Why is it so hard for patients with ED to choose recovery, make a plan, and stick with it? Why can't patients simply decide that they will get help, enter into a treatment program, and start eating?
There seems to be evidence that patients with ED may have a hard time planning their meals/food intake ahead of time. While they could do this well in all other areas of their lives, making decisions and plans about their meals/recovery was harder. Are patients stupid or dumb because of this? No. It is simply that their brains have not had to think about eating in so long. So, making plans for recovery is something new to them. And new things take time to get used to or to master.
Why is this important? Does it really matter if meals are planned beforehand?
Well, yes. Kind of. Imagine this: if the patient is anxious about food intake, it is already difficult to eat. Now, it is time for the individual to eat. And there are so many options to choose from! Instead of thinking, 'hmm...what looks good to me? What do I WANT to eat now?', the individual may simply choose not to eat because he or she is overwhelmed. Or, there might not be any (or little) food options, and the person may therefore feel that they don't 'have an appetite' or are too anxious to go find food elsewhere (or doesn't have time, etc.).
Or what about an event where one does not plan meals, opens the fridge, and discovers that there is no food inside? Do you think ED will tell them to go to the grocery store and buy it? NO! 'You don't have what you need to eat? Oh well. I guess that means you cannot eat', Again, ED wins. So, by planning, the patient ensures that they are one step ahead of ED. They are prepared for all the challenges he might throw at me because they know that he will take any small chance to make them slip back into his control.
So, while the brain chemistry of ED patients may show that there is some difficulties with planning, this does not mean that patients are stupid or silly. It does not mean that they cannot make decisions. It simply means that their brains have been used to avoiding food, so it will take time to get used to it again. In the meantime, planning is the safest way to go. Plan your meals, what you will eat, when you will eat, who will make your food, etc. It may sound challenging and boring, but putting in about ten minutes to plan a week's meals will save patients the anxiety and stress of not eating and falling back into ED's traps. 10 minutes from a day planning meals for the next week saves the individual a lifetime of health issues related to ED. 10 minutes of planning what they will eat for the week means that ED has NO TIME to try to convince them not to eat. 10 minutes of planning - that's all it takes. An ounce of prevention is worth a pound of cure.
Wednesday, 10 August 2016
Well, yet another study now gives us more insight into why eating for ED patients is so hard (http://onlinelibrary.wiley.com/doi/10.1002/eat.20937/full). This study found that in patients with ED, eating does not stimulate the 'reward' centre in the brain (the dopamine system, DA). In people without ED, eating causes DA release, which makes our brains realize that it is 'happy' or 'good'. As a result, our brains learn that food = happy and food = reward and food = good. But, what if our brains DID NOT release DA when we ate? What would happen? We would think food = bad, food = not exciting and food = not rewarding. So, why would we want to eat? We wouldn't. And it appears that this is exactly what goes on in the brain of a patient with ED.
This finding also helps to explain why patients with ED find that restricting helps alleviate anxiety or stress. Think about it: if dopamine (DA) is released and this makes us feel happy, we would not feel anxious at that time. So, if DA is NOT being released in response to food, we would feel anxious. When presented with food, patients with ED feel anxious, angry, and frightened. Why? Perhaps because of the DA malfunction. The brain seems to sense that food is dangerous and unrewarding. As a result, the patient truly is fearful of eating - their brain is telling them so! What this also implies is that if their brains are saying that food = bad, it might also be saying that no food = good. This would help to explain why starvation is a symptom of ED - patients seek out restriction and stop eating because it really DOES feel 'good' to them. The reward centre in the brain is altered and no longer recognizes food as being enjoyable - and this seems to explain why patients with ED restrict, but also why recovering from ED is so hard. To recover means to eat, and the patient does NOT want to do this...plus, their brain is giving off signals that food is not rewarding. If it isn't rewarding, why would anyone possibly want to eat? AHA! So now we can come to see why this is hard for ED patients.
I like this kind of information because once again, it gives hope to people with ED. This is proof that this is not 'all in their head'. It really is a mental illness, and sadly, the brain and body seem to adapt to restriction in such a way that works against the patient in recovery. In simpler terms, because the patient's brain is telling them that not eating is rewarding, they find it very hard to eat in recovery because eating does not feel good or rewarding. Imagine doing something that you don't like. Then doing it again and again, almost six times a day. Does that sound fun or easy? No. This is exactly what ED recovery is like for patients. Not fun. Not easy. Not enjoyable.
But it comes with its rewards in the long run. Of course, recovery is not easy. Eating may mean that the person feels full, uncomfortable, and anxious. It may be associated with weight gain if that is what the patient requires – and this is very difficult for the patient with ED to accept and be comfortable with. However, it is definitely worth it. This is what people with ED need to constantly remember: pain and challenges now will certainly bring positive and desired results soon! But you must keep going.
Recovery is challenging because one must 'ignore' what the brain and body are saying for a while (ex. Not being hungry but still eating according to a timed schedule, cruising through the anxiety of gaining weight and feeling full, not feeling excited or happy to eat, etc.). But over time, the body and brain start to adjust and it becomes a habit. Over time, the brain will start to realize that food = good, food= strong, and food = life. And soon enough, food = freedom from ED. It may take time – and unfortunately, no one knows how long that will be. But one thing is for certain: it is possible, doable, and worthwhile. In the meantime, keep fighting. Surround yourself with people who love and care for you, and can support you during this time. Find ways to cope with difficult feelings. Pamper yourself, and use distractions. Do whatever you can to keep pushing…trust me, it is worth it. And you can – and WILL do it.
Posted by MA at 16:03
Tuesday, 19 July 2016
How do you feel right now?
This is probably a lot harder to answer than you may think. Maybe that is because right now, nothing is truly happening. But try answering the same question when you've just found out that you may be laid off work. Or that your best friend is in the hospital. Or your parent has a car accident. Or you failed an important test. What are the feelings associated with those situations?
Why is it important to label how we feel? Why do we even bother with putting a word to our emotions? Well, interestingly, labeling our emotions is actually a lot more important than many of us (myself included!) once thought.
This study is a great example of how labeling emotions can have positive effects. In this study, participants who were scared of spiders were asked to either label an emotion (ex. I am anxious about being near a spider. I feel scared that it will hurt me") or to just approach the spider without labeling any emotions. When their brains were imaged, those who labelled their feelings had less activation of the amygdala, a part of the brain that regulates stress, fear, and emotion (so, those individuals who actually labelled their fear as being such experienced less stress and anxiety around the spiders than those who didn't label their emotions). In other, simpler words, when we label our emotions, we are less likely to feel the negative aspects of the situation or emotion (ex. labeling that you are feeling angry because your sibling just lost your phone allows you to remain less stressed, and you are less likely to 'act out' because of this anger).
Cool, huh? This has many implications for our everyday lives. Personally, sometimes I am so overwhelmed with a situation that I don't pay attention to how I am feeling, or I am unable to properly label my emotion. But, taking a deep breath and asking myself 'what am I feeling right now?" really helps me focus. For example, imagine that you are in a car accident. Do you feel angry that you lost your car? Are you scared that you hurt yourself? What thoughts are going through your mind at this moment? When we stop to analyze things this way, and put a label on our emotions, we are better able to deal with them, and cope with our experiences.
I challenge you today to begin to label your emotions - do not be afraid to say that you are feeling frustrated, angry, scared, tired, hopeless, etc. When you do so, you'll find that you feel a lot better about the overall situation, and you will also help yourself find a way to deal with that emotion. Remember that labeling your emotions is not only good for your well-being, but also helps you to slow down and push through a tough situation.
So....how do you feel right now?
Posted by MA at 12:30