Healthcare professionals are not infallible and have their own biases
Apologies in advance for probably a relatively ranty post.
I am not considered overweight, I have been at the complete opposite end of the spectrum and have been often rewarded by health care professionals for being “healthy” when I was slowly killing myself.
When I was considered emaciated this positive reinforcement shifted, I met a lot of stigma from healthcare professionals.
Today I have just experienced horrific weight bias whilst at a medical appointment. A nurse who had my medical record on screen, open in front of us displaying my history: Anorexia nervosa.
Whilst I sat there she began to discuss how next week brings the onslaught of patients booking in for weight maintenance, counselling after “over indulging in the holidays”. She was clearly ignoring this history. She continued with her opinions and judgements regarding patients eating “bad foods” and expecting to lose weight.
My response was somewhat blunt, probably rude. I wish I was brave enough to point out my history but instead I shared my very anti-diet views. Explaining I do not believe in the multi million dollar industry that promotes dieting. I explained if there was a diet that genuinely worked the industry would not be in business. If people successfully reach their goals and stayed there there would be no diet industry. But I explained that simply doesn’t happen and leads to obesity. She went on to demonise foods. To me.
She started talking about a group of people who exercise every day “and aren’t overweight” and do not lose weight. She stated it’s because they aren’t dieting with it. “You can’t do one and not the other” if you cut out rubbish you will easily lose weight she went on to express. She told me how cutting out “unhealthy food, sugar” it’s easy to lose weight.
At this point I was like, are you fucking serious. You’re sat telling a patient in recovery from anorexia about losing weight and demonising foods and promoting the idea that weight gain is to be feared by anyone.
Again, I wish I had felt stronger to call her out. But there’s still a part of me that can’t quite do this in an non anonymous setting. I will get there.
It got me thinking and really feeling for patients. If someone with a history of anorexia, not that long in recovery and not overweight can be subjected to this. Then people who are considered “over weight” according to a BULLSHIT MEDICAL INDEX scale, aka BMI then this is horrendous. We are terrible in the health industry and really under educated in this area. This is one of the reasons I started this blog. To educate and reduce biases in health, society and reduce stigma.
Stigma does occur in very low weight too. When I was very unwell, doctors told me I was irresponsible, like it was a choice. I was marched across busy waiting rooms and made to step on the scales in front of audiences and then condemned publically if I’d lost weight or not gained. I remember one occasion being made to walk up and down a corridor (waiting area) by a GP to make sure my heart wasn’t failing, and saying aloud if you don’t put on weight by the next review you will be forced to be admitted. This is fucking awful when I think about it now.
Scales can be terrifying to someone with an eating disorder ( or no eating disorder)
If you are a healthcare professional: keep your own biases and fear of weight gain to yourself.
If you are knowingly looking after someone with an eating disorder it is highly inappropriate to make them step on scales with an audience, if you must weigh someone keep it neutral without judgment. Scales are one of the scariest things you can ever imagine for someone with an eating disorder, underweight or overweight. In my opinion scales in a hospital or doctors should not be in a public area.
If you have ever experienced stigma, judgement by a healthcare professional I am truly sorry. One day I hope we can shift the narrative. If you feel brave enough and you find yourself in a similar situation to that of mine today, please speak up. I promise I will try to myself next time.
Eating disorders pretend to be your friend. They are anything but a friend. The lies an eating disorder tells, or criticism it shouts at you 24/7 are far from what a friend would say. It is a contrast to how you would talk to or treat a friend. In fact you’d probably wind up in prison if you treated a friend how the eating disorder treats yourself.
But yet, they are seductive and mendacious.
Eating disorders are sly and cunning, and often start out with subtle changes “to be more healthy” etc.
But at some point, a switch gets turned. Your healthy voice dissapears and the Hitchhiker that is the eating disorder takes front seat, planting lie after lie in your brain.
Initially your healthy voice challenges this Hitchhiker. But to no avail, and soon this healthy voice gets lost and almost forgotten about after constantly losing the inner battle.
You may not even recognize this is happening until you start recovery, to bring back this healthy voice in an epic battle of the voices. The healthy voice, although silenced is still there.
Instead you have spent so long believing the lies and deceptions of this hitchhiker.
But, your eating disorder will always lie to you. Some lies my eating disorder told me:
1. If I control my intake to the finest detail I will be healthy and clean
2. “You are fat”
Even though at heart I knew this was a lie and didn’t care about size the constant bombardment eventually made me believe it and not see through the distortions. It’s like a smoky mirror. It’s a deception and becomes increasingly distorted . When I used to challenge this lie, I was met with you need to lose more. The “HH was never satisfied. It never will be satisfied not matter how much you lose”. The Eating disorder wants to kill you, that’s it’s end game.
3. “I am not sick enough” to need help/ I do not deserve help.
The eating disorder will never allow you to see how grave things are. Additionally there is no such thing as “sick enough” if thoughts are consumed by rules, obsessions and you are not mentally free you are sick enough. If you do not believe you are sick enough, this is a symptom- you are sick enough and being lied to by your ED. Any disordered behavior or thought is harming your mental health and physical health. “HH” had me believe that because I had gotten through college, Med school and was working I didn’t have a problem, but my life would have been so much easier if I had more brain capacity and stopped believing the deceptions.
4. “Food has to be earned”
Food is a basic human need. No one ever has to earn or compensate for food. But my “HH” told me I could only eat under very strict, rigid circumstances. When I ate I had very explicit rules about compensating. All because I was being LIED to. This still bleeds into my recovery now. I have rid myself of behaviours but periodically the lies creep back about what I should do to “deserve” or make up for. For me this shows up at unknown situations (holidays, Christmas, or trying new things) I have to work hard to challenge this. Otherwise you will never be free of the rules (lies)
5. “Recovery will make you fat
Recovery will make us many things, free and alive being the most pertinent. But the lie that my eating disorder tells me- “your therapist and family will make you fat”.
Now, realistically who gives a shit if this is actually the case? The eating disorder. Fat is a disordered, unkind word. So let’s challenge ourselves. It’s fat phobia and it is wrong. We should be promoting the Health at every size concept.
Aside from this our bodies have a set weight it likes to sit around- we can’t choose it. It is what it is. Some of us may temporarily “overshoot” this set point because it’s necessary to recover. But the body will work shit out when we stop listening to the lies.
6. “Recovery means losing control.”
I believe many people with eating disorders will identify with this fib. And let me affirm it’s a massive lie. It’s a way the eating disorder is trying to hold onto you. Having an eating disorder means you have lost control, it gives you a false sense of control. People don’t lose control when they start to recover. Our eating disorder makes us think that controlling our body shape and intake is a form of control but it’s far from control it’s controlling us. I feel far more in control now than when I was meticulously trying to control everything, because you can’t control everything. My anxiety has never been higher than when my days were led by rules constant lies and trying to see through the fog.
If I had of been in control there’s no way I would have missed out on social engagements for fear of eating or life events to sneak in that extra workout to make up for having to sit an extra 30 seconds in a meeting? No, don’t be fooled the eating disorder has control until we take it back.
7. “Eating in front of people makes me weak”
This is the eating disorder thriving on secrecy and shame. Eating is a normal behaviour and often social building connection. Connection’s something the ED fears.
8. I am a failure if I give in to hunger, break a rule
I doubt in 10 years from now I will give a flying f*ck about the biscuit I just ate, but I will remember the years I missed out on them and the part of my life I gave up for it. Hunger is normal, ignoring it does not make us super human or strong. It made me fucking miserable.
9. “Bad things will happen if I break my rules/ rituals”
I have co-existing OCD. So my eating patterns followed strict rules and breaking these or not carrying out rituals provoked immense anxiety. If I messed my routine up or someone interfered I would go into full blown turmoil. I had specific utensils, cleaning rituals etc. On one occasion my mother in law came to visit, unknowingly used my “special spoon” and I had an absolute shit fit like a crazy person because she had used it. No one could use it except me and I couldn’t eat without it!!
The more lies I heard the more rules I developed. Now in recovery, having broken the rules, nothing bad happened, no one died and I don’t blow up over someone using a spoon! I don’t have to clean the kitchen from top to bottom before every single mouthful.
10. “You look better the thinner you are”
The truth is we are not defined by our appearance or number on the scales. You will never be thin enough for you eating disorder until you’re dead. It would have you to shrink until you don’t exist.
11. Food is either “good or bad”
I had list after list of condemned food. My “good” food list became almost non existent where all good became terrifying. No food is good or bad. It’s just food.
12 “Emotions and feelings should not be felt or shared”
This was a huge one for me and I believed showing emotion or vulnerability was a flaw rather than an attribute. I defined myself by this. Without realizing, for so long I had turned to this destructive force to numb out any difficult emotion as a maladaptive coping mechanism. The eating disorder convinced me this was strong and desirable rather than an avoidance mechanism. But by acting on the lies and behaviors eventually you fall into a trap of further despair living life bound by rules and fear. Everything is numbed. It’s an existence not a life.
13. “All exercise is good for you”
This for the majority of the population is not an unfair statement taken at face value. But when you are lied to by your eating disorder and made to believe that you must exercise to compensate, debt, whether injured, tired, unwell or to punish yourself maybe not so true. I’ve shared previously compulsive exercise is one of the biggest things I am having to over come. I didn’t think this was a problem or real. But compulsive exercise is very common in Eating disorders and very real.
There are so many other little lies my eating disorder proclaimed, but I feel these are the biggest and worth sharing. I imagine some of the lies your eating disorder tells you will be similar and there will likely be others. The important thing is knowing they are lies and can be challenged to reclaim your truth.
For some people their work relies upon social media. It has so many roles and uses in today’s society.
Social media can be helpful to us in our recovery, but it can be a minefield. I actually removed myself from most social media accounts early in my recovery. I don’t believe there is a right or wrong solution to this, but I believe an awareness of the impact social media has on you personally and whether it is helpful or detrimental in your recovery is the most important question. Your motives for following particular accounts, whether they serve you, or your eating disorder.
If you look for it, there are tons of recovery orientated social media platforms. But, it’s not always easy early on to identify motives of some and whether they are 100% pro-recovery.
Some platforms, target our vulnerability. Ads, pop ups etc all follow your history and if you are trying to move away from certain paridigms it can be really hard being constantly reminded about the latest fad-diet or exercise programmes etc! You get my point. Equally you can’t control what people post/ talk about. Your friends, family and colleagues may post things that are particularly sensitive for you. So sometimes taking some time away from this can help at least until you are in a stronger place.
Social media can be anxiety provoking, for those in lockdowns, isolation the conflicting and unhelpful messages can impact upon mental health. It’s not surprising around the world the new diagnoses or relapses of eating disorders that have occurred during the pandemic. Social media I believe plays a large part in this. Adding to pressure around health, diet and exercise. As well as the change to routine and access to normal resources. Knowing that not everything on social media is real, or as it appears on there I think can help.
I am glad I didn’t grow up in the ‘Tik-Tok’ era, and facebook/ instagram was only really around when I was late teens. I feel for teens and young people now with the pressures of social media. This really worries me for future of their health.
It’s the time of year where the diet and fitness industry try their hardest to sell their products. So social media is swamped with diet culture and all the shit that goes with it. I am now in a place where I can mostly see this for what it is, selling a product. This industry generally targets a vulnerable population too, people like myself. However I am aware of it, and I’m aware of the impact it can have on me. I will not be deleting my social media accounts this year. Last year I needed to, to escape this onslaught. Instead I am using my social media to promote the ‘fuck it diet attitude’, following positive influences that are pro-recovery. If an ad pops up, I will simply reject it. Friends, family and colleagues dieting that’s up to them, I can choose to ignore this. But if you are in a place where this is going to be damaging to your recovery, a social media holiday can help. I found it quite liberating and realised how reliant upon social media we are. Returning to social media has been a big test in my recovery.
I love Christmas. I used to start getting excited for Christmas in September. The air smells different, the trees change and nights get shorter and staying in on a cold winter’s night with a festive movie is magical.
I still love Christmas. But Christmas can be a challenging time for many people especially people with eating disorders or recovering from eating disorders. It can invade every waking second, robbing the joy and replacing it with fear and dread. Let me be clear it is NOT just about food. Eating disorders are not just about food. They are so much more complex than this. People with eating disorders feel so much pressure, and that they cannot share this because it’s not festive or worry about disrupting the joy.
It’s a time of year where celebrations continue for most of the month (covid aside). Even in isolation the social media, the promotions during this time and messages about new beginnings in the new year etc.
Eating socially becomes more prominent. But at the same time people start discussing New Years resolutions, which inevitably involves shitty diet talk. This is so hard for people in the midst of their eating disorder or working hard to recover. Where it’s normally easy to excuse yourself from the bull shit diet speak, or judgement around food it’s harder. Often it can include spending time with people you haven’t seen for a long time (probably not so much this year) but that can be daunting and the fear of comments even when well meaning can be hard! If you are in that situation, try and be kind to yourself and see it as a positive. And the comments such as “you look well” probably are genuine and mean you look well and that you just simply no longer look like you’re dying, it’s not saying you look fat or whatever else your stupid ED tells you.
You are bombarded with conflicting messages, unhelpful quips, comments that even for those of us who are solid in recovery can be really fucking hard. The classic I will have to run this off, I’m going to be so fat, is that all you’re eating, you’re eating so much are all likely. Be ready for them and choose to stay on track. How you respond to the comment is up to you.
I have noticed myself this last couple of weeks, I’ve had to work really hard to check myself as thoughts have slowly crept in about ‘how much I should be eating, moving, what’s not “allowed”’ all bullshit and all because of the time of the year and the inevitable society pressures.
In a way it’s helpful, because although frustrating as it is to be experiencing the thoughts and anxiety return, It highlights there’s still work to be done. Clearly I still have a lot of re-wiring to do. I still clearly have an irrational fear of weight gain, which I thought I was passed. But that’s what it is, an irrational fear. It’s a phobia and it’s ingrained through the years and years of inappropriate reinforcement. It’s not surprising that events ignite these brittle pathways. I have not engaged in behaviours for close to 5 months, but it shows how easily old pathways can be re-ignited by old habits, reminders. Which is why it is so vital to continue to recognize triggers and continue the work.
For me, this means, not allowing myself to compensate for the Christmas period/ holiday (event restricting). Not entering into diet behaviour or allowing myself to be drawn into other people’s diet talk, fears and plans. Not engage in ridiculous exercise regimens because society expects it. I love you Joe Wicks BUT please stop the constant before and after pictures!
Not allowing myself to demonize food because other people are. NO FOOD is bad.
You do not have to compensate for food or inactivity ever. People’s biases around food and exercise, new years resolutions are their business and serve no place in recovery no matter how uncomfortable you feel. Be kind to yourself, ask for support and keep talking. If it helps, set boundaries before the event and if it’s too much to be in control yourself ask a support person with decisions etc.
There are tons of resources online that serve as toolkits/ survival guides for holiday.
The purpose of this blog however is not so much to share tips for how I have managed Christmas or will manage Christmas. Although I appreciated podcasts, vlogs, resources myself to help me. Rather this purpose of the blog is for people in the midst of their eating disorder, or recovering and just a simple understanding. That’s what I have found the most useful. So if you are in this situation, I see you I understand.
If you are a friend or a family member of someone with an ED, my thoughts are it’s tough on you too. Please, think about how you talk about diets, your own fear of weight gain in front of the person. Be their advocate as they may not be able to speak up so divert unhelpful conversations where you can. Maybe ditch the unhelpful comments about calories.
Ask the person (if you are in a position where you talk about the eating disorder) what the eating disorder is telling them. What they are thinking. But be warned you might not like or understand the answer. But if someone does feel comfortable to share this with you, show them support without judging them. No one expects you to get it, we don’t get it most of the time ourselves but feeling supported is huge.
My husband and I were hiking yesterday. We had hours of trail ahead and in between goofing around, talking about our plans for the week ahead we talked about the last year, 18months. So much has happened in this time, like for many people. We talked about people missed. Career paths, life plans and we made jokes about previous events. One event, now an often feature of his jovial mockery and light hearted goading is one of our darkest moments. Often making a situation that was once very unfunny can flip it on its head, make it more bearable. You see that a lot in the healthcare setting, jokes that someone from a non healthcare background would shudder at, is often daily practice. Why? because it makes pain and darkness more bearable and shareable.
This situation we were joking about was one of my biggest meltdowns, i’ve ever had. We were in New York exactly a year ago. I wasn’t really in recovery at this point, although I was fooling myself I was. We had been taking in sights all day, darting all over the place. I had done, what I did a lot at this time. Bargained with myself. I was “allowed” to eat whatever I wanted in the evening because I had been so active during the day. Fucked up beyond all reasoning, but this is how the eating disorder often works. Often that bargaining never actually leads to “eating whatever you want’ but we were looking for a restaurant that would suit us both. I didn’t have much input in restaurants at this point, so it was usually down to my husband to select somewhere. He talks about how incredibly stressful this was. I have no doubt, it must have felt like he was checking for poison for some medieval royalty. I would quash most selections before they had left his lips. However this particular day, it was 1 week from Christmas, we hadn’t booked. So the stress for him was ridiculous. Before he found a place, we spent an hour with us scanning menus, me rejecting. It got to the point where we retraced our steps and chose one at random that would allow us without a reservation. What came next, I don’t really remember. But he does very clearly.
It was a steak & lobster restaurant. There were no other options. There were chips and meat. That was it. After looking at the menu for all of 30 seconds, I burst into full blown tears, sobbing in a packed restaurant. I cannot describe what was going through my mind at this point. Except it was like the world had just ended. I had built the meal up, I was going to eat. Then I was presented with two things I hate, red meat and shellfish. I was petrified of chips at this point. A menu had reduced a 30 something to full blown tears. Inconsolable, snotty ugly tears. We stayed. ‘HH’ screamed that my opportunity had been ruined bla bla. I struggled through the dinner eating chips. Both of us shocked at how irrational I was. I had had moments like this at home but this was in the middle of New York. It’s obvious now, this was plain and simple fear.
But whilst cringing at this event, we chatted about the narrative now.
Eating disorders are not rational.
My world didn’t end. I didn’t die. I just looked totally mental. Now after lots and lots of little moments, challenges, meltdowns I can laugh at how absurd this moment was.
The point of this, recovery doesn’t happen over night. Recovery isn’t a case of going to bed one night and waking up recovered. It’s full of obstacles and challenges. If it’s not challenging it’s probably not recovery and doing jack shit.
Today, he asked me if I wanted an Ice cream. I heard myself say ‘no thanks’. This is a response ‘HH’ has trained to become my default. I am changing this narrative to ‘Yes, please’. Some days yes please is easier than others. But it felt uncomfortable, spontaneously having an ice cream. ‘HH’ certainly did not approve. This is another moment, challenge towards recovery. It was a world apart to the lobster joint. I felt uncomfortable, I got on with it and used to distraction techniques I’ve learnt along the way after. ( Today was repotting some of my veggies, other times breathing techniques can help) But if I’d said no thanks, it would have been a missed opportunity. Without challenges, nothing changes. In recovery discomfort is action. I don’t think I would sob in a restaurant now, unless the world genuinely was ending. I don’t bargain with ‘HH’ any more. There is no bargaining with an eating disorder, that’s an argument you won’t win unless you decide to do the complete opposite of what it’s telling you.
Yesterday, I had a strange realisation. It’s taken me almost 30 years to get to it, but yesterday I realised food is not just fuel. Food has no rules, no moral value and no foods can be ‘good’ or ‘bad’.
Whilst reflecting about my relationship with food, I craved a chocolate Hobnob. I heard ‘HH’ stipulate, ‘but you’re not hungry’. It was this thought, I rewound and re-framed my life-time’s thinking. Food, although important for fuel and nutrition is also part of connection and ENJOYMENT. It’s always blown my mind that people have just been able to easily eat something, just because. But yesterday, I understood food can be eaten whenever. Whether we are hungry or not. If we want to eat something we can, without judgement, without compensating, because it’s just food.
I was feeling particularly reflective yesterday, because I felt really fucking sad. The fact the I felt sad, set off a whole chain of thoughts. But what made me grateful amongst it all, the fact I could acknowledge and identify that emotion. For years I have numbed my emotions, to the extent when I started to feel again, it took me a while to recognise what I felt. That’s pretty common I think amongst us who have eating disorders. I no longer associate with the nickname I have had for years and use to value, ‘the ice queen’. This is not me now. Nor do I want it to be. The fact it became at one with my identity is quite disturbing to me now, as I am a compassionate person. But in the depths of ‘HH’s grips I was an emotional void. I’d get angry, anxious & irritable if my routine was disturbed, or challenged but these were pretty much the extent of my emotions. Instead of returning to my old behaviours yesterday, exercising to the point of exhaustion, pain or restricting to the point of false euphoria, to numb out the events. Instead I went for a walk out in nature listening to a podcast and then had a cup of tea with a Hobnob.
I felt grateful. Grateful I have reached a point of mental freedom to enable me to feel. Being numb is not living. I was grateful I could feel sadness and sit with it. Feelings pass and are not permanent. But eating disorders are. Recovery although hard, is also temporary.
The next thing I’m working hard to reach, is body neutrality. There is so much talk about ‘body positivity’ at present. I believe the premise of this is great, but I also feel it’s a double edged sword. It’s general concept to love and accept your body, sure. Promoting acceptance by society of shape, size, gender or race is the main aim. But, I feel there’s pressure with ‘body positivity’ as a concept. It over values of the body image itself, rather than appreciation of the body’s functions. For me, I don’t know if I’ll ever ‘love my body’ but I love the things my body enables me to do. I think very few people eating disorder or no eating disorder love their bodies. So for me, getting to a point where I do not care, or have any value from my appearance will be sufficient, beyond that a bonus. But I feel it’s healthier to see our bodies as a vessel, a vessel that allows us to do what we desire. It does not matter what that vessel looks like. That’s what I believe the social media message should be, that’s what body positivity should be.
Interestingly my ‘negative body image’ didn’t truly start until I was in the depths of my eating disorder. Sure there were things I had insecurities with, but I think most people on this planet do have hang ups. But I can say, the negative body image spiralled and it took so much value. This value is incongruent with my own true values, i’m not a shallow person, I couldn’t give a rat’s arse what someone looks like if they are a good human being. But the world becomes so small, consuming and out of alignment with our own beliefs. I really struggle with this aspect of my eating disorder, because on a bad ‘body image’ day it still has far too much space. Space that’s not relevant or part of me. However this is part of the divorce from diet culture and unlearning so many untruths that are so engrained in society. Most days now fortunately I am neutral towards my body, but i’m not where I want to be yet. I’m not where I want the whole of society to be, where body image is as relevant as yesterday’s weather. But rejecting diet culture and accepting ourselves is a start towards remodelling society’s beliefs . Ultimately change starts with yourself.
I say normal, loosely. Because the majority of the population has some form of low grade restriction going on. Whether they realize it or not, any diet behavior is restriction. This is not normal eating. But it is ‘societies normal’ This is not an option for us.
When we restrict, our body adapts, by lowering metabolism and a whole heap of other changes like disrupting hunger cues. (This is partly why diets don’t work, restriction leads to a response known as ‘hyperphagia’ (increased hunger) to counteract this unnatural behaviour. Our bodies function in equilibrium and so will adapt or correct the perceived famine. For anyone who is interested like me, in evidence or scientific explanations, the ‘Minnesota Starvation experiment, led by Ancel Keys’ is the closest we will ever get to depicting what happens to humans when starved, both physiologically and psychologically. It would never pass an ethics committee today but the evidence still stands. This was a practice changing study from the forties that still helps to shape nutritional rehabilitation. It provides explanation for experiences such as hyperphagia.
In early recovery most of us experience “extreme hunger”, hyperphagia. For me this wasn’t so much physical hunger, for the most part, but it translated more as mental hunger or feeling off. Regardless it’s still hunger, if we are obsessing about food it’s because our bodies are needing fuel. I was constantly thinking about food, when I was next going to eat, what I could eat, worrying about whether it was ok/ not enough, even dreaming about food, obsessing about food, reading recipes the list goes on. It felt relentless and really intrusive. It was hard to think about anything else. During this period, I would also find it hard to leave food on my plate, even if I felt full, I guess it was my brain freaking out, fearing that I was going to return to a state of famine again. I’d feel almost a compulsion to finish everything. I never felt satisfied early on, I would be painfully full but still thinking about food. This has gotten better with time. I don’t feel the need to finish everything in front of me. This obsession with food was different to that in the depths of my eating disorder, where I would obsess over food then. When under the grip of ‘HH’ I would control everything around it, I’d cook for others, but never eat what I’d made. I’d bake a lot at this point, now I bake if it’s someone’s birthday, I’m just not interested or obsessed like I was. This is common I think, now we have a rule in my house if I make it, I eat it. Some days, if I haven’t eaten quite enough, I find my extreme hunger can return the next day, but this is getting less and less.
This is terrifying when it first happens. If it is happening to you, or someone you know, extreme hunger is normal, it’s a healthy response to energy deficit and reintroducing nutrition. It showed up for me months later in recovery, after I got back on track from a relapse. I didn’t experience it prior. Bingeing is normal in this setting. It’s distressing, it feels it’s going against everything the eating disorder believes. But the only way I found it improved was to listen and respond to it. Restriction remains the enemy for this.
Some-thing I still find difficult, is what’s normal. I also think, there probably isn’t actually a normal, because what’s normal for one person is not for another. However serving sizes is a tricky one, I can under-eat some times because I have done so for so long and my perception of what a ‘normal portion’ is warped.
I have found asking for help with this, although humiliating as an adult and at time unbearably uncomfortable, I often run my lunches past my husband and if he tells me it’s not enough, I don’t argue, I add more. I am trying to re-learn normal eating.
Another thing that helped me, although at the time I hated it and argued until I was blue in the face was relinquishing control around food. By this I mean, I was lucky my partner took complete control of what I ate, when I could not make healthy decisions geared towards recovery without ‘HH’ sabotaging. I was not allowed to cook, prepare meals, or enter the kitchen when meals were being prepared. It was one of the most humiliating experiences of my life and there were times when I would argue, shout, cry, throw, he would force me to eat what was in front of me. I was like a child. But worse, I was an adult having a meltdown. But this role was necessary for a short time, because if left alone, I would skip ingredients, make smaller meals, substitute ingredients ‘for healthier’ alternatives etc.
But it was important for me to regain independence quickly (for me and my partner) and the only way I could was to suck it up.
I cannot express the grattitude I have for my partner, I think people who support a person through eating disorder recovery are saints, they see the worst side of a person imaginable, because a caged animal will always lash out. I have apologised more times than I wish I’d ever have to in a life time. I think this is where it’s useful to seperate the person from their eating disorder. We are not our eating disorders, and the non-negotiations are with the eating disorder, not the person being over shadowed by it. This does not give a free pass to be a dick, it’s just to help understand why you have to keep fighting for recovery. Thankfully this wasn’t needed for long.
For a short while, I followed the principles from Gwyneth Olwyns, homeodynamic recovery. I like evidence and this is evidence based. I will link this below. I do not count calories and find doing so to be detrimental, however this principle sets minimums and it helped me for a short period when trying to become independent again.
One thing I’ve accepted is, comparing what we need to eat in recovery to someone who has not just waged war on there body is never going to be helpful. We need more than most people to heal. Healing doesn’t end at ‘weight restoration’, we still have a nutritional rehabilitation, inner repair, mental healing beyond this. Who knows how long this will take. This, Is hard for someone with a restrictive eating disorder, but I believe it’s true and giving yourself permission to eat whatever, whenever and often ‘more’ than people around you is an important step. Letting go of the judgment. I’ve only recently gotten to this point, I used to find it really really hard to eat in front of, or with others. That’s isolating and something a lot of us have to overcome. So ignoring comments about food is important, hard but totally achievable.
I found it hard to eat anything today. I still ate. But “HH” had a lot to say every time I took a bite today, before, during and after. Today is not a typical day. It used to be. It used to be every day.
Saying f*ck you to restriction like..
Precipitating events, factors feeding eating disorderbehaviors or thoughts: AKA triggers..
I had a trying day at work, where I was being compared and judged by a superior. It fired up the perfectionist side of me that I’ve been trying really hard to quieten. My brain instantly returned to thoughts regarding: ‘I need to start coming in at 6:00am every day, I have to be the best, I have to be the ideal that I picture’. The comparison wasn’t even harsh it just didn’t meet the preconceived standard I’d set (HH had set). I ignored all the positive feedback and honed in on the 1 comment.
I quickly realised this seeped into how I thought about food, movement and myself the rest of the day, how I have always used restriction to control. Eating disorders give a false sense of control in unpredictable times. Probably a big contributor to the surge in new ED diagnosis and referrals during covid.
For me, restricting, exercising, etc has been a short term comfort. I emphasise the short term. Because short lived reward does not equate to long term, sustained happiness. And it’s not real comfort, but I suppose it’s predictable and has known outcomes in other times of uncertainty. I.e X behaviour leads to Y result, always the same, no matter how shit. And some instant endorphins are just that, short lived and then perpetuate the more longer term negative aspects. Sure you can feel good for a moment but at what trade off?
Immediately following this work meeting, when it came to lunch, the thoughts of doubt crept in; ‘you don’t need lunch, you could just have….’
STOP IT.
Our thoughts are just thoughts. We are not our thoughts. I have been asked before what I mean when I say my ‘HH’ voice. It’s not a voice really. It’s my inner voice, my critical voice. Everyone has this, it’s the voice that spouts the unkind thoughts you have from time to time. But with an eating disorder voice it becomes the only voice and constant. The voice is actually more like thoughts or feelings rather than an actual voice. But it’s very distinguishable from my own healthy intuitive voice. Some other examples of my ‘HH’ thoughts, ‘you’re not doing good enough, you’re lazy, you don’t need to eat that, you shouldn’t eat that, you should eat the healthy version, you need to be fitter’ etc. None of them are compassionate. And I can spot them a mile off now.
I think that’s why it’s hard after a session with a therapist early in recovery to follow through on some things. Because as much as I knew what I had to do, wanted to recover, once I left that room it was just ‘HH’ noise whirling round. Initially the voice was too strong and I wasn’t equipped to separate the thoughts from me. But therapy builds and helps the momentum to start making changes and helps identify fear. Until you learn to go against the thoughts, it remains in control. That’s where I think recovery coaches or close support have a massive role. Because they can be there to encourage you in tough moments, moments of crippling fear, to follow through until you become accountable and equipped. I didn’t have a coach and there were definitely times early in recovery where i’d leave my therapist’s room knowing what had to be done, but in the moment especially a few days after the session ‘HH’ was too strong for me to go against alone. This I believe is one reason recovery is not linear. It took me a while until I could separate my thoughts from ‘HH’ and the power balance to start shifting. Recovery is meeting fear face on.
Today could have been easy to return to behaviours, to relapse. But the skills I’ve learnt along the way, I won’t. I chose to not act on the thoughts. I don’t have to be perfect. Frankly I’m happier trying not to be perfect. Learning triggers is part of recovery, preventing relapses. For me being in control and ‘perfectionism’ is a big one. Medicine is full of unpredictable situations and competition, and so it’s down to me to trigger proof myself. I’m not going to beat myself up about the return of ‘HH’ thoughts today, instead I am choosing to recognise I need to continue to learn to develop other areas in my life I can control. Setting boundaries is certainly one and it’s helping.
I expect many people who have developed eating disorders during covid, or have found themselves relapsing, it will be through returning to something that gives a sense of “control”, something familiar, known and ‘safe’. Another trigger (for me anyway) is boredom (filling the space with something), or needing better ways to connect etc, regardless eating disorders are never the answer. I get why people relapse for these reasons. But if that is you, be kind to yourself. Learn from each slip and reach out for help. Recovery is perfectly imperfect.
I believe there are many milestones in eating disorder recovery. For starters the first day of entering recovery, this is always going to be the biggest. Monumental. Then after that there are thousands of milestones (some more like marathon check-points). Like the first time we conquer a fear food, and then reach the check point of there not being fear foods. So many. Getting your first period (if you lost it/never had), then its recurrence becoming so normal and boring and moaning about it like the general population. But what about when ‘our formal support’ becomes less required?
For those of us fortunate enough to have quidance, follow a treatment plan or having a coach etc, maybe it helps path the way. But, regardless for the most part, your recovery belongs to you. Own it!
I graduated from “regular recovery support” today. Feel like I have my big girl pants (pun very much intended). I have completed CBT-E, MANTRA and have now reached a point with my therapist (OT) to move to “check-ins” rather than scheduled, regular sessions or following some kind of plan.
I know for some people navigating the world beyond regular support, is scary and daunting. I get it, it means YOU are accountable for the ongoing recovery process. But that’s pretty cool right? You have gotten far enough into recovery to be able to make healthy decisions for your recovery. You’re moving towards full recovery and this is another check-point smashed!! That’s the way I’m viewing it. Part of recovery is learning to “cope” in an informal way, that’s life.
Just because my ‘regular’ sessions are finished does not mean I can’t continue growing my support network or learning. One of the things I’ve recently found to be instrumental to my mental shift is connecting with others who have had similar struggles, are struggling or recovered. There is tons of support, whether it’s real connection, following people’s blogs, podcasts or joining a support group, they all help to validate how we feel and strengthen our healthy self. So I’m not nervous about not having regular appointments. I’m proud I’ve gotten here. I’m grateful. If I can get here, I believe anyone can, because I never believed it at the start.
However, I am anxious regarding the next challenge in my life. Something I think for anyone who hasn’t had an eating disorder finds challenging anyway. That’s getting pregnant, becoming a parent. This is another area I think in medicine that doesn’t get spoken about or shared much. What happens when someone in recovery gets pregnant? Is it wise? Should O&G teams be aware? Do they ask or look for history of eating disorders?
I wanted to wait until I was solid into my recovery and even still I worry. I worry if the child will be small, pre-term, miscarry. Will I stay on track?
For my partner and me, having a family has been something we have always wanted. For reasons not related to my eating disorder, fertility is a difficult issue which I won’t go in to.
We are about to embark on IVF. This is something I haven’t entered into lightly, I’m all too aware of what’s required in the IVF process, the follicle stimulation, multiple hormones. This I’m sure is hard in a normal setting, but for those of us with significant body image issues to begin with, these issues need to be factored into planning. Hopefully help prepare the person for the changes and enable them to remain accountable. Support, hopefully can help to prevent slips.
Next issue, if we are fortunate enough to get pregnant… avoiding energy deficit. Some people experience nausea (both during fertility treatment and then in pregnancy). Hyperemesis gravidarum (aka morning sickness) this is not a good situation for someone with a restrictive eating disorder. Breast feeding post-partum.
Our bodies change throughout pregnancy. This is a fact. Something I am trying hard to prepare for. I feel going through the weight-restoration phase of recovery helps this, perhaps. My body has changed beyond any prior recognition and that’s ok, and I don’t even have a baby to care for and love. Or to explain my pregnant looking belly, aka recovery belly. I like to think that having a child will mean that none of the ‘HH’ thoughts will matter, because that child will be the most important, most amazing achievement I will ever have. But I wanted to share this because people with eating disorders go through pregnancy. It never gets spoken about and I don’t know whether we look for it in medicine. I think people could have help and support. I expect there are many people with eating disorders too afraid to share their struggle with the medical team, for fear of judgement, lack of understanding. What will I do?
Not really sure what the point of this post is, other than I’m happy to be here. I hope if you’re reading this and perhaps your treatment has just ended and you’re freaking out, or you’re starting recovery alone or with help, you can just know that there’s support available. Support doesn’t have to be formal or structured and remember celebrate the milestones. Navigating this is like an ultra-marathon but with no clear finish line.
Quash stigma not fat: ED recovery blog 