Three Years in Eating Disorder Recovery

Sat in the car with Ben driving me to my first ED therapy session was the scariest day of my life, but it was also the beginning of my life. Sounds dramatic, well it was.

I sobbed the entire way, I yelled at him when we got stuck in traffic and the prospect of missing this appointment. The extreme reaction came from utter terror that if I missed this appointment I might never be able to re-find the courage that was leading me there and fear of starting the hardest battle of my life.

I had been to therapy before, when I was 7 and struggling with OCD and again a couple of times as an adult but I’d never talked about the eating disorder.

I remember the room and the welcoming demeanour of my then therapist who went about my intake assessment, I recall the paper questionnaire she had me fill, (EDE-Q) exploring my relationship with food body and mood. Distinctly I remember the battle in my head about how honest to be.

The room was cold and it was pitch black outside and I’d rushed from work, because I didn’t feel I could attend this appointment in work hours. At the end of the session I remember telling the therapist “please don’t label me”

She replied with a sentence that changed my life. “You have anorexia, restrictive type”

I felt a rush of complex feelings, Shame, disgust, denial and most prominent RELIEF. Relief I might not have to do this anymore.

Relief that now it was out in the open I couldn’t completely deny it anymore. Although at that very moment in time there was no part of me that felt “ready to give this part of me up” I also knew I couldn’t keep it up either.

The weigh in, which would become a regular feature of our sessions following, made the ED scream. I wanted to leave and not return for my second session but the present but quiet healthy voice would make me show up.

And three years on, that quiet healthy voice is now the predominant voice and I’m grateful to her.

I went back 3 weeks later and started CBT-E. It was the toughest and still remains the hardest thing I’ve ever done, hands down. I affirm it saved my life, in every sense. But 3 years on from that first meeting I wanted to share some hard truths.

1. Recovery isn’t a quick process. When I wrote a blog last “year- two years in recovery”, a large part of me hoped and thought by now I’d be saying I was fully recovered. In some ways this black and white all or nothing thinking kept me stuck. It was putting an unnecessary pressure on myself. There’s not magic crossing line.

2. You don’t always have to want to recover in order to do it. I mean when I reflect on that first appointment I certainly didn’t, but I started it anyway. There are days now, where the constant of my eating disorder feels like an easier option than recovering. But when it comes down to it, I hated my life with an ED far more than in recovery. Recovery will also not be forever, whereas an ED would be or a race for death. I don’t want to die and so even on the days where the ED comes knocking it no longer has as much power.

3. My definition/expectations of recovery have changed with time. Like I said, I no longer have a self determined end date for recovery. Instead it’s a commitment I make to myself over and over, with the hope and expectation that one day I will confidently exclaim I am free.

4. Slips, lapses happen. I’d be completely disingenuous if I pretended recovery has been linear. I’ve probably had more slips in the last 12 months than the 12 months prior to that, but each slip/ lapse has given me much needed information and education. I’ve gotten to learn so much about myself and it’s been generally easier to pull myself out of each one. It’s shown me areas of recovery that require my attention and focus to move forward and prevent the same slips later.

5. Self compassion. As a typical ‘all or nothing’ thinker and perfectionist tendencies it’s been one of my biggest challenges to learn to be self forgiving, to show myself kindness and compassion particularly in moments of struggle. But eating disorders feed on this inability to be kind to ourselves and practicing these have been by far one of the most powerful tools I’ve found in my recovery. This includes learning to talk back to the negative critic with kinder & gentler affirmations. Often, accepting what the eating disorder tells me and countering those thoughts with a healthy alternative. This continues to be something I work on. My journal is full of dialogues between my healthy self and the eating disorder voice and I gain insights to recurring themes or things that are keeping me stuck.

6. There are many beautiful things in recovery. My husband recently sent me a text “do you know what I really love? That the real Nikki is almost fully back, despite the shit that goes on in your head, the goofy girl that’s always been there is coming back more and more”

I screen shot that text and in moments where the ED is screaming at me, I read it and use it to motivate me to make the right decision. Finding something that can help motivate you in tough moments can really help, whether it’s a post card or somewhere you want to visit, an affirmation or a text from a relative can often empower you to fight back.

Now here’s where I highlight once more, I don’t always like recovery but if I want to stay that “goofball” my husband, family and friends love, I have to fight that voice, sometimes many times in a day. And this lends me on to another recovery tid bit.

Connection. Connecting with others in recovery, connecting with those that have trodden the path before you and connecting to your why’s is like an eating disorder recovery essential survival kit.

Connecting with people who ‘get it’ has helped me more than I can express in a simple blog. But if it’s something you’ve been reluctant or afraid to do, please consider it. Talking to people who ‘get it’ often without having to say what “it” is, really helps in several fronts; feeling seen, not alone or crazy. Not to mention the unwritten support and etiquette that most people in recovery show each other (I.e automatically knowing what Info is harmful, like numbers etc) without having to ask someone not to share things likes diets etc that is normalised outside of the ED recovery community. This can also lead to a level of accountability the “wanting to set an good example or help others” can inadvertently push you forward.

7. Connecting to my why. If I was to share what my why was three years ago, it would be very different today. The only thing I knew then was I couldn’t live that way any longer. Now, my why remains dynamic but is also much broader. I’m no longer a one dimensional figure where my life revolves around food and exercise.

What has recovery taught you?

That’s it my reflections on the last three years in recovery, who knows what I’ll find in the next 12 months, but I know one thing I’m letting go of the pressure of setting myself a recovery deadline and I’m just going with it.

Navigating Work and Recovering From an Eating Disorder.

Might work be an area that requires your attention in ED recovery?

If I was to ask you what one of your most challenging situations in recovery has been, I expect a lot of you will answer, navigating recovery and work.

What is it about work that makes it difficult to remain in recovery or on course with your goals?

Taking time off from our jobs/ school or college may not be possible for everyone in ED recovery. It wasn’t for me personally. There are times, where I know not being at work would have been really beneficial to recovery. Taking time out is beyond the scope of this blog and very individual.

I want to share some reflections regarding the relationship my work has had in my own eating disorder with the hope this may help you.

Considering many of us spend more than half our adult lives at work, it may be we need to put extra “work” in to maintaining our health in our place of work. Finding a way that means the two are not in conflict is vital. Both living with an eating disorder and recovering can be very stressful, managing this with the stressors of work can compound this further. It’s exhausting.

Ideally a person who is in the early phases of recovery wouldn’t be worrying about their career when the main goal at this time is to stay alive, yet because of a plethora of reasons, such as financial worries, stigma, access to care this is the reality for many. Many jobs lack the flexibility that is so needed to make progress in recovery.

Recently, I moved city and role in a new hospital.

Before we moved I told myself , “this was going to be an amazing fresh start in terms of recovery”. Before I go any further, I still have this view but I’ve had to shift my expectations and time line.

I came here with the mindset; people here don’t know my past which means I can start a complete fresh, ‘I will eat with people, eat all the foods I’ve not been able to in previous jobs and I will break away from the ED disorder identity’.

** To be clear, I ’m not ashamed of my background or struggles and if asked I will elaborate, however I want to recover, and not being tied to this ED persona is important to me.

My goal is to not be seen as the person who is ‘weird’ around food, or left out of social engagements that involve eating. I’ve missed out on this for years and my goal is to heal this relationship. Making connection with others, is recovery to me. To get to that, this for me means taking smaller steps.

Okay, so fast forward 6 weeks into my new job. I’ve felt completely perplexed by why my intentions hadn’t come into full fruition.

Let’s break this down, why might be harder than anticipated?

1. Firstly, let’s bin the notion you can ‘out run’ an eating disorder. I believed for years I could move and leave my ED behind. Time after time I proved this wasn’t a thing. I moved half way across the globe and my eating disorder followed. And so, let me save you the wasted time: YOU CANNOT OUT RUN AN EATING DISORDER.

2. People spend a lot of time at work. Sometimes people are afraid to share their struggles for fears of; discrimination, stigma or bullying. I was and to a certain extent still am.

3. Work can be a trigger for many. I’m not for a second saying certain occupations cause an eating disorder, however I strongly believe in those of us with the vulnerability to developing an ED, certain jobs may perpetuate them. Having this knowledge may be an asset in preventing and helping people to recover, for both employees and your employer. For instance certain occupations attract particular personality traits. Working in fitness, fashion, catering may draw specific trait’s. Working in the food industry may both be motivated by an ED or exacerbate. Certain careers like professional sports, fashion, entertainment and healthcare reportedly have higher incidences of people with eating disorders. Doctors’s may be at risk through; perfectionism, hard working, people pleasers and combine that with a culture where it’s praised if people forgo breaks, being vulnerable and speaking out against struggle is seen as a weakness. The stress of looking after others, exams, career progression, missing social events, It’s a perfect storm for those of us with the ED vulnerability.

4. Neural pathways take time to develop and naturally take time to deconstruct and rebuild new pathways. If your ED mindset and behaviours are entangled with your job, then it doesn’t take a rocket scientist to get why it takes time to resolve. (Though it’s taken me until now to realise this for myself).

5. Culture and societal pressures, “diet culture, weight loss, fad diets” are almost seen as a way of workplace bonding. People can fear being ostracised by speaking against this or simply excluded if they try to protect themselves from these otherwise seemingly innocuous conversations.

6. In the same theme as above fearing social engagements that involve eating with others can feel like it’s thwarting making connection’s and perpetuate this spiral.

7. Work place canteens may serve as a barrier to some people, the lack of options coupled with social anxieties may add a layer of stress.

8. Time pressure, work related stress may exacerbate eating disorder thoughts and behaviours especially when eating disorders have been the maladaptive coping strategies for stress.

9. Work may reinforce self esteem issues. If a person’s eating disorder is entwined with poor self esteem, a person who feels negatively about themselves at work or has poor confidence it’s unsurprising this may manifest in their eating disorder’s.

10. Imposter syndrome may be both perpetuated by an eating disorder and in some ways recovery. This is a big one for me, as I battle the eating disorder it can cause a imbalance of energy. I become anxious my focus on recovery is thwarting my career progression. I feel added stress and pressure, which can become a trigger in itself. However if I am not focusing on recovery, my work performance slips at the cost of my obsession with food and numbers. My anxiety can make me worry about losing out on promotions or career progression. Yet despite having to expend this energy, it will never impact upon my work in the same detriment that living with an eating disorder can. Being patient and kind to yourself here, I feel is the key. Forgiving for what is.

Now we can see some of the ways our eating disorder might be entwined in our work schedule, we have given ourselves insight and a place to focus our recovery goals.

I personally feel like identifying this, is a milestone in my own recovery, but I also feel frustrated by the fact it’s something I have to consciously focus on. It’s another hurdle when so much I want to be able to say; I’m free. Free to focus on anything but recovery from anorexia. However, I also fully embrace this is part of my healing journey.

Though I don’t claim to have this figured out, these are some of the tools I’m using to help me navigate this part of my recovery:

1. Make realistic goals. I am very much a black and white, or all or nothing thinker. Recognising my thought processes around recovering in the workplace has served as a catalyst to make changes. It’s not a failure if you can’t challenge everything all at once.

2. Be honest with yourself and importantly your support team. Make use of help anywhere you can get it.

3. Set yourself goals and debrief if they need tweaking. For example my initial goals were to eat with people every day when I started here. When that wasn’t working I needed to go back to basics and work out what was serving as the barrier. If eating with others is something that causes you a lot of anxiety, perhaps starting with smaller challenges first and building up to this might be a good one. I’ve been working on challenges like; making eating regularly non negotiable, practising eating different foods and buying the occasional meal or snack from the canteen. Something I have never been able to do until now. As I’ve become more comfortable in doing this I’ve then aimed to eat with others on occasion. I might not be in a place to buy foods and eat with others everyday yet, but that’s okay! I’ve often brought my lunch in and then gone and sat with my new peers outside or in the canteen. My point here is, you don’t have to achieve everything at once, take a step back from striving for perfect. Perfection is an illusion. Start with what feels achievable right now. I was focusing on the end goal rather than where I am right now.

4. Perhaps find a colleague you feel comfortable with, someone you can eat with (they don’t have to know about your eating disorder). I used to eat with a colleague in my old job, because she had a “fuck it mentality’ around food she was a great role model ( and she didn’t know how much she was helping me)

5. If it’s an option, sharing your struggles with a co-worker or employer. This is very personal and not for all. However having people around who know about your ED may allow other ways you can be supported: making time for breaks or allowing you to attend appointments etc.

6. Boundaries, boundaries and boundaries. Whatever boundaries you need to protect your recovery, whether it’s removing yourself from triggering comments, or carving specific times in your day that align with recovery. Boundaries are like a recovery superpower.

How can you, as someone without an eating disorder help a co-worker?

It’s highly likely you work with someone struggling with their relationship with food and body. You may never know someone is struggling ( kind of the nature of an eating disorder).

But you can be a real ally in someone’s recovery by:

1. Being mindful of how you talk about food and bodies around others. Don’t be that person who encourages the cheap diet talk. Keep the diet talk out.

2. Don’t comment on others eating habits, an innocent comment such as “ I wish I could eat that, or is that all you’re having or you’re going to eat all that” might just be the comment that serves as a barrier to a person eating.

3. If someone turns down an invitation to join you in social eating, don’t stop inviting them on other occasions. When someone feels excluded or isn’t given the opportunity to participate it may perpetuate the cycle that they cannot join in or they have to keep isolated. Eating disorders are extremely isolating.

4. Be kind. Don’t judge someone.

5. If you think someone you work with may be suffering from an eating disorder, share your concern with them in a non judgemental manner ( this may depend on your relationship). They may not open up to you, but you may have given them encouragement to talk to someone they’re comfortable with. It’s not your responsibility to make someone recover ( no one can do that) and so often a person won’t need advice but a supportive ear.

6. Educate yourself about eating disorders, some of the most harmful comments come from ignorance rather than a place of malice.

7. Be a role model, show people it’s ok to show vulnerability, to talk. You’re vulnerability may be the gift a person needs to feel safe.

8. If you are an employer, you can make your workplace a safer, more inclusive environment. Providing mental health training, awareness to make the workplace inclusive and reject stigma surrounding mental health.

I expect if asked, a lot of you would join me in saying one of the biggest threats to you recovery is work. Right?

With that, it makes sense a lot of our recovery energy needs to be focused on creating balance where the two are not in conflict. Perhaps talking with your support team can help you create a more symbiotic relationship.

What else would help you at work?

Let’s Review the Evidence Behind the New Jab To be Available on the NHS, to “Defeat Obesity”

Disclaimer: these are my own opinions, personal interpretations and are for information purposes only, reader discretion advised.

On the 8th of February NICE (National Institute of Clinical Evidence) approved the use of semaglutide as a “weight loss” intervention. 

If you’ve been following me for a while, you’ll already know some of my likely thoughts on this. 

But, I wanted to look into the evidence behind this.

First of all, what is semaglutide?

This is an injection that has been used for diabetes, it essentially helps a person secrete more insulin. It is a glucagon-like peptide-1 analogue.  Simply, insulin is the hormone to lower blood sugar and insulin resistance or lack of insulin is the driving factor in diabetes. 

What’s all the hype about?

A clinical trial published in the New England Journal of medicine; the Obesity STEP 1 Study, https://www.nejm.org/doi/full/10.1056/NEJMoa2032183 

Once-weekly Semaglutide in Adults with “Overweight or Obesity” concluded semaglutide once weekly, plus lifestyle changes was associated with sustained weight loss.

What is NICE? this is an independent organisation that decides which drugs/ treatments are to be made available on the NHS.  The aim is to make care more equitable, provide evidence based care that is cost effective and safe. I’ll return to this shortly.

Back to the evidence:

The STEP 1 study aimed to investigate the effectiveness of semaglutide on weight loss in people who are defined by the BMI criteria as overweight.

Participants were eligible for the trial if:

  • They were 18 or over (pretty standard for most medical studies)
  • **with self reported unsuccessful attempts at weight loss efforts
  • A BMI of 30 or above
  • A BMI of 27 or above with “an existing weight related health problem” these included high blood pressure, high cholesterol, heart disease or sleep apnoea 
  • BMI >40 with Dexa scan prior

Participants were excluded (not eligible to participate in the trial) if:

  • they had a history of diabetes or pre diabetes
  • Had taken glucose (sugar) lowering medications 3 months before trial start
  • Treatment with similar medication to semaglutide 6 months prior
  • Had a history of depression (2 years) prior
  • Major psychiatric conditions defined as: schizophrenia or bipolar disorder
  • Previous suicidal ideation (1 month before trial), attempt (lifetime)
  • Alternative medicine supplement use 3 months prior
  • Pancreatitis 
  • Elevated markers of inflammation measured by raised calcitonin 
  • Genetic disorders in first degree relatives
  • Impaired renal (kidney) function
  • History of cancer (5 years)
  • Strokes, TIA, myocardial infarction (heart attack) 1 month prior
  • Pregnant, breast feeding or intending pregnancy 
  • Investigators’ opinion where something not covered by exclusions might interfere with participants safety or participation in the trial

So, what was the obesity START-1 trial?

A phase 3 randomised double blind, placebo-controlled trial. (what is that in English!?

Basically before an intervention or drug can be adopted it undergoes rigorous testing, the gold standard of evidence in medicine comes from good quality trials. Phases of trials indicate both information about the size and stage of the evidence. 

For most medications that make it into practice they’ve been through phases, at least phase 2 and ideally phase 3, which investigate their effect (phase 1 generally is small numbers looking at safety, phase 2 dosage before finally phase 3 the effectiveness compared to xyz). Double blind Randomised control trials mean neither the investigators or the participants know whether they are receiving the intervention (drug and In this case semaglutide) or the placebo (dummy drug). By conducting trials this way it avoids biased results (in theory).

This trial took place in 16 countries, 129 sites (a broad sample in theory). 1961 participants were included in the trial (again not small numbers)

Once enrolled participants were randomised (selected at random by a special software) to receive either semaglutide or placebo. 1306 participants were randomised to semaglutide vs 655 randomised to receive the placebo (this is a common method of trials where people are randomly allocated 2:1 fashion in the drug arm and placebo) although most trials participants are allocated 1:1.

They gave the participants the semaglutide or placebo weekly for 68 weeks as well as lifestyle interventions. After the 68 weeks participants had a 7 week period of no semaglutide, placebo or lifestyle intervention. 

Lifestyle changes prescribed to participants included 500-calorie daily deficit relative to activity, 150 minutes of physical activity a week and recording daily of both activity and intake. 

The main outcome measurements were achievement of 5% or more reduction in body weight  from baseline and percentage difference from baseline in body weight at week 68. Other secondary outcomes ( measurements that were not the central focus of the study) included: achievement of reduction of more than 10%, 15%of body weight from baseline, systolic blood pressure, cholesterol levels, HBA1c various functional questionnaire’s Including physical activity, quality of life.

What were the results?

At the 68 week weight check there was a -14.9%  change in body weight in the semaglutide group compared to -2.4% with the placebo.  This was statistically significant ( the chance that this would be demonstrated again under the same circumstances and not as a result of chance).  There were more reductions in weight in participants who received semaglutide than the placebo. The percentage reductions of 5%, 10, & 15% from baseline weight were all higher in the semaglutide group. However, although included in the results, reductions in cardiovascular metabolic risk factors such as HBA1c, cholesterol levels were not statistically different between those receiving semaglutide compared with placebo. Additionally more participants receiving semaglutide discontinued the treatment owing to adverse events (side effects) from the medication. The most common being gastrointestinal side effects including, nausea and diarrhoea. 

What were the results?

At the 68 week weight check there was a -14.9%  change in body weight in the semaglutide group compared to -2.4% with the placebo.  This was statistically significant ( the chance that this would be demonstrated again under the same circumstances and not as a result of chance).  There were more reductions in weight in participants who received semaglutide than the placebo. The percentage reductions of 5%, 10, & 15% from baseline weight were all higher in the semaglutide group. However, although included in the results reductions in cardiovascular metabolic risk factors such as HBA1c, cholesterol levels were not statistically different between those receiving semaglutide compared with placebo. Additionally more participants receiving semaglutide discontinued the treatment owing to adverse events (side effects) from the medication. The most common being gastrointestinal side effects including, nausea and diarrhoea. 

Here’s where I think it’s important to know how to understand where evidence from trials can be misleading. On the face of it, this looks like a wonder drug for obesity. ( I say this with a bitter taste in my mouth because that in itself is a stigmatising sentence). The whole pretence of this study is filled with weight stigma, it is medicalising fatness. From the inclusion criteria you can see many of the participants were included by being fat, but without any “co-existing fat associated” conditions. They were included simply based upon their BMI, which is an unhelpful assessment of health. If I believed what the media reports about this and I hadn’t have been fortunate enough to a understand that fat does not equate to unhealthy and second my medical training that enables me to appraise the findings of such research I would have been led to believe two things: all fat much be medically treated and this is an effective method in doing so.

And so lets look closer at the trial design itself:

Most trials that are considered refutable minimise biases (any factor that may make the results difficult to interpret or apply to a wide population).

Let’s delve a bit deeper into the participants included in the trial:

Both groups of participants were fairly well matched with respect to age, BMI, pre-existing problems, diabetic status, ethnicity and gender.  This sounds good at this point. But on a deeper look the participants in the trial were predominantly white female 1453 (73%) in both placebo and semaglutide group and 75% (1472) of the study population were white. 

When you have an imbalance like this, it already makes it difficult to interpret findings and apply them to non white or female populations. 

Another criticism I have with this trial, ( something to always look at when interpreting a paper is where did the funding for it come from?) This trial was funded by and designed by the drug company who make and sell the drug-  Novo Nordisk. That in itself  creates conflict of interest and potential biases. The randomisation was 2:1 this, although not uncommon in trials already results in unequal allocation and the potential for biases. Caution should be aired when reviewing confirmatory trials such as this. The trial was powered  to be able to demonstrate a difference with these numbers, but if the hypothesis is that the group receiving semaglutide are going to benefit more than placebo, then really the justification for recruiting in an uneven fashion is null and void.

The next consideration that is not documented in the trial, what happens when people discontinue the medication or life style modifications? This study promoted a restrictive diet- calorie restriction. We know from a plethora of research that >95% of people who participate in diets regain the weight they lost and more, within 3 years.  We do not know the long term changes in these participants. Additionally, the majority of the population within this trial were female and white and so I would be cautious to apply this to a wider population including non female or any other ethnicity. 

In conclusion;

I believe it is important to understand a few things before thinking about prescribing this weight loss intervention or seeking it. Fat does not equate unhealthy. Weight stigma and bias is unfortunately an inherent problem within healthcare and society and so there would be an obvious appeal to approve another drug to “fight obesity” . Being fat is not in itself a medical condition. The focus should be on addressing risk factors that are “associated with fat but are not proven causational” ,  and addressing those, for example cholesterol, high blood pressure and diabetes andit is likely more all of these are more nuanced than prescribing weight loss.

Prescribing weight loss seems like the easy solution. You’ll note, I personally do not adopt the terms, obese or overweight because these are both stigmatising and medicalising a size rather than an individual patient. 

I am not proposing to have a solution, but adopting a one size fits all approach does not seem to cut it. 

Further more, my intention was to highlight the evidence is not as black and white as you may hear and I’m imploring fellow health care professionals to entertain the notion that weight is not a reliable measurement of health in isolation. I encourage anyone who is not familiar with the Health at Every Size movement to educate themselves;https://asdah.org/health-at-every-size-haes-approach/. To not blanketly prescribe weight loss to patients in front of you. I am concerned, these medications have the capability to be abused, patients with eating disorders living in larger bodies are potentially at risk of being prescribed these rather than receive treatment for their eating disorders.  As a doctor it is our duty to do no harm, please consider this when you have a fat patient sat in front of you. 

https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

https://www.fatdoctor.co.uk

https://linktr.ee/marquisele

https://asdah.org/health-at-every-size-haes-approach/

Bye Bye BMI…

https://www.change.org/-ByeByeBMI

If I was to ask you what someone with an eating disorder looks like, I imagine most of you just described; a teenage, cis gender, emaciated white female.

I don’t blame you. That’s the current societal and media depiction of an eating disorder. Hell, most medical professionals hold this image too.

However, that image you just described is the rarity. It is so far removed from the truth.

The truth is; only 6% of people suffering from an eating disorder are underweight according to BMI. (Which if you have been following me for any length you will know that; BMI is bullshit and secondly it was never intended for individual health status)

You can not look at someone and know if they have an eating disorder. Like I said in, 94% of cases the person is not underweight by medical definition.

Here’s the real kicker, many treatment’s for eating disorders discriminate based upon BMI. The diagnostic criteria, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes BMI as a marker of severity for Anorexia. Now with the figures I just gave you, you can begin to see why this is at best problematic and at worse a health crisis. Further more, this archaic diagnostic criteria separates “Anorexia and Atypical Anorexia” into seperate diagnoses, purely based on a BMI number.

People can be underweight at any weight. A weight is not a useful health determinant. Someone can been dangerously ill at any weight.

Remove BMI and Atypical anorexia becomes exactly what it is; ANOREXIA without the weight stigma and discrimination. The BMI is an excuse to not allocate sufficient funding and it NEEDs to change if people with eating disorders are going to get the help they need.

A person can be experiencing extreme adverse effects from an eating disorder, both physically and psychologically at ANY weight. The difference is again, the DISCRIMINATION a person who is not “medically underweight” experiences.

What’s terrifying is, many people who are very ill, are denied access to life saving treatment, because their BMI is not deemed to be “low enough” and what’s worse many are encouraged to lose weight before they can access help. This also perpetuates the common notion held by sufferers “I’m not sick enough”.

Let’s frame this in another way to really highlight how twisted this is. If someone walked into a doctors office with a tumour, they would not be told to go away and wait until it gets to XYZ size have help. No because that’s just mental. Eating disorders should be treated like the serious health issue that they are.

But the problem is how we view and understand eating disorders. We don’t recognize them for the life threatening illnesses they are. Doctors don’t recognise them and society doesn’t recognise them.

Eating disorders have the highest mortality of any psychiatric condition, second only to substance addiction. Yet 94% of sufferers are not getting the life saving help they need.

We need to do better at raising awareness, recognising them for what they are, severe mental illnesses. We need to improve access, education and funding. Change doesn’t happen over night.

With the current pandemic, eating disorders have soared. Yet the most common message globally is to “avoid the Covid weight gain, start xyz diet” This is not helping anyone, least of all those with an eating disorder.

At the bottom of this article I have included an online petition directed at the American Psychiatric Association (the body responsible for publishing the DSM-5) requesting they remove BMI from the diagnostic criteria of Anorexia. The aim of this to improve access to help for 94% of those with an eating disorder that are currently denied help based upon this outdate measurement.

So far, >1100 people have signed this, including some big names in the eating disorder treatment field. But before I can take this further I need more signatures.

Please sign this petition and share, so that things can change for the better. Nothing changes is nothing changes.

The link is below, as well as a link to my instagram so you can see what others have to say.

Bye Bye BMI petition: https://www.change.org/-ByeByeBMI

Follow the petition progress: https://www.google.co.nz/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwj-sJXF8Mb1AhUowzgGHX7LCsAQFnoECAIQAQ&url=https%3A%2F%2Fwww.instagram.com%2Fp%2FCUGlCKpBskk%2F%3Futm_medium%3Dtumblr&usg=AOvVaw2EpH5DSOE42kkcv_N5PHpH

Tabitha Farrar: https://youtu.be/SjDAsvj3igI

Is That “Before” Recovery Photo Actually Thinspiration? Don’t Be Fooled!

https://www.recoverywarriors.com/is-that-before-recovery-photo-actually-thinspiration-dont-be-fooled/

What is thinsporation? And how does it play into eating disorders? And is that “before” photo helpful, or actually harmful?
— Read on www.recoverywarriors.com/is-that-before-recovery-photo-actually-thinspiration-dont-be-fooled/

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

Recovery Super Powers

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.