Trust issues

We can keep arguing whether or not people with anorexia were different before they suffered from malnutrition, but there is no question that it takes more than just regaining healthy body composition for systems to become normal again. It takes time.

Much of the internal repair is invisible to us, but the patient's brain knows things are still awry for many months after the assault of even brief malnutrition. The brain produces anorexic thoughts to protect itself from famine, and it has trust issues when it's been starved; wouldn't you?.

Full nutrition, behavioral stability, extraordinary social and emotional support, for a long time -- they are worth it.


  1. This is so true. Is there any further information you know of on this topic? I was just talking about this with my therapist the other day, especially the anorexic thoughts that are all consuming. It is ironic because they get worse with time, not better. Keep writing Laura! Best, K

  2. My folks never trusted me, which was good because I was a "bad" child. I was always getting into things but my folks made every effort to stop me.

  3. This is so true, Laura. Weight restoration is the first step, no doubt. But it's not the *only* step. For me, maintaining my weight has been much more of a battle than gaining it. There is a tremendous shock as your brain and body become alive again, and it's not full of cute kittens and much rejoicing.

    That's what I wish people had told me more about. The aftermath.

  4. Laura, It makes so much sense that time is needed, but how much time? How, as a mom, do I know that my d just needs time or that she needs more intervention (weight gain, meds,something). We've done the weight charting, based on twelve years of data and she is slightly above where she would have been without an. However, the an thoughts are active. It's so frustrating and scary, especially when I don't know that I'm doing enough.

  5. Clearly, every case is different. I know that one rule of thumb is that it takes 6-12 months after weight restoration for most of the psychiatric side-effects of malnutrition to fade. Only then do you really know what co-morbid issues exist. So some clinics and clinicians wait until after that to diagnose any other condition. Malnutrition really works a hurting on the brain and metabolism.

    And some kids, after weight restoration, resume their expected growth spurts all at once - throwing them off again.

    Good clinicians could help you compare this to others in similar situations and help make a plan. You deserve it: it is exhausting to just press on without clear goals.

  6. Thanks, Laura, we haven't hit the six month mark yet, so I guess the an thoughts are to be expected. I talked to my team about developing a plan. We're going to discuss it at our next session, without my d in the room. There really is so much to consider. I know at some point my d will have to add weight, just to stay on her normal growth curve. Keeping up with it all is exhausting. Your wisdom helps.


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