“Recovery Burnout”

Maintaining momentum in recovery is exhausting.

Some days feel like you are cruising along. But I want to talk about the days where you feel exhausted by recovery itself, when motivation wavers.

I feel it’s important because without acknowledging, this “burnout” has the potential to hinder one’s recovery, through frustration, boredom or just sheer mental fatigue.

Burnout has been defined as a state of complete mental and physical exhaustion resulting from prolonged stress, where a person’s ability to meet demands is impaired. Often, through feeling overwhelmed and/or emotionally drained. Not surprising the pandemic has resulted in high levels of this and likely far more to come.

This definition is also applicable to recovery don’t you think?

When I was all consumed by my eating disorder, if I’m honest, I found every day exhausting. Living by the constraints of so many rules and behaviours made every waking minute punishing , not to mention the insomnia. Oh my god the insomnia that results from a starving brain, it’s like a waking nightmare, you’re haunted by the food “you won’t allow yourself” and all the while your brain is trying to scream at you to eat. Your brain wants you to live and in doing so constantly reminds you about food, 24/7 it doesn’t sleep and so you don’t sleep.

Life with an ED was sapping, but I didn’t appreciate this at the time, partly because I was permanently living in a high state of stress all the damn time, my body didn’t allow me to feel it. It’s the fight or flight mode, the product of an overactive sympathetic nervous system. But I was tired.

When you enter recovery your body has the chance to pause and take a breath when you finally stop. It begins to heal. Healing hurts, when you injure yourself, it’s the inflammation and body’s response to healing that’s sore.

I’m not going to sugar coat it, this moment of stopping, everything might hurt. All the injuries, the pain your body has concealed from you, just so you can “keep going” hits all at once. It’s a wall like I have never faced before and barely have words for. This fatigue and pain gets better as you feed yourself, rest & heal.

Early recovery is exhausting. There’s so much healing and adjusting to do, but the anticipation of better days ahead kind of pushes you through. You and most people around you expect tiredness in the early days, it makes sense from what your body has been through.

It’s what I’m going to discuss next that I think has been a difficult concept for me to grasp or allow myself not to become overwhelmed by.

Recovery is boring. Really fucking boring at times. Realising you will likely need to deal with recovery each day to varying degrees. Recovery still has to fit in your world. It has to so that you don’t fall into a pithole.

For example as we get further along in recovery, so many things change, mostly positive let me just get that out there now.

However…as your world starts to get bigger and your eating disorder brain is taking up far less of your mental space, you start to see who you are and what life without your ED can be. You start to have goals and dreams that are “normal” people dreams, not unrealistic eating disorder standards. You don’t want your ED to even factor in, but for a while to protect your future it has to.

You know in order to realise these aspirations you still have to have recovery goals, because how can we dream of a life without an ED if we don’t put the work in to recover?

It’s more like an irritation on these days where you are mostly free, without the constant barrage of intrusive thoughts, you have room to deal with life, “normal” thoughts & goals. Here, I try to reframe my thoughts to be grateful for these days because the alternative of not being bored, sucked.

There are days like today, when I have lots of things I am focussing on, career progress, my job in hand, family, where we will be living in a few months etc that it irks me that I have to spend any extra energy thinking about recovery. Today this meant a bit of extra attention to meal structure because I’ve lost my appetite. I can’t afford to fall into that trap and I have to focus on fueling myself properly on top of the other things. Frustrating as it is, that recovery still has to fit into that world and those future plans, it’s helpful to reframe this thought process, I am happy to inhabit a big world that my recovery has made possible.

Other times where I think recovery can become arduous is when we ruminate on the past. I often experience regret for lost time to my eating disorder. I no longer feel ashamed about it for the most part, but I do feel sad. I find this regret prevents the resentment to recovery orientated thinking/ behaviours when I’m feeling “over it” because I don’t want it to be my future as well.

This can be emotionally draining. I think it’s important to return to your self care toolkit on these days. I think becoming tired of dealing with recovery is real but I would choose to be here, rather than be a slave to it any-day. Recognising how you feel and that you can’t make massive progress EVERYDAY is ok, Burnout is ok. Be kind to yourself. Acknowledge that this is a good sign.

If you’re feeling the recovery burnout I hear you. One day you won’t have to use as much energy to protect your health legacy. So be grateful for the boredom and keep going

Lunch box policing

First of all, I am not a parent. However, I have nieces, nephews, friends with children all of whom I adore. I write this because they deserve a better future. One that we have a big say in.

We live in a society that is afraid of fat. We are surrounded by diet talk but worse so are your children. It’s important we teach our children in a non judgmental manner how to feed themselves, to grow up healthy, to learn where their food comes from.

Lunch box policing occurs for many reasons and is a cause of debate. There is nothing more emotive than a child’s health. Healthcare and the education sectors historically have been the main access to health information, often driving health campaigns. However we know that sometimes the campaigns are not a “one size fits all” pun intended. The messages are often outdated.

Lunch box policing originated with the intention of helping children, but it has actually the potential to cause harm. It assumes that all parents have equal access to all foods, it instills rules around eating which can lead to disordered eating. There is a strong undertone of focusing on weight rather than health. This is stigmatising and not accurate, body size is not holistic in terms of overall health. Whilst it is important to educate children it is important to do this in a nurturing manner. This could be outside of the “lunch box”, teaching them where food comes from in the classroom.

The following is a letter I have written for anyone who wishes to use or not, in the event of “lunch box policing”

An open letter to schools, clubs and whom ever

Dear teachers, peers, coaches

Thank you for taking such great care of our children. We appreciate all of the lessons and compassion you provide.

Whilst we need to teach our children the importance of eating nutritious foods we also need to teach them that food has no moral value, there are no “good and bad foods”. For example a packet of crisps is exactly that, a packet of crisps.

Please be cautious in the language you use around food and body size, the child you are talking to may have a sibling or parent with an eating disorder. A comment such as “that is bad for you or fattening” can be particularly dangerous, children with relatives with an eating disorder are at risk of developing one themselves. We have a broad body of evidence thats supports the fact that eating disorders are genetically driven with environmental and biological triggers. This comment may be the match that ignites the fire. So please consider your language.

Additionally there may be medical reasons for a parent’s choice of their lunch box provisions, or socioeconomic factors influencing access to particular foods. When it comes to lunchboxes, and if you have concerns please talk to the parents as the first step, without shaming them or the child. Parents generally know best for their child, and you may not know what goes on in the background to influence their choices.

Diets have negative health consequences. Studies have substantiated evidence that dieting in childhood can impact upon development. Health is not determined solely by weight, bone density or periods, they are all important components and can be impaired by dieting. Fat is an important part of a person’s diet and function. It is not something to be taught to fear.

Some of you may not be familiar with the concept of “lunch box policing” or aware that you are doing it. It can be subtle. The following are examples of lunch box policing; excluding certain food items or groups, advising a child they have to eat “healthy foods” before other items, this only helps to further reinforce the “good & bad” food notion. More subtle examples may be commenting on the volume of food, comparing peers’ lunches or appearances.

You can help our children develop healthy relationships with food and their bodies. Please refrain from commenting on the content of our children’s lunch box, please consider the language you use when talking about food and bodies and if you think you do need to say something, please contact the parents first and do this in an appropriate setting.

Thank you for reading this, by continuing the conversation we can help path our children’s future in health and developing healthy relationships with food and body.

Feel free to share or use this as a template if it may be of use!

Arrested State of Development

Last week I was setting my intentions for the New moon. Whilst beginning to manifest and set in place the foundations of those intentions, I had a realisation.

When we are experiencing an eating disorder we are living in a state of “arrested development”. Loosely this is defined as a cessation of growth, this can be both psychological and physical. Initially ALL of our focus and energy is used in sustaining our eating disorder, then it becomes recovery orientated, both requiring substantial energy and attention.

I’m in the process of some major life changes and upheavals over the coming months with a ton of uncertainty. I’d been ruminating over the fact I wasn’t where I wanted to be, in terms of the standards I’d set myself for my career, my life. I was feeling resentful to the time lost to my eating disorder and to some extent recovery.

It dawned on me, for the last two years I have been fighting for my recovery, fighting to have a life not dominated by and eating disorder and before that I was expending all of my energy on the disorder itself, leaving room for very little else. I was feeling frustrated that I was now “no longer considered the best doctor of my cohort”. This is an egocentric attitude I need to work on anyways, but I have always been a perfectionist and through uni I had never settled for second place. Now, academically I am viewed as “capable”, but not excelling. There is nothing wrong with this, it’s how my brain processes this that is the problem. Now, I’m the doctor who has the good rapport but hasn’t necessarily recalled every hazard ratio from every journal ever written, but this was me, a long time ago. Before my life priorities had to change.

I realised some of the standards I’d set myself had become external expectations and now I don’t match those either. Again, this is not a problem, it’s how you react to this. The thing is I have been trying to be “that standard”, but I’m not, I can’t be right now. I essentially took two years out. If I was a professional athlete I couldn’t expect to compete at the same level after two years out, it’s the same here. The difference is, the people with those expectations don’t necessarily know I have been trying to survive and recover again, this was because I kept my eating disorder hidden through fear of stigma and so why would they? It was only recently I felt able to be open about my journey.

It’s only now that I was beginning to feel “bored of having to be recovery orientated” and have so much more mental capacity I could see unmasked I had been living this state of arrest. It’s releasing, I’m ok with who I am. I’m proud of what I have overcome and where I am. Letting go of unrealistic standards and expectations is what’s helping me in my health legacy and provide my patients with care. I think it would be unhealthy and unrealistic to want to be the same person we were before recovery.

How can we develop and grow when our worlds are so minute and focused on such specific details such as weight or that grade. I didn’t have the energy or time to be reading the journals I now am, when I was merely trying to survive.

I worry about my colleagues, the pandemic will fuel burnout, but unless the healers have a place to heal themselves this won’t go away. I wish for the unforgiving environment that is the healthcare profession to become a more open and compassionate one. One that does not depict personal struggle as failure. I shared my struggle not so long ago, because this unrealistic image of what a doctor should be is harming those that look after you, the more we normalise the narrative the healthier the healers.

I do think recovery burnout is a thing, it’s emotionally, physically draining, it becomes tedious but for the days where recovery is not boring it’s important to keep recovery orientated.

Hypothalamic amenorrhea #1

This post is not intended as medical advice and I am not an expert. I write this with lived experience, the intention of raising awareness and promoting self advocacy.

Have you lost your period?

Losing your period is never something that should be taken lightly, it can be a serious indicator that your body is functioning suboptimally.

What is Hypothalamic Amenorrhea?

The absence of a period for 3 or more months related to an problem with the hypothalamus. The hypothalamus is situated in the brain it connects our endocrine system to our central nervous system. It has many roles- it basically acts as a regulator for many of our bodies systems. It is the main regulator of the pituitary gland which is the where central regulating hormones are released. Some of those hormones include reproductive hormones, needed for menstruation.

Hypothalamic amenorrhea- When the control centre of the brain that regulates hormone secretion– is turned off.

Why does this happen?

There are several factors that can lead to disruption to the hypothalamic signalling. This post is focusing on the reproductive aspects- hypothalamic amenorrhea. My intention is to give a brief outline to help you understand 1.why it happens, 2. Why doctors don’t necessarily consider it when they see someone in front of them.

Factors that lead to HA:

Energy deficit, this is the biggest factor and can occur due to a plethora of reasons. One of those is dieting. Whether this is through intermittent fasting- where the regular signals are not being maintained, caloric deficit, or excluding specific food groups such as cutting carbs/ fats, they all disrupt the signalling from the hypothalamus.

◦ If your hypothalamus perceives energy deficit it shuts down non vital functions of the body. It keeps you alive, it’s like a book balancer. What you don’t “need” it cuts. Menstruation is a function of reproductive health. Therefore, it is not a vital component to staying alive. Therefore it shuts off this non vital function, in order to preserve other functions including keeping your heart beating. This is another reason why we tend to feel COLD ALL the time when we are in energy deficit or have HA- the generator shuts off the heater to conserve other functions.

Weight loss regardless of your size. You can have HA at any BMI. Firstly, If you lose weight it’s likely related to energy deficit, however when you lose weight you lose important regulating hormones (leptin) which are in fat cells and this is part of the feedback system to the hypothalamus.

Stress. Something that puts stress on your body can disrupt periods. This may be through emotional or physical stress. Cortisol turns off the hypothalamus. Therefore it can cause you to lose your period.

◦ For similar reasons to above- exercise especially high intensity exercise can raise your cortisol by placing stress on your body. Additionally it can lead to energy deficit and weight loss and so it’s continues the issue. This is part of “female athlete triad”

Unfortunately HA is a common issue, however it’s not always recognized. Partly because it’s not understood and there are many misconceptions around HA. For instance people inhabiting in larger bodies are often rewarded for their weight loss efforts and exercising, but we know that HA can occur at any size. But often we are not as open with healthcare professionals about our lifestyle and they often don’t enquire.

When women lose their periods they are sometimes then commenced on the contraceptive pill to “restart” their cycle, or in some instances diagnosed with Polycystic ovarian syndrome (PCOS).

Unfortunately this is a problem because the management of PCOS- is often the complete opposite of HA. The contraceptive pill does not address the underlying issue, energy deficit. A bleed induced by the oral contraceptive pill is not a real period. If you took the pill away likely the person would not bleed.

I lost my period for a long time, thankfully I have healed from HA personally.

When in the depths of my eating disorder I did not advocate for myself or share my situation with healthcare professionals. I was advised at times to take hormones, I was not advised to stop/ reduce my exercise or eat more for instance. Getting a diagnosis is challenging because one, we don’t share and two it’s not always on the healthcare professionals radar.

However sharing knowledge with health professionals can help raise awareness.

I am no expert, I write this purely from personal experience and getting to know people within the recovery community.

I encourage anyone who has lost their period to seek medical advice, there are many reasons for this not just HA. But if you are someone who could be at risk of this you may need to advocate for yourself here.

I’ll write a separate post about some of the myths and issues associated to HA.

Journaling #1 ED recovery

Journaling can be a game changer in eating disorder recovery. It has been for me.

Your journal can become one of your most powerful allies, it can become a well honed tool from your ever growing recovery toolkit. It’s versatile and you can scribble anything you like anywhere. There’s no right or wrong way to journalling. Journals can be sculpted to wherever you are at in your recovery. Journals can be used for outpouring your thoughts or completing specific activities.

If you’ve not tried the whole journaling shizzle out yet, I highly recommend you give it a go.

Why?

Journalling gives us a safe space to churn our thoughts on to the page in all their ugliness or beauty depending how you view it. Thoughts you wouldn’t otherwise exorcise.

The journal itself can be used as a recovery tool, through various journalling exercises and practices you can solidify some of the groundwork from therapy sessions etc.

Sometimes the journal can be as simple as your listening ear when your struggling with an urge. Often the time it takes to write out the thoughts and feelings around a behaviour or an urge is long enough for the urge to pass and you’ve got written evidence of what led to the feeling or thought to help you next time it occurs. Win. Win.

We often take progress we’ve made for granted, but re-reading journals can really help you see each tiny step you’ve made even when you feel like you’re stationary.

I’ve never been a “big sharer” of my thoughts or feelings (until I was well into recovery and now I write a very un-private blog with all my craziness laid bear). However journalling helped me to share some of my most shameful thoughts, fears and emotions without judgement. Part of the eating disorder problem is the inability to share, or express difficult emotions or the feeling that what we have to say is wrong etc. It’s this rhetoric that keeps us locked in. Journalling releases a lot of this and makes it easier to begin to talk outside of the pages.

Keeping a journal can help us to identify recurring themes, thought patterns, processes especially those that occur around our eating disorder “self”.

Although my eating disorder is not your eating disorder we all share some common thoughts patterns that make us similar, which is why I write this blog in the first place. If it resonates with one person I’m glad I write. I find reading about what has helped others in recovery not only inspires and motivates me it actually strengthens my recovery. I remember reading about journalling on NEDA and completing some journal prompts from the “8 Keys To Recovering from eating disorder recovery workbork” and they really helped get me started in journalling in early recovery. Now journalling is part of my daily routine. Mostly in the form of gratitude practice, but I will elaborate on gratitude later.

Once I have written the thoughts out on to page, it becomes so much easier to see them for what they are; THOUGHTS. Just because we have a thought does not make it true.

For example, an old entry of mine in June 2019:

I couldn’t make a single decision about what to eat for dinner, I stood in the kitchen for ages agonising over whether to add oil to the pan, all I could hear was how fat I’m becoming and how unhappy I will be

I reminded myself restricting has never resulted in happiness, I was not able to add the damn oil tonight, but I know I am capable of making hard choices and I will find the courage to do it”

After writing thoughts like this out on paper over and over, I began to believe my healthy voice again. Restriction doesn’t make me happy, neither does endlessly pursuing “skinny” They are just thoughts and my truth is I can be happy living an unrestricted life at any size.

My next post I’ll share some journal prompts that have helped me.

But for now, perhaps try and think about if you were to go to bed and wake up recovered ( I know I wish right?!) what would that look like, what are some of the things you would do and feel as someone without an eating disorder? How would your life be different?

Can you scribble somethings you have learned this week? What is helping you, what’s holding you back. What have you discovered about yourself?