"How will I know when I have fully recovered?" This is a question many of my clients in eating disorder (ED) recovery ask. And the answer is multi-faceted.
As a teacher and student of ancient systems for comprehending the patterns in nature and applying them to our own healing processes, I offer these aspects of ED recovery through a 5-element lens. This approach is founded in the wisdom of both Ayurveda (the ancient medicine system of India) and Chinese medicine. I've written other articles on how these systems can support (or if used incorrectly, hinder) your intuitive eating journey here and here.
Whilst full recovery looks different for everyone, and we all have our personal idea of what it looks like, here are five basic elements to consider when asking the question, "have I fully recovered yet?"
As a teacher and student of ancient systems for comprehending the patterns in nature and applying them to our own healing processes, I offer these aspects of ED recovery through a 5-element lens. This approach is founded in the wisdom of both Ayurveda (the ancient medicine system of India) and Chinese medicine. I've written other articles on how these systems can support (or if used incorrectly, hinder) your intuitive eating journey here and here.
Whilst full recovery looks different for everyone, and we all have our personal idea of what it looks like, here are five basic elements to consider when asking the question, "have I fully recovered yet?"
Nutritional (EARTH)
With complete nutritional recovery, eating becomes regular with adequate amounts and variety of food required for full physical and emotional nourishment. Social, flexible eating for enjoyment and pleasure become normal parts of life, perhaps for the first time in a person's life. In my clinical practice I use the RAVES approach created by fellow dietitian Shane Jeffrey to guide the process of nutritional rehabilitation for my clients.
In addition to the above, with full nutritional recovery a person's hunger and fullness cues often reliably come back online again... although for some groups of people (e.g. neurodivergent folks), eating regularly may be a better focus and determining factor for recovery than restoration of hunger/fullness cues.
In Chinese medicine the EARTH element is associated with balance and nourishment, and in Ayurveda and TCM it refers to a sense of groundedness in our physical bodies, predictability and practicality. The body benefits from and can settle into physiological safety (rest and digest mode) when it knows food is coming at regular, predictable intervals.
When we can offer the maternal energy of this element to our own bodies through regular, adequate nutrition, a balance of both receiving and giving can be found. We cannot give perpetually to other people and causes without first nourishing ourselves at a deep level.
Physical (WATER)
In full physical recovery, your heart rate, blood pressure, and body temperature have normalised. Ideally, before even starting on your recovery journey your GP would ensure you are medically stable and that outpatient recovery is an appropriate level of care. But beyond this, regular check ups with your GP can make sure any postural hypotension or postural tachycardia are detected. These are symptoms that the body is decompensated nutritionally and is struggling to achieve normal homeostasis.
For physical recovery to be possible, we need to move the body's needle back to normal physiological function through nutritional rehabilitation. So, nutritional recovery is integral to resolving the physiological symptoms of the ED.
Other signs of physical recovery include improved skin and hair health, digestive and hormonal function. This may look like - as an example - menstrual periods becoming regular. Or healthy hair regrowth after loss or thinning of hair due to nutritional depletion. Or fingernails becoming strong once again.
As many of these things are subjective, I like to use regular testing of oestradiol levels, bone mineral density, and body weight when appropriate (this can be blind weights taken by a health care practitioner) to ensure my clients are on track to or approaching full recovery. For some folks, weight restoration and stabilisation are important signifiers of full physical recovery.
In full physical recovery, the systems of the body are in flow again. Like WATER, this flow can be as gentle and consistent as a healthy river, just a trickle like a spring in drought, or a forceful tidal wave that can be destructive and a loud wake up call alerting us that something isn't right (fainting at work, for example). We are aiming to rehydrate, resuscitate, and bring flow and healthy movement back to the "rivers" of the body - cardiovascular, lymphatic, reproductive, digestive. And to keep those rivers flowing well. Earth is the mother of Water in the Five Elements theory - similarly, nutritional rehabilitation is integral to opening the gates of physical recovery.
Psychological (METAL / ETHER)
Psychological recovery is another important aspect of eating disorder therapy that doesn't necessarily take place in tandem with physiological recovery. Even if physically things have improved, regaining a period (or indeed, never losing it in the first place) are not sure signs that the eating disorder has left the building. Even if weight restoration has occurred, this can take place before complete recovery and occur even while a person is still restricting calories.
When a person has psychologically recovered from an ED, their self-worth is less dependent on eating, body weight or shape. There is a reduction in mental rigidity, anxiety and stress around food, body and exercise (although this can temporarily increase during ED recovery, which is why psychological support is so crucial!). There is a cessation in compensatory behaviours like exercising calories off or saving up calories for meals, which are disordered behaviours, not health behaviours.
In short, with full psychological recovery from an eating disorder, far fewer waking hours are spent thinking about food, body and exercise. This leaves more clarity, space, and mental energy to go towards the things that are important to you.
In Chinese medicine, METAL represents spaciousness, clarity, and mental sharpness, as does ETHER in Ayurveda. It's the ability to discern what is valuable to us, and what must be released. We cannot think clearly if our eating disorder thoughts are front and centre, and our minds are impaired by low blood glucose (the brain's preferred form of fuel). We cannot make neurotransmitters or keep our nervous systems healthy for even moods if we aren't getting enough protein, fat and energy. Again, full psychological recovery largely hinges on full nutritional recovery, and can also be greatly facilitated with psychotherapy.
Functional (WOOD / AIR)
As body and mind heal there are improvements in sleep, energy levels, and ability to focus. As nutritional, physical and psychological recovery gain a foothold, there is a general expansion of your capacity to do and be the things you wish to do and be in the world! Many recovered clients report that they start to achieve things they weren't able to when their eating disorder was still in the driver's seat, like finish a university degree, travel overseas and enjoy new cuisines, or start a family.
The WOOD element in Chinese medicine represents expansion, growth, direction, and it carries the energy of new possibilities, like the first germinating seedling in early Springtime. AIR in Ayurveda carries a similar expansive, upward moving energy.
Social (FIRE)
This element encompasses an improved ability to flexibly and spontaneously engage in social engagements like seeing friends, building relationships, sexual intimacy, going out for meals and treats, and doing things that were previously impeded by disordered behaviours like exercise compulsion, body image concerns, and/or food restriction.
In Chinese medicine philosophy, the FIRE element is associated with passion, joy, compassion, and the ability to connect with others. Fire is also a symbol of transformation. As a species that needs to relate, deep and meaningful connection with others can be truly transformative as well as provide the support we need to keep the eating disorder thoughts at bay.
If you or a loved one are struggling with disordered eating, exercise compulsion, and/or body image concern, please reach out to me or another ED-trained health care practitioner. Help is out there and you deserve to heal. You can contact me here or check out my 1:1 consultation information here.
This article is inspired by NEDC's article on "Recovery" as well as my own insights into 5 Element Theory.
With complete nutritional recovery, eating becomes regular with adequate amounts and variety of food required for full physical and emotional nourishment. Social, flexible eating for enjoyment and pleasure become normal parts of life, perhaps for the first time in a person's life. In my clinical practice I use the RAVES approach created by fellow dietitian Shane Jeffrey to guide the process of nutritional rehabilitation for my clients.
In addition to the above, with full nutritional recovery a person's hunger and fullness cues often reliably come back online again... although for some groups of people (e.g. neurodivergent folks), eating regularly may be a better focus and determining factor for recovery than restoration of hunger/fullness cues.
In Chinese medicine the EARTH element is associated with balance and nourishment, and in Ayurveda and TCM it refers to a sense of groundedness in our physical bodies, predictability and practicality. The body benefits from and can settle into physiological safety (rest and digest mode) when it knows food is coming at regular, predictable intervals.
When we can offer the maternal energy of this element to our own bodies through regular, adequate nutrition, a balance of both receiving and giving can be found. We cannot give perpetually to other people and causes without first nourishing ourselves at a deep level.
Physical (WATER)
In full physical recovery, your heart rate, blood pressure, and body temperature have normalised. Ideally, before even starting on your recovery journey your GP would ensure you are medically stable and that outpatient recovery is an appropriate level of care. But beyond this, regular check ups with your GP can make sure any postural hypotension or postural tachycardia are detected. These are symptoms that the body is decompensated nutritionally and is struggling to achieve normal homeostasis.
For physical recovery to be possible, we need to move the body's needle back to normal physiological function through nutritional rehabilitation. So, nutritional recovery is integral to resolving the physiological symptoms of the ED.
Other signs of physical recovery include improved skin and hair health, digestive and hormonal function. This may look like - as an example - menstrual periods becoming regular. Or healthy hair regrowth after loss or thinning of hair due to nutritional depletion. Or fingernails becoming strong once again.
As many of these things are subjective, I like to use regular testing of oestradiol levels, bone mineral density, and body weight when appropriate (this can be blind weights taken by a health care practitioner) to ensure my clients are on track to or approaching full recovery. For some folks, weight restoration and stabilisation are important signifiers of full physical recovery.
In full physical recovery, the systems of the body are in flow again. Like WATER, this flow can be as gentle and consistent as a healthy river, just a trickle like a spring in drought, or a forceful tidal wave that can be destructive and a loud wake up call alerting us that something isn't right (fainting at work, for example). We are aiming to rehydrate, resuscitate, and bring flow and healthy movement back to the "rivers" of the body - cardiovascular, lymphatic, reproductive, digestive. And to keep those rivers flowing well. Earth is the mother of Water in the Five Elements theory - similarly, nutritional rehabilitation is integral to opening the gates of physical recovery.
Psychological (METAL / ETHER)
Psychological recovery is another important aspect of eating disorder therapy that doesn't necessarily take place in tandem with physiological recovery. Even if physically things have improved, regaining a period (or indeed, never losing it in the first place) are not sure signs that the eating disorder has left the building. Even if weight restoration has occurred, this can take place before complete recovery and occur even while a person is still restricting calories.
When a person has psychologically recovered from an ED, their self-worth is less dependent on eating, body weight or shape. There is a reduction in mental rigidity, anxiety and stress around food, body and exercise (although this can temporarily increase during ED recovery, which is why psychological support is so crucial!). There is a cessation in compensatory behaviours like exercising calories off or saving up calories for meals, which are disordered behaviours, not health behaviours.
In short, with full psychological recovery from an eating disorder, far fewer waking hours are spent thinking about food, body and exercise. This leaves more clarity, space, and mental energy to go towards the things that are important to you.
In Chinese medicine, METAL represents spaciousness, clarity, and mental sharpness, as does ETHER in Ayurveda. It's the ability to discern what is valuable to us, and what must be released. We cannot think clearly if our eating disorder thoughts are front and centre, and our minds are impaired by low blood glucose (the brain's preferred form of fuel). We cannot make neurotransmitters or keep our nervous systems healthy for even moods if we aren't getting enough protein, fat and energy. Again, full psychological recovery largely hinges on full nutritional recovery, and can also be greatly facilitated with psychotherapy.
Functional (WOOD / AIR)
As body and mind heal there are improvements in sleep, energy levels, and ability to focus. As nutritional, physical and psychological recovery gain a foothold, there is a general expansion of your capacity to do and be the things you wish to do and be in the world! Many recovered clients report that they start to achieve things they weren't able to when their eating disorder was still in the driver's seat, like finish a university degree, travel overseas and enjoy new cuisines, or start a family.
The WOOD element in Chinese medicine represents expansion, growth, direction, and it carries the energy of new possibilities, like the first germinating seedling in early Springtime. AIR in Ayurveda carries a similar expansive, upward moving energy.
Social (FIRE)
This element encompasses an improved ability to flexibly and spontaneously engage in social engagements like seeing friends, building relationships, sexual intimacy, going out for meals and treats, and doing things that were previously impeded by disordered behaviours like exercise compulsion, body image concerns, and/or food restriction.
In Chinese medicine philosophy, the FIRE element is associated with passion, joy, compassion, and the ability to connect with others. Fire is also a symbol of transformation. As a species that needs to relate, deep and meaningful connection with others can be truly transformative as well as provide the support we need to keep the eating disorder thoughts at bay.
If you or a loved one are struggling with disordered eating, exercise compulsion, and/or body image concern, please reach out to me or another ED-trained health care practitioner. Help is out there and you deserve to heal. You can contact me here or check out my 1:1 consultation information here.
This article is inspired by NEDC's article on "Recovery" as well as my own insights into 5 Element Theory.
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