We've talked about this over and over again - recovery in ED is very hard. The patient must eat, despite being scared of doing so and of gaining weight. We know that this is part of the disorder, which makes eating and being healthy a nearly impossible task. But what happens - on a biological level - when eating actually occurs? How does the patient's brain respond to food? Why are patients so angry, tearful, and scared when eating their meals in recovery?
A study showed that patients with ED who eat shown abnormally high cortisol levels when they eat.(http://europepmc.org/abstract/MED/23759466/reload=0;jsessionid=FcDxHPdkZvLZH71huW6N.10). Let's talk about cortisol for a bit. First, you may remember that cortisol is a 'stress hormone', which our adrenal glands release when we are in a stressful situation. On a short-term basis, this is actually a good thing because coritisol prepares our bodues to 'fight or flight' (ex. increased heart rate, more blood to the muscles, decreased energy going to digestion, etc). This helps us deal with the stressor. On the long run, however, this can be very harmful to our bodies. Long-term effects of excess cotrisol or the 'stress response' include altered reproduction, heart problems, indigestion, etc.
Another effect of cortisol, despite making us aware that we are stressed and are in danger, is that cortisol might make us feel full. Think about this for a moment: if you are in a terrible situation and need to run fast, would you be thinking about eating your next meal? Not likely. Your body would rather save this energy into running! It appears that in patients with ED, this is what happens. Eating activates the stress response and therefore alters the patient that eating is stressful. This makes patients nervous, angry, frustrated, and stressed. Add this effect to all the other brain/hormone changes we have discussed, and you can now begin to see why recovery is so hard.
What about the solution to this? Is there one? Maybe, maybe not. Many patients are put on medication to control their anxiety around meal times, while others actually have comorbid disorders like depression and need other medications. While I am a nurse, I need to make something clear: medicine cannot solve everything! If you need it, then yes - take it and take it according to schedule! But if you do not need it, you might benefit frm trying other things (provided that they are safe and you check with your medical team). What 'other things'? I'm not talking about herbal medicine. I am talking about relaxation techniques or distractions. When I was first recovering (and even today) I always make sure that I have something to do while eating. It helps take away the stress around eating for me and makes me feel relaxed. I can read, write, play a game, talk to someone, etc. Other distractions that people find helpful are watching movies, drawing, studying, etc. Find what works for you.
Like everything else in recovery, this takes time to become normal. Does the brain of a patient ever return to normal and stop secreting excess cortisol in response to meals? We don't know yet - everyone is different, and it totally depends on the patient. To be honest, though, that does not really matter. I do not personally care if my coritsol levels during meals are high, as long as I am dealing with it and there is no harm from it. Note that in ED patients, extra coristol is present only during meal times - this tells us that patients need to get used to eating meals and realize that it is not srressful or dangerous. Maybe in recovery, you will still find meals hard. That is okay, as long as you are eating and sticking to your plan. Find ways to challenge your brain's response that eating is dangerous or stressful. It will take time and practice. But I promise that it gets easier. Today, a year and a bit after very hard work in recovery, I can eat all my meals without a fuss. I might not enjoy feeling full or the weight gain, but I can do it without panicking. Constrast this to last year, when I first started recovery. I would scream (I'm not kidding) at every meal, I would cry, and I would cry even after I finsihed eating. What a difference in a bit more than a year! Stay strong and do not let ED win this battle. Recovery is tough, and now we can appreciate that this is partially due to the many brain changes that occur in patients with ED. But that does not mean that it is impossible to change.