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 (http://onlinelibrary.wiley.com/doi/10.1002/eat.22045/full) 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!

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