Why it gets worse before it gets better

"People with AN enter a vicious cycle which accounts for the chronicity of this disorder because caloric restriction results in a brief respite from dysphoric mood."

Translation: people with a certain kind of brain chemistry feel better when they avoid eating.

"However, malnutrition and weight loss, in turn, produce alterations in many neuropeptides and monoamine function, perhaps in the service of conserving energy, but which also exaggerates dysphoric mood."

Translation: The bad feelings they are self-medicating by not eating get even worse, leading to more restrictive eating.


  1. Yep - they've got it. Now how do we translate this into practice to help those who (quite naturally given the science) find it so difficult to recover?

  2. I just wrote a very long response ... very similar in nature to what Marcella said. I deleted it.

  3. BY giving them full, loving support, and by making eating non-optional.

  4. See, when I see these findings I see immediate applications - exactly the ones Harriet describes.

    It seems to me that the history of ED treatment has been under the belief that the patient can and will overcome the ED by force of will and logic. They can't. And now we see why.

    These findings give me sympathy for the patient, and help me see the necessity of full nutrition regardless of what the sufferer believes.

  5. I just wrote a rather wordy response in another thread.

    I'm starting to wonder ... if maybe ... my responses to the world of eating ...are not unlike my sons entry into this world. He had severe sensory integration, they thought he was autistic.

    I fought hard to get into his world and pull him into ours.

    Maybe ..what *I* need as a patient with an eating disorder, is someone who can get into my world, and pull me out into the real world.

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  7. But how do you do that?
    How do you get somebody to pull you into the "real world" when you're an adult?
    Hospitals can attempt to pull you out of your own world, but what they are pulling you into is certainly not the "real world." It's only a fake setting that leaves you with very little upon discharge. And with much less when they discharge you when you're still at an anorexic weight and still actively using behaviors, but are "medically stable."
    How, as an adult, do you get pulled out of this??


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