In this episode:
Venessa: Eating disorders don't just affect the body. They can have a profound impact on how you think and feel day to day. Emily, can you tell us about your experience of living with an eating disorder?
Emily: Absolutely. My eating disorder started or came about around the time when I was sort of coming to the end of my sixth form years. It was a time where there was a lot of change, and I think the stress of not really knowing what I wanted to do meant that I had sort of a slight reduction in my appetite.
And it wasn't like a pinpoint moment, but the reality was that that then brought around this kind of gradual loss and disconnection with me, and this sort of slippery slope of restrictive behaviours. And it's not like I can look back and think, "Oh, that was the pinpoint moment where I had an eating disorder."
And in terms of the reality of that, my life just got really, really small. I felt less and less like the me that I knew deep down I was and could be, but I also felt this sense of "I'm fine"-ness and, well, this is just how I am, that sort of could get in the way and mask that somewhat as well.
Venessa: So this is how I am, that's what you started to believe?
Emily: Yeah, absolutely. And I think there was always deep down within me, this flickering fire of, mm, no, but the more I walked that path of sort of disordered behaviours and sort of restriction, the more I got lost in the quagmire.
Venessa: So those are the external factors. What did that feel like on the inside from day to day?
Emily: Yes. Well, generally I would say that it was this strange mix of being really numb, but also incredibly volatile and vulnerable. I felt like things kind of happened in my world and my life that I knew deep down I probably should be more upset about or more engaged in, but I just felt disconnected and stepped back, like I was watching myself live my life.
But there were also other times where I felt so vulnerable, and particularly if something was to happen in the day where it didn't go as I had thought it might, or it didn't go as it was planned, or where I was challenged in a certain way, that would often lead to a sort of real volatility in how I felt.
I also very much, that word of kind of smallness and my life getting really small, that's something that really stood out in terms of the day-to-day feeling of living in that place. I gradually noticed this reduction in wanting to do things.
I wanted to want, but in terms of really actually wanting to get out and do something, like someone could make a plan and two days away from it I'd think, "Oh yeah, that sounds wonderful." But then when it actually came around to the evening, I'd think, "Oh, no, I just, I don't want to."
It was like this conveyor-belt existence took over everything, and my life just became from A to B and B to C, and then on repeat. And it was almost like peace and joy and freedom was kind of this carrot on the end of a stick, and so it just felt on a day-by-day basis like I was going through the motions, constantly reaching and trying to get to that point where I would feel able to have peace and be still and enjoy that thing or join in in something.
And I was just never able to get there, and I suppose that's what I mean by that conveyor belt.
Venessa: Thank you. So Charlie, how does malnutrition affect the brain and emotional regulation?
Charlie: It affects both of those things, the brain and emotion regulation, in lots of different ways. In terms of emotional difficulties, often people have a really heightened sense of anxiety on the one hand, but at the same time, a lot of emotional flatness.
Alongside that, there's a difficulty very often tolerating discomfort and regulating one's feelings and impulses.
On the thinking side of things, there can be a really obsessive preoccupation, increase in rigidity, and a challenge managing uncertainty or changes to plans.
And then another area that's really affected is information processing. Being malnourished profoundly changes one's ability to interpret internal signals and what's going on around you in the world, which are an important way in which we all make sense of ourselves, our experiences, and how we're interacting with the world around us.
And in eating disorders as well, that can be reflected in things like distorted body image and difficulties making decisions.
Emily: There's so much there, and I think the rigidity is such a huge thing. Also, another thing when you were speaking there, I thought, that makes so much sense in why very often recovery, I would describe it as feeling like this odd mix between being numb and a toddler.
Charlie: Mm.
Emily: I felt like so often emotionally, I felt this intense vulnerability, this intense tendency to be volatile, mixed with this significant numbness and capacity to just feel stepped back and sort of disconnected from everything, and it's really interesting listening to some of the things in terms of the brain that are going on that contribute towards that.
And with the rigidity piece also, I very often felt that on the surface I had everything together.
Charlie: Mm-hmm.
Emily: And on the surface, people looking in would just think, "Wow, she's so efficient. She's doing everything. She's here, she's there. She's this busy bee doing everything, achieving everything."
Charlie: Mm-hmm.
Emily: ...doing everything, achieving everything. But realistically, deep down, that was not how it felt in that time. Deep down, there was often a lot of turmoil going on behind the scenes.
But more poignantly, it was like I could fly my "I'm fine" flag through all of that unless things changed, and then the moment something changed, like I could be going through my day, achieving all the things, going to my studies, doing that, helping this person, going, popping here, doing all these things, and then the moment something might change ever so slightly, that complete inability to deal with the flexibility that life requires us to navigate so much, that really stood out to me, and that's often where the kind of flip would occur between that numbness and that volatility.
Charlie: Mm-hmm.
Venessa: Thank you. So Charlie, you mentioned lots of elements, including energy deficits and numbness, and you've spoken about that as well, Emily. So how do you think being in an energy deficit affected your mental and emotional state?
Emily: The very first thing that I thought about when I opened my eyes in the morning was food, and that would continue, and it would be a mix between my body and my core self thinking about food in a very natural way because ultimately my body was energy deprived, right the way through to that real battle and turmoil of eating disorder suggestion for, well, if you have this, then not that, and if you do it like this, then it needs to be made in this way, and then just all of that labyrinth of rules and boxes to tick.
I feel like that basically just continued all the way through every single day, and everything in my life that wasn't eating or food related started to just feel like filler stuff, and it just felt like I was waking up, doing things to get to breakfast, having breakfast, and then doing things to get to lunch and doing things.
And that's just, again, when I speak about that conveyor belt, this all comes into why my life felt so small and so much like, yeah, this endurance event rather than something that I was living and enjoying.
Venessa: Yeah. How you describe that, of doing things to get to the next meal or food. Yeah, that would feel like that, definitely. So as you began to nourish your body more consistently, what shifted in your mentality?
Emily: So the thing I want to say first and foremost is that it was not immediate, and I think for me, in recovery, when I boldly committed to eating more, to resting more, to doing the opposite of what my eating disorder suggested I should do, I think I maybe naively thought that everything was just going to instantly feel brilliant.
I was going to be skipping along the street and going out for burgers and chips with my friends, and I was going to just instantly feel this surge of energy and enthusiasm, and it couldn't have been further from the truth in reality.
I very much felt in the immediate term that life got even smaller. I often refer to it as this kind of cave bear mode, and now when I look back, recovered, it makes total sense.
Ultimately my body at that time was suddenly being given indication that food was available again more abundantly than it had been for a long time, and understandably, it was then like, "Right. Well, let's settle down. Let's make good use of this because who knows when the next period of scarcity or starvation is going to show up."
And it was a rollercoaster. It was not linear in any way, shape, or form. It's not like from that day and I was in that cave bear mode, and then it was just this gradual linear progression. It wasn't. It was up and down. It was sticky and messy and lumpy and bumpy.
But by and large, there was this gradual progression out of that sort of hazy black and white state and back into a place where, yeah, it felt like someone had put the colour back in my life.
Venessa: So Charlie, why is nutritional rehabilitation such a key part of supporting both physical and mental recovery?
Charlie: Well, it's a huge element of psychological recovery and the recovery of the brain.
But pausing briefly to think about the importance of nutritional rehabilitation for the body, there's an awful lot of repair that needs to happen from a physical perspective as well, in terms of things like bone health, cardiovascular functioning, metabolism, the digestive system, the immune system, all of these different areas that become compromised when people are in a starved state.
Also, this restless energy that a lot of people experience when they're in that starved state as well, this feeling like they can never quite rest and sit still, like they need to constantly be on the move, busy doing something, an obsession with productivity, whether that's on an academic side or in terms of one's work or feeling like one constantly needs to be there and showing up for people in a sense of duty to friends and family.
Venessa: So Emily, what would you want someone to understand if they were struggling to see how much their body and mind were connected right now?
Emily: I would want them to know the biology of energy deficiency is irrefutable. The only thing fundamentally that heals that is nutritional rehabilitation. It is nourishing your body adequately, consistently, allowing your body to do all of that healing work, its body, its brain.
It's doing the rest and allowing your body to have the space and time that it needs to heal. And I would want people to know that there is a rollercoaster ahead of them.
It's so important to know that it is not just going to instantly feel great and be great. You can't just go over a bridge in recovery. You've got to go down the bank, wade through the mud and the water, and scramble up the other side, but that truly there is sunshine on the other side of this storm, and it is absolutely worth pursuing that place of full freedom.
