What’s up Doc?

What’s up Doc?

This is a slightly different post to my usual.

I want to talk about well-being amongst healthcare professionals.

The people that look after you when you are sick are humans too but it can be hard to view them as anything more than the doctor/ nurse/ psychologist in front of you. They have a life outside of the workplace, they have their own families, insecurities and problems.

Doctors, nurses, first responders & all members of the healthcare profession make huge sacrifices for their patients and do so willingly.

But who looks after them?

Mental health problems amongst medical personnel is at an all time high. If we don’t look after our healers they can’t look after you.

Yet, we are a profession that is notoriously bad at seeking help for ourselves. It’s a common theme of jokes “doctors/ nurses make the worst patients”. We provide diligence to our patients but it’s a hard pill for us to swallow when we need help ourselves.

What are some of the reasons behind the resistance for a healthcare worker to seek the same help they provide without a second thought?

A study published by the lancet offered several reasons for this.

An old fashioned and harmful rhetoric that still bleeds into the healthcare industry: “we don’t get sick, we treat the sick”. It’s hard for healthcare workers to accept they are not infallible and often this narrative alone prevents them from seeking help, often meaning problems are advanced by the time the do access care.

The well-being of doctors is becoming increasing challenged.

The medical field is an unusual one.

For most of us, we give up our twenties to dedicate ourselves to studying or long hours working as junior doctors. We are often forced to make difficult balances, missing out on important life events and socializing because of the restraints of the profession. It’s not uncommon to battle to get leave for major events such as weddings or funerals.

Often, we can’t just go home when our work day is supposed to finish because we are looking after someone in their moment of need. We stay late because we care.

But this can come at a cost.

Our contracts can mean constant changes, junior doctors move around every 4 months, sometimes this means transferring miles away from your loved ones. This can make things like registering with a general practitioner difficult.

Long shifts, antisocial hours, plugging gaps in rosters, studying for endless exams and extracurricular activities can take their toll both mentally and physically.

Often these are accompanied with limited access to healthy food or basic self care including rest, relaxation or exercise.

There is an undertone within the healthcare profession that being anything less than perfect 24/7 is failure. Fear of disclosure and the implications it may have on our license to practice I’m sure is a common barrier to seeking help.

Doctors have an increased rate of suicide compared with any other profession, high rates of mental illness, including depression, anxiety, burnout, imposter syndrome and substance abuse. But it doesn’t get talked about. It remains “taboo”.

The resources for help aren’t made readily accessible, the encouragement to seek help is virtually non existent. This needs to change as early as medical school training. This needs to be openly discussed and normalized. Otherwise the stigma stays and nothing changes.

Doctors are making life or death emotionally demanding decisions. This is what being a doctor is. But sometimes the weight of these decisions is enormous without resources to help.

The threat of litigation is real, the trauma of some of the decisions they face, with often no debrief or acknowledgement of the enormity of these decisions.

Burnout rates are increasing.

Dealing with uncertainty is something doctors become adept at, changes in rosters, no two days being the same.

Teamwork can be challenging when there is conflict between management and the frontline workers or finite resources.

It’s not uncommon to come across bullying and not enough is done to mitigate or reduce this.

If you are a healthcare professional what were the barriers you faced to seeking help? I’d love to hear your experiences

What do you think needs to happen to protect our community’s wellbeing? How can we do this?

There are some charities that exist but again they’re not widely known about. I’ll share some links below. If you know of other’s please share.

References:

Trigger Warnings…

Trigger Warnings

What are trigger warnings and do they work?

These are often at the beginning of an article or social media post, either labelled as; trigger warning “TW’, or content warning ‘CW’. Triggers have many different definitions. The discussion regarding their use is not straightforward or easy.

I’m keen to start a discussion about how we perceive them, use them or alternatives that we could implement.

This is a heavily nuanced subject and I do not claim to have all of the answers, in fact my experience and knowledge is finite.

However I wanted to explore this topic further after an Instagram post I shared about them sparked a few interesting DM’s. https://www.instagram.com/p/CUYQe2Mhae4/?utm_medium=copy_link

Before I get into my own views, lets discuss the origins of where “trigger warnings” for content originated.

Trigger warnings originate from trauma, PTSD content. They were specifically attached to protect people with a history of PTSD/ trauma from experiencing the negative effects of reliving the traumatic exposure and secondary response. “Being triggered” in any other setting is different to this. People with PTSD often cannot regulate their response to the trigger.

I do not have experience with PTSD and so I’m not equipped to be able to talk about all of the nuances associated with this. I can however talk about the use of “TW” outside of trauma & PTSD and the potential harm they cause.

Multiple studies have demonstrated TW used in any other context at best do not work and at worst can cause harm. Yet almost every post I come across in the eating disorder community comes with a “TW”. It’s almost as if a trigger warning absolves a person from any responsibility of what they are posting.

If you are consuming, participating and engaging with particular content on social media you have a level of personal responsibility.

What do I mean by this?

It is your choice to visit certain pages, hashtags and communities. You have the same choice to avoid or unfollow content that does not help you.

Additionally you have a degree of responsibility regarding content you share. If you feel it may be harmful, caveating it with a TW is not solving a problem. Before I share anything, I consider a few things; does this post have the possibility to harm, does it serve the community I want to be an ally to and how would I have perceived this when I was unwell?

There is also a big difference between being “triggered” and discomfort.

Unlike people with PTSD, most of us with eating disorders whether you like it or not can choose to be triggered by something.

People with PTSD find it difficult to self regulate/soothe when they come across a trigger and reminder of the traumatic event. It can have many physical, somatic effects such as dissociation, soiling, hyperventilation and these are not in their immediate control. Therefore trigger warnings applied to topics/scenes depicting graphic violence/ sexual assault may help. There’s also debate that avoidance of such can do harm to some people’s recovery but again I am not equipped to go into the nuances regarding these.

I know when I was deep in anorexia, I would seek content with “TW’s, my eating disorder wanted me to be triggered. A trigger warning did not deter my unwell brain. If anything they helped keep me stuck in the cycle. I chose to be triggered by them. Why?

Eating disorders by nature a incredibly competitive. When the eating disorder voice is the dominant voice it will go looking for anything that validates it and makes it “more successful”. I could have controlled my response to them, I could have avoided them all together, but I chose not too.

Trigger warnings do not prevent this. They are the problem.

Now I’m solid in recovery, if I see an post with ‘TW” I can view content without allowing myself to become “activated”. I will often choose not to open such posts depending on how I am feeling in myself. I take responsibility in what I engage with. This is self regulation. But let me lay this out there…the “TW’s” on content I used to seek when I was ill with anorexia would reinforce intrusive thoughts. Labelling content with a “TW” would often lead me to engage in things I wouldn’t other wise. It’s like when someone says “don’t think about the colour red” all you can think about is the colour red. TW’s don’t tell you to avoid the content but they may increase the intrusive thoughts too. There’s increasing literature to show that “TW’s” do not work and can result in increased anxiety (I’ll share some links below).

As I have referred to already there is a difference between “being triggered” and feeling uncomfortable (feeling our feelings). I can feel uncomfortable about something but still remain within my parasympathetic nervous system and not enter the fight or flight mode invoked by the sympathetic nervous system. Commonly posts will elicit feelings of grief because I resonate with them to a time when I was unwell. These feelings are healthy and transitory- they do not keep me stuck in a state of “activation or triggered into a trauma state”.

Again I’m not knowledgeable in all of the nuances regarding this. I wanted to start the discussion about how blanketly these warnings are being used and whether they are causing more harm than intended.

I’m not saying there is no role for TW’s, I am encouraging you to reflect on why you use them, is it truly to prepare an individual or to remove responsibility from what you share or engage with?

Do trigger warnings help you are they as useful as we think? Do they cause you more intrusive thoughts? I’d love to hear your opinions, either via the comments or email me.

A few published studies:

It’s OKAY to Talk About Suicide

It’s ok to talk about suicide. Suicide is not the solution.

CW discussion of suicide

Feeling suicidal is terrifying and if you have these thoughts please call the crisis line or someone you trust.

This is a difficult post to write, but it shouldn’t be. September is suicide awareness/prevention month. Really every day should be suicide prevention. For some reason, suicide continues to be a stigmatised, taboo subject.

Suicide is the second leading cause of death in young people aged 10-35. Yet it’s not talked about. Not nearly enough. 90% of people who die by suicide have suffered mental health symptoms. Marginalised communities have a 4-12x risk compared with the general population.

Anorexia is the most fatal of all mental health diagnoses, 1 in 5 anorexia deaths are from suicide.  27 people die everyday globally from eating disorders. Suicide is a large proportion of these. It shouldn’t be and doesn’t need to be.

We need to make society a safer place if we are going to reduce these stats, it starts with talking and normalising mental health.

When I was deepest in my eating disorder, I was haunted by thoughts of escaping, but this was not something I ever admitted, voiced. I was even asked many times by my team if I was depressed or had suicidal thoughts. The truth is, I wasn’t depressed, I felt hopeless, like there was never going to be anything else. The idea of living another day in this never-ending self-loathing, food obsessed brain was sometimes overwhelming. I used to say over and over in my mind- I wish I was dead. In those moments I believed it, I meant it.

The reason I want to share this, there were many times I felt like this when I was trapped in the ED. I felt so much shame for having these thoughts, I grew up in an environment that didn’t believe in mental health, I grew up believing suicide was selfish, cowardly or attention seeking. That’s so far from the truth.

Isolation was the worst part. I can hand on my heart say, it is none of the above. Suicide is a permanent solution to what I feel is a temporary problem and preventable with support.

Eating disorders are incredibly isolating. Not feeling I could talk about this added to the shame and perpetual cycle.  We often ask people “are you okay, how are you” but it’s an empty question. We don’t ask people how they really are, because as a society we are afraid of how to respond if someone was to really answer. Personally, I wouldn’t have wanted someone to have the answers. You can ask someone how they really are and not have to have the solution. You can offer support in many ways. Listening, not judging a person, advising they get professional help, letting them know their feelings are valid (even if you don’t truly understand). One of the biggest things is not perpetuate the rhetoric that suicide is selfish, cowardly or a choice. People who feel suicidal may be experiencing feelings of not wanting to be a burden, isolation, guilt. People who are feeling suicidal are living with pain and so many other horrible emotions. It is not selfish and making someone feel guilty or selfish is only going to fuel anguish and isolation. People are more likely to withdraw and not get the help they desperately NEED AND DESERVE.  Suicidal thoughts are a symptom and can be treated with help.

Raising mental health awareness, particularly in the healthcare profession is something I feel very strongly about. Healthcare professionals have higher rates than the general population of suicide. Female doctors are 2-4x at risk of ending their lives than the general population. It doesn’t surprise me, but it deeply saddens me. The medical profession is one of the worst for stigmatising mental health. It’s not a safe place to openly talk about mental health.  Not seeking help for our own mental health is a huge risk factor, that’s without all the other issues including making life or death decisions, giving up a large part of our own lives for the career and the fear of complaints. It’s not really surprising, is it?

Today, I started the first day of annual leave. Ben and I went for “afternoon tea” and as I sat there laughing at some of his silly jokes and we tasted the tiers, I felt grateful. I was so thankful that I could be sat here, laughing, and eating with ever increasing freedom. Not being trapped in an endless cycle of shame and torment. I would have called you a liar if you had have told me 12 months ago, I would be sat, relaxed and most of all HAPPY. I felt the happiest I have felt in, a long time. I’m so thankful to be alive, but I almost wasn’t. I never imagined this life for myself.

I don’t know why I am here and others are not so lucky. But I know this, I’m not prepared to continue the narrative that suicide is selfish, that mental health is not as important as physical health. Truly if mental health has the possibility to take a life, it’s about as serious as it can get and needs to be treated as such.

How can you recognise someone may be feeling suicidal?

Perhaps there will be no signs, but if you don’t ask someone how they are and mean it, it could be easy to miss.

  1. Isolation, withdrawing
  2. Expressing feelings of hopelessness, being a burden
  3. Talking about death, other self-harming behaviours
  4. Speaking negatively about themselves
  5. Talking about suicide
  6. Getting affairs in order, giving belongings away etc
  7. Access to means to harm oneself
  8. Mood changes
  9. Turning to substance abuse/ alcohol as a way of coping with feelings
  10. Drastic weight changes
  11. Appearing to have lost interest in things they would typically enjoy or life
  12. A sudden sense of calm, or appearing calm
  13. Ceasing regular medications

Risk factors for suicide;

  1. Prior history of suicide attempt/ self harm
  2. Depression, anxiety any mental health problem.
  3. Alcohol, substance dependence
  4. Bereavement
  5. Physical illness/ disability
  6. Knowing someone who has died from suicide
  7. Subject of violence
  8. Loss of self identity- loss of job, sexuality
  9. Major life events
  10. Relationship breakdown
  11. Financial worries
  12. Isolation.

What can we do?

  1. Making access to help easy, without stigma or judgement
  2. Don’t be afraid to ask someone, ask them how they are feeling in a safe space. It’s ok to ask about feeling suicidal. Let them know many people experience feeling suicidal and they’re not alone.
  3. If someone trusts you enough to confide in you, acknowledge this. “I’m glad you are telling me, you can tell me anything” “I am here”
  4. Be prepared to listen even if it’s difficult to hear and upsets you.
  5. Talking about suicide does not cause suicide but it may help prevent it.
  6. Listen to someone struggling. Don’t judge them, even if you disagree. Don’t attempt to fix their problems or dismiss them.
  7. Help someone find professional help, charities, organisations
  8. Small acts of kindness “saying hello to a stranger” you never know a simple hello may make someone feel noticed, loved.
  9. Actively seek help from mental health services for the person- call emergency services or crisis line if someone is clearly in danger.
  10. Offer them support by asking open questions like “you don’t seem your usual self, is there anything you want to talk about? Tell the person you’re concerned about them

If you are reading this and you can relate, are experiencing suicidal thoughts, you ARE NOT ALONE and YOU DESERVE TO LIVE. Please get help now.

It’s okay to talk about suicide. Start the narrative.

Help:

**these are my own experiences and are not professional/ medical opinion*

Lived Experience..in ED Recovery.

Lived experience is one of the most valuable assets to recovery.

You can read about eating disorders in as many text books as you like and on some level you will understand them. Cognitively you may get it, but unless you’ve walked in the path it’s difficult to “really get it”

When you have lived that experience, You get it on a whole other level. People in recovery “get it’ on a level that reaches them to their core.

This makes people with lived experience such important allies in a person’s recovery journey and can be crucial alongside treatment.

I will never be able to express the gratitude I feel for my therapist, I know she saved my life, literally. Therapy was huge in my starting recovery and breaking free from the ED. But the most transformative part in my own recovery has been through connecting with those who have lived it.

At all stages of my recovery lived experience has been influential and important in my own growth.

Reading blogs, listening to podcasts/vlogs and following pro-recovery accounts on social media has really assisted me in the process.

There’s a deep level of trust that develops, knowing that others who have fully recovered, or are in a strong place in recovery helps us to feel connected, validated and most importantly gives us HOPE.

I reflect on the times I listened to people like Jessica Flint, Tabitha Farrar, Mia Findley and Millie Thomas sharing their stories, their wisdom and experience and aspiring to reach many of the milestones in recovery. Believing through sheer faith in their stories that recovery IS POSSIBLE for everyone. Even in some of my darkest moments in the throes of the ED or difficult moments in recovery, trusting what those who have lived and come through the other side has felt comforting and at most motivating.

Connecting with others in recovery seemed terrifying to me when I first started. If I had have been offered group therapy or any form of treatment that meant connecting to others, I would have ran a mile. In fact, I did. I was so ashamed of my eating disorder and terrified my “sordid secret” would become common knowledge. But through listening to others, joining platforms or groups a lot of this shame began to disappear, because there was nothing in this community that was judged, hadn’t been felt, said or done before. I started to see I was NOT ALONE, that there were millions of us who have experienced eating disorders.

A common theme I began to understand was the level of shame we all suffered. The more I read stories, listened and talked the more the shame began to dissipate.

Things I felt I could never share with another living person, suddenly felt like no big deal in the recovery community. The nuances that we believe are so shameful and not to be brought out into the light of day, are everyday struggles we share and is part of non-judgemental wonderful conversations. They say shame is fuelled by secrecy, I believe this is so true.

Following other’s journeys enabled me to find my own voice. I refuse to be ashamed of something that has made me who I am and helping me to connect with my true self.

I used to say I wanted to recover to the person I was before the eating disorder. I no longer wish this, because recovery has made me someone else, someone bigger than I was ( pun intended), but the level of growth that comes from choosing to recover & surviving an eating disorder is such that I wouldn’t trade it for the world. I’m becoming more connected with myself with every recovery orientated decision and becoming aligned with who I want to be. I’m grateful to those who were brave enough to share their experiences, that motivated my own recovery and helped me keep faith.

People recovering from eating disorders have to do this in a world that still challenges many of the beliefs we have to unlearn and to be able to recover in this society is so hard. For some this society can be incredibly cruel and the more people who share their struggle, experience the better this will be one day, especially for those who cannot find their voice. Lived experience is becoming a much bigger part of recovery, with the ever increasing resources available, recovery coaches becoming mainstream and peer mentorships, this can only be a good thing alongside traditional recovery. These people have experienced the struggles, the up’s downs and navigated their way out and are so valuable in helping others do the same, with compassion and sensitivity that is as authentic as it can get.

I’ll share some resources that have been so imperative to my own recovery below.

  1. https://www.recoverywarriors.com/ From blogs, to podcasts and online community platforms such as the “Courage Club” this has been huge in my recovery. Jessica Flint is fully recovered from her eating disorder and has now founded a recovery community that has reached thousands of people in recovery. This has introduced me to some of the most incredible people I’ve ever met.
  2. https://www.instagram.com/lindseyhallwrites/?hl=en Lindsey Hall has herself recovered from anorexia and she shares incredible insights
  3. https://tabithafarrar.com/ Tabitha is a recovery coach, who has fully recovered from her eating disorder. She’s very direct in what she believes recovery is, but she has shared some amazing blogs, podcasts and now mostly posts video content on youtube. I followed her avidly when I first started recovery. She posts about things from “extreme hunger, weight gain, and neural rewiring”
  4. https://www.instagram.com/millietnz/?hl=en & https://podcasts.apple.com/au/podcast/end-eating-disorders/id1534539219 End Eating disorder recovery Podcast.
  5. https://www.beyondbodycoach.com/ Mia Findley- is an Australia based recovery coach, who has fully recovered. She posts videos and podcasts with her experiences.
  6. http://maintenancephase.com/ This is a great podcast that promotes HAES, diversity and is anti-diet
  7. https://www.instagram.com/drheatherirobundamd/?hl=en

Protecting Yourself from Harm in Recovery..

Protecting your recovery can be like developing a super power. It’s also incredibly important when we are surrounded by potential triggers every where.

If we are in recovery from an eating disorder, we need to learn to reject diet culture, which is really difficult when it infiltrates every part of our society.

I recently came across a blog, where the author was promoting a weight loss regimen, whilst sharing their own ED Recovery.

 That tells me two things, firstly it is not something helpful to my recovery, secondly the writer very likely still holds a lot of internalised implicit biases around weight and fear of weight gain and unlikely recovered.

 The intention of this post is to highlight the importance of being aware of  the content you chose to follow and your motives behind it.

People have the right to write/ talk about whatever they like. However, it can be really damaging to a person who is trying to heal from an eating disorder to follow accounts like that. You have a choice regarding the content you chose to follow or not.

My thoughts are and they may be unpopular, YOU CANNOT recover from a restrictive eating disorder whilst still actively attempting to pursue a smaller body. Believe me you cannot. It took me long enough to come to terms with this. You might get the idea of “I could go on x diet, lose this much and I would be ok”. Take it from me you will not. It is a relapse waiting to happen. That is how my last real relapse happened. All it really tells you, if you get those thoughts there’s still work to be done on neural re-wiring. It gets easier. I get these thought from time to time, “If I could just lose X amount I will be happy” this is my eating disorder voice and one that I know cannot be trusted. A size, or shape will never change how I value myself, I am so much more than a measurement but this is not what my eating disorder believes, it will make me buy into the notion that my worth is solely based on a number. This is not happiness.

I cannot diet ever. ever. ever. Choosing to go on a diet when you have a history of an eating disorder is like saying a person who has recovered from substance or alcohol abuse can have the occasional drink. You would not say this. Dieting is our drug. We cannot safely dabble.

In recovery the focus should be on challenging our fear of weight gain, body image, learning about the health at every size movement. Dieting becomes less appealing. I’m not saying you won’t get those thoughts. However your brain will learn that you don’t place all of your value on a number and it’s not something we’re interested in. If the concept of Health at Every Size (HAES) is new to you, I encourage you to explore some of the resources I’ve shared at the bottom. However, a very brief summary of HAES; the basic premise supports people in implementing health practices for the purpose of overall well being rather than the focus on weight control. There are some key values to HAES, it encourages people to eat intuitively, accepting of body diversity shape and sizes and that health is about much more than weight. This is a very simplified explanation.

I do not believe a person can endorse weight loss and be fully recovered themselves, because the aim of eating disorder recovery is to unlearn your fear of weight gain, to rewire implicit fat bias/ fat phobia. Therefore by promoting weight-loss on an eating disorder recovery site is an oxymoron. It does not have a place in recovery. I personally do not follow accounts whereby the premise is promoting weight loss or any form of diet culture based content.

If you are trying to recover from dieting, disordered eating or an eating disorder it is your responsibility to not allow this to trigger you. Therefore avoiding unhelpful information such as “losing weight” in eating disorder recovery might be the easiest way.

My last real relapse came from thinking “I can safely diet”

How I deal with these thoughts now; I challenge myself with the following questions:

Why do you want to diet, what are you actually trying to do? What are you lacking in an area. (It’s usually self care and self compassion for me).

Why do you feel the need to change your body- can you learn to accept your body at any shape size and understand a number on the scale has no bearing to who you are as a person or your health?

But, I find sites like this are dangerous in the ED recovery community, they do not realise the potential harm they could have. This particular individual has a large following. Many of the followers suffer with binge eating and the blog is the last thing a person experiencing such should be taking notes from. Dieting no matter how you look at it is restriction. Restriction is no friend to bingeing in fact restriction causes bingeing.

I recently shared this checklist on my social media- it serves as a way to protect myself and maintain healthy boundaries.

Resources:

Celebrate The Small “Wins”In Eating Disorder Recovery

How often do you hear “It’s The Small Things”



WELL NOW I BELIEVE, DURING RECOVERY FROM AN EATING DISORDER, GREATNESS COMES FROM CELEBRATING “THE SMALL THINGS”
 

After a minor set back a few weeks back, I write this with a newfound sense of self confidence.
 
I am here, writing this because of thousands of little victories. I cannot take credit for this idea, I share this after a recent interaction with the founder of The Recovery Warriors, True Warrior, Jessica Flint. Jessica introduced this principle to me and I feel it’s incredibly empowering. https://www.recoverywarriors.com/

This morning as I caught a glimpse of myself in the mirror, instead of the familiar self-loathing and negative chatter, I heard myself say, ‘you look good today‘. I celebrated this. I don’t recall the last time I heard myself pay myself a compliment.
 
Another example of  a “small win”, yesterday after a migraine, I embodied the definition of a ‘self-care goddess’ and practiced it as if it were some kind of art. I ordered comforting foods that would leave me feeling nourished and happy, I stepped onto my yoga mat for five minutes and did a simple sun salutation. I celebrated it afterwards, “Yey, go me I did yoga”, instead of my adopting my eating disorder  (ED) voice that is harsh and critical that would normally tell me “this did not count”. Instead, I celebrated the fact I stepped on my mat. It does not matter how short it was.
 
I felt a sense of pride, accomplishment that I had honoured my body rather than “I hadn’t done enough, I didn’t deserve to eat XYZ” It felt victorious whilst I sat eating my salted popcorn. I also celebrate this because the guilt was gone. One week prior would have been a whole other story and I would not have been celebrating this little victory if I hadn’t celebrated each individual victory last week. Take credit for your wins and use them to motivate you.
 
We all know recovery is not linear. I have shared posts on lapses and relapses and prevention previously. However, even in setbacks, celebrating victories is incredibly empowering. Three weeks ago, I started to notice ‘that voice’ becoming increasingly noisier. It appeared to come out of the blue. One day I felt like I was almost ready to “hang up my recovery shoes and call myself fully recovered” and the next I was unable to trust a single thought.
 Today, I feel stronger mentally, physically, emotionally than I have probably my entire adult life. I celebrate I got back on track rapidly and far more easily than even a year ago when I went “all in” after my last major relapse. It was the small victories that helped me pull myself out of the vacuum that appeared in front of me.
Choosing the difficult option time after time, riding the ED anxiety waves. It is amazingly simple I had inadvertently restricted when I lost my appetite and had fallen into energy deficit. The warning signs were there.

Lesson learnt, eat more even when I lose my appetite, enlist help. That voice became almost crippling during the week that ensued and I celebrate I did not engage in its demands. I celebrated that although I felt like I had fallen from a great height, I was able to recognize it, I did not bury my head in the sand or isolate, instead I asked for help at the point I recognized things were slipping. I relished this triumph because previously this would have been extremely hard, highlighting how far I have come in recovery, all was not lost. Every bite, every opposite action I made against my eating disorder voice I chose to recognize and celebrate.  
 
Since I started this process, I have a much deeper understanding of how my brain became sick. Each set-back has provided me with valuable information and it was so much easier to pull myself out.
Pausing. This is something so simple. Yet, if I were to ask you, when did you last pause, and slow down? When did you take a deeper look at your thoughts or emotions? Developing an awareness around my thought patterns has been a gift in recovery.
 
One of the things this setback demonstrated to me, was just how important it is to me to be with myself, to listen to my thoughts and become curious about my actions. This for me often involves my yoga mat or my journal. Both things had been neglected for the weeks leading up to the setback. Self-care should never be an afterthought, or “if I have time” instead it needs to be part of our lives in order to have a healthy mind and body. Reframing can be an incredibly valuable tool. The times where we feel we don’t have time or the actions are too small to count, try reframing them to “I did well today because despite being busy, ‘I still stepped on my mat’, just the process of stepping on it and giving time for you counts. Same principle with exercise, perhaps you go for a short run and normally your brain would tell you it’s not good enough, how about ‘go me, I ran today’
 
It is incredible how we can ignore such seemingly small moments or deem them as insignificant or unimportant, yet they often hold such empowering insights or lessons. Leaning in, acknowledging, and celebrating the small things is how we grow.  Do not ignore or just brush aside these important moments. Celebrating the small stuff makes a BIG difference.

What win will you celebrate today?

For the days where you are feeling nostalgic towards your eating disorder…

During the recovery process, I believe it’s common, even normal that many of us feel some kind of nostalgia towards our eating disorder. 

The times in recovery where our ED comes knocking and tries to lure us back, nostalgia is a tactic it uses. 

I found this crazy, why would I ever want to return to something so destructive, yet I experienced a sense of wistfulness for it at times. 

Your ED will not remind you of your darkest days in the depths of it, it will tell you mistruths, altered memories- such as, “it wasn’t that bad, you didn’t really have an eating disorder, not every day sucked, you still ate xyz, you didn’t miss” bla bla. But it will not be reminiscent of the rules you had to allow yourself to do that, the guilt and shame you felt and the resentment from others when their concern fell on deaf ears. No, it will not remind you of any of this. 

It will recollect and romanticize the euphoria you felt on occasion, but not the crashing low points that always followed and were the majority. It is deceptive and the memories are modifications.

Your eating disorder has been a maladaptive coping strategy. It’s not surprising it tries to draw you in, at a point in your recovery where you are experiencing so many challenging emotions, new experiences, loosening of support, why wouldn’t your eating disorder try and lure you back, romanticize its role in your life?

 It might be on a bad body image day; the voice whispers a reminder of old compliments you used to get. It will not remind you of the days where you missed out on happy events in order to follow the ED demands or how the compliments left you feeling conflicted and confused. 

Nostalgia is natural in recovery, but do not dwell in it and do not believe the romanticized picture your ED paints, your ED was not a happy place.

On the days where your ED tries to convince you otherwise:

I find reminding myself of the many things I DO NOT miss about my eating disorder helps snap me out of it.  Here are some of those things I do not miss…

  • My entire brain being consumed by nothing but thoughts of food and numbers.
  • Being “bone cold” all the damn time no matter what the temperature was.
  • The deception, the constant lies and shame that accompanied.
  • The isolation, the missed social events and memories 
  • Not being able to eat with company, not being able to eat alone.
  • Not having a period
  • Feeling lightheaded most of the time 
  • The pain, and many injuries through not allowing my body to rest.
  • The inability to laugh the inability to cry real tears. 
  • The crippling fear when faced with a “fear food.” 
  • The incapacitating supermarket, menu, choice “blindness.” 
  • The brain fog and difficulty to concentrate and apply most of my brain.
  • The sore throat 
  • The bloating and constipation 
  • Never getting a full night’s sleep, sleep being haunted by fear foods.
  • Not being able to eat out without planning a year in advance. 
  • Having to move 24/7. The unbearable discomfort of being still.
  • Being boring because I had nothing to talk about
  • Feeling like a constant failure no matter what. No number, image or achievement was ever enough. 
  • Feeling like I wanted to crawl out of my skin all the time. 

The list is not endless. I could continue

However, I feel it is important to remember a few things:

Nostalgia towards your eating disorder is nothing to feel ashamed about, it makes a lot of sense in recovery. We should normalize it. 

Nostalgia is natural in recovery, but do not dwell in it and do not believe the romanticized picture your ED paints. Bit by bit this nostalgia will dissipate and become replaced with the truth so long as you keep addressing it. 

Orthorexia

Photo by John Finkelstein on Pexels.com

Orthorexia- the “socially acceptable” eating disorder

My eating disorder like many, has been a shape shifter over the years, meaning at various times I would have met criteria for more than one diagnosis besides anorexia nervosa.

We are all human beings. Fitting into criteria or a neat little box isn’t congruent with being human. And so whilst diagnostic criteria can be useful to help identify or guide which treatments may or may not work for you, I think that’s where their relevance ends.

What is Orthorexia?

The Diagnostic & statistical Manual of Mental Disorders (DSM-V) does not currently hold a separate diagnosis for Orthorexia. Instead it technically fits under the diagnosis Avoidant Restrictive Food Intake Disorder (ARFID) , although not perfectly, we return to my point about us being humans and not fitting neatly under one set of criteria.

This is a disorder characterized by an obsession with eating “healthily” or “clean” foods. A person becomes fixated on eating only foods they deem to be “pure”, meaning they can adopt strict rules and restrictions around foods and how they are consumed. I called it the “socially acceptable” eating disorder because it can be hard to detect in a society that praises restriction and demonizes anything else. People often reward people for eating “cleanly”. No eating disorder is ok. Orthorexia is when a persons focus on eating healthily actually becomes detrimental to their health, as a result of the obsessions, restriction, nutritional deficiencies and effect on the body.

It wasn’t until I started recovery for anorexia I realised I needed to challenge this too.

Orthorexia complicated my recovery, as I mentioned eating disorders are shape shifters, my way of “coping” with recovery became focusing on nutrition for a short while. If you are trying to recover by eating only “healthy” foods, you need to challenge this.

You cannot recover from a restrictive eating disorder holding on to ANY rules around foods. My obsession with eating healthily also preceded my development of anorexia and at some points other ED symptoms.

It is generally accepted that people experiencing orthorexia are not always driven by a fear of weight gain or drive to be thin, unlike anorexia. It can result in body dissatisfaction but weight loss it is not the driving factor (usually). It is about feeling clean and pure. I have no doubt that it could lead to anorexia in those of us with the genetic susceptibility because it can result in energy deficit.

Some of the warning signs of Orthorexia may include:

  • Unhealthy obsession with checking ingredients or contents of food (not driven by a fear of weight gain)
  • Cutting food groups because they are deemed “unhealthy”
  • Rigidity, not being able to eat foods not prepared by themselves or consume foods they do not know the ingredients (again not as a form of intentional energy deficit)
  • Distress, obsession impairing well being

If you think you have a problem, any concern with disordered eating, it is always good to seek help. Talking to a GP, a health at every size aligned dietician or therapist would be a good place to start. You deserve to have mental freedom.

Helplines/websites:

Recovering from an Eating Disorder doesn’t Automatically Guarantee Life Will be Perfect..

But when life is challenging , you won’t have an eating disorder to contend with as well.

Rather naively, I think many of us hold this notion of “if I could just fix my ED, my life will be perfect”. So let me get in there early and save you the “aha” in months/years to come, set your expectations now, be realistic .

This is something I have come to realise throughout my recovery. The many times I’ve contemplated what recovery means, how I define it, what life will look like beyond my ED.

As I’ve gotten further into recovery and shifting away from my eating disorder, it’s become increasingly apparent that recovering from an eating disorder does not mean life will ultimately be all rainbows and flowers once the ED is conquered. No. That’s just not possible. But, life’s so much better, just putting this out there early.

But, the big thing here, the “aha” moment for me, was recognizing recovering from an eating disorder means we have tools to help us when life throws us a curve ball and returning to the eating disorder does NOT have to be an option.

Additionally when something in life happens out of our control, not having to contend with an eating disorder simultaneously, means we are better equipped to handle the stress.

An eating disorder is a big problem, not a solution. It may feel like it gives you control and comfort around times of difficulty but I promise you, that is the mask of the ED. It is definitely an added problem that you do not need.

Recovery will not mean that when you have a stressful time in your life, a loss or lots of change you won’t experience human reactions such as anxiety, low mood or whatever else we all feel according to life events. Recovery doesn’t make you some kind of super hero that doesn’t feel or get rocked by anything- but it does mean you don’t resort to dangerous/ maladaptive coping mechanisms that you have relied upon until this point. Learning to feel has been a skill I’ve developed in recovery and how to respond to these feelings.

It would be unrealistic to believe you will never have a day of insecurities, or god forbid a bad body image day. Because even people who have never experienced an eating disorder experience these human emotions. But if you’re recovered you won’t obsess over them, you will be able to deal with them and it won’t “ruin your day your week or even your year”! Yes I did just do that.

Recovery is a beautiful thing and it means something different to everyone. The recovery process is not the same for any of us, but I do believe it is important to consider your expectations of what it will mean for your life.

Personally, it has led me to an understanding that beyond ED Recovery work, in order to remain in recovery, l will need to put work into ongoing stress management, imposter syndrome and work anxiety. For me they are interlinked.

It is highly likely this will mean continuing with therapy of some kind to help me work with these issues, because I want to protect my health legacy.

One thing I know, life stressors are not something that are going away because it’s part of life, everyone has problems. BUT don’t let having an ED be one of them or believe that once you have recovered you will be a unicorn and NEVER have another issue.

Extreme hunger- exactly what it says. Extreme

Extreme hunger in #EDrecovery Because it needs to be when you’ve been starving

When will my extreme hunger end, is my extreme hunger normal? Should I trust this hunger? How do I get rid of this extreme hunger? Why can’t I eat like a normal person? Am I mad? Are these questions you’ve asked?

You’re not alone.

Hunger is normal. Most people wouldn’t give it a second thought, they experience hunger, they eat and move on with their day. It is a normal human function.

For those of us who have been through an eating disorder or any form of disordered eating we have tried to avoid hunger. Lost touch with it, broken our trust and relationship with it.

Almost as a sick joke, when you start recovery, it is very likely you will experience the well recognised phenomenon that is hyerphagia, a.k.a ‘extreme hunger’, though not everyone does. Realistically you are unlikely to be able to go from heavy restriction to eating ‘normally’ straight away.

What is extreme hunger?

It is essentially a biological reaction to a period of restricted intake, this can be through disordered eating such as dieting or an eating disorder. It is the body’s mechanism to heal, there are physiological aspects to do with hunger hormones such as ghrelin as well as psychological mechanisms. It is a means of repaying the deficit of energy the body has undergone to repair itself. So whilst we are here, let’s emphasise that although it feels ‘excessive/extreme’ it isn’t under the circumstances is it?

When you restrict, even in short periods your body begins to utilise energy from all parts of your body. This basically means your body has started digesting its own organs etc. Now imagine if that was for a very long time, the damage done, eating normal quantities of food would be a drop in the ocean, it’s not enough.

As someone who has ignored hunger, restricted their intake of food, this feeling of intense hunger is terrifying but makes complete sense if you break it down logically. I wanted to wait a while before writing this, I wanted to write my experience from the other side to reassure you IT REALLY does get better.

Not everyone will experience it, it will look different for everyone, it may show up right from the offset of recovery, or like me later after a relapse.

I remember trawling the internet for hours, reading scientific papers, watching YouTube videos to try and predict when my ‘extreme hunger’ might subside and if it was normal asking all of the above questions, hoping for an answer.

The truth is, no one can tell you when it will happen, if it will happen or when it will go. The only thing you can be reassured in, IT IS NORMAL, IT WILL GO AWAY when your body is ready for it too. And yes, there may be times it returns, for instance if you enter a period of inadvertent restriction i.e. after a small illness.

I didn’t experience this “extreme hunger” when I first started recovery in 2019, it showed up for me when I truly let go of all restriction and got back on track from my last relapse in August 2020. It manifested in many ways which I’ll elaborate on.

When I was seeking comfort from online sources, article after article would reassure me that what I was experiencing was in fact a completely normal response mechanism to restriction and that if I honoured this hunger it WOULD dissipate. I did not believe any of this at the time. It felt so wrong, like I was doing something wrong (I was in terms of my ED brain, which is a good thing), I felt like it would never end.

But now, if you have found this by searching “will my extreme hunger ever go away, how do I get rid of extreme hunger” I promise you as someone who has come out the other side IT WILL GO AWAY if you obey and don’t judge the hunger. I know you’re probably laughing at me now, “how can I not judge this hunger, I am never going to be able to get through it” YOU WILL.

What does it feel like...

It feels like bingeing. It’s not. It is eating what you need for the deficit. The key difference is restriction and the behaviours associated such as compensation etc. Although- I personally believe BED (Binge Eating Disorder) patients are often in a difficult position- where many treatment providers inadvertently promote restriction, by trying to limit intake, which in my opinion can set the sufferers up to binge more, which makes their recovery journey difficult. But that’s just my opinion. This is why health at every size aligned treatment is so important.

Your mind and body tells you to eat ALL foods ALL the fucking time.

You’ll think you can control it, “I won’t eat as much as that tomorrow, I’ll be normal” but you won’t, you can’t win that, so settle into the discomfort.

You will likely feel full to the point of pain but hungry all at the same time. Your stomach may feel bloated because it’s not yet well rehearsed at digesting and it’s like your stomach can’t keep up with your brain. Or you’ll think your full and done only to then feel as if you haven’t eaten just 15 minutes later. This is completely normal. (I mean nothing about restricting, starving is normal, but this response to that is)

I could eat my dinner & pudding then 30 mins later repeat this and still feel un-satisfied. I felt like a bottomless pit. It was like a survival drive.

I also experienced mental hunger. Mental hunger is a form of hunger, where you are constantly thinking about food, it often occurs when we haven’t 100% connected with our physical hunger cues or satiety.

For me this included dreaming of food, often nightmares of my fear foods, thinking about what my next meal would be, worrying about what it would be, when I would eat, if it was enough/too much, if it was ok to eat XYZ, if I was hungry, am I eating out of boredom, emotions, would I like it, would it be horrible, It was probably more distressing than the physical hunger because it was relentless and totally unimportant. If you experience mental hunger, it’s hunger. It will get better with eating.

For someone who has not experienced this, it’s hard to actually express how intrusive this is. It makes thinking about ANYTHING else really hard. My rule of thumb during this time was, if I thought about it, I ate it.

THIS is highly traumatic to a person who has restricted their intake for so long. I would advise you to enlist support during this phase. Distraction can work a treat when you are eating. Watch a show that holds your attention, eat with someone you trust, take up puzzling, anything to shift focus from the anxiety of eating. (I don’t personally believe mindful eating is very helpful at this stage as it just increases anxiety and our ridiculously critical brains, mindful eating is for WAY further down the track, intuitive eating is the goal. Just not now.

Hot water bottles become your best friend as do things like peppermint tea, they help soothe some of the gastric symptoms (I.e. unbearable gas – having a pet helps for blaming purposes!).

Yoga not only helps with the anxiety side of things, it can help with the bloating.

This is not a time to be wearing things that make you uncomfortable. Wear elasticated pants, those comfy sweat pants, flowy dresses, loose clothing, nothing that makes you feel constricted.

One thing I did, which is probably really weird but it helped me, was to name my belly “Bob”. This wasn’t a particularly conscious effort. But I like to use humour for many things, my distended belly ‘Bob” became a running joke between my partner and I. When I reflect now, I can also see it made the process easier, I separated myself from ‘Bob’, which meant I could seperate myself from my ED. If ‘Bob’ was hungry it was easier to feed ‘Bob’ than it was myself. If ‘Bob’ wanted something my ED was utterly disgusted by, ‘Bob’ got what they wanted, it was ‘Bob’ not me. When Bob was bloated I could laugh and show them compassion rather than receive the barrage of abuse and contempt my ED voice would show me.

I HAVE NO IDEA if this is something that ANYONE else would do. But it worked for me and I wanted to share.

I haven’t fed ‘Bob’ for ages, I feed myself now. But when it was really difficult to do, responding to ‘Bob’ was easier. As a thirty something year old there’s nothing less de-humanising than not being able to feed yourself, and until I could, I enlisted this tool.

Will my extreme hunger ever go? Yes, when? no clue.

Eventually over months my appetite “normalised” I use this term very loosely. There’s no such thing as a ‘normal’ appetite but what I mean is I now have a pretty reasonable relationship with my hunger cues and desires. I am leaning into intuitive eating. This extreme hunger fixed itself with time. I would find it very difficult now to eat large quantities of food (outside of what I was desiring).

One thing I had to accept was, during this time and possibly for the foreseeable future my requirements are not the same as someone who has not waged war against their body. I had a lot of damage to repair, to pay back and so comparisons to your peers will NEVER be helpful. It is not a normal situation to be in, recovering from an eating disorder and so your requirements will not likely be the same as someone who has not experienced this. So leave the judgement behind. YOU do YOU, stay in your own lane. For example there have been times where I have been able to demolish double what my husband can eat, I do not believe in the “his and hers” portions. Or portion sizes full stop for that matter.

Eventually your body will start to heal, it will start to trust you and your hunger and satiety cues will return without any intervention. Just hang in there.

Eating disorders, Stigma and Labelling..

Stigma has many definitions and layers.

But from my A-level psychology days the works of a psychologist Goffman defined it as an attribute that is “deeply discrediting’and reduces the bearer from “whole, to a tainted version” of themselves. Though much of his theory has been disputed most still accept this part of the definition.Goffman definition

“n. Stigma; the negative social attitude attached to a characteristic of an individual that may be regarded as a mental, physical, or social deficiency. A stigma implies social disapproval and can lead unfairly to discrimination against and exclusion of the individual’. Definition

Stigma is not a new concept, dating back to Ancient Greek and Latin, where it’s common meaning “a mark, or “sign of” as well as ‘to brand undesirable”, hence the origin of the word.

Labelling has been an area of great debate for decades. Various psychologists and sociologists have attempted to argue in favour of labelling and it’s impact upon stigma or refute it. Each arguing different consequences of labelling.

Regardless, one thing I have witnessed as someone with an eating disorder is a fear of attaching a label and the stigma associated with it. The reason I am writing this was prompted by a discussion with someone within the ED recovery community this week. They themselves were struggling with the label they had just been given at diagnosis. I recall vividly feeling this way, it served as a barrier to me seeking help.

It reminded me of my very first appointment with my then therapist. After completing the EDE-Q questionnaire and the weigh in, she said with conviction “You have anorexia nervosa”

I remember practically begging her to not attach “the label”, it meant everything to me, to not have this “blemish the tarnish” on my record. It felt dirty, shameful. Even though, I had know myself, in the moments free of the anasognosia I had had Anorexia for many years but NO one had formally named it, labelled it, discriminated against me for it. Suddenly this would be the first thing doctors saw on my record. It mattered.

This fear appears to be a common amongst many fellow eating disorder sufferers. I expect, though I cannot blanketly say so, for many other mental health issues.

Labelling has been attached to concepts including, self-fulfilling prophecy, stereotyping and stigma. Suggesting close interconnection. Labelling theory broadly states people behave or identify in ways that society or people have labelled them. This can also work on a societal level that people develop stereotypes attached to a label and expect specific behavioural patterns attached to those with a label. This can have positive or negative consequences.

Lending itself to the self-fufilling prophecy whereby an expectation results in fulfillment of embodying the label.

As these roles tend to be “deviant” from the societal norm stigmas can develop. These are derived from negative stereotypes and thus resulting prejudices and discrimination result.

The structure of stigma can then be further categorised into self stigma, label avoidance, public stigma, social and structural stigmas: ( this is by no way comprehensive and just my simpleton understanding). For this post I’m focussing on stigma within mental health.

There’s a breadth of information available pertaining to the many types, mechanisms and structures of stigma.

1. Self stigma: Self stigma impacts upon how you see yourself and your interpersonal relationships. Self stigma can be a barrier in recovery, in seeking help. It can distort perceptions of how you believe other people view you. An example in the case of anorexia might be: “ I am not worthy of help, seeking help makes me weak” self prejudices– “having an eating disorder is my fault, Why would anyone want to employ me, be friends with me”. Self-stigma and resulting discrimination: self-imposed isolation, the person cuts off from world and opportunities, including help)

2. Label avoidance: An individual may be aware of stigma surrounding a particular diagnosis and thus engages in behaviours to avoid the label. With respect to eating disorders this might look like: “having a diagnosis will mean I am vain, or I chose this “lifestyle” so they avoid seeing a heath professional. Prejudices that result- ‘I am ashamed to have an eating disorder, to be seen as someone with anorexia’. Discrimination: Concealing the “label” from my family or employer and therefore not being able to attend important appointments, because I am afraid I will lose respect and my career. The best way to combat this is through finding your voice, self-disclosure. This may be through sharing your diagnosis with a small circle or friends, family or being open to talking more broadly. (This is very personal)

3. Public stigma: Where general beliefs and prejudices are affirmed to a marginalised group ultimately leading to discrimination towards them. ‘People with eating disorders are vain, People choose to have eating disorders’. Prejudices may manifest as; employers are worried to employ the person, as they may fear their mental health makes them unreliable. Discrimination may result in a person not being employed.

4. Societal/ Structural stigma: this refers to policies invoked by large organisations or systems such as governments, health facilities that lay down restrictions on opportunities and rights of those with mental illness. An excellent example of this is weight stigma. The DSM-V label of atypical anorexia. Where this diagnosis is exactly the same in terms of criteria as anorexia with one difference the sufferer is not of a low BMI. The prejudice- fat people cannot experience as severe symptoms or implications as those who are underweight. Which is not the case. The discrimination that may result; many people living in larger bodies are denied access to health care or resources because of their size. This is a big one. Structural stigma is the one that affects marginalised communities. It’s interconnected to societal stigma. How we address this is through education, challenging the narrative. But it takes time.

There are MANY types of stigma and I have barely touched the surface. My aim was merely to shed light on how public, structural and self stigma are closely interlinked and can serve as a barrier to those with mental health problems from seeking help. Understanding the origins of stigma means we can continue to break down the cross links within it. My hope is that one day, no one will fear seeking help or a diagnosis because the label will not hold power.

Permission to Eat, Eating Disorder Recovery..

Answer this question honestly, do you ALWAYS, without fault give YOURSELF full permission to eat exactly what you want, when you want?

If you are some one like myself recovering from an eating disorder it is an essential skill we must master.

For a person who has never endured an eating disorder, you have still been subject to the messages from society that eating xyz is bad, eating after x o’clock is unhealthy. It’s all bollocks but it’s been ingrained into us and so I reckon if you really answered this question truthfully the answer would be no, for the majority.

What does permission mean in eating disorder recovery?

There were times/ are times where I have required external permission to eat. Questions like, is it okay to eat XYZ, is this too much, are you sure I need to eat XYZ? These are all utterances that have left my lips. Obviously, like any human being, I do actually know the answers to these questions. But giving myself that permission to eat is something the eating disorder makes very difficult. The eating disorder tells us there are many things we cannot/ should not do. Permission to eat intuitively, unconditionally is not something the ED permits.

This is something we have to master for ourselves.

There were times early in recovery, where I just couldn’t give myself that permission. At this point, I think it’s often helpful to have support, where permission can be granted, whether it’s from friends, family, therapists, dieticians or coaches, until you are strong enough to start permitting yourself. Ultimately that is the goal. Full unconditional self permission. It doesn’t happen over night. I have given myself permission slips before. If I couldn’t do it mentally then having a permission slip physically was helpful.

Intuitive eating is the goal, but it’s not something we can just start doing. Particularly in early recovery, when you are re-kindling hunger cues, trying to restore weight because realistically left to our own devices in this phase we would likely not eat enough. My ED would not allow me permission to eat more than I intuitively felt in early recovery. This is where external permission was really helpful until I could do this. I would set an alarm every 3 hours, my snacks, meals all non negotiable. Until I started getting hunger signals and cravings.

Even now, there are occasions where if I’m having a stressful time where this self permission can be difficult. I can walk through the process in my mind but then following through is the issue. So permission slips or external permission can be helpful.

The following are some common permission pitfalls/ situations I’ve come across- I don’t think they just apply to eating disorders but I do believe they are very important for us not to fall into.

1. I ate a lot of food already/ I ate so much for dinner I can’t possibly be hungry or eat now. If you are hungry you are hungry. What you ate before is old news and irrelevant. Your ED won’t like it, but so what.

2. I haven’t exercised. You do not need to move to eat.

3. I’m not hungry now so I’ll just have a little bit. Then 30 minutes later or just before bed you’re hungry. It’s normal. Respond. You’re bodies not on a timer.

4. It’s after X O’clock I can’t eat now because “it’s unhealthy”….Your body does not tell the time, it doesn’t work to a schedule, this is a diet industry myth that is not substantiated by evidence.

5. But I’m going out for dinner in an hour so I’ll wait. Nope if you’re hungry, you’re hungry.

6. No one else around me is eating but I’m hungry. This is a tough one for those of us in ED recovery. Eating in front of others can be challenging as can eating when no one else is. But YOU have to be able to give yourself permission to eat whenever, wherever.

7. You don’t know what the nutritional value of something. (You don’t need to). Your body is not a calculator, again this comes from diet culture.

8. You gained weight. Giving yourself permission to eat when you have gained weight- whether you’re in recovery from an eating disorder or just rejecting diet culture is courageous.

9. Don’t feel hungry. Eating when you don’t feel hungry but are not sure when you will next eat etc is smart eating. In ED recovery there will be times where you don’t feel hungry as your hunger signals are not working. Eating mechanically here is important, giving yourself to eat even when you’re not hungry is essential. Set an alarm, reminder if you have to.

10. Eating when other’s around you are dieting. Giving yourself permission to eat unconditionally- this is definitely a hard one. With or without disordered eating.

11. Permission to eat, just because. Because it’s nice- something our weird ED brains can have a hard time with. My brain often questions why. There does not have to be a reason.

12. When you don’t feel you deserve to eat. Food has no moral value. You always deserve to eat. Find that permission.

You always have full permission to eat what you want, whenever you want no matter what. We all need to be able to grant ourselves unconditional permission.

Identifying Core Values, in Eating Disorder Recovery

Finding life/ meaning beyond an eating disorder

Recovery involves a great deal of self exploration and a deep development of self -awareness, a level that most people will not their entire lives. This is something to be grateful for.

When I first started treatment for anorexia, I remember my therapist drawing out two pie charts. She asked me to fill in the blank circles with what was important to me in life and as a person. Her point was to show me how warped our thinking becomes when we are living with an eating disorder.

My pie at the time is a world apart from the one I would draw today.

The original pie was occupied by over valued pre-occupations with food, fear of weight gain and then tiny snippets of other aspects such as family, friends, career, “hobbies’ (at the time it was labelled as hobbies rather than individual interests because I didn’t have many besides controlling my food and shape) now this would include things like, creativity, art, writing, yoga, running, being outdoors, travelling, my veggie patch, puzzles, learning and discovery. My point being it’s a lot bigger and I have reconnected with individual interests and no longer struggle to think of what my “hobbies” actually are. Recovery involves increasing self awareness and discovery.

I wrote a blog on “you are not your eating disorder” some months back. Whilst I still believe this to be true, it is somewhat simplified because much of our identity is unveiled to us as we move through recovery.

When I was first asked, “what are your values?’, by my therapist I had the default answers, but they weren’t the core. I’d long lost touch with what they were. I suppose I identified as my eating disorder.

I had my values I would spurt as if off of a script because I felt they were what they “should be” I had my values that came from my eating disorder, but truthfully at the time I had no clue what my “true” values were.

Personally discovering and reconnecting with “my” virtues and traits has been instrumental in my recovery. There’s a sparcity in research pertaining to the use of connecting with values and eating disorder recovery but I believe for many of us it could be the missing link.

We know that eating disorders can be ego-syntonic ( we believe our actions, beliefs to be appropriate and congruent with our central personality, in contrast to ego-dystonic). Meaning many of us “value our eating disorder, see nothing wrong with it” and it helps to explain the resistance to give it up. This is where the whole rhetoric “you are not your eating disorder comes in, but to begin with we often view this as synchronous with our identity. Through the self exploration we bring the ego-syntonic values into question, essentially resulting in dissonance between the contradicting values.

I’ll use my own example, when I used to turn to restriction, I’d escape the negative emotion I was trying to avoid and feel a sense of mastery of control, in the early days anyway. All of these appeared congruent with my core values; self control, self discipline, hard working, dedicated. But the more I explored what my true values were, I could see there was an incongruence. It was bringing these values to the surface that helped me move past the ambivalence I felt towards recovery.

Some of my own values and how honing them helped motivate me in recovery..

1. Honesty and integrity. I don’t think I need to expand, I became extremely deceitful in order to protect my eating disorder. I could see that lying was causing a great power struggle. Giving myself permission to become my authentic self, learning to communicate with myself and support helped me to align with these values and realise living with anorexia was not living as my authentic self

2. Compassion, forgiveness, courage, perseverance, curiosity are some of my core values. Part of my self healing work has been to learn to set boundaries, to have an “off” switch, developing the compassion towards myself that I show others and practicing self forgiveness.

3. Solitude is important to me, I can be at home in my own company. I try and nurture this by following my morning routine where I get up slightly earlier and have 30 minutes to myself. I often use this time to journal and check-in. Expanding on this further I’m someone who needs routine to keep grounded

4. Connection is important to me, although I need time on my own, I thrive on connecting with others. My family, friends, other people in this community. This was incongruent to how I was behaving with my anorexia, I become isolated, withdrawn. I believed my behaviours were helping me connect, enabling me to control anxiety around social events for instance. However, what actually happened is I avoided the social events, I pushed people away. Highlighting the conflict of the ED value and my own.

Some food for thought…perhaps journal prompts

If you’re in a place where you are still trying to figure out your values, something I found helpful to start with, was thinking of people I admire. What is it about them that I admired?

What are some of your character traits? How do they help you or hinder you?

What are some things you believe in?

Identifying our core values helps us make decisions about the future, they shape our relationships are central to who we are. They help us to understand that when we are acting out of alignment to our core values it brings about distress and often maladaptive behaviours. This is why I truly believe connecting with our core values assists us with developing coping skills for situations and finding inner peace.

“Weigh days” in ED recovery

Your worth can never be defined by a number

Weigh day in recovery This used to instil dread and fear into me and so I want discuss this further as I’m willing to bet it’s a common experience in recovery.

I’ve already talked about my tenuous relationship with the scales. However in early recovery when we are “ nutritionally rehabilitating” the scales can be important in therapy. Weight restoration can be an integral part of ones recovery.

I was doing my usual re-reading old journal entries and so many were about “weigh days”.

For me, I used to experience extreme anxiety leading up to weigh day and then days following.

Why is “weigh day”so traumatic for someone in recovery?

People with eating disorders tend to obsess over numbers, whether it’s calories, clothes sizes, or the frigging number on the scale. The numbers torment us. We live by them, we fear them. Therefore on the days I had managed to gain weight my eating disorder voice would throw a full on wobbly, if I’d lost it would throw a full on wobbly. You cannot appease an eating disorder.

For my family the “weigh days” were important to them, they were afraid it was one of the only ways the could tell if I was “doing ok” or slipping because of the secretive nature of ED. This reinforced the anxiety as-well, the concern of feeling like a failure or the threat of more focus being placed on me. But, I had lied before, many times and so I respected the validation they needed whilst I rebuilt trust.

The “target weight” issue

I personally don’t feel that “target weights” are helpful to most of us with EDs. I completely get why health professionals use them, but I personally feel that they have the potential to perpetuate trepidation and internal judgements that exceeding that target weight is to be feared or avoided.

Realistically most of us go way over. We go over because we need to, it’s called overshoot and it’s natural. It’s your bodies way of protecting you in case another famine arises. It’s why when people continually diet end up heavier because their bodies no longer trust them. However eventually when you let go of the diet BS, your body figures it’s shit out. But try rationalizing that with someone fighting an ED voice and going against an entire society who shares the ideology weight gain is a negative.

I believe holding on to my target weight kept me stuck, every time I got close to I’d bail on my recovery efforts, if I surpassed this arbitrary number I slipped. Until I let go of weighing and ate unrestricted. For some I imagine having a rough idea of a target may help them but for many like myself it can be a sticking point.

I know that, eating disorders love to hold on to numbers, to manipulate our thoughts and behaviors. Mine convinced me I needed to know my weight in early recovery to “monitor progress to “check”. Let’s cut through the crap, my eating disorder wanted to know the number as a “form of control” to ensure I wasn’t “gaining too much, too fast” it colluded with the numbers and therefore my behavior. This was continual until I was willing to accept my motives to know the number was not healthy.

Additionally certain values held specific connotations to previous relapses, or behaviors. For example the “target weight” hurdle was a huge trigger. I found it almost impossible to reach or pass when I knew the value because my eating disorder voice would get so much louder.

Recovery is hard enough, why make it harder for yourself by observing the scales? If you follow the recovery process, eating enough, not engaging in behaviors your body will recover and reach its natural weight without your eating disorder trying to complicate/ control things along the way.

For a while, I couldn’t know my weight, or (when agreed with my therapist) we reduced the weigh days.

There are pros and cons to this. Weight provides teams with anthropological information about recovery.

Regardless of whether it’s vital you are weighed you do not need to know your weight, you have the right when you attend a medical appointment to be blind weighed.

Fast forward to now, I’ve been in recovery for a while, there are days where I feel a draw to the scales. I know it’s never about the scale and I return to my recovery tool box to find what I need. I do not weigh myself. If I have to be weighed I would like to think it would cause little more than an internal stir.

If I have the situation where I have to be weighed:

I will likely follow my own healthy voice’s advice and ask for the number not to be made known to myself. Because, weight has no value to who we are. We do not need to know. It’s not worth giving the unhealthy part of my brain ammunition.

Fat bias

When I started this blog, I had simple objectives. First of all I wanted to share my lived experience of recovering from anorexia nervosa. Blogs were a really instrumental source in my own recovery. Secondly I wanted to debunk myths and stigma attached to eating disorders, especially from a perspective of someone working within the healthcare profession. However as time has gone on, I still have these intentions, but I also wish to be a voice in the health at every size movement. It has become increasingly apparent how much fat bias exists within healthcare. Now I am more aware of it than ever, I do not intend to be quiet about weight stigma.

People are being harmed every day by weight stigma. The issue here is, weight stigma is not widely recognised yet. How can something change when it’s not recognised as a problem? We keep talking about it.

We aren’t even taking steps to reduce it within healthcare, because we don’t know it exists, even amongst ourselves.

Just yesterday a fellow doctor posted a question on social media asking for weight loss advice for her and her partner. The doctor went on to describe all the various diets both she and her partner had tried over the years. Further more she described her thin privilege but then “menopause occurred and I gained an unacceptable amount of weight”. Most of the responses to the post disappointingly were encouraging various other diets, only one of my colleagues responded encouraging her to explore HAES, discouraging dieting.

If those of us working within healthcare have such implicit biases, how can we expect to provide non discriminatory care to “fat patients”? I do not use the term obese as obese implies pathology, it’s a medical label for “fat” and fat is not a disorder or pathological problem in isolation. It’s a deep seated belief that has infected our entire society that fat is directly related to health. Though correlations can be present in certain conditions, it is not causation and not the sole indication of health. I repeat, correlation does not equate to causation.

I would be very hesitant to receive eating disorder treatment from a provider who was not health at every size aligned. I believe biases here potentially harm our recovery, comments such as, “we won’t let you get fat in recovery” this to me should be a red flag. You might get fat, if you are supposed to, if your body needs to and so harmful statements like this perpetuates the fear of weight gain and does not address the core beliefs that need to be rewired.

We need to be shifting the rhetoric of weight = health. If we move away from this paradigm healthcare becomes a lot more accessible and non discriminatory.

Why does it matter?

One of the fundamental lessons from medical school is to provide holistic care, individualised to every patient. Doing no harm to our patients. Yet, we try to treat every “fat person” like they are one person. There is a lack of individualised care. We are not providing holistic care when we have a “one size fits all approach” as long as that size fits within a certain range on the BMI chart. This in itself causes harm and is not practicing the fundamental principle “do no harm”. Patients do not receive the appropriate treatments to many conditions because of weight stigma, whether it is surgical procedures, access to eating disorder treatment it’s all discrimination.

What can we do?

Educate ourselves. If this is the first time you have even heard the concept of health at every size, or weight stigma I encourage you to check out some of the links below.

Leave weight out of the picture, not every patient needs to be weighed every visit, consider if it’s necessary. Ask if the patient wants to know the number before you do it, some people prefer or need this to be blind.

Address your own implicit anti fat bias.

Learn about the negative consequences of dieting.

Everyone has the right to weight inclusive care. I just want to say now, these are my own views and opinions. I’m a doctor sick and tired of hearing weight loss is the answer. I have had to work on my own biases in eating disorder recovery. I am fully aware many will not agree with my opinions, colleagues, peers and friends included and this is intended as a conversation starter.

Resources: