Pain I: Why Is There So Much in Recovery?

Here is another short extract from the Weekly Forum Roundups of 2012 to reiterate the answer to an oft-asked question: why is there so much pain when I felt fine all while I was starving, exercising demonically, cycling through starving and eating cycles, actively purging (and so on)?

Your body is severely damaged. The pain, the aches, the fatigue, the discomfort and the water retention are there to force some immobility so that the body can attend to repairs.

Cat Craig:

An eating disorder has very effective signal-jamming abilities when it comes to your body's distress signals to the brain when you are actively practicing restrictive behaviors. Most people who begin recovery feel like they've been hit by a freight train of aches, pains, swelling, and deep, deep exhaustion and they wonder why that happens when they are beginning to care for their body's energy needs instead of when they were actively letting the eating disorder damage them to near extinction.

In the initial 'honeymoon' phase of being with your abusive eating disorder, you feel energized, calm and dissociated from all negative feelings. Whereas the non-ED people hate dieting because they feel instantly like complete garbage (tired, cranky, miserable and moody), the ED-generated neurological anomalies create an initial signal-jamming and false surge of energy in the face of energy deficits. 1

Then, as the damage starts to mount, the body cannot find the energy needed to keep sending distress signals to the brain that more energy is required NOW! That's when more of a sense of numbness, narrowing of thoughts, lost trains of thought, memory and retention issues, and pounding background hunger and increasing fear of food start to mount.

In the progression of an eating disorder the shift from feeling fabulous to feeling numb is usually when the patient starts to get a bit scared and she (or he) feels a sense of isolation, as any attempt to try to break away from the eating disorder creates instant punishing waves of guilt, anxiety and shame.

Once someone makes the leap to minimum guideline (+) food intake, the body finally has energy to send all the cease and desist messages to your mind and the mind is getting more and more able to function such that it can register those messages.

There is a rare genetic condition that impacts about 1 in 2000, where affected individuals truly cannot feel physical pain. It's a very dangerous condition because they are not made aware of when they are damaged and can inadvertently cause much more damage as a result. So if they tear a ligament in their knee they can keep running on it until the leg is rendered too damaged to fix with surgical intervention.

I view the active ED experience as a physiological equivalent to that genetic condition of congenital analgesia (as it is known). While someone with an active eating disorder can feel pain normally, there is such a dulling and distancing of the reception and interpretation within the central nervous system (CNS) of that electrical pain signal originating from the damaged tissue, that the patient can keep applying further damage.

Some of you may notice you start getting colds, whereas in the worst of your restriction you did not. In addition to some of the analgesia that is occurring due to an inability to perceive pain (because the CNS is too starved to interpret signals fully), there is both analgesia and an on-steroids (literally) immune system associated with extreme stress as well.

Restrictive behaviors are extremely stressful to the body. Cortisol (steroid) is surging through your body and this fires up your immune system beyond its usual level (for a while). Eventually the long-term impacts of higher-than-normal levels of cortisol will move patients in one direction or another: autoimmune illness (body attacking its own cells as though they were foreign), or immunosuppression (getting very sick all the time).

When you stop restricting, the entire stress system is told to stand down. So now you’re feeling the pain and you may have a wicked cold along with it as well.

We have a very Calvinistic work-ethic skew in our society that has us all believing an optimal immune system is one that never allows you to get sick with a cold or flu. However, this is not how a resilient immune system is really developed.

In fact, there is evidence that many of the febrile illnesses that involved higher childhood mortalities prior to the discovery of antibiotics and the implementation of standardized pediatric immunizations may have allowed for critical maturation of innate immunity and a commensurate lower incidence of autoimmune reactions (assuming the child survived of course!) 2,3,4

I am not saying don’t immunize (although I do have something to say on the specific timing of pediatric immunization schedules, but another time). However, your immune system likely benefits from practice and the odd unpleasant cold or really unpleasant flu only adds to your overall responsiveness to pathogens throughout your life.

It takes months and months for the body to fix the damage and of course a lot of energy is needed to finish the job.

The aches, pains, swelling and real discomfort is there as a clear message from your body: "Would you stop already?!!"

Take it easy and eat. It’s not “disgusting”, “lazy”, “selfish” or “self-indulgent”. It is mandatory. It is from a higher authority than doctor’s orders—it’s Body Orders.

1. Guisinger, Shan. "Adapted to flee famine: Adding an evolutionary perspective on anorexia nervosa." Psychological Review 110, no. 4 (2003): 745.

2. Cohet, Catherine, Soo Cheng, Claire MacDonald, Michael Baker, Sunia Foliaki, Nyk Huntington, Jeroen Douwes, and Neil Pearce. "Infections, medication use, and the prevalence of symptoms of asthma, rhinitis, and eczema in childhood." Journal of epidemiology and community health 58, no. 10 (2004): 852-857.

3  Zeyrek, C. D., F. Zeyrek, E. Sevinc, and E. Demir. "Prevalence of asthma and allergic diseases in Sanliurfa, Turkey, and the relation to environmental and socioeconomic factors: is the hygiene hypothesis enough?." Journal of Investigational Allergology and Clinical Immunology 16, no. 5 (2006): 290.

4. Holt, P. G. "Postnatal maturation of immune competence during infancy and childhood." Pediatric Allergy and Immunology 6, no. 2 (1995): 59-70.