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

From eating disorder recovery & advocacy, to losing weight, to bread baking?

Got 30 minutes? Check out this podcast I was interviewed on yesterday on Heritage Radio's Feast Yr Ears. http://heritageradionetwork.org/podcast/lori-lieberman/



Topics discussed include:

• Why I love working with people with eating disorders--the most challenging of all my patients
• More nutrition pet peeves, what simple step pediatricians can take to catch an eating disorder
• What to say and not say to someone who has lost weight
• The me and Cate story of Food to Eat and Drop the Diet aka why I adore Cate Sangster
• My major food obsession. You mean you don't already know?

If you like it, please share it.

And thanks for your recent comments which I promise to respond to!

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

Spouses, partners, parents of loved ones with eating disorders--I need you to keep reading. Really.

You may have no idea how they're suffering. Your wife, or mother, or partner or son. It's about shame. And fear. That's why they can't tell you. That's why it's so hard for her to ask for help. I'm not placing blame, but I'm asking you to start to listen like you never have before. Because it's hard for those living with anorexia, bulimia and binge eating disorder to say what needs to be said.

Don't be fooled by his size or his weight. People with eating disorders come in all sizes. And don't be fooled by how well she had been doing. Slips happen. That's normal. But recovery requires acknowledgement that things are amiss, and that support is available. Right there. In person. Not just virtually through this blog, or a virtual support group or a friend across the world.

Yes, they need to know that you are there for them, unconditionally. Even if you really don't understand. Even though you wish they'd just 'get over it'. Struggling with an eating disorder is something they simply did not choose.

She may not discuss it with you, seeming as if all is well. And he may deny that he's restricting or over exercising. Besides. It's so much easier to see what we'd like to see.

So if you suspect that there's something not quite right, please start a discussion. And use open ended questions, ones that can't be dead-ended with a simple yes or no response.

You just might have your blinders on to
what's really going on--right before your eyes.

Do you know how trapped she's feeling?
Like there's no way out of her misery?

Sometimes we're a bit too close to the situation to
see the whole picture.

Does this nutritionist count calories, track exercise on a Fit Bit, or limit her gluten, sugar or carb intake? You just might be surprised.

Time for lunch? Thinking about dinner?  I've gathered a bunch more pics to share from my recent meals. But first I need to respond to a couple of comments and questions you've voiced in person and on the last post.

Lean steak which I have infrequently with grilled farm-fresh
potatoes and watermelon.

Do you think about balancing your day's eating depending on what you ate earlier in the day?

Not at all.  I don't think "I shouldn't have bread again since I had some at breakfast" any more than I think "Oh, I had three fruits already so I'd better have something else for snack." I go with what I feel like, when I'm hungry. 

So you don't give any thought to your food choices?

Homemade pizza topped with artichoke and peaches.

That's not the case either. There's a balance between nutrition information and pleasure/preference that informs my decisions about what to eat. I might have lox at a meal but I wouldn't include olives, let's say, as the sodium would be quite high. And since I have high blood pressure I try to be moderate about my intake. Besides, I think it would be disgusting together. I might have pasta--white, low fiber pasta, but I don't eat a pound of it. I'll add veggies and perhaps a protein source such as chicken or tofu for some balance; the protein and fiber impact fullness which helps make the pasta meal more satisfying.  

Similarly, I'll routinely have a large salad with my pizza or I'm apt to eat a lot more pizza than I need, before recognizing that I've had enough. I happen to love fruit and vegetables so I eat them generously. But my favorite food just might be bread which I eat no less than twice a day. My latest favorite is homemade sourdough.

Do you calculate your calories? And if not, how do you know how much to eat?

I never calculate my calories. Okay. Not true. I did it once after a 2 day bike ride at my husband's request, as he was curious about how our constant eating (and cycling) measured up with our calculated need. In fact, it was strikingly right on--but calculated after the fact; I did not count my calories to limit my intake or determine my portions. When you allow your self to acknowledge hunger and not mask it with water or coffee or deny it until you 'deserve it', and respond to it with food for fuel, the system starts to work just fine.

This is a special meal I prepared from Gramercy Tavern cookbook
featuring halibut, zucchini in various forms and corn salsa.

But you also need to be eating regularly to prevent excessive hunger and impulsive eating. And it helps most of us to control the environment--removing food as a visual trigger to eat. Store food behind cabinet doors, in the fridge or freezer instead. And beware of the impact of other triggers such as alcohol, stress, and mood. Feeling a sense of hopelessness about your eating doesn't help either.

A veggie heavy pasta meal.

Do you think some people are born unable to do this and others aren't? Because I think I'm different, and this simply won't work for me.

No. I felt the same way many years ago when I struggled with a cycle of restrictive eating followed by binge eating. It feels like there's no way out. I don't buy into the addiction model for foods (http://dropitandeat.blogspot.com/2012/09/what-ive-learned-about-food-addiction.html) but I do see that behaviors can be addictive. So focusing on eating behaviors (which I address a great deal on this blog) is key. Search this blog for mindfulness, hunger and fullness to start.

Sure, you can do this because you must exercise a lot. 

Pasta with an indian flare-with some cashews and coconut.

Sometimes I exercise a lot, like when I'm training for my annual fund-raising bike ride. But I usually work out about 3-4 days/week (once is just a walk with you-know-who*), with an additional day of Pilates. In cycling season the rides may be long, but aside from then,  I don't spend more than an hour working out. 

And I don't intentionally adjust my food choices or portions on non-work-out days. I know my body burns calories at rest, even when I'm sitting at my desk for 8 hour days, 4 days a week. 

Hope this helps. Still thinking this is unhealthy? Let's discuss.
And by the way, all the meals above right were dinners, and those below were my lunches. Missing are the frequent PB and P (preserves of all kinds) sandwiches I bring for lunch but neglected to photograph.

A grilled cheese, arugula and tomato. Yes, on sourdough.

That's cheese hidden under the figs, and lox. Admittedly a weird 
mix, but I had little time to make a lunch when I was
running late.

Add caption

Bread and houmous, with yogurt and granola.

Lemony Lentil Stew with goat cheese, served on 2 corn
tortillas. From Drop the Diet www.food-2-eat.com

Yum!

*yes, you know who.

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.