Challenging fear foods and food rules

Food challenges. Ugh.

This is a part of recovery I’ve only ever touched on, and I think it is one of the main reasons I have been stuck in quasi recovery, taking two steps forward, one back, one forward, two back and on and on.

It is a core part of CBT-E but I’ve yet to had a therapist really push it. Part of this is probably because I’m sneaky and I can look like I’m challenging myself but actually I’m always up against the boundary but never quite over it. I change the rules, I’ll compensate, I’ll hold back just a little or sometimes I’ll outright lie.

The nature of outpatient treatment in the UK is that across the two different services I’ve been with, the four different nurses/counsellors/therapists- none of them have actually seen me eat. They’ve made meal plan suggestions, talked me through the ‘healthy plate’ etc. but have never seen me actually eat. They’ve never even really seen my food- once I showed a counsellor my lunch and she just looked at the different pieces (I was going through a small bits of lots of things phase which involved various Tupperware pots) and labelled it disordered and told me I need to stop that (that really helpful sentence…).

While they’ve certainly stressed the need for structured eating and sufficient calories, the onus on designing the meal plans has always been mine. So a great looking ‘pasta and veg’ on the meal plan actually means a tiny amount of red lentil pasta with mostly veg , chopped tomatoes and herbs if Im feeling wild. ‘Yoghurt and grapes’ as a snack means carefully measured fat free natural yoghurt with 12 grapes. ‘Peanut butter on toast’ means a tiny spread of one brand of peanut butter on one band of bread very carefully worked around my other meals for the week. There is always a rule, always a complex calculation, always an attempt to quieten the voice that tells me I’m a failed anorexic and it doesn’t matter how little I eat I will never be thin but I must keep trying anyway as imagine how huge I’d be if I ate normally.

But this time I am committed, so with that comes a pledge to be honest with my nurse about the rules, the thoughts, the worries, the rituals, that are tied to my approach to food, and to face the horrendous anxiety and panic that this will provoke. The decision to recover is made, and this is part of it, however much I wish it wasn’t. But this might be the key to real freedom, so surely it’s worth a shot.

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CBT-T week one

I’m sitting at my desk feeling overly full after lunch, so I’m writing to distract myself from this horribly uncomfortable feeling.

I do think I am physically full, but I know I had a chocolate bar as part of lunch and I think that is adding a dollop of mental fullness too. If I’d had a ‘safe’ food after lunch, say some extra veggies, I don’t know if that would be making me feel this uncomfortable and anxious, so I’m guessing part of this is ED mind games. I’ve been spending a lots of time thinking about ED mind games these last couple of weeks. I’m two sessions into my CBT-T programme (10 weekly sessions of CBT-E) and I have had to be on continuous alert for ED trying to mess things up.

In my first session the ‘homework’ was to write and follow a structured meal plan. It didn’t matter what was in it, but it had to be three meals and 2-3 snacks per day. Had this actually been my first ever session of treatment that would have been an impossible challenge from where I started, but although I was out of structure with my most recent dip, in general I can manage this.

So I set about my first week, determined to give it a good shot. The first thing ED clung on to was that my nurse had said ‘it doesn’t matter about what you eat, it’s just about structure’. All ED heard was ‘it’s fine for you to eat the smallest amounts and restricted in range as otherwise it means you’re greedy and fat and weak’. I couldn’t shout down that argument the first few days, so while I did great with structure, I know I didn’t eat enough calories for my needs.

Originally I thought I would have to wait until the next session to tell my nurse that what she said made it too hard for me to eat more. But as I thought about it more that seemed like a cop out, and a blatant ED excuse. I know how that conversation would go – ‘I tell her that’s what I heard – she’d say that obviously wasn’t what she meant and that was ED voice trying to persuade me- I’d say I know that but it’s hard – she’s say yes it is hard but only I can challenge ED- she can help me but she can’t do it for me’. Why would I waste one of my ten sessions on that conversation when I know the answer already. Sure, it’s easier eating more when someone is telling me to do it, but that is not sustainable for long term recovery.

So I turned it around and upped my calories and ended up with 4 pretty decent days and a week of no purging. This is a big deal given I was back to regular purging in the last relapse. When I showed the meal plan to my nurse she was really proud of me, which meant that I was proud of me too. ED was hating this and shouting out the narrative of ‘you’re not actually proud you’re just relieved you could eat enough and that’s pathetic, and you’re pathetic for not being strong enough to starve’ but I’m working really hard to ignore that. It’s a tired old story and it has no place in my life now.

I’ve gone back and forth so much around recovery but the decision is made now, I am giving it a proper go, and I will make the most of this treatment opportunity. I am trying to become a person without an ED, so I cannot listen to something that I don’t want to exist.

One week done, I’ll remain cautiously optimistic and keep moving forwards.

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.

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-E (typically 20 sessions). I have had variations of CBT-E 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 free (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.

My disorder may not be ‘culturally popular’, but it still exists

One of my recurring negative voices is “you never did anorexia probably, you were never thin enough, you were never sick enough, bulimia is an eating disorder to be embarrassed about, you couldn’t even do anorexia properly, no one cares about a bulimic etc etc etc.

I’ve never quite got rid of this voice, and while I can recognise it as not having a useful place in my life, it’s always like a low hum in the background.

Every now and again something happens to crank up the volume on it and today it was this:

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This headline came up on my news feed (yes I need to clear my browsing history so the internet stops highlighting this stuff). It is is the relation to the the new BBC3 show ‘Overshadowed’ which while very good, and important, is the latest addition to a recent wave of anorexia shows/films.

I read it and thought to myself, you know what, actually we need to be talking about other eating disorders. We need to be talking about bulimia. We need to be talking about binge eating disorder. We need to be talking about the atypical presentations of anorexia and bulimia, we need to be talking about unspecified eating disorders.

We need to be talking about the disorders that are not a priority for treatment funding or research funding. We need to be talking about the eating disorders that the very people who suffer with them don’t even want to talk about. We need to normalise these illnesses to take away the insufferable immense deep dark shame that they can result in. I will talk about my periods of anorexia, but I won’t talk about how I would drive out of town to a supermarket to not be caught buying binge food. I will tell you about how cold I was when restricting, but we won’t discuss details of how to throw up into a plastic bag in your wardrobe without it leaking. I sought help when my weight reached a magical threshold that might make people pay attention, but no one would comment on my over-exercise if my thighs and belly are wobbling when I run. I cannot verbalise ‘I have an eating disorder’ at the moment because I am far too afraid that the response from a person who is educated by media such as above will be ‘but you’re not thin’.

Then, just to wind me up even more, I saw this:

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Yes- it’s that hoodie. The slogan is wholly inappropriate, no one will disagree about that. Yet I’ve been more disappointed by the articles that have been written about it. I know I know these are quickly written response to capture a passing barely-news story but the fact that anorexia is the default go-to just reinforces that negative voice. Most of the stories are about how this hoody trivialises anorexia, how it’s disrespectful to people with anorexia, how anorexia is far more than self-control, about how we need to educate people about anorexia more. Throughout this, there are barely any referencing to bulimia. The hoody is far more insulting to the illness of bulimia but no one seems to want to talk about that – but is that again due to the shame that the illness can carry – that we’re far less likely to raise our hands and say ‘bulimia sucks too (and I have it)’.

Okay, rant over, I just needed to get the crazy out of my head. I know this is something I have to work on, and I’m aware the above rant is definitely not a well-researched critical appraisal of modern media- it is just my thoughts going ‘arrrrgggghhhh’.

Good night all x

 

 

Two goals: boyfriend and porridge

I had a therapist appointment today and it was a rough one but I came away with two clear goals that is all I need to focus on for this week. One- telling the boyfriend and two- eating porridge for breakfast.

I’ll start with the second goal first as it’s probably the most manageable. Breakfast was always my safe meal of the day. For the past 7 years probably I’ve had porridge made with water and some kind of seeds or berries as my breakfast. I have varied this on occasion e.g. at weekends, when out etc. so I’m not stuck to it, it’s just more that it works for me and it’s nice to start the day with a meal that makes me feel okay and is nutritious. Then last week I ate porridge for dinner and ever since then I have a new rule that I can’t eat porridge for breakfast anymore. Such a random ED rule, but it’s meant that breakfast has been a nightmare for the past week. I agreed with my counsellor that I need to nip this in the bud as I can’t let ED have so much power over me, so for the next week I am to eat porridge for breakfast. It’s a bit frustrating that I have a goal for something that I could do fine a few weeks ago, but I guess recovery is two steps forward, one step back.

The other goal is far far scarier. We had a good chat about telling the boyfriend. I talked through all the points you guys had raised (can’t express how much I appreciated your comments) and she reiterated that she doesn’t think I will manage recovery on my own, and that she thinks I am frightened of me telling him as it will mean reducing opportunities for behaviours. I think she’s right about the second point, and probably about the first point although it makes me sad to admit that.  I asked her about what I should say, and what I should be expecting. She said that best case scenario he would offer me emotional support, which freaked me out a little. Practical support I could deal with, but any other kind of support makes me wince. Clearly a bigger issue there. She agreed the small steps approach would be best- so my challenge for this week is to tell my boyfriend that my eating issues have flared up again and that I have started to see a new counsellor to help with them, and that I may need his support in the future. She asked me to tell him about the purging but that felt like too much.

So I have a week to eat porridge and admit to the love of my life that I’m still quite messed up in the head. Fun times ahead! I’ll keep you posted.

 

Telling the boyfriend

My new counsellor has brought something quite important up that I have been mulling over for the last few weeks. Having spent the last 5 hours binging and purging I’m coming to the realisation that if I ever am to really recover I need to take action on it.

She thinks I need to tell my boyfriend about my purging. She thinks I need to remove the secrecy in order to remove some of ED’s power. And I guess to reduce my opportunities to purge at home.

The boyfriend knows about my ED in theory. We first got together when I was in an anorexic phase and he was very tolerant of my behaviours and food avoidance. When I started regaining weight I did talk to him about having to fight binge/purging, but we never really spoke about it and haven’t ever since. I guess he still knows I’m somewhat funny about food, but we’re now living together and I have no idea if he knows about how regular the purging is.

I feel sick having to talk to him about it. I could just about handle telling him about restriction but binging and purging is a whole other issue. I’ve no idea how I’d even bring it up. I know he would just be worried about me and would never say if he was grossed out by it, but I basically have been keeping a giant disgusting lie from him for well over a year now – how do we deal with that?

If any of you have experience of telling boyfriends, husbands, girlfriends, wives or parents siblings roommates etc. – anyone you lived with – I could really do with some advice about how to broach the issue, and how to survive once it is out there?

I love my boyfriend, I really really do. And while I hate ED, to date that has been my longest most passionate relationship.  How am I going to introduce them to each other?