Recovery from an eating disorder is still possible. Even after all these years.

Against all odds

She's not someone you'd expect to recovery. Decades living with an eating disorder, endless barriers to jump over.  But seeing the progress that my patient (I'll refer to as) Amy has made should provide hope to anyone who has long given up. Yes, recovery is possible. Not easy. Not quick. But possible. Please read through the end and share your thoughts with "Amy". 

In the last 50+ years, I cannot remember a time in which I was satisfied (even slightly) with my body.  As a matter of fact, I view it as disgusting and embarrassing.  Even at my sickest state, I was convinced I was the fattest one in the room.   In this point of my recovery, I deem it important to reflect on how far I’ve come.  Below is my life’s journey thus far.

It is uncertain to me why I have suffered from Eating Disorders for most of my life.   However, in my past, could lay the meaning for all of this.  My mom had EDs always.  My ED could be attributed to nature vs. nurture.  In other words, it was perhaps either a learned behavior or maybe it was genetically passed down to me.   It seemed important to my Mom that I should watch what I eat.  She was always suggesting that I should not have seconds at meals.  I remember my Dad taking us for ice cream when we were kids.  My mom would always get a diet soda so it seemed appropriate to me to follow her lead. When I was 8 years old I experienced a terrible trauma.  Even all these years later, I cannot reveal the details of this trauma.   All of these childhood memories are what, I believe, set the course for this ever-lasting emotional rollercoaster that is my life.

As I was preparing to graduate from high school, my ED became quite severe.  I was passing out on a daily basis.  My pediatrician told me that I was being “ridiculous”; I did not need to lose any weight and to just “eat more”.  It was at this time that I realized that if I ate just enough, it would not raise suspicions. It was also in my teen years that I started to self-harm.  I did this to the point of being certain it would kill me.  I didn’t care.  These behaviors even led into my adult life.

At the age of 23, I was married and eventually had 3 kids.  During this time, my behaviors somewhat subsided until my husband began drinking heavily.  This not only effected him, but it also effected me and our children.  What at first seemed like a “silver lining” was actually the calm before the storm.  I became engrossed in my ED once again.  All my behaviors emerged all at once.  I was unable to sit with my family at the kitchen table during dinners.  I would make my own “safe” foods and eat at the counter while doing chores while I ate.  Even as an adult, I was still following my Mom’s lead.

After 20+ years of marriage I finally somehow found the strength to separate from my husband.  As I began trying to pay our bills, it quickly became apparent that there was no money left in our joint accounts.  I had to begin again.  This stress increased the frequency of my ED behaviors.  I became quite sick again.  I refused to admit it.  My foggy brain kept me from the reality of my life.  Even when close friends and family claimed I needed help, I thought they were just trying to make me fat.  Kathy, my therapist, challenged me to attend an intake interview at an ED treatment center.  She even called them for me.  I went in order to prove my point – I do not need help!

Getting help--no quick fix

What I thought would be one hour out of my day, turned out to be four years of my life.  Since that day, I have been in residential 3 times, and PHP and IOP too many times to count.  After each stay, I felt like a failure.  I’m not sure if I felt this way because I couldn’t be cured from my ED or because I was letting my treatment team talk me into eating. Insurance was not a great help.  They would only approve 2 weeks max in resi for my first 2 stays. I would be discharged from residential and immediately make excuses for using just 1 or 2 behaviors.  “That’s better than all of them”, I would assure myself.  My outpatient treatment team were instrumental in convincing my insurance company to extend my treatment in my last resi stay to 6 weeks.  Upon discharge, I thought I was cured.  I felt great for a few weeks before the ED got into my head again.  I relapsed.

I overcame that relapse thanks to the support of my RD, Lori and the rest of my treatment team.  She could see through the ED lies.  She knew I was relapsing even before I did.  Yet I've turned it and I’ve had many accomplishments in the last few months:

I dug myself out of financial debt.

I eat my meal plan consistently

I’ve attempted to move away from “safe” foods.

I haven’t used ED behaviors in 3 weeks.

I’ve enrolled myself into a 16-week DBT group.

These are all accomplishments that I would not have believed possible even 3 months ago.  I will strive to add to this list within the next 3 months.  I feel more peace and contentment in my life now than I have ever before.

The journey isn't over. But recovery is in site

Even though I reached so many incredible accomplishments, that is only the beginning of the end of my recovery. Today, there a different challenges to face. Being closer to recovery than ever before, I am now terrified of losing my ED.  It’s been my stress control, my safety net, my numbing against my life.  How do I let go of it when I may need it again?  What if I can’t get it back? Even though I know that it is in my best interest to continue to move forward with my recovery, part of me does not want to let go of my ED forever.   My goal going forward will be to use my “wise” mind to conquer these thoughts.  I want to be able to look in the mirror and think, “I am who I am; I’ve done the best I could, given my circumstances, and I am proud of what I’ve accomplished”.  I WILL continue to fight and learn to love myself, whoever that may be, “Against All Odds”

Here's another recovery story you might like:

http://dropitandeat.blogspot.com/2014/03/theres-no-gift-like-recovery-and.html

So you think you're recovered from an eating disorder? Take this quiz to find out.

1) Recovery is about weight gain. Period.

The simple answer? 

It just might not be going the way you planned. 

False. Now don't let your eating disorder get all excited, saying "See! I told you so!"

Weight restoration is surely a must for those who have fallen from their usual weight or in the case of kids, their weight for age and BMI curves. That is, their expected pattern of gain based on their age and their weight history. For kids, falling off their usual growth curve suggests a problem. It shouldn't be praised or rewarded, but evaluated. (Pediatricians, did you read that?!) But if someone's weight was high due to unhealthy behaviors such as binging, emotional overeating, or general disregard for satiety, and weight dropped with improved eating and coping, weight gain is likely unnecessary.

Simply reaching a healthy range based on the charts also isn't enough. Perhaps your restrictive eating and suppressed weight began as a young teen, and you've lived for years with eating disordered behaviors. Did you rely on cigarette smoking or other substances? Was your appetite suppressed by ADHD meds? As you recover, weight gain may be essential regardless of what the BMI charts say. Focusing on the weight is misguided!

Your weight may be technically in the normal range, but your behaviors may indicate a problem. You know, like restricting, binging, purging, laxative abuse, compulsive exercise.

Weight is just one component of eating disorder recovery.

2) If I get a period (and I'm not a guy) then my body is healthy.

False

Surely losing your period when you're of age and sex to be getting a period is cause for concern. But getting your period is not evidence that all is well and you have recovered. You may get what seems like a period when you're on the pill, or start to get periods back without all the hormones being back to normal. Or maybe like one adult patient I used to see, in spite of her struggle with anorexia, she managed to conceive and deliver 5 children, never missing a cycle. Similarly, weight may be restored to the appropriate place, but it may take several months for menses to resume. For guys, low testosterone level is a more silent red flag that things are amiss; is resolves with adequate eating.

3) If I can take in enough calories, then I've recovered.

False

Can you eat foods you used to enjoy?

Sure, you will need enough calories to get your body bad to normal function--with a healthy heart rate and blood pressure, without major drops in pressure when you go from lying down to sitting or standing; with normal body temperature and energy level; with better sleep and mood. But full recovery means eating a range of foods and nutrients. It requires eating enough carbohydrates and fats-- not just protein. Recovery, true recovery, demands you include foods that seem scary, foods that you used to love, so that you aren't controlled by them. Like eating some pizza or an ice cream if the spirit moves you.  It means eating bread that may be whole wheat, or white, sourdough or french, without relying on ‘sandwich rounds’ or high fiber, low calorie flatbreads, or “Ezekiel” bread. If you’re truly recovered you can eat foods even if you can't justify them for their nutritional value, even if you don't think of them as "good for you".

4) I've stopped using laxatives, vomiting, and I'm eating better. I'm healthy now that I'm exercising every single day. So surely I'm recovered.

False. Replacing one behavior with another-- in this case, having to exercise to allow yourself to eat-- is also not healthy. Be careful that you aren't just swapping one behavior with another-- even a 'socially acceptable' behavior like exercise. If you feel you can't eat if you don't exercise you have work to do!

Ok. So I am doing fine with all that. But I need to be the one preparing the food. I'm still recovered, right?

I know. This is a scary idea. I will
settle for nourishing you
with words.

Not quite. Full recovery includes some flexibility and acceptance of what you can't control.

It means eating meals out without having to look up the calories before hand, and without having to modify the entire meal according to ED (that said, being vocal about your preferences doesn't have to be disordered. While Sally didn’t have an eating disorder in "When Harry Met Sally" this scene is worth viewing for some comic relief. Recovery is being able to eat a meal without watching the food be prepared, fearing the secret addition of ‘toxic’ ingredients.

Recovery acknowledges that people you know diet or overexercise or are losing weight, and it is what it is. (see husband triggering) And that you stay the course with eating and avoiding behaviors because it simply has to be; because you can be a great dieter-- but it didn't serve you very well being in that place before. And because you simply deserve to feel better.

Not as far along as you hoped? 

Then move your frustration to action. If you've just started on this path, hooray for improving your intake and taking steps toward recovery! Perhaps you're finding other ways to cope, so you're freeing yourself from unhealthy disordered behavior. Maybe reading this post helps you realize that more recovery pieces are in place than when you started. Progress! The point of this piece is to raise your awareness to help you keep going and reach fuller recovery. And to shake up some denial that stands in your way.

Yes, there's hope. See some of the links below.

Any changes to your thinking or eating you still need to make? Perhaps the post below will help to motivate.

Please share your thoughts!

And thanks for reading.

http://dropitandeat.blogspot.com/2011/09/beyond-calories-learning-to-embrace.html

http://dropitandeat.blogspot.com/2012/09/lessons-from-my-final-day.html

http://dropitandeat.blogspot.com/2013/05/do-you-believe-recovery-just-isnt.html

http://dropitandeat.blogspot.com/2012/03/normalizing-eating-and-hiking.html

FB and your diet, weight, fitness & happiness: A cautionary post about comparing.

Everyone is so happy. And doing so well, always having a great time. They’re all eating amazing food and managing their weight. They all look so healthy, too. And their kids are always smiling—they have the perfect families. Everyone else is so good at exercising—Map My Ride/Run and other apps prove they’re doing so much better than you running and cycling and walking. Yes, by comparison you hardly rate.

Hardly his happiest or his best mug shot.
Posted with permission.

Or so it seems.

It was quite timely that my patient whom I’ll call Beth, described her frustration having spent too many hours on Facebook. (Imagine that. Spending too much time on social media.)  She saw far too many ‘friends’’ photos displaying beach-bound bodies with a confidence she doesn’t possess. Like those ‘before and afters’ from diet ads from Diet Center and Weight Watchers (where the print too small to read confesses that these images are of rarely occurring weight loss that normal people don’t usually experience nor maintain in the real world) they showed what everyone else was capable of—except for her. These photos of Beth’s friends and acquaintance were beautiful—looking slimmer, happier and more fit than her for sure. 

Or so it seemed.

These pictures of friends struggling
 hardly get seen.

Ok. Raise your hands if you post pictures of yourself that you'd rather destroy. Right. We only post our best shots, the ones that get the ‘likes’, right? And we surely don’t see people throughout the day, at all times, when they may be looking their worst—like we see ourselves. No early morning “I-just-rolled-out-of-bed” shots posted on FB.  And did you know that some ‘friends’ even use apps which photoshop their pictures, like they do in magazines with airbrushing? Yes, it’s even possible that some pictures you’re thinking are real have been touched up. 

Comparison is a tricky business. You only see a small slice of a person’s life, of what’s really going on. The rest, no doubt, is projection. They ‘seem’ happy, or healthy, or content. But maybe it’s just how it appears. Their exercise level may be awesome, or excessive or a rare event advertised to their Facebook friends.

No, these imperfections don't make
it to FB.

Your friend who’s lost all that weight may have cancer, or may be struggling with anxiety and depression, causing her to feel anything but happy. Or fit. Or relaxed. The bikini clad acquaintance may be so preoccupied with what she believes she can and can’t eat that she hardly enjoys herself at the beach, or when she dines out, or even when at home deciding what she could possible have for lunch.

Yet another recent study showed that using social media can have a negative impact on our eating behaviors including binging, purging and using diet-pills. “Both online physical appearance comparison and online fat talk were associated with greater disordered eating” the study by Dr. Bulik and colleagues showed. Without the comparing, however, greater Facebook use was associated with decreased disordered eating behavior. So it’s all how you use it. "Comparison is the thief of joy"--I can't agree more with this quote attributed to Theodore Roosevelt.

Looking neither happy, nor energized.
I was actually quite miserable here.

Maybe it’s time to challenge your Facebook and social media friends. Are they capable of posting a picture where they don’t look so awesome? Can they post the ride or run where their speed was less than impressive?  I doubt that most can bring themselves to do so—but wouldn’t that change things?

I’d love to hear what you think. So please leave a comment! And thanks for reading.

The truth about the rumors about me.

Yes, I'm direct.

Today I heard reference to me and how I practice, shared by a patient, spoken by a therapist. "She's extreme", the therapist reportedly said, referring, no doubt to my reaction to my new patient's eating disorder behaviors and her severely restrictive intake. I bypassed the "let's just wait and see" approach after a mere couple of visits, after noting the wac-a-mole pattern to her "recovery". Stop the laxatives, increase the purging, increase the food, double the exercise. And there weren't the necessary supports at home to help implement change and ensure her safety and her progress. 

It's not the first time strong descriptives have been used about me and my management of eating disorders. I've been called  "tough" and "not easy". It's a wonder anyone would choose to come to see me. I sound so scary, no?

So let me fess up. It's all true. 

My stand against eating disorder behaviors is extreme-- extremely intolerant. Not of the patient, but of the disordered behaviors. Purging and laxative abuse and severe calorie restriction has extreme consequences. Yes, eating disorders can and will kill, regardless of BMI. And in my view, there's no other stand to take than an extreme one, a zero tolerance for allowing the eating disorder to suck away the life of you or your loved one. 

A dietitian who tells it like it is and sets limits
isn't all that bad.

That doesn't mean my recommendations are extreme, although one's eating disorder may believe otherwise. 

Being told to stop exercising, yes stop exercising, when you consume too few calories to prevent damage from exercise can feel extreme.But so is the muscle wasting that results from starvation when your body tries to produce the fuel to sustain your workout or sport. And, the consequential reduction in bone density, the osteopenia and osteoporosis and resulting fractures. And the impact on hormone production, and mood, and energy level. Yes, the impact of eating disorders is extreme. 

When indicated, I will shake things up. I'll recommend moving from rigidity around foods and nutrients, but I'll guide patients on moving forward. I'll expect patients to be medically stable and low risk before supporting exercise. And if additional support is needed, I'll direct patients to a higher level of care when necessary.

Do families and those with eating disorders really want a provider who simply says what they'd like to hear? Someone who agrees that there's no need for a higher level of care if you don't want to go? Someone who speaks words the eating disorder prefers, shares messages that keeps the anxiety low, and placates those parents in denial about the eating disorder reality--even when things aren't going well? Colluding with the eating disorder is not therapeutic support and patients and their families deserve better.  So call me tough. 

It's my hope, though, that tough isn't equated with uncompassionate or insensitive. Because if that's the rumor something has to change. As I've written before, there needs to be support and compassion, and a sense that you and your disorder are well understood to begin to trust that recovery is possible.

Yes, I'd love to hear your thoughts! Thanks for reading. See more below:

http://dropitandeat.blogspot.com/2011/02/lessons-from-tiger-mom.html
http://dropitandeat.blogspot.com/2013/12/coming-clean-my-biases-and-what-they.html
http://dropitandeat.blogspot.com/2011/01/fuller-bodied-strong-and-intense.html

All about the numbers.

If you share my frustration please share this post with those that need to see it.

Dear Insurance Company,

I wish you could see what I see. I wish you could know how much work it requires to motivate an adult living with an eating disorder to trust enough to agree to enter a program.

Everything is against their entering treatment—taking time off from work if their job will even allow it, getting coverage for their kids, telling people they know when their eating disorder is often their own secret, and enduring the shame of acknowledging that they are actually struggling with this disease—the shame of feeling that they ought to be over this by now. And the shame that comes with not fitting into society’s skewed perspective of what someone with an eating disorder looks like—because even those of normal weight and BMI can live silently with an eating disorder.

Image what it’s like to then have your patient dumped from program. Sound harsh? Well that’s how it feels, both to them and to us as their providers. A mere 2 weeks in a residential program (following years living with their disorder) and they’re required to step down, told they don’t need to stay there any longer, that it will no longer be covered.  And the patient? She is not happy at all. That very reluctant patient is finally finding her voice and stating loud and clear that she desperately needs to remain there. Her ED thoughts are so loud that the controlled environment of resi is the only thing that is resulting in the positive outcomes observed at program. So she is discharged because she has done well.

The premature move to partial day program, PHP sets her up for failure. And because her behaviors return, she is again discharged. Yes, now released because she’s not doing well enough, without a plan to move her to the more appropriate higher level of care. Can you see the absurdity?

Some numbers matter

We certainly do need to look at numbers—but not necessarily the ones that insurers like you are assessing. Weight may tell less than most other measures. Believe it or not, a weight may be completely in the normal BMI range (or even high) and an individual may be struggling with an eating disorder.  This is anything but rare, I’ll tell you. And weight may change little as eating increases significantly as metabolic rate increases in patients with anorexia. Patterns of restrictive eating followed by binging and even purging may have little impact on weight, or may support weight gain. So focusing on this number is truly misdirected.

These numbers matter

How about the EDE-Q score which assesses eating behaviors and disordered thoughts? It’s a quantitative test to measure change in recovery. Pulse, particularly lying, sitting and standing—that’s a number worth assessing. And self- reported number of skipped meals? Or frequency of purges? Or binges? Or number of hours or compulsive exercise? And of course there’s caloric intake relative to need. These are numbers that may tell you something about a patient. These numbers are worth counting.

I realize there are not unlimited funds for care. But perhaps listening to the professionals who can really assess their eating disorder patients—aside from relying on simple weight and BMI—might save you more money in the long run. You’ll collect no premiums from our patients who lose their eating disorder battle.