Many patients and parents begin treatment without any knowledge of the difficult journey before them. There are 4 stages of recovery, and individuals can stay or progress to these various benchmarks at different rates.
- Weight Gain
When a patient first begins eating at recovery levels, the body begins the process of healing. This internal healing cannot easily be seen, but individuals may notice a sudden increase in weight, bloating (water retention), edema, constipation, gas and overall discomfort. The stomach and intestines that were laid dormant for so long now have food passing through, and it takes awhile for the body’s digestive system to function normally. Water is also hoarded at this time, and patients will be alarmed at gaining 5, 10, even 15 pounds within the first week or two. This is quite normal and just water weight. While in a starvation state the body doesn’t know when its next meal will be, so when food is suddenly thrust into the system, it holds onto every nutrient it can in case of famine. Most patients will be extremely uncomfortable at this point, as their stomachs will protrude and it may be difficult to eat at such frequent intervals. Medication is available to help the gut digest food quicker, and wearing loose, comfortable clothing aids in body dysmorphia. Exercise is normally prohibited during this phase.
2. Internal Repairs Finishing Completion
As the body reaches its normal weight, the metabolism actually increases, and patients will find they need even more calories than they first ate in treatment. Night sweats, edema, constipation/diarrhea, gas and a distended stomach are some symptoms of this stage, yet as the hormones become reawakened, much of the weight disperses from the stomach to other areas of the body (chest, legs, and hips). The initial weight gain that was quick starts to slow, and even gaining a pound a week will be momentous—this is now “true” weight gain, and what the body needs for complete recovery. Even when a menstrual cycle resumes, it’s important to continue to gain at least 5 pounds over that weight. This ensures some “padding”, where if weight is unintentionally loss due to illness, etc., a relapse is still prevented. Many patients will often overshoot their weight goal, but after their systems are regulated, they find that their bodies return to the weight they are meant to be. It is important, however, to note that individuals still must eat at recovery amounts and not cut back. Internally, muscles and organs are being repaired. The hormonal system and metabolic system are still in need of reaching homeostasis too, and that takes a fair amount of calories to achieve. Exercise is sometimes allowed once close to or at goal weight, but there are stipulations on the frequency, intensity and type of movement allowed.
3. Perfecting Interpersonal Skills/ED Prevention Skills
During the first 2 phases of recovery, it is difficult for patients to learn how to “feel” their emotions and speak their ideas. The brain is overwhelmed and undernourished, and in order for psychotherapy to be effective, the thought process needs to be clear. As individuals are more physically recovered, psychotherapy sessions help patients learn how the disorder operated in her life and what to do to prevent relapses. The treatment team will also teach how to create strong interpersonal relationships—this skill has been shown to be vital in recovery and remission.
4. Remission
A person can finally be considered in remission after maintaining a stable weight for a number of years and demonstrates an understanding of how the eating disorder operated in his life. Monthly, bi-monthly, and quarterly check ins with doctors and nutritionist are still recommended.
Kristen Lindsey-Dudley, RD MPH 