3. juni 2016

Recovery and remission.

I use the term “in active recovery” across the site, but what you achieve at the end of a successful recovery process is, hopefully, a full remission. The end state is not a full recovery. No one ever recovers from a restrictive eating disorder. The nature of chronic neurobiological conditions is that they cannot be cured.
I have often reiterated the following as well: restrictive eating disorders are either active or in remission. Remission can be permanent, or there can be flares of the condition in times of stress (a relapse).

Signs of remission:
1) You look forward to gatherings and celebrations that center on food. Like all those without an eating disorder, you indulge happily and do not compensate either before or after the event.
2) You have no forbidden foods, unless of course they could actually kill you (think peanut allergy).
3) You are a force for moral absolution. Your relationship with food is a morality-free zone and it has far reaching influence on those around you, not to mention yourself.
4) You experience your body, and every body, as a miracle every day. You marvel at the healing of a bruise. You stop to watch your fingers flying over a keyboard and are amazed. You see form and function and the innate power of the body.
5) You understand on a cellular level that “savoring” is a state of transcendence and transubstantiation. Transforming food into life-giving energy is freaking phenomenal!
6) You feel connected.
While many with eating disorders can feel strangely energized and alive in a state of extreme energy depletion, they rarely feel connected in that state. In fact, they feel a high in the disconnection. Connection is actually an ambivalent state and you are able to hold the ambivalence with appreciation. It is not always joyous, supportive or healing to be connected to others. But you are ok with that.
7) You are fluid. (I think she means like fluid, Changable, flexible)

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**Here is how you know you are ready to attempt eating to your hunger cues:
Your weight appears stable. (weighing yourself is not necessary to determine that).
If you have dealt with amenorrhea during your restriction, then you have achieved 3 consecutive periods in a row.
You are continuing to eat minimum amounts and it is comfortable to do so.
Other lingering signs of repair seem complete (no longer cold, tired, achey, dealing with water retention, no brittle hair or nails etc.)
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.
You move from meal plans or counting calories to eating to hunger cues by attempting a 3-day experiment. Eat to your hunger cues but jot down everything you eat. At the end of those three days you should discover that your hunger has taken you to approximately the recovery guidelines you have been following thus far. If so, then you can likely trust your hunger cues and move into your remission with some confidence.**

If you have a couple of the following you haven't recovered:
- Reflections in mirrors/surfaces are 'dysmorphic' eg look disconnected etc.
- Don't feel muscles properly = nerves not repaired yet.
- fidgeting/restlessness/agitation = bodies way of getting you to move to find food.
-tingling
-no expendable energy

If you are six months or more into the recovery process and you’ve found yourself unhappy with having to eat to the minimum intake, then eat 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 within 200 or so calories of 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 are likely in remission.

When body fat is completely recovered and fat free mass recovery is still well below normal, excessive hunger is still evident, but disappears as fat free mass recovery approach to 100%.




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