you're scared of actually come true?"
    Putting it in a different perspective has helped me out a lot with the metal aspects of some of my obsessions.