For most people, negative energy balance (expending more energy than you consume) is an unpleasant state. Negative energy balance, even in the form of a delayed meal, can lead to hunger, grumpiness, irritability, shakiness, cognitive fuzziness, anxiety, and low mood. Because of these generally unpleasant feelings, many people try to avoid negative energy balance. The story is quite different for people prone to anorexia nervosa. For them, negative energy balance can be a dangerous biological trap.

The world has “psychologized” the quest for negative energy balance in anorexia nervosa for far too long. Convenient but misguided explanations that focus on control, willpower, and even stubbornness fail to capture the biological reality that the physical experience of negative energy balance is fundamentally different in people prone to anorexia. The starvation state is alluring to them, not because it signals weight loss, but because it is anxiolytic. That means that negative energy balance actually confers a sense of calm on their otherwise unsettled biology. What makes the rest of us more anxious makes them less. Obviously, the job of providers is to help them be able to achieve that sense of calm in other ways—ways that are not physically harmful.

This aberrant response to negative energy balance might be what kicks off anorexia in the first place, and it may be a salient risk factor for relapse.

Imagine a group of sixth grade girls who decide to go on a diet. Or imagine a boys’ wrestling team that decides to engage in some serious crash dieting before weighing in for a meet. Most of the girls and boys find the period of negative energy balance unpleasant and can’t wait to break the diet and go out for pizza and ice cream. For a few, however, they find that they actually feel better under negative energy balance conditions. The diet feels good; they feel calmer. The anxious chatter in their heads diminishes enough to suggest that this might be an escape route from the pervasive discomfort with which they have been living. The positive biological reaction to negative energy balance lures them into continued and escalating dieting in a quest for the paradoxically improved sense of well being that it confers. It is simultaneously seductive and destructive. It is seductive because of the promise of calm and control it holds; it is destructive because it has the power to kill.

During and after recovery, negative energy balance can sneak up and grab hold of you without even being aware that you are in its grip. Starting a new exercise program, travel and the attendant time zone changes and disruptions in routine, or a busy schedule that doesn’t allow times for planned meals and snacks can all blindside you into experiencing just a whiff of the seductive calm that mistakenly leads you to believe that starvation holds an answer to your discomfort. Don’t be duped. Starvation is a false friend that does not have your long-term best interests in mind.

My dad used to smoke. For the longest time, even though he had become a vociferous anti-smoker, he would occasionally catch a whiff of a cigarette and be transported back to those days in the 50s when he could reach for a cigarette.

Anorexia is no different. Just dabbling in negative energy balance, especially under times of stress, can tempt. So maintaining vigilance for balanced energy intake and output is a critical component of long-term recovery. Tipping that balance in the wrong direction could send you back down a dangerous path. Every one of us who has had health issues has to remain vigilant for situations that can exacerbate a problem—even problems that we think we have completely recovered from. Nothing makes us stronger than being aware of our vulnerabilities and respecting them.

Especially during the holiday season, when schedules are irregular and emotions are closer to the surface, be mindful of your own energy balance and seek out positive avenues to capture calm.

Cynthia Bulik, PhD, FAED