Failing at treatment

So it turns out commitment isn’t enough in the end. I tried my best. I really did, I promise I’m not lying to myself or the world out there when I say that. I ate all the scary things and broke all my rules. I’ve done it day in and day out for the last 7 weeks. I’ve gained a little weight and didn’t freak out about it. I caught myself body checking nearly every time and talked myself out of it. I’ve kept my food diaries and attended my appointments.

But, and this is what it comes down to, I purged three weeks ago once, then again once last week, now this week twice. My therapist was flexible the first two weeks it happened because she could see how hard I was trying but if it happened this week then game over, treatment is done. Its officially not effective for me so there’s no point in me still attending. I will be discharged and that’s it. That’s the way the treatment approach works, that what makes it effective apparently. I’ve had my chances, and I have been very fortunate with all the help I have been offered, I know how lucky I am. But the reality is that the treatment available hasn’t worked for me and I have to accept that now.

I can sound rational about it but inside I’m petrified. When I first sought help my greatest fear was that I would reach out and it wouldn’t make a difference, and in some ways that fear is coming true. But in other ways that’s not actually what’s happened. My life is so much better for the treatment I have received: I am so much more open about my difficulties. My dark little world has lots of wonderful chinks of light in when I look for them. My weight is relatively stable and for the possibly the first time since I was 9 I am not trying to lose weight. I can skip a run when I don’t feel like going. I can keep most foods in my house without binging on them (still not 100% there but so much better), I can eat in restaurants or in others’ houses without purging. I can drink an iced coffee and trust the world won’t end! had an ice cream in the sun last week and didn’t cry! Miracles are happening!

I could lie tomorrow at my session and say nothing happened, that I didn’t use behaviours. Believe me I am tempted to do that, but really what would I gain from that? And I respect my therapist too much to abuse the service in that way. The reality is that the best evidence based treatment there is out there has not worked, and so continuing is just wasting resources that could be spent on someone who does respond to it. I have made so much progress, but I am still purging on a regular basis and maybe now I need to take stock of where I am, make sure I don’t slip backwards, but also accept that maybe this will be a part of my life forever. I can keep fighting to maintain the progress I’ve made, but I think I’m too tired and too beaten to keep trying and failing with getting rid of behaviours completely.

Maybe this will change in the future. Maybe I’ll be ready to try again on my own. I’m not discounting the possibility of full recovery for me, but I can accept that the conditions of the treatment available is to stop purging and I haven’t been able to do that. So I will be honest tomorrow, and I will accept the consequences of failing at treatment for now. But if stop for a moment, close my eyes and take a breath I can find peace with this. I can be okay. I will be okay.

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Commitment

I am committed this time. I can see that what I have tried hasn;t worked and I need to let it go. I’m never going to be the the anorexic I so desperately wanted to be. And that’s okay, well it will have to be okay, because I am so many other things. I have a full life and I do not need my ED in it any longer. I have to make room in my life for ED now, and that is coming from my career, my friendships, my relationships. I am choosing my failing dream of being thin over the potential for a family, my PhD, social experiences, and that is a decision I will surely regret later, so I have to make a different choice.

I dread the inevitable weight gain but I know I can’t fight science and also I feel now that body could do with a chance at being properly healthy (not food restriction ‘healthy’). My mind could also – I am so fed up of feeling so crazy around food. I have been a valuable opportunity at a relatively good time and I need to make the most of this. I need to show I’m grateful by giving it my best shot. I’m nervous as the reality of addressing some food rules which have governed my life for years is likely to be pretty tough, but I’m tough. This is my chance to be free, so yes I am committed this time.

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.