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.

Precipitating events, factors feeding eating disorder behaviors 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.