As I sit with clients who face the steps of recovery from anorexia nervosa, it is the desires to be close, to offer closeness, to be held, to hold, to be understood, and to understand that are some of the deepest seeds of recovery. Along with the significant risk of medical complications that can lead to death, one of the worst parts of anorexia nervosa is the way it may interfere with interpreting, seeking out, bonding with, and holding onto human connections. Researchers and clinicians recognize that interpersonal problems are linked to both the maintenance of and recovery from anorexia nervosa.
In a recent article “Seeing things differently: An experimental investigation of social cognition and interpersonal behavior in anorexia nervosa”, Ambwani et al (2016) suggest that for those with symptoms of anorexia nervosa, there may be a deficit in the ability to recognize warmth and accurately perceive social cues. In anorexia nervosa, as the body and brain are starved, there is a hyper-focus on food, eating, and body. The body and mind seem to divert from seeking rich deep relationships to focusing on survival and overcoming starvation. The longer starvation continues, the more time there is for relational divides to set in. This distance may make recovery more difficult and less compelling.
In my experience, the sequelae of isolation are often paradoxically some of the saddest aspects of having this life-threatening illness and one of the most important motivators for recovery. I was recently reminded by a client in recovery that even in prison, solitary confinement is one of the worst punishments. Anorexia nervosa can lead to a similar experiential aloneness. Sometimes the motivation for recovery begins with family, partners, and friends when they acknowledge that their person is physically or emotionally slipping away, becoming unreachable. Other times, the person with anorexia nervosa recognizes the relational fallout.
Unfortunately, the reach for connectedness is not always explicit or evident in the early stages of the recovery process because the first focus is often on fear, control, and physiological needs. But once nutritional restoration is well underway and the body and mind achieve some semblance of balance, relational needs and desires start to rise up. This is an exciting, hopeful time in recovery. Clients begin to want recovery, to feel motivated, to voice who they want to be closer to or more distant from. It is relationships with peers, partners, families, and the treatment team that often become the anchors back to the true self —-the self that both preceded the illness and remains despite it.
The types of comments I hear as nutritional recovery takes place are…I feel like myself again, I know what I want, I’m sad but relieved I can feel again, I can laugh easily, I am not numb anymore, I don’t want to lose ground because I don’t want to risk losing my relationships again. While the most urgent medicine is food, in my experience, the deepest inspiration for healing often has its roots in meaningful relationships. Vincent Van Gogh wrote, “Nothing awakens us to the reality of life so much as… love.” Recovery is a process of leaving isolation behind and seeking the path to being fully connected and awakened.