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Anorexia is one of the deadliest mental illnesses because of the impact it can have on your physical health. Recovering from anorexia requires mental health treatment and medical care.
During the recovery process, you might experience certain symptoms as your body adjusts to eating and drinking the appropriate amount. One of these symptoms can be fluid retention, also known as edema. 
Anorexia Recovery and Nutritional Rehabilitation
Anorexia can lead to severe malnutrition. During the recovery process, it’s important for a medical doctor or registered dietitian to guide you in increasing the amount of food and water you are consuming. Renourishment is a process. 
When a starved person begins to take in food and water, it can drastically shift body chemistry. This can be dangerous if done without proper medical supervision.  However, safely restoring weight is a necessary part of recovery.
Fluid Retention in Anorexia Recovery
Nutritional rehabilitation is necessary but can come with uncomfortable, temporary side effects. Edema is one common symptom.  Edema is when your body swells due to trapped fluid. This results in swelling in the lower half of the body up to the lungs. 
Edema ranges in terms of severity. For some people, edema may just be uncomfortable while for others it can be dangerous.  It is very rare for someone to experience dangerous edema.
Even in severely medically compromised people with anorexia, this symptom occurs only for 30-40% of patients. There are medical interventions that can help with this form of Edema. 
What Causes Edema During Renourishment?
There are a lot of biological changes that happen when you start eating again, especially after a prolonged period of restriction.  The body goes through a complex process as it tries to get nutrients back into the cells.
There are two reasons why you may experience edema during anorexia recovery. These are: 
- When someone starts eating more carbohydrates, their body produces more insulin. Insulin pushes electrolytes into the cells to try and energize them. Insulin signals to the kidneys to hold onto salt and water. 
- As insulin levels increase and electrolytes are pushed into cells, someone may develop low levels of phosphorous. This can lead to muscle weakness and breakdown of blood vessels. This results in a dangerous form of edema.
Some eating disorder professionals say that edema is a sign of healing, but this isn’t true.  It is a common side effect, but Edema alone does not mean that someone’s body is recovering.
There are other medical markers that eating disorder professionals should look for in order to assess for physical recovery. 
How Long Does Edema Last?
Edema should only last for a few days up to a few weeks.  The swelling that can occur can be really emotionally distressing for people with anorexia. A key feature of anorexia is the fear of becoming fat or gaining weight.
Sudden swelling in the ankles, legs, and stomach can feel like they rapidly gained weight overnight. For someone with anorexia, this might be their worst nightmare.
Edema and Body Image Distress
If you are experiencing edema and it’s triggering body image distress, hang in there. This is temporary.  In the meantime, here are some tips to cope with negative body image during this phase of recovery:
- Distraction: Distracting yourself can be a healthy coping skill when used temporarily. Distraction is not meant to be a way to suppress your feelings, but rather helps you get your mind off of the situation temporarily. This can help if you are tempted to engage in disordered eating behaviors or other mechanisms of self-harm. If you are really upset about the changes happening in your body, it can help to focus on something that you find pleasurable. Whether it’s watching TV, watching Tik Tok videos, or calling a friend, finding a safe distraction can help you tolerate the emotional distress.
- Gratitude: Your body is going through so much right now. Practicing gratitude for the things your body is doing for you can shift the focus off of what it looks like. Maybe you notice that as you eat more, your energy has improved and that helps you with school work or in relationships.
- Talk to Your Support System: Lean on your support system. It can help to talk about your discomfort with people you trust. It can be a friend, family member, therapist, or people in an eating disorder support group.
Edema is uncomfortable, but it’s temporary. Support from medical professionals during this phase of recovery can help ensure that your nutritional rehabilitation is done safely and in the most comfortable way.
Resources: Gaudiani, J.L. (2019). Sick enough: A guide to the medical complications of eating disorders. Routledge.  South Carolina Department of Mental Health. (n.d). Eating Disorder Statistics. Retrieved June 3rd, 2022 from https://www.state.sc.us/dmh/anorexia/statistics.htm
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At Eating Disorder Solutions, compassion is at the root of everything we do. We understand that eating disorders are complex, deeply rooted mental health and medical conditions which require personalized treatment for a successful recovery. By integrating behavioral health modalities and clinical interventions, we endeavor to address disordered eating at its source.
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Published on July 1, 2022. Published on EatingDisorderHope.com
Reviewed & Approved by Jacquelyn Ekern, MS, LPC on July 12, 2022