Orthorexia

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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:

Two years in recovery..WAKE UP CALL

TW and this may be difficult to read.

Yesterday a memory came up on my Facebook feed.

A trip we made to Sri Lanka in March 2019. My final wake up call before seeking help for my eating disorder.

It was not the wonderful experience that it should have been, or our pictures from our travels captured. They say “a picture paints a thousand words’, but most of what you see is what my eating disorder did for years, fake an exterior. It was this trip that I for the first time in 15+years, began to see how much of an issue my eating disorder really was.

For years my eating disorder had concealed the negative impact it was having on me.

My eating disorder was slowly killing me. If you are starving, you’re slowly dying. My friend if you need this sobering reminder, people die from eating disorders. We forget this when we are dancing with the devil. Or perhaps, we no longer care, when it’s painful to sit, or our body is covered in fine hair because we can no longer keep ourselves warm. We ignore message after message from our bodies until, if we are lucky we WAKE the FUCK up. It’s not just us that our eating disorders impact upon. Truthfully when engaging in behaviours and driven by the numbers, I didn’t worry about the effect each action could have on my partner, parents, brother, friends. But our actions do matter, If I had have continued I would have likely ended up as a stark statistic. Remember, YOU matter, your life matters and you affect many people’s lives. Please wake up.

That trip I felt completely lost and trapped in my relentless behaviours that had been by my side for years. I had no idea how I was ever going to step outside of the grips my eating disorder held on me. But I knew something needed to change or I would slowly but surely die.

What made me wake-up?

I realised I wasn’t living. If I wasn’t living, what was I? It became so obvious to me on this trip because Sri Lanka is full of beauty, but I felt nothing but cold.

I was done with the comments from peers and concerned looks. I hated it.

I was done with feeling nothing but bone cold, ALL OF THE TIME. Even in 30 degrees heat. I wanted to see past the brain fog and constant chatter.

I didn’t want to live like that anymore. I couldn’t live like it anymore.

This was not the first time I had had a moment of clarity, a few years prior I knew things were far from in control, but I didn’t seek help. I thought I could fix myself by eating a little more. Things got better for a time, but without support things soon descended back to the familiar chaos and calm of my eating disorder.

But this trip was different. Something needed to alter. I had reached “rock bottom” and I had to crawl out.

I wanted to be present, to share the experience but my eating disorder bled into everything. It was all encompassing. I was afraid for the first time. I was scared this was either going to be my life, or it would take my life.

It was the first time I realised how much stronger the eating disorder voice had become and how buried I was. I feared I had lost myself forever, I couldn’t recall when I was last in the driver’s seat of my thoughts. This was a sobering moment, at the same time I felt powerless to do anything about it.

These moments of clarity would pass again, and my eating disorder would begin to fool me once more that I was in fact fine, convinced me I wasn’t “sick enough” or that I even had an issue. However my healthy thoughts, were desperate to be heard and me listen. And so, it was this trip, I shared with my partner some of my story, although by this time it was hardly a secret.

Even though this trip was incredibly painful, I remain grateful for it, because it was like a wake up call and it kickstarted my true recovery process. Seeing pictures of the trip makes me sad for memories and experiences my eating disorder stole from me but I’m so thankful to be where I am now. Writing this.

If you’re in this dark place, THERE is always hope, It is never too late to seek help. And, you don’t have to go at it alone. You don’t have to have answers. Choosing to reach out of help is the biggest step, the rest will follow if you trust in the process and take that massive leap of faith.

There are stages we go through prior to starting recovery and then during recovery itself. I think we flip flop between them whilst we go to war with the two voices in our head. But we can all win, it is possible.

To me the stages look something like this:

◦ The “I’m fine. I’m just super healthy. I’m totally in control” stage.

◦ “Something’s not quite right with what I’m doing, but it’s ok right? I know I can stop if I want to. But I don’t want to” stage.

◦ The “Shit, I can’t stop. Well better just keep going. It will pass. It’s not that big a deal?” Stage

◦ The, “Ok, I think this is probably a problem. Not sure I want to do anything about it. But not sure how long I can keep going on like this” stage

◦ “Ok, I’m so done with this, I can’t keep living this way. But I don’t feel I have any control. I’m not sure I can stop” stage. This is the point I got to when I sought recovery. It’s one of the scariest decisions I’ve ever made.

◦ “Let’s try this recovery malarkey out. What do I have to lose? But I’m so scared of the thought of change”. Stage

◦ The, “Oh my god, this is way too hard. I’m never going to recover. Why even bother trying” stage. I think it’s common here, we often resort to old behaviours intermittently whilst making small changes in recovery. But the small changes matter and count.

Then something clicks/ it’s like a switch. Recovery becomes easier. It’s still bloody hard but it’s less of a monster than the one that’s been dictating your life. This stage, you start to question your eating disorder thoughts, your own thoughts start to become clearer and in the foreground more frequently.

It doesn’t take much for your ED to lure you back, a slip or relapse happens. But you learn from them and each slip you get wiser. Recovery gets stronger, you get stronger.

◦ Now you really want this, recovery feels achievable . You begin to see who you really are, what your life can be without this hitchhiker. You remain vigilant and know how recovery can look and you make it your mission to not go back. You’ve got this. Your actions and thoughts are all protective of your recovery, you have worked harder than anyone will ever know to be here.

Recovery is always possible, no matter how deeply trapped, lost or afraid you feel. Wake up, and rejoin the world, you deserve a full life and the world deserves to have you in it.

Check out the links below for seeking support/ starting the conversation:

  1. https://www.beateatingdisorders.org.uk/recovery-information/tell-someone
  2. https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/how-to-talk-to-a-loved-one
  3. https://www.ed.org.nz/getting-help/what-to-do/

Strength in vulnerability.

“Strength in vulnerability” Sound like opposites to you?

I have lived my entire life holding this belief. With the sense that showing vulnerability was demonstrating weakness. How incorrect this belief is.

From the wise words of Brenè Brown:

“Vulnerability is the birthplace of love, belonging, joy,courage, empathy, and creativity. It is the source of hope, empathy, accountability and authenticity. If we want greater clarity in our purpose or deeper more meaningful spiritual lives, vulnerability is the path.” (1)

This concept is a difficult one, when we have spent our entire lives believing weakness and vulnerability are one of the same.

But for me, I didn’t truly understand the meaning of vulnerability. Why is it such a difficult emotion for us to experience, why do we numb it?

Brenè Brown defines vulnerability as “uncertainty, risk and emotional exposure”.(1) I feel this depicts eating disorder recovery in one sentence, it’s beautiful; and it’s true.

People in recovery are anything but weak, I am yet to meet or speak to someone with an eating disorder who I consider weak. The people I have come across are some of the strongest, kindest, most resilient people I’ve encountered on all parts of my life.

Eating disorders are encompassed by guilt, shame and fear of being vulnerable. Feelings and emotions are viewed as weakness. During recovery, emotions that had been buried, lost or numbed are reclaimed and owned. Sometimes, all at once!! Some days in early recovery it’s a cluster fuck of emotions. Recovery is learning to tolerate these emotions and not numb out. This is embracing vulnerability.

Vulnerability for me has been, fear of being perceived as weak, judged, failure or a disappointment.

My eating disorder numbed everything,including these feelings but at the cost of all my positive emotions.

Exploring vulnerability has opened up my authentic self. I have never felt so vulnerable than these past 18 months, admitting my imperfections, my shadows.

I don’t see vulnerability as a negative now. It’s neither positive or negative, it’s just part of what makes us all human.

“Imperfections are not inadequacies; they are reminders that we’re all in this together.”(2)

Why shouldn’t we show vulnerability if it’s the foundations of how connections are made, creativity and passion is discovered? Connection can overshadow shame.

Yesterday I did something I would have never imagined myself doing, even a few months ago.

I shared my experience with anorexia publicly on my personal facebook account. It’s National Eating Disorder Awareness (NEDA) week in the US, which will be followed by the UK and Australasia next week. And So I decided, why not share my most “feared” secret with the hope of encouraging others to seek help, de-bunk myths and stigma and challenge attitudes.

I’m not going to pretend it was easy. It was more terrifying than either of the bungee jumps, sky dives I’ve done. Not nearly as scary as starting recovery, which is why I felt so compelled to do this . I know I am not alone but I am lucky, so lucky I have had help and support. It took nearly 2 decades to seek the help, which is sad, because this is not uncommon.

If my share changes one attitude, helps one person reach out for help then a little bit of fear is nothing. I’m fortunate I have found my voice. Many people remain struggling in silence. I’m not advising everyone to share their stories. It’s taken a long time for me to reach a place of acceptance and resilience. I know there will be some negativity from sharing such. It will come from ignorance. I feel equipped to deal with these because the majority of responses have been positive and most importantly I didn’t do it for the external validation. I am happy enough with who I am, I did it for those who are not. Those battling stigma and shame everyday.

There’s tons of ways to raise awareness for a subject, not everyone will comfortable with sharing personal accounts and that is ok. Have a look at some of the links below, NEDA and BEAT of how we can raise awareness and fight stigma.

For a deeper look at vulnerability, shame and guilt I recommend checking out:

1. Brenè Brown: TED-Ed https://youtu.be/iCvmsMzlF7o

2. Brenè Brown: Book; https://www.amazon.com/Daring-Greatly-Courage-Vulnerable-Transforms/dp/1592408419

3. NEDA awareness week: https://www.integratedeating.com/blog/2021/2/22/national-eating-disorders-awareness-week-2021

https://www.nationaleatingdisorders.org

4. BEAT: https://www.beateatingdisorders.org.uk/edaw

References:

1. Brene Brown (2017). Daring Greatly : How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead. Penguin Random House Audio Publishing Group.

2. Brenè Brown: The Gifts of imperfections.

‘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

SHOULD, is not a nice word..

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Should has no place in most daily language, but especially not in eating disorder recovery

Should implies rules, an obligation. That word is the reason I’m sat on my ass writing this. I was looking forward to going for a run, or joining my husband at boxfit tonight. However throughout the day at work I started to feel tired and that what I probably needed was to chill out with the cat.

Then that sneaky SHOULD word crept into the foreground. I heard my thoughts say “you should go tonight, you’ve not done anything all week”

That was the point I decided I will not exercise today. Exercise should be a priveledge/ pleasure, not a punishment.

This “SHOULD” demand was from my eating disorder, “HH” thinks I should exercise today, but that’s the very reason why not. A few months ago, I would have acted on this demand, the next day I would find it harder to eat or I’d feel more anxious about what I was eating.

Now I move my body because I want to, because it feels good, not because I feel I have to. The discomfort I used to feel if I missed a day of exercise was insurmountable before. I have to really listen to where the intent is from, whether it’s my voice, or ’HH’s.

I’m feeling proud, I can sit here and write this, instead of dragging my butt out to torture myself without enjoyment. Because I know when I truly want to move/ exercise it’s for me and not for the service of ‘HH’.

I have been a runner all my life. One of my favourite things even a a tiny child, before the days of my eating disorder was to go outside in the rain. As I got a bit older, if my athletics session was a wet session it was like Christmas for me! I loved the feel of the rain and being hot and the smell of it on the track or grass. Then ’HH’ showed up some years later. And my running, exercise was no longer for me, for the fun. It was all about targets, shifting goal posts that I would never be satisfied with.

It would be like the world ended if I had to miss a day, or I’d exercise when I was injured, sick and obviously that’s not fun. I’ve had to work really hard in my recovery to re-kindle my healthy relationship with movement, channeling that child who loved running in the rain and not the crazy person running in gale force winds/ all weathers all hours.

I took a period of abstinence, but not an extended period. I had a good support to help me workout where the intent was from. Some days I had meltdowns when I knew it wasn’t my healthy self and had to abstain. But doing that has got me here. If it feels wrong it is wrong. Exercise/movement is never meant to feel shameful, guilt driven (pre or post), like a chore. It’s a pleasure/ priveledge. Today was a day I know it was not for me, rather for ‘HH’. One day by continuing to listen to my healthy voice over and over, ‘HH’ won’t suggest I move when I don’t want to. The voice will be gone.

Challenge, Practice, Repeat…..Recover I hope.

Today was definitely helped by ‘Recovery Warriors” resources. Check out The Recovery Warriors app, website. They are currently holding a ‘holiday special” with lots of useful resources and videos etc. https://www.truewarrior.me/holiday-support

https://www.instagram.com/recovrywarriors/

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