ARFID

Food is more than just food.

Best biscuit ever……

Yesterday, I had a strange realisation. It’s taken me almost 30 years to get to it, but yesterday I realised food is not just fuel. Food has no rules, no moral value and no foods can be ‘good’ or ‘bad’.

Whilst reflecting about my relationship with food, I craved a chocolate Hobnob. I heard ‘HH’ stipulate, ‘but you’re not hungry’. It was this thought, I rewound and re-framed my life-time’s thinking. Food, although important for fuel and nutrition is also part of connection and ENJOYMENT. It’s always blown my mind that people have just been able to easily eat something, just because. But yesterday, I understood food can be eaten whenever. Whether we are hungry or not. If we want to eat something we can, without judgement, without compensating, because it’s just food.

I was feeling particularly reflective yesterday, because I felt really fucking sad. The fact the I felt sad, set off a whole chain of thoughts. But what made me grateful amongst it all, the fact I could acknowledge and identify that emotion. For years I have numbed my emotions, to the extent when I started to feel again, it took me a while to recognise what I felt. That’s pretty common I think amongst us who have eating disorders. I no longer associate with the nickname I have had for years and use to value, ‘the ice queen’. This is not me now. Nor do I want it to be. The fact it became at one with my identity is quite disturbing to me now, as I am a compassionate person. But in the depths of ‘HH’s grips I was an emotional void. I’d get angry, anxious & irritable if my routine was disturbed, or challenged but these were pretty much the extent of my emotions. Instead of returning to my old behaviours yesterday, exercising to the point of exhaustion, pain or restricting to the point of false euphoria, to numb out the events. Instead I went for a walk out in nature listening to a podcast and then had a cup of tea with a Hobnob.

I felt grateful. Grateful I have reached a point of mental freedom to enable me to feel. Being numb is not living. I was grateful I could feel sadness and sit with it. Feelings pass and are not permanent. But eating disorders are. Recovery although hard, is also temporary.

The next thing I’m working hard to reach, is body neutrality. There is so much talk about ‘body positivity’ at present. I believe the premise of this is great, but I also feel it’s a double edged sword. It’s general concept to love and accept your body, sure. Promoting acceptance by society of shape, size, gender or race is the main aim. But, I feel there’s pressure with ‘body positivity’ as a concept. It over values of the body image itself, rather than appreciation of the body’s functions. For me, I don’t know if I’ll ever ‘love my body’ but I love the things my body enables me to do. I think very few people eating disorder or no eating disorder love their bodies. So for me, getting to a point where I do not care, or have any value from my appearance will be sufficient, beyond that a bonus. But I feel it’s healthier to see our bodies as a vessel, a vessel that allows us to do what we desire. It does not matter what that vessel looks like. That’s what I believe the social media message should be, that’s what body positivity should be.

Interestingly my ‘negative body image’ didn’t truly start until I was in the depths of my eating disorder. Sure there were things I had insecurities with, but I think most people on this planet do have hang ups. But I can say, the negative body image spiralled and it took so much value. This value is incongruent with my own true values, i’m not a shallow person, I couldn’t give a rat’s arse what someone looks like if they are a good human being. But the world becomes so small, consuming and out of alignment with our own beliefs. I really struggle with this aspect of my eating disorder, because on a bad ‘body image’ day it still has far too much space. Space that’s not relevant or part of me. However this is part of the divorce from diet culture and unlearning so many untruths that are so engrained in society. Most days now fortunately I am neutral towards my body, but i’m not where I want to be yet. I’m not where I want the whole of society to be, where body image is as relevant as yesterday’s weather. But rejecting diet culture and accepting ourselves is a start towards remodelling society’s beliefs . Ultimately change starts with yourself.

‘Portion sizes’, re-learning to eat like a ‘normal human-being’, anorexia recovery..

Re-learning ‘normal eating’ ED Recovery

I say normal, loosely. Because the majority of the population has some form of low grade restriction going on. Whether they realize it or not, any diet behavior is restriction. This is not normal eating. But it is ‘societies normal’ This is not an option for us.

When we restrict, our body adapts, by lowering metabolism and a whole heap of other changes like disrupting hunger cues. (This is partly why diets don’t work, restriction leads to a response known as ‘hyperphagia’ (increased hunger) to counteract this unnatural behaviour. Our bodies function in equilibrium and so will adapt or correct the perceived famine. For anyone who is interested like me, in evidence or scientific explanations, the ‘Minnesota Starvation experiment, led by Ancel Keys’ is the closest we will ever get to depicting what happens to humans when starved, both physiologically and psychologically. It would never pass an ethics committee today but the evidence still stands. This was a practice changing study from the forties that still helps to shape nutritional rehabilitation. It provides explanation for experiences such as hyperphagia.

In early recovery most of us experience “extreme hunger”, hyperphagia. For me this wasn’t so much physical hunger, for the most part, but it translated more as mental hunger or feeling off. Regardless it’s still hunger, if we are obsessing about food it’s because our bodies are needing fuel. I was constantly thinking about food, when I was next going to eat, what I could eat, worrying about whether it was ok/ not enough, even dreaming about food, obsessing about food, reading recipes the list goes on. It felt relentless and really intrusive. It was hard to think about anything else. During this period, I would also find it hard to leave food on my plate, even if I felt full, I guess it was my brain freaking out, fearing that I was going to return to a state of famine again. I’d feel almost a compulsion to finish everything. I never felt satisfied early on, I would be painfully full but still thinking about food. This has gotten better with time. I don’t feel the need to finish everything in front of me. This obsession with food was different to that in the depths of my eating disorder, where I would obsess over food then. When under the grip of ‘HH’ I would control everything around it, I’d cook for others, but never eat what I’d made. I’d bake a lot at this point, now I bake if it’s someone’s birthday, I’m just not interested or obsessed like I was. This is common I think, now we have a rule in my house if I make it, I eat it. Some days, if I haven’t eaten quite enough, I find my extreme hunger can return the next day, but this is getting less and less.

This is terrifying when it first happens. If it is happening to you, or someone you know, extreme hunger is normal, it’s a healthy response to energy deficit and reintroducing nutrition. It showed up for me months later in recovery, after I got back on track from a relapse. I didn’t experience it prior. Bingeing is normal in this setting. It’s distressing, it feels it’s going against everything the eating disorder believes. But the only way I found it improved was to listen and respond to it. Restriction remains the enemy for this.

Some-thing I still find difficult, is what’s normal. I also think, there probably isn’t actually a normal, because what’s normal for one person is not for another. However serving sizes is a tricky one, I can under-eat some times because I have done so for so long and my perception of what a ‘normal portion’ is warped.

I have found asking for help with this, although humiliating as an adult and at time unbearably uncomfortable, I often run my lunches past my husband and if he tells me it’s not enough, I don’t argue, I add more. I am trying to re-learn normal eating.

Another thing that helped me, although at the time I hated it and argued until I was blue in the face was relinquishing control around food. By this I mean, I was lucky my partner took complete control of what I ate, when I could not make healthy decisions geared towards recovery without ‘HH’ sabotaging. I was not allowed to cook, prepare meals, or enter the kitchen when meals were being prepared. It was one of the most humiliating experiences of my life and there were times when I would argue, shout, cry, throw, he would force me to eat what was in front of me. I was like a child. But worse, I was an adult having a meltdown. But this role was necessary for a short time, because if left alone, I would skip ingredients, make smaller meals, substitute ingredients ‘for healthier’ alternatives etc.

But it was important for me to regain independence quickly (for me and my partner) and the only way I could was to suck it up.

I cannot express the grattitude I have for my partner, I think people who support a person through eating disorder recovery are saints, they see the worst side of a person imaginable, because a caged animal will always lash out. I have apologised more times than I wish I’d ever have to in a life time. I think this is where it’s useful to seperate the person from their eating disorder. We are not our eating disorders, and the non-negotiations are with the eating disorder, not the person being over shadowed by it. This does not give a free pass to be a dick, it’s just to help understand why you have to keep fighting for recovery. Thankfully this wasn’t needed for long.

For a short while, I followed the principles from Gwyneth Olwyns, homeodynamic recovery. I like evidence and this is evidence based. I will link this below. I do not count calories and find doing so to be detrimental, however this principle sets minimums and it helped me for a short period when trying to become independent again.

One thing I’ve accepted is, comparing what we need to eat in recovery to someone who has not just waged war on there body is never going to be helpful. We need more than most people to heal. Healing doesn’t end at ‘weight restoration’, we still have a nutritional rehabilitation, inner repair, mental healing beyond this. Who knows how long this will take. This, Is hard for someone with a restrictive eating disorder, but I believe it’s true and giving yourself permission to eat whatever, whenever and often ‘more’ than people around you is an important step. Letting go of the judgment. I’ve only recently gotten to this point, I used to find it really really hard to eat in front of, or with others. That’s isolating and something a lot of us have to overcome. So ignoring comments about food is important, hard but totally achievable.

1. The Minnesota Starvation experiment: https://archive.wphna.org/wp-content/uploads/2016/01/2005-Mad-Science-Museum-Ancel-Keys-Starvation.pdf

2. Gwyneth Olwyn, Homeodynamic Recovery Method: https://edinstitute.org/blog/2013/3/31/homeodynamic-recovery-method-guidelines-overview

Re-reading old journal entries, anorexia recovery. What language does your ED voice use?

Reframe negative eating disorder thoughts

I’ve been journaling for a long time. I was re-reading an old journal, one I started in early recovery. I found there was a theme to the language I used to describe how I was feeling, or when journalling about behaviours.

It was all self critical. Extremely negative.

Common words I used: ASHAMED, DISGUSTED, LONELY, ANGRY, FAT. This was even when I’d documented small positive steps to change.

“I feel ashamed, I want to crawl out of my skin, I feel trapped, consumed & powerless. I’m disgusted I’ve allowed myself to get into this predicament. I don’t feel I deserve the help. It’s a spell I cannot break no matter how hard I try I’m stuck”

This was an entry I made a few weeks into recovery.

Comparing this to more recent entries, there’s none of the negative language. It’s incredible how consuming our eating disorders are, they overshadow us, they thrive on secrecy and feed the feelings of isolation and shame grows and grows.

Now that I’m much further into recovery, I can seperate this unkind voice from my own, kinder, compassionate in built healthy self voice. I do not allow myself to use language such as ashamed, disgusted, instead I reframe them and ask myself what I’m needing. Why the ‘HH’ voice is spouting these terms. If I have a thought that sounds hypercritical I know it’s coming from ‘HH’ and not me, and serves no purpose in driving my recovery.

Self compassion is difficult in early recovery because we are listening to the negative thoughts. But as we grow stronger in recovery it’s easier to be kinder to ourselves. Something we have to re-learn to do. After being the opposite for so long. It feels uncomfortable. But anything in recovery that’s uncomfortable is good.

I found it hard to do NOTHING. Or pause have a cup of tea when I felt tired, or allow myself to feel emotions. But with time, one of my favourite pass times is to sit and literally do nothing with a cup of tea ( and most often a chocolate hobnob) Yes I am English and do believe this solves everything. I never thought that weekend early in recovery I would be able to to do that. I thought ‘HH’ would berate me for sitting for a second. Sure, there are days where I do hear the negative utterances. But the difference is now I don’t turn against myself, I don’t tell myself I’m ashamed of myself, not deserving etc. I tell myself I am worthy, I can live however I want and I don’t have to listen to the thoughts. I am not those thoughts. What thoughts do you need to re-frame?

Reflecting on Christmases past, present and Christmas future in anorexia recovery

Rockerfeller tree. ED freedom

This time last year, I was getting both excited and off the chart anxious about surprising my family in the UK for Christmas, with a holiday on the way via New York.

So much has happened over the past 12 months. We couldn’t go and do this now even if we wanted to. COVID-19 has changed everything for everyone.

We were lucky we could make this trip last year. However I think we become increasingly reflective in our recovery. We have to I believe, to make sure we don’t become complacent and let the foot slip off the gas of progress and allow ourselves to slip backwards. SO naturally this means we reflect on where things lie. I have been thinking about last year’s trip a lot these past few weeks, partly because my family bring it up at every zoom chat and partly because we are making plans for this Christmas.

I can see how far I have come during this time. I felt more dread and fear around the whole trip than I did excitement. How fucked up is that?! I have always loved Christmas and a massive dream was to visit New York at Christmas time. My family Christmases have always been epic and I hadn’t spent Christmas with my family for 8 years so it was going to be special.

Uptight and not present…

Seeing the Rockerfeller tree, snow in Central Park, Macy’s displays was magical. But something still felt missing. ME. I wasn’t really present. It was like I was observing someone else experiencing what I’d always dreamed of. I sat feeling the coldest I had ever felt at a Soccer game, worrying about what we’d eat, how I’d compensate. Fixating on what my families reactions would be having not seen me for ages. Worrying about the Christmas dinners, socials it went on and on.

Then the Christmas itself- I felt numb and empty and so sad. It was not the reunion, surprise I envisioned. I was stressed the whole time, controlling everything. I wanted nothing more than to make last Christmas special, happy. But I hadn’t really committed to recovery at this point, so I had set myself up for a difficult time. Which was unnecessary.

Reflecting on progress…Now fast forward 12 months- I don’t act on ED behaviours, we are spending Xmas with friends this year. I have worked hard to be here, I have so much more freedom with each day. I’m not worrying about this Christmas, I’m looking forward to it. Looking forward to being present, being relaxed and not a controlling freak who has to micromanage everything. But this brings me sadness too. I cannot share this with my family. I cannot show them how things have changed. I hate that, the memory that should have been really special I allowed my ED, yet again to dominate, dictate and taint.

This brings me on to my next point, I know in order to get here, to keep moving forward so that I will be able to share happy holidays with my family again, I have to make a conceited effort every day to make positive steps. If you had have asked me 12 months ago, what does recovery mean, I didn’t really have a clue. I remember my therapist asked me to write down what recovery meant. However, I think at the beginning of recovery we don’t know because we are still overshadowed by our ED personality. Not so much our healthy self. I think it’s important to think about this early on, but I’m not surprised my list is different now. For starters 1 thing that is on my list of full recovery means, being able to spend time with family without any ED anxiety, complete freedom. Being able to travel without any compensation, anxiety about eating a different routine. Not being bothered by other peoples comments pertaining to my food, appearance, diets bla bla. So many more.

But in the early days it was two dimensional and clearly written by “HH”: I.e I don’t want to be cold, develop healthy relationship with exercise etc.

I think we grow in every sense as we recover. I have a far better understanding of who I am now. So in short reflection helps us to continue forward.

These would have given me so much anxiety a year ago. Now they’re just yum.

Clothes shopping in eating disorder recovery…

Phases of clothes shopping through recovery is Like “the origins of man” demonstrated by this spongebob gif!

I went clothes shopping last week. No one tells you how hard this experience is in recovery.

I decided to charity shop my “skinny” clothes. I will never need them again. It’s almost like a grieving process. I never liked how I looked at my lowest weight. I was self conscious. But buying small clothes was something my ED used as targets. Although I never felt better when I met them. I actually felt worse and worse, especially when nothing actually fit. When I started gaining weight, “HH” freaked out. Suddenly nothing fit and I felt self conscious all over again.

EDs will try and make you hold on to old behaviors or reminders of it. For me it was keeping these clothes “just in case” but they were holding me back. How can you recover with the thought you might one day fit in the clothes that fit when you are nowhere near your natural body shape or size. You can’t stay there. Not healthily anyway.

Buying clothes throughout the “weight restoration phase” is traumatic. I would recommend if you’re going through it, you don’t do it alone. It’s triggering no matter how far in you are or how committed. I would say this corresponds to the third picture in the gif. You are in no mans land. You’re not in the emaciated shell, you have fat in weird places so it’s hard to find things that fit and feel comfortable.

I went with a friend I could trust and my husband. I asked them to ask me questions like, how I felt in the clothes rather than making comments about appearance or fit. I looked for clothes I’d feel comfortable in at this stage in my recovery where my weight isn’t evenly distributed. Clothes that would accentuate other features that I’m less insecure with. For me this was flowy dresses. I have spent a long time in clothes hiding my weight for the other reason. I don’t want to hide my shape at all now, but I do want to feel comfortable. ‘HH’ longs for the old clothes but healthy me sees it a triumph of how far I’ve come.

You don’t have to like your body, I have become relatively neutral towards it. However uneven distribution, clothes shopping with size tags, mirrors is not fun. I also only bought a few things I really needed rather than a whole new wardrobe.

I didn’t do it all at once and checked in regularly. I talked through my HH thoughts with my psychologist.

Last week I went shopping on my own. It wasn’t that hard. It doesn’t need to be hard. Plan what you need, check in with your support and look after yourself.

Reckon this stage 4th sponge bob on the gif. Powering through, accepting the changes. Grateful for what you can do in your body and with your recovered body. Don’t think it’s necessary to love your body but if you do that’s a win and definitely the last sponge bob on the gif.

Eating disorders don’t discriminate

Eating disorders affect any age, gender, body size, ethnicity and socioeconomic background

One of my main motivations for starting this blog was to contribute from the ground up in informing misconceptions surrounding eating disorders.

Look at the person to your right, look at the person to your left and in front of you. (If you’re currently alone try this next time you’re in a room full of people). Chances are one of those people has had some form of struggle at some point in their life with relationship with food/ body image.

If you’re like me, you had possibly never thought about what a person with an eating disorder looked like before you had one or supported a person suffering with one. Eating disorders affect ANYONE. The sad truth is, society has helped create an image of what an eating disorder should look like. Typically a white, emaciated, teenage girl with anorexia nervosa. Although I fitted this demographic, this is actually the rarity. I want to help change people’s understanding of this. I want treatment to be available to everyone, this happens with awareness of what an eating disorder really looks like.

A person in a “larger” body may be as unwell as the stereotypical emaciated person. Anorexia, can affect any size, weight and BMI cannot identify this. A person in a larger body is less likely to seek help when they are significantly impaired by disordered thoughts or physiological consequences of eating disorder. They can be as malnourished as a person who appears emaciated. Seeking help is harder, why? Because when a person in a larger body loses weight they are often rewarded by society, health professionals. Making it impossible for them to find help or feel like they need help. Health professionals carry their own biases and this needs to change.

Additionally anorexia although the most portrayed eating disorder, is the least common eating disorder. Binge eating disorder, Bulimia, OFSED are more common but talked about less. Why? Because often they are not the stereotypical image.

Globally eating disorders affect close to 1 in 10 people (10% roughly)

Eating disorders have the highest mortality than any other psychiatric illness. Startling.

Before I started recovery, I used to get angry with myself. I questioned how as a doctor I could possibly be having this struggle. I have seen first hand the consequences of eating disorders. Even in the thick of my disorder I treated patients medically, this makes me feel sad now. There was a constant dissonance within. It was like a DVD playing on repeat in my brain, you should know better, you’re a doctor, why don’t you stop? This highlights beautifully the grip an ED can have on someone. It is a mental illness. I could not stop. It was not a choice. It was not a diet “gone wrong” I didn’t like being thin, although I couldn’t stop. So how can we expect others to understand when we don’t understand ourselves.

Not only was I a doctor, I was an adult and in healthcare there is a stigma towards anything other than being 100% all the time, let alone suffering from a mental health problem. Not only did I question myself, how could I be so irresponsible as a doctor. I received the same judgement, confusion from those I chose to share my struggle with. They could not understand how a healthcare professional could behave this way. That made the inner disgust and struggle that the ED likes to feed on so much more powerful. This was not their fault, this is society’s lack of understanding of mental health full stop.

This, I hope highlights how EDs sink their ugly claws in, and become an unwanted hitchhiker. The sufferer may think they have control, but when challenged to stop behaviours, thoughts they cannot. It adds to shame when people describe eating disorders as a choice. Some EDs may have started from “good intentions” like a special diet for health reasons etc, but once the disorder develops, takes hold it is crippling. My ED was a perfect storm, I had the “perfectionism traits” genetic vulnerability and I dieted. I wanted to stop, I did know better, I couldn’t stop until I sought help. But once I knew it was an illness, even if others didn’t understand (they don’t have to) I could use it to my advantage and make choices towards recovery. EATING DISORDERS are not a choice, or a lifestyle. They are a mental illness.

The earlier someone seeks intervention for an eating disorder the better the outcome. That’s not to say that someone who has had an ED for many years cannot recover, because ANYONE can recover. But recognising signs you or someone has an eating disorder is the first step towards recovery. Understanding the diversity within eating disorders is fundamental to change.