Committing to a final offer of help

I saw my counsellor yesterday and I had to admit what has been going on in terms of my behaviours. It wasn’t exactly fun. We discussed, as we always do, that not eating sufficiently, regularly and with freedom will always bring me back to binge/purging and that there is no way out of this without accepting that I need to expand my eating and I need to tolerate the weight gain. I still get frustrated with these conversations as if I could tolerate the weight gain I wouldn’t be in this mess, but I just can’t seem to manage it. But she’s right in that there is no other magic solution, so I either get disharged or commit to what she is offering.

What is available to me now is a 10 session structured CBT programme as part of research project. It’s based on research showing early success with a ten session version of CBT-ED (typically 20 sessions). I have had variations of CBT-ED now and when engaged and active with it, I did respond quite well. However, it was always my slightly adapted version in that I while I managed the structured eating of 3 meals and 2/3 snacks (that 3rd one at night is always tricky!), I never committed to extending my diet, and therefore was continuing to restrict. Had I been particularly underweight this might have been addressed, but as I was always teetering around normal no-one ever seemed to challenge it, and therefore ED kept his nasty claws in enough to keep me trapped. My current counsellor is on to this though and has clearly stated that I can choose 3 dislike foods but everything else has to be considered (only 3 – you can imagine my panic levels right now…). The research is solid, or at least as good as it gets in ED outcomes with a 42% abstinence rate from binge/purge behaviours at 3 month follow up and significant improvement in self-reported psychopathology.

I really want to be part of that 42%. I’m sceptical, but that’s perhaps to be expected given my history. But equally maybe my knowledge and skills gained over that history might help. Really, the only thing standing in the way between me and a life free of ED is me.

We had a good (sniffly sobby) discussion and I signed up. I should start in a month or so. I do 4 weeks and if I can’t make the dietary changes and abstain from purging then I am discharged at that point. Tough love, but it makes sense. No point continuing with other aspects if eating commitment doesn’t happen. I’m scared that this is my final offer, and that if it doesn’t work I shall be on my own to figure it out. But at the same time I’m aware that I have been very privileged to have had all this help so far. If I can get to 10 weeks behaviour (including restriction) that will be the longest period in quite a while, which might just give me the boost to keep it going. I’m mostly petrified and stressed about it, still debating whether I do actually want recovery (as only perhaps other people with EDs will understand) but there is a glimmer of determination that hasn’t been around for a while so hopefully that will grow. We’ll see.

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The right question about the wrong behaviour

I’ve just finished writing a progress report for my PhD which had to be submitted today. I’ve known this was due for a month but it has only just got done. In my defence my workload is ridiculous at the moment, but those of here in this little corner of the internet also know that I’ve been wasting plenty of time hiding in my chair and engaging in behaviours. So now it’s sent I’m asking myself why do I do this to myself? but then a little voice of reason pipes up and says maybe I should be asking that about bulimia and not just my study habits. I should be challenging why I spent two hour earlier eating and vomiting  and not just my procrastination tendency.

Why do I do it to myself? My eating disorder. Why do it do it? That’s the topic I should be addressing. Not tonight though, I’m exhausted, but as I summit these work deadlines I need to stop avoiding the real issue and start properly tackling it again.

Rituals

Something I’ve noticed as part of this most recent slide is some new compulsive rituals. OCD has been something I’ve had since a very young age but wasn’t diagnosed until I started with ED services. Some of it has obviously been very related to my ED e.g. food rituals but the intrusive thoughts have been separate to these and I have some compulsions that are not food related. It’s never really been addressed in therapy as I think the assumption is that is will resolve when ED does. I’m not so certain about this but it doesn’t overly bother me as most of the rituals that had a bigger functional impact have been managed – and I am so relieved about that as they were so annoying (understatement but the best word I can think of to describe how they were for me). The few ‘low-level’ rituals I have left I can cope with so haven’t thought about them too much, however over the last few weeks/ months I’ve noticed an increase in behaviours which are stressing me out. They’re harmless – finger movements and opening and closing things ‘properly’ but they’re starting to impact on things like leaving the house on time, sleeping and..well…looking like a weirdo in public.

I’m fairly certain it’s just another symptom of being in a bad place so I’m hoping as I come out of that they will decrease, and I know I should stop acting on them, but at the same time there’s other things I should prioritise not acting on so I’m not overly worried about addressing them, but yet I know how these things can slide. I’m also due to give a presentation at the end of the week and I’m already getting ‘rules’ about what I have to do, but not sure how I can do them subtly. I’ve also got a doctor appt and every time I think of it I get a rule about closing the door four times – and it’s a new doctor – how am I meant to have a rational conversation if I start my appointment with that?! But equally, how do I squish that thought when the consequence of not doing it is (according to my twisted brain and its intrusive thoughts) much worse? Argh. I’m hoping writing about these things will help me see them for what they are – just thoughts. I’m not quite at the point of writing down the intrusive thoughts but maybe writing about the rituals will help? Who knows! Worth a try!

Sustainability and my eating disorder

In my non-ED world I am really trying to make an effort with considering the sustainability of the planet. I have successfully avoided single use coffee cups for nearly a year now, I generally avoid single use plastic bottles (the occasional bottle of diet coke sneaks in..,), I shop at a fruit and veg store to avoid plastic at supermarkets, I refill cleaning products at a zero waste shop and for my sins I have even experimented with menstrual cups (although they’re not quite yet my friend).

When it comes to my ED though I am at odds with these values. A binge is so wasteful, both for the obvious reason of ingesting food just to throw up, but also because of all the packaging, I am definitely not making decisions about what to buy based on reduced packaging, and once the binge is over I have to face the waste around me which just adds to the guilt.

This is relevant for when I’m in restriction mode also: I end up wanting to buy pre packaged ‘safe foods’ and single serve portions as I am afraid of larger sizes. I buy food and then don’t use it so it gets wasted (although I do try to freeze but it’s not always possible).

My ED conflicts with so many of my values; sustainability is just one of them. Unfortunately this just adds to my guilt and shame, which then increases need for ED behaviour to deal with negative feelings (‘cos yeah, haven’t mastered how to do this otherwise) and on goes this dreadful cycle. But there is a way out, I’ve figured it out before, and I just need to channel my concern about waste to make better choices. First step is admitting it – so here it is!

Attempting day one

I can’t quite believe I’m back to the point of needing to focus on one day without purging but somehow here I am. I’m overly full and could easily vomit right now if I went near the bathroom, but I know it is psychological: dinner was a sensible size and I’m only feeling this way as have been purging so much recently. I can ride it out if I try, I just need to distract myself and focus on getting one day down. I’d been managing weeks purge free until this recent slam, it’s so frustrating to find myself back struggling with even a day, but it is what it is and the only way to make it easier is to get to day one and slowly add up from there. I know I have this in me I just need to prioritise it and ride this awful wave.

For those of you also trying to keep head above water these days – you’re not alone in this.

This armchair

I’ve developed an unhealthy relationship with my armchair. I am doing a great show of coping with life outside of this chair – I go to work, I pretend to do life, but then I come home, plonk myself down in this chair and let my eating disorder and depression swamp me.

I’m struggling with having to fake being okay when I’m really not. The only place I feel safe is in this armchair, hidden under a blanket with the curtains closed. But around me are empty wrappers from a shameful binge, there are dishes that need doing, sheets that need changing, study that needs doing, friends that need seeing. And all the while I am stuck to this chair feeling worse and worse about myself.

Bulimia has overpowered me. I’m in a horrible place with it. My stress is teetering on unmanageable and I’m not sure how I’m going to face tomorrow. But I will, because I always do, but it doesn’t mean it’s easy and sometimes I just need to have someone hear that.

A sad confession

I had a review meeting with my counsellor today. I haven’t seen her for three months as I had gotten stuck and needed a break. I needed to stop pushing forward for a little while- I wasn’t dealing well with the weight gain, I was absolutely fed up of monitoring my intake and I was just generally stuck. So I had a break, and used the time to lose just enough to get me back into a safe zone. A classic ED move that I keep falling for over and over again. Add in a excessively large dollop of stress (two and a half jobs and final year phd will do that to you) and my mood plummeted and the binging and purging has started again.

It was excruciatingly embarrassing having to admit that I was binging again to her. It is the bit of my ED that I hate the most. It sets off the old repeated record that I am weak, fat and can’t do restriction properly. Most days the only thing I really want is to just get really skinny one time, one time enough for people to notice and worry and take action, and after that I could move on. What a sad sad goal. I just get stuck on the fact that when I first got ill I lost a lot of weight, but because I started at a higher weight, it wasn’t really picked up. So, if I hadn’t been fat, I would have been thin enough, so being fat when I was younger was the problem and has stayed the problem every since. Even when I’m drastically restricting I don’t lose weight in the way others might. I should be thankful to my body for this, but I just feel it let me down. All I really want is to be properly anorexic and it seems to be the only thing I can’t achieve. I recognise this is an awful thought, and I recognise how awful it is for people with anorexia, but I get so much of the sh*t of an ED without the only bit I really wanted, being thin. I’m going to submit my PhD this year and I know that while most people think it’s an achievement but most days it means nothing to me, and I would happily trade it for weight loss.

So that’s my sad confession for the night. Yes, I feel completely ashamed by it, but it is the truth, and I honestly don’t know what it will take for me to move on from feeling like a failed anorexic.