Friday, 21 March 2014

Why many patients don't feel 'sick enough'

'Maybe I have an eating problem - or maybe I don't. I don't know. But I don't feel sick enough to get help, or to need or deserve help. My case is not as bad as what others might go through...'.

I have heard this statement from many people with ED. Heck, even I used to say and think it a lot! But why? Why is it that so many people with ED never feel sick enough? Why do they keep getting sicker by the day but not realize or see that they are getting weak and ill?

A study ( showed that in patients with ED, there appears to be an altered response to pain and body image related to their size. What this means is that the part of the brain that senses pain related to weakness (ex. from not eating enough or getting enough nutrition and energy) does not function properly. So, someone ill with ED might be very weak, but their brain does not sense this. They may therefore live their lives and not realize or feel the effects of ED because their brain cannot do so. This also means that even if a patient with ED is very sick, their brain might not register that this is the case. As a result, patients can actually be very ill but truly not 'feel sick enough'.

This definitely happened with me. I knew that I was ill, and I was fully aware that I was not eating enough. But I never felt weak or sick enough to get help. Sure, my legs hurt everytime I walked, but that was not enough of a good reason to seek help. Or maybe everyone told me that I looked thin, but I did not see it like they did. Perhaps this research has helped me understand why. When I hear from others sufferers that they do not feel ill enough, I understand what they mean. With ED, you actually DO NOT feel sick enough. It seems that the brain develops this adaptation in order to protect the human from feeling pain. Think about it: if you were hungry and starving and your body was weak tired, would you want to feel pain? Maybe for the first few days, your body would. But after chronic starvation, would it be helpful if your brain registered that your body was weak and malnourished? Likely not. So, the brain seems to develop this mechanism to protect the victim.

What this means for victims (and for those who recover, in fact) is that we need to be aware that patients with ED might actually be sicker than they FEEL. If they cannot feel pain or weakness, then they likely will not seek help for it, either. Perhaps this is why many patients must be 'forced' into treatment - they literally cannot see or feel how ill they are. On top of that, they are scared of gaining weight and eating, so that makes it even worse! Remember how before I discussed how the patient with ED might not be able to feel hunger cues as well? It all relates! The combination of all these brain and hornone changes makes it very hard for patients to get help and stay in recovery. This is why recovery takes so much work, patience, and motivation. Taking steps to recover from ED means that the patient is likely doing everything that they DO NOT want to do. This is definitely not fun. But what is helpful to remember is that it is worth it.

To be honest, we don't yet know if the brain ever gets back to normal after ED. Or maybe some parts do, while others do not. That is not actually important, anyways. What is important is that you choose recovery and stick with it. No matter how hard it is, no matter what is going on around you, you must remind yourself that this is worth it. Do not give up, and surround yourself with people who can support and help you. Know that even though your may not feel sick enough, everyone deserves to get help and support. We ALL deserve love, support, help, and treatment. YOU ARE WORTH IT!


  1. What a very cute picture even when he is sick on a hospital bed,still cute


  2. Marina
    You set an example and a role mdel.
    You did choose recovery and you did stick to it and you did commit to it and showed every body despite hard but worth it.
    You and all of ED deserve the care,love ,respect and support.
    Excellent post.

    Kelly W


  3. This real struck a cord with me this week, I have just started the process of recovering for the second time after a significant relapse into bulimic behavior. I ignored it for several months as I did not see myself as sick enough to need help, even with significant sleep issues too. I am still very embarrassed to admit that I am ill (especially as my problems do not show up visibly, as with all the Bulimic forms of ED), and this has really helped me understand why.

    I was only persuaded to get help around 6 weeks ago when we hit the preparation for lent and I realized what was happening to me. My Parish Priest had been encouraging me to get help for months and I had been avoiding it, though I am shore if I had not sort help he would have used his authority as a priest (and only recently elevated to hear confessions) to make me get help, because of his love and care for me.

    Choosing recovery is hard, especially when you do not feel sick. It really helps to know you are not alone in the journey, and this blog has really helped me with this, though I have found a local support group too which really helps.


    1. Phoebe
      Please hurry up and get help ASAP.
      Do not wait till very late.
      Continue to read Marina's blog espcilly the prevois posts
      Her experinece tell every body that this disease is deadly

      Master psychlogy student

  4. I agree choosing recovery is very hard but it is the very right decision you have made.
    It is the difference between life and death.
    between good life and Evil ED
    Between happiness and misery
    Between weakness and strength.
    Between being in control or slaved by ED.
    Between awareness and denial

    I am very happy for you choosing recovery and congratulations to all those recovered

    Recovered ED survivor

  5. Wonderful post
    I am recovered now because you woke me up.
    The disease basically blinded me and made me unaware of my health and made me numb and was taking me to death.
    Sometimes it is helpful to have a friend from faraway as on line that you feel trust to wake you up.
    That what you did to me Marina and I am thankful


  6. ED is the most deceptive illness and that is why it fools victims to believe that they are o k and well when they are very ill and may be dying.
    Raising awareness and education can protect many especially teenager.
    I admire you for this blog and sharing your experience.


  7. I can understand ED now and why people with ED do not eat even when dying.


  8. Now I know why I was very sick and was not admitting and I was resistant to any advise ,rejecting any help.
    Now I know it was ED who damaged my brain and was not me who was stubborn.
    Thanks to you who advised me and convinced me and thank God I listened to you and I went for treatment and now I am fine.
    I admire you for made it clear why victims do not feel sick enough ,hopeful ED victim read this and get help before their brain permanently damaged


  9. You explained the reason behind not eating very articulately


  10. What an excellent post.


  11. It took me long time to understand little about ED ,however this post made be understand why they are not eating and refusing to admit they are sick.


  12. Excellent blog

  13. Does this explanation apply to all ED??


    1. Oswaldo,

      If you notice my comment earlier this issue with not accepting you are ill happens in Belimic's ans well as Anorexic's. I think (though this is my personal opinyan) it may well be a common feachor of all forms of ED. I have defently heard it said by others recovering that they did not even realize it was not normal for a long time.


  14. This make me undersatnd why 5% of people(anorexic) hate food what 95% love and enjoy


  15. The best senstense I heard is what you said Marina

    Today do one little thing to make yourself feel better..
    I love this .


  16. Kudos to you marina and all your readers


  17. The picture of the little boy on the bed with thermometer is cute even when he is sick.


  18. I am impressed with this explanation Marina as I have ulcerative colitis and when it flares up, I lose appetite and I even feel no motivation to do things I used to do .
    So it is the disease that lead ED victim to ignore their health till death and not the person who chose not to eat.

    S K

  19. Today I will pamper myself going my hairdresser and do my hair and go for massage >Yes I need to do one thing good for myself every day and keep going.
    Thanks Marina for reminding me


  20. I add my voice to Marina and urge every body with any form of DE to get help quickly as this disease sneak on us like a snake .


  21. This is exactly how I feel right now. Although I am in recovery and in an outpatient program, it was suggested to me to consider inpatient. I do not feel sick enough. I do not feel like I look sick enough. Even though my heart rate is low and my weight has not increased, I feel normal.


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