National Eating Disorders Association

Recovery – It’s Like Learning to Ride a Bicycle

June Alexander

Recovery from an eating disorder can be like learning to ride a bicycle – at first, it is wobbly, dangerous, and difficult. Taking both feet off the ground and pushing on the pedals in a bid to move forward is plain scary. Time and repeated efforts are necessary to develop a sense of trust and balance. Only when we achieve this do we start to feel safe and secure; slowly we feel confident enough to start looking around, engaging in life, and accelerate our progress.

As someone who developed Anorexia Nervosa in 1962 and was not diagnosed for 20 years, my experience comes from the survivor end of the spectrum. I was an adult and mother of four young children when I started to my ride to recovery.

Early intervention with the Maudsley Approach or Family-Based Treatment (FBT) is the best solution for most children and adolescents, but many miss the opportunity for this help, and the illness becomes embedded in our identity, masterly manipulating our thoughts and behaviors as though we are a puppet on a string.

Adults with eating disorders can face an enormous struggle in finding the right help to guide them to recovery. It does not help that the medical profession has differing views on which treatments work best.

When I started to seek help in the early 1980s, six years of misdiagnosis passed before a psychiatrist recognized the illness and began addressing it. The psychiatrist prescribed drugs that certainly saved my life at the time, as I was chronically depressed and anxious, but they did nothing to help me understand who I was, connect me with my feelings, or challenge eating disorder behaviors and thoughts. The years rolled by: I struggled from one year to the next, diaries full of eating disorder-fuelled thoughts. My life was a part-life, at best.

Love for my children inspired my continued efforts to escape the black hole – all that was left of my soul - in which the ED kept me prisoner.

June Alexander's three-year-old granddaughterBy now I had been seeing the psychiatrist for 15 years. There had to be another way out of this blackness, this helplessness, this hole. Deep down I knew that to be free, it was up to me. In an effort to provide my tortured brain with nutrition, I saw a dietician. This dietician helped me most. She did not talk about food. She talked about feelings. I was 47 years old when we met for the first time.

She helped me see which thoughts and behaviors belonged to my illness and which belonged to the real me. This magical, simple insight helped enormously in recovery – in liberating 'self' from the debilitating illness. It enabled a gradual (total) rebuild of self, and development of coping skills to eliminate deeply embedded ED thoughts and behaviors. Focus on your feelings and the food will take care of itself, the dietician said.

People – whether they are patients or clinicians – cannot be separated into boxes. Lines are blurred in the real world – in the home, as opposed to university research environments, hospitals and treatment centers. Yes, we need theory, we need evidence-based research, but we also need practice. We need to allow for movement to allow the research outcomes to become part of our everyday treatment options. Recovery is a team effort. Knowledge is no use – in fact, it is useless – unless the therapist or caretaker passionately believes the message they are delivering, and has skills to help the patient believe and feel likewise,which leads to trust. Establishment of trust is essential between therapist (clinician, dietician, and caretaker) and patient to achieve a successful outcome. The patient needs to feel safe enough to let go of their ED and follow guidance.

My dietician had this knack. She enabled me to feel safe and secure. She could have been a psychologist or psychiatrist, or social worker, or FBT therapist. She happened to be a dietician with training in mindfulness and FBT. She happened to be the one who connected with the tiny thread of self that remained within my soul.

June Alexander, age 5 Did we talk about food? Rarely. Regarding food amounts/nutrition in early stages of recovery – it is like learning to ride that bicycle. Little kids use training wheels. The wheels give them security and stability until they get their confidence up. When they let the trainer wheels go, they excitedly find they have more freedom and can go faster, they can go anywhere they like. Set amounts of food also can give security and stability, until the patient gets their confidence up, and can start letting go of set foods, set amounts, set routines, set behaviors and thought patterns, set life. It is a gradual process.

This is how it was for me – a chronic, long term AN/BN sufferer, now free of all ED behaviors. Doesn't matter how old the kid is when they get on that bike – if it has training wheels, if they have a trustworthy guide who believes in them, they can learn, build their confidence, throw away those training wheels and embrace freedom.

For children and adolescents where early intervention is possible, implementation of FBT can quickly get them back on the road of life, but for the person who has missed early intervention, and the ED is embedded, the assistance of a dietician as part of the treatment team can be a lifesaver.

I wish Maudsley had been around when I was a kid. It wasn't. The good thing about Maudsley is that, ideally, it involves all members of the family – and an ED affects all members of a family. Recovery without family support is tough. But it can be achieved if we have the support of at least one person who we feel understands us, does not judge us, who accepts us and believes in us. I know this.

The most important factor in any recovery guide, whatever their profession is, simply, trust. When we trust, we can ride our bike anywhere.

About the Author: At age 11, June developed anorexia nervosa, a severe psychiatric illness that challenged and shaped her life. A love of words became a tool for survival and June became a senior writer, editor and newspaper columnist. Since gaining freedom from her illness in 2006, June has applied her experience of living with an eating disorder in disseminating evidence-based research in words that mainstream readers can understand. Her books include: My Kid Is Back – Empowering Parents to Beat Anorexia Nervosa; memoir A Girl Called Tim – Escape from an Eating Disorder Hell; and A Collaborative Approach to Eating Disorders; Anorexia Nervosa – a Recovery Guide for Sufferers, Friends and Families; A Clinician’s Guide to Binge Eating Disorder; and ED says U said – Eating Disorder Translator. June speaks internationally on the theme ‘Hope at Every Age’ and is a member of national and international mental health and advocacy organisations. Her website and blog offers support to people with eating disorders and their families.

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