Many patients with eating disorders are highly intelligent and very emotionally intuitive...great traits, and ones often accompanied by a truly sensitive soul. Many of my patients glow a little too much when praised, and can withdraw like a closing sea anemone when criticized or corrected. I think of this sensitivity as the darker or more difficult side of a two-sided coin – the other side being incredibly bright and representative of a patient’s intelligence, work ethic, and thoughtfulness.

Frequently, folks who have this very bright/dark sided coin start experiencing belly pain, nausea, or other digestive issues very early in life – sometimes as early as elementary school. Although these symptoms feel very, very real, doctors keep telling them that they are “fine” - something they have been repetitively told their entire lives. This unexplained digestive discomfort/dysfunction is often diagnosed as Irritable Bowel Syndrome (IBS) or attributed to food allergies or symptom somatization. Regardless of what we choose to call it, it must be understood that the pain and discomfort arises from emotions being made physical – a prime example of the mind/body connection.

Cerebral atrophy — or what’s known as “starved brain” — is a common complication of anorexia nervosa and describes a loss of brain mass due to starvation. When a person does not get adequate nutrition regularly, starved brain will affect concentration, memory, cognitive flexibility, and fear responses, regardless of brain size. 

Many of our patients at the ACUTE Center for Eating Disorders — even while being high-functioning — realize about a week into nutritional rehabilitation that they do have some type of so-called brain fog. They realize their concentration was compromised, that they were driven by rigid rules and fears rather than having the ability to be spontaneous, creative, and flexible, and that their memory was worsened. 

We all know how hard it can be for a patient with an eating disorder to find the motivation to enter and stick with treatment. (Because I work in a hospital setting, I use the word “patient” rather than client.) Whether you suffer from an eating disorder yourself, are a loved one of someone who has one, or are a clinician, it’s clear that sustaining motivation is one of the greatest challenges.

So many of my patients—brilliant and articulate and sensitive and driven—hear a constant message from their eating disorder that they are “fine” (Aren’t they getting great grades? The star employee? Still able to complete their run?) and in fact should probably restrict more, purge more, go further.

It’s an exhausting and deafening message, and it’s incredibly hard to overcome. Since self-esteem often runs low at the same time, encouragement to “get treatment because you deserve something better” may not be motivating enough.

You may be someone with an eating disorder, a parent/partner/sibling/teacher/coach/grandparent of someone who has an eating disorder, or a clinician. You are all welcome to read on…everyone who has anything to do with eating disorders should understand why bone density loss and underweight are linked. I want you to understand the basic science behind the linkage, to grasp what’s at stake, and to use this scary example of objective body suffering to break through the syndrome of “I’m fine.”

So let’s start with some basics. During adolescence, 90% of your bone density is laid down…that’s the healthy, strong, resilient bone that has to carry you around the rest of your life, so it’s incredibly important. After age 20, the window to lay down this dense bone closes, and you will live in a balance of building up and breaking down bone until (if you’re a woman) menopause, at which point you’ll probably slowly start losing more bone density than you make because you no longer produce estrogen.