Smoke ‘N’ Mirrors

I’ve never written a post whilst “in the thick of it” before. But one of my values is authenticity. We often forget our struggles when we come out the other side and often some of the biggest lessons are lost if not shared when we are truly at our most vulnerable. I’m out of alignment and stuck. That’s basically an eating disorder summed up.

The last few months have been hard. I let small ED things creep back in and before I knew I was back under anorexia’s grip. I didn’t think they were a big deal. Individually they probably weren’t but if like me, you have a history of an eating disorder, we have to be vigilant of these things because one slip can become a landslide before we even realise. It’s a lot easier to deal with when it’s small and early. My aim of this is to reach someone, perhaps you’ve noticed a couple of things slipping, shut this down before it becomes an uphill battle.

The best way I can truly describe being amidst a relapse of an eating disorder is “Smoke and Mirrors”. I could kind of see it happening, but the smoke just kept coming.

The eating disorder serves as an obscurer. It’s made it near impossible for me to accept/ see I am in a relapse, I have a problem, I need help or that I’m not making my eating disorder up. It confuses my brain on a daily basis. It will have me believe I’m fine when everything and everyone I care about tells me the contrary.

All of this is the smoke that has kept me in the grips of anorexia, it’s made me hard to “reach”. How do you solve a problem when someone doesn’t believe there’s one to be solved? It’s taking me time to figure this out. It can’t be unless I decided to trust the people telling me I’m on fire. Some days I believe it, other days I can’t see past the smoke.

This is the main reason for wanting to share this, because I forget this feeling when I get back on track and yet it’s a feeling I can guarantee anyone who’s lived an eating disorder has or will feel at some point. When this started a few months back, I didn’t talk about how things were slipping, instead I isolated and went to anorexia’s open arms. Anorexia and eating disorders thrive on this secrecy, isolation and vulnerability.

Talking might have pulled me out of this faster and so I urge you, if you can feel things slipping, don’t wait for it to get worse before you ask for help. “It’s no big deal” may well be a big deal. It gets harder to ask for help the longer you wait and the eating disorder will do anything to trick you into believing you have this “shit in control”.

It’s a scary and lonely place to sit in. When your brain doesn’t allow you to see through the smoke. Everyone around you might be trying to pour water over the fire, but you struggle to even feel the burn. Occasionally the smoke clears for a moment and you might get glimpses of the situation and it’s suffocating. Realistically it comes back to putting one foot in front of the other to pull yourself back out. Because I only I can pull myself out, just like only YOU can pull yourself out. BUT*** We don’t have to do it alone. Which is something I’m yet again grappling with.

My goals are to go back to basics.

What does that mean?

– Attempting acceptance and when it’s not there trying, to trust my support team because I sure can’t trust my brain right now. If people are telling you they are worried, try to listen to them even if the eating disorder doesn’t believe it. It may never believe it, but one thing I do know is, I can trust people that care about me.

– Try and be honest. There’s no point saying you ‘want’ to recover when you don’t, but that doesn’t mean we can’t commit to recovering or at least trying. It’s a very strange concept to explain to someone who has never lived an eating disorder, why on earth wouldn’t someone want to recover from something that was harming them. For me the work here is coming from “unpacking what my beliefs around what the eating disorder does for me“ It’s hard for me to say I want to recover when in the short term recovery makes me feel shit but I know that long term it’s short term pain for freedom.

Again being honest about what’s realistic for you to challenge now. Only you can really know this. Recovery is meant to feel hard. But I know if I over commit and I can’t meet that goal it only fuels the critical voice of anorexia. Everyone’s recovery is different. Your goals will be not be the same as the next person. Whilst we are at it, releasing comparison full stop.

– Going back to basics. Trying to re-establish the healthy routines.

– Trying to re-establish things like regular eating.

– Using tools that I have learned in treatment or that have helped me in the past- such as dialoguing (as much as I dislike this exercise) because I know it helps to bring my healthy self to the foreground. Dialoguing is something I have let slip, yet it’s a tool that has always helped me see my eating disorder thoughts and healthy self more clearly and allowed me to reinforce that healthy side of me in moments of difficulty. (For anyone who is unaware; dialoguing is an exercise where you write out eating disordered thoughts and counter them with your healthy self (non disordered brain) to try and separate yourself from your disordered thoughts and strengthen your healthy self, you should always end on a healthy self point)

– Connecting not isolating or withdrawing. For me this looks like: keeping appointments with my team, talking to friends and family and even writing this blog because it’s connecting with my authenticity. This is something that I’m finding hard right now because the eating disorder wants me to be quiet an secretive. I’m also having a tough time saying eating disorder or anorexia and so I’m being deliberate in using it. Calling it what it is. Connecting with reality, truth and people. All the things the eating disorder tries to stop me from doing.

So where am I going with this…

Am I motivated to recover at every waking minute at the moment HELL no, But I am COMMITTED to keep trying every day. You don’t have to want to recover. But first step is to meet yourself where you are and work with that.

Eating disorders will distort and hide the truth of your suffering from you. Making it hard to accept or see your reality.

But no matter where you find yourself, even in times of relapse it’s important to remind yourself you’re never starting at square one, even if you feel like you’re starting again. You’re starting with more knowledge and resilience than you did at the beginning. Recovery is not linear. It’s ok to not be ok.

https://www.eatingdisorderhope.com/recovery/self-help-tools-skills-tips

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?

Orthorexia

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:

USA: National Eating Disorder Association (NEDA) https://www.nationaleatingdisorders.org/
UK: BEAT: https://www.beateatingdisorders.org.uk/support-services/helplines
Australia: https://butterfly.org.au/who-we-are/contact-us/
NZ:https://www.ed.org.nz/
International: https://www.eatingdisorderhope.com/treatment-for-eating-disorders/international/india
A really good Instagram account:https://www.instagram.com/OrthorexiaBites/

“Weigh days” in ED recovery

Your worth can never be defined by a number

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

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

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

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

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

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

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

The “target weight” issue

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

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

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

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

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

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

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

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

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

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

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

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

Journaling #1 ED recovery

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

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

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

Why?

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

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

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

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

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

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

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

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

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

I couldn’t make a single decision about what to eat for dinner, I stood in the kitchen for ages agonising over whether to add oil to the pan, all I could hear was how fat I’m becoming and how unhappy I will be
I reminded myself restricting has never resulted in happiness, I was not able to add the damn oil tonight, but I know I am capable of making hard choices and I will find the courage to do it”

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

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

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

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

Your Weight Is Not Your Personal Responsibility

Some things are not supposed to be controlled. They are not our personal responsibility. Weight is one of them. I repeat, your weight is not your personal responsibility or choice.

This may sound controversial because we have been taught that our weight is inversely correlated with health. But this is oversimplified and largely untrue.

We cannot “healthily” manipulate what’s not supposed to be manipulated.

Your weight, much like your height or eye color is predetermined, by genetics. But it’s influenced by environment, your health, your diet history, & both diet and exercise. The latter two are only small contributors. With all the other factors that you have no influence over, it’s futile trying to micromanage. If you go too far in one direction, your body will fight it to live in homeostasis.
If you are genetically built to live in a larger body you will never have a “healthy” smaller body regardless of all the exercise or dieting you do. It just won’t work, the body will fight it and you will see all of the negative effects of this.
The larger body you were born into was healthy.

What’s prompted this post is following announcements from the UK governement they may financially reward weight loss in a campaign to “fight obesity”. They talk about providing incentives with subscriptions to restrictive diets such as weight watchers and slimmers world. This is such a harmful campaign. Further more, this announcement was released in the middle of national eating disorder awareness week, the theme of this was Binge Eating Disorder (BED) (1). Binge eating disorder sufferers are already statistically less likely to seek help than any other eating disorder, despite it being the most prevalent eating disorder. 1 in 50 people in the UK are expected to be affected by BED. A staggering 40% of people in the US following weight loss programmes meet the criteria for BED (2). BED is a serious mental disorder with physical side effects. People with BED, consume large quantities of food quickly without feeling in control, it is NOT the same as “over indulging”. Patients often restrict heavily between binges which fuels the cycle. Often patients with BED do live in larger bodies, they are “obese” by societies definition. The UK government’s message is damaging and harmful to those with BED. Weight stigma is a huge problem in society and in healthcare. Patients with BED are stigmatised, invalidated and often do not seek help. They are too commonly prescribed restrictive diets as an answer. However evidence has proven time after time, binges follow restriction.

Campaigns like this, will have a ripple effect, making access to treatment all the more difficult. More patients are likely to develop eating disorders such as BED, following restrictive diets will not end well.

I anticipate- the “obesity crisis” will increase after everyone regains the weight they lose and more, furthermore it is encouraging disordered eating, which will raise the incidences of eating disorders. Without tackling the core issue of weight stigma, many of those eating disorders will go undetected. “Atypical anorexia” is another diagnosis used by the DSM-V ( diagnostic, statistic manual psychiatric disorders) to diagnose patients with anorexia but are not underweight according to BMI. However Anorexia can manifest in any body shape or size. The difference is the weight stigma those suffering with anorexia in a larger body experience. They are often congratulated for their disordered behaviours, not taken seriously making access to help more difficult.

Let’s discuss BMI. The BMI was invented by a Belgian mathematician in the early 19th century. Lambert Adolfe Quetelet was a mathematician, statistician, sociologist with an interest in anthropometric sciences (3). Anthropometric study is essentially is body measurement study. He had no medical training. He has since been heavily criticised for his population studies of BIPOC and labelling people of colour as “separate species”. One of Quetelet’s areas of interest was in the “average man”, he used data including height and weights to help him determine this.
His studies were largely population based, cohort studies, mostly including white European males. He developed a formula to calculate a ratio of body weight to height squared, after an observation that there were weight and height variations within populations. More specifically that weight did not appear to be directly proportional to height, he discovered weight varied in proportion to height squared. This became known as the Quetelet index, before Ancel Keys renamed it the BMI in 1972. Ancel keys a famous physiologist, attempted to prove correlation with obesity, BMI and poor health. He did not succeed.
The BMI was not used to determine health it was to show “population averages”. It was designed to track population’s weights. It did not measure adipose tissue, or account for muscle. Once again it primarily referenced white European men.

It can therefore not be used as a predictor of individual health status, at best it’s a population screening tool, particularly if that population is white, male and European.
It identifies potential “population risk” of certain diseases such as diabetes, coronary artery disease. However an individual’s BMI, in isolation is not helpful, as a person can have a high BMI but very little visceral fat which has been associated as a greater risk factor. Muscle mass contributes significantly to weight and therefore BMI.

Interestingly, the optimal BMI for mortality is actually within the “overweight” category on the BMI scale. The most optimal BMI statistically from latest studies is actually 27 (4). Yet the BMI scale has not been updated to reflect the definition or risk stratification. Go figure.

The more I learn the less I know, but the more I want to know. Nutritional science is an incredibly complex field of science. It’s also a very difficult area to interpret. I am relatively confident in my ability of interpreting scientific papers coming from an oncology background, but I do not feel equipped to interpret and advise patients on nutritional science. The studies I tend to go to as my default for information and decision making in my career comes form the “gold standard” of evidence, which is data from meta-analysis of randomised control trials.

Meta-analysis analyses data from big randomised trials. (For anyone non medical or non scientific, randomised control trials (RCT) are the holy grail of investigating an intervention. It involves studying two groups, randomised to receive the intervention or a placebo. The difference in the two groups is studied. For example a group of patients with diabetes are randomised to receive a new blood sugar lowering drug. One group gets the drug, the other does not. The changes in their blood sugars are observed. You can control for variables because people are selected based upon specific characteristics, such as age, starting blood sugar levels for example.

Nutritional science is difficult to interpret, because, the studies are largely cohort studies (population based), i.e. you cannot ethically conduct randomised control trials in this field (i.e. you couldn’t restrict a particular nutrient from a group). You cannot control the variables that vary like you can in an RCT (you have no idea how much carbohydrate someone eats compared to the next or how their body actually uses it). Interpreting them is difficult. Therefore I feel uncomfortable ever promoting something I have little or no understanding in. Examples that have come from nutritional science are: the “carbs are bad”, high fibre diet and colorectal cancer risk reduction, ketogenic diet, vitamin E and reduced risk of developing alzheimers. But, unlike medical studies, we cannot control variables in the studies and then apply them to individuals or draw cause and effect. Vitamin E, has been shown to reduce the risk of Alzheimers, but when you look at how, it is not actually understood. Therefore taking a supplement that is not that same as the vitamin E absorbed from a persons diet is just not generalisable.

At medical school we get minimal training on nutrition, yet we are asked important questions that I feel we are ill equipped to provide. I find it concerning when people advocate things such as low carb diets as a one size fits all, pun intended. It’s an issue, there are so many shades of grey. However I am confident in my knowledge and the evidence surrounding BMI, and weight bias. Weight bias is dangerous and our lack of understanding or inappropriate use of nutritional science is concerning. Nutrition is also a luxury and we do not acknowledge this. I am a white middle class female, I acknowledge my privilege, what this means is I am fortunate to be able to choose what I eat. Many people are not as fortunate and they eat what they can, therefore prescriptive diets by nature are also not available to a large population, and yet they are stigmatised for choices that are actually not really a choice.

The BMI was never intended to be used as the measure of individual health, that is is used for today. It is also not applicable to a wider population as it included a narrow cohort. Yet we base such importance on a number that never had any intention for medical use.

For anyone who has received weight stigma or bias, please understand you are not alone. Binge eating disorder is serious and everyone should be able to access help. We can be healthy at any size.

References:

BEAT Eating disorder Awareness Week: https://www.beateatingdisorders.org.uk/edaw
BEAT information page BED: https://www.beateatingdisorders.org.uk/types/binge-eating-disorder
Quetelet index: https://pubmed.ncbi.nlm.nih.gov/17890752/
BMI associations and mortality: Change in Body Mass Index Associated With Lowest Mortality in Denmark, 1976-2013 Afzal, S., Tybjærg-Hansen, A., Jensen, G. and Nordestgaard, B., 2021. Change in Body Mass Index Associated With Lowest Mortality in Denmark, 1976-2013. https://jamanetwork.com/journals/jama/fullarticle/2520627?resultClick=1

Vacationing with an Eating Disorder..

Vacationing then vs Now

We have just returned from a few days holiday, which I feel incredibly lucky to be able to do for numerous reasons, 1. We live in a place we can travel at present and secondly my eating disorder was not allowed to dictate my behaviour for the first time in many years.

Why are holiday’s so hard for people with an eating disorder? Often in the midst of an eating disorder we use behaviours to cope with uncertainty, change or triggering situations. Firstly, you are away from home, your regular environment. This can be full of uncertainty and planning can go out of the window. Tonnes of food challenges can arise. Challenges you may not have foreseen, such as not being able to follow a regular schedule, a meal plan. Eating out and experiencing new dishes. All of these things can be extremely triggering. It’s hard to imagine if you’ve never experienced an eating disorder.

Here’s how a holiday for me used to look like:

Weeks leading up to vacation:

Enormous anxiety and dread. Escalation in behaviours in response to increased thoughts and fears regarding the uncertainty of said trip. I would buy into the “ prepare for the summer body diet culture crap” and it would set my eating disorder into a frenzy.

Then the event would arrive, no matter how much “ event restriction/ compensation” I had undertaken I would still feel ridiculously out of control and fearful that my constant was about to change. I would not be able to predict every meal and therefore calculate my intake. Holidays can be inactivity. This used to terrify me, how was I going to hide my “craziness’, fit in my ridiculous workouts in new territory? All the while Hitchhiker ‘HH’ would be telling me I was disgusting. How can anyone be present and relax on holiday when this is going on?

Changing experience of holidays’ with time and at various points in recovery;

Once I commenced recovery the anxiety around the trips shifted to a different kind of anxiety. When you start recovery, especially early on, you need to eat very regularly. Holidays can make important established routines very tricky to follow. I would worry if I would be able to eat the food available. Eating in front of people can be immensely anxiety provoking and largely, trips involve eating out. It’s a point where you are challenging ‘fear’ foods and there’s all kinds of food challenges that can happen on trips which for the person experiencing an eating disorder is overwhelming.

Some restaurants very unhelpfully have nutritional values on their menus which can be a minefield for those of us trying to recover from an eating disorder. Trying to do the “ right thing for recovery” when in an already stressful situation and then presented with your demons on a plate, in every sense is really freaking hard. I used to use one hand to block out the numbers. Or ask someone I trusted to look at the menu, find something I’d like and pick until I could deal with this. Until I got to this point, my eating disorder was too strong and it would not allow me to choose what ‘I desired’. This adds to the stress, feeds the eating disorder and makes the time really challenging. It gets better, I promise.

You can’t switch your calculator of a brain off overnight. It takes time and practice and many situations and repeated actions until your brain doesn’t equate the numbers with relevance. But it can be helpful to go to places you don’t know the nutritional value, because your well trained brain sometimes doesn’t switch off for familiar items. Now I can go to a restaurant with the nutritional values and choose what I desire without coercion. It irritates me that the diet industry even seeps into the catering industry and influences our choices. (I spent ages in recovery with a black marker pen scrubbing out nutritional values on boxes etc) Now I don’t automatically read or know the content of EVERYTHING. IT is possible to train your brain to stop paying attention with effort. Black marker pens are brilliant for this.

ALSO, FOR THOSE WHO NEED TO HEAR THIS, I’M GOING TO SAY THIS ONCE: CALORIES IN DOES NOT EQUAL CALORIES OUT. OUR BODIES ARE WAY MORE INTELLIGENT THAN THE PEOPLE WHO CAME UP WITH THIS LIE.

What my life would look like after I returned from a holiday:

A completely false sense of guilt for the “loss of control”. I say false because, I was not in control on any of the trips. I had abided by my eating disorder rules and stipulations. I might have eaten something slightly outside of ‘HH” rule book and paid an enormous price of guilt, shame and most importantly regret for all the things ‘HH’ made me miss out on because I listened.

I would return from holiday, unhappy, compensate for my warped view of the trip and over value I placed on it and nothing would change because an eating disorder is a constant event planning, life of restriction.

A Vacation now:

Leading up to the holiday, the old neural pathways are fragile and the ‘HH’ thoughts do get louder. The thoughts around compensating return. But the big difference now, I know these thoughts are lies. The do not lead to me feeling happier, more confident on my holiday, more relaxed and present. No the complete opposite. Therefore, I have to be vigilant I have to make an effort to do the opposite.

Vacations are a trigger. Knowing triggers, helps you plan and prevent slips or relapses or in the event of either recover from them quicker.

My husband and I talked about the trip prior. He knows my triggers pretty well now.

For me, this meant, making sure we always have ample snacks around incase we get caught somewhere ( we spent 6 hours driving and quite remotely at times).

We knew some of the foods would be challenging- so I set myself some food challenges. Like eating spontaneously on the road, eating foods that are deemed as “unhealthy”. When realistically no food is unhealthy it’s all fuel.

It was going to be the first time on a beach in my togs since I weight restored. This was a huge one. Putting on swimwear for the first time, since weight restoring is a whole new chapter in recovery. I’ve gotten used to wearing larger clothes to my previous weight restored body. That was a challenge in itself. But putting on swim wear is next level discomfort and vulnerability. Society tells us, to go to the beach we need to be “bikini/ beach/summer body ready”. Just putting it out there now, “bikini/summer body’s” do not exist. It’s a societal fat phobic term, the body you inhabit in, is beach ready whenever. If it can get you to the beach, it’s ready!

Learning to adapt. This has been a massive one for me. Whether it’s adjusting to body image, which is something that naturally creeps in on vacation. Being surrounded by different body sizes, it is important to feel as comfortable in your skin as you can. Wearing clothes that make you feel comfortable helps. My body is very different now in recovery, feeling confident and comfortable is hard. It is possible my friend, you shift your focus to the activities you are participating in, rather than the body you are in. I am grateful to this body because it’s this body that allows me to enjoy rather than fixate and agonise. No matter what body you are in in the midst of an eating disorder you won’t be happy.

But for the body image stuff: I tried to think about it this way..

Why is it, the least interesting thing about someone, their appearance is what we judge them on so heavily?

Personally, I think I have nice eyes, but that is one of the least interesting things about me.

There is nothing interesting about your, shape, weight or appearance. I don’t care how much you weigh or size jeans you wear.

This has helped me this week when I found my thoughts drifting to judging my recovering body. Instead I know I was mean on a paddle board, I am funny and a kind person, that’s way more interesting than worrying about the other crap.

I’m at a place in my recovery where I can eat out, and this can be regularly. I found this really difficult previously. Even so, my old thoughts were there on occasion but each meal I challenged them and moved on. That doesn’t mean I found the holiday as easy as someone who has never experienced an eating disorder. I still had to choose recovery at least 3-6 times a day and not let those decisions impact upon my plans or activity. But I did not engage in the ‘HH’ thoughts.

The holiday was more free and flexible. I felt present. I wasn’t bone cold in 25 degree heat. I wasn’t calculating. Goofy yes, calculating no.

This level of flexibility and freedom is something that has come with persistence and time.

Holiday’s are a time for rest and recuperation from the craziness of our day t day lives, for people with eating disorders they can instil extreme anxiety which diminishes any prospect of relaxation and enjoyment. But there are ways of managing them. As outlined above I think some of this will depend on the stage one recovery to the extent of planning and support required around them. But they should not be as stressful, so I hope if you are someone with or supporting someone with an ED, you can find someways of reducing the anxiety.

Things that I have found to be helpful when planning trips:

1. Talking with your treatment team before (and after)

2. Planning for potential triggers

3. Identifying potential triggers and a plan in the event of trigger-what’s in your toolkit

4. Planning food challenges for the stage of recovery, with appropriate support.

5. If following a meal plan, how the trip might be helpful or detrimental and planning around this

6. Wearing clothes that make you feel good.

7. Making sure you always have appropriate fuel available

8. Do you need to know where you are eating? (again I think very individual) I did at some stages.

9. What activities will you be participating in

10. Who are you going to be travelling with, are you supported/ triggered by them.

All of these are or have been part of my own trigger prevention and plan. This is growing/ changing as I encounter potential triggers or progress through recovery. You might have some similarities but you WILL have your own.

You are NOT your Eating Disorder…

You are not “anorexic, or insert ED”

It’s never been you.

You have experienced anorexia/ bulimia, BED

It has been with you.

I recently shared a post on instagram after hearing a person with an eating disorder referred to as their disorder. “They’re bulimic”

It infuriated me. I wanted to remind that individual “they are not their eating disorder” It’s hard enough for the person to seperate themselves from this idea without it being fuelled externally. It continues the shame and stigma attached to these complex disorders.

I see this identity as the sufferer playing underdog to their eating disorder, but that does not mean they are that disorder. Most times the underdog prevails eventually.

This notion was something really important for me to hear when I first started the recovery process. From day one my therapist repeated this mantra, that I was not my eating disorder. Even when I didn’t see it or believe it.

We often attach our identities to the the eating disorder, because we have lost touch with who we truly are. That does not make the identity true or real.

Still not convinced? Picture this. You would not call a person suffering from cancer, “cancer”. The principle is the same for us experiencing an eating disorder. A person is not “cancer” anymore than a person is “anorexia, bulimia or Binge eating disorder” You have an eating disorder, it is not you.

When we embark on recovery, there maybe times where it is easier for the person to hold on to that identity whilst discovering who they are without that disorder. REGARDLESS, It is still helpful to be reminded that they are not their disorder. The disorder is acting as their safety blanket. Of course, early in recovery you will return to the safety of that blanket. But it’s a blanket, it is not part of you. Eventually you don’t need the warmth the blanket offers.

During recovery I think it’s important to explore who you want to become? Who is that identity?

Picturing who I want to be, what I want my life to look like helps me stay in recovery from anorexia. It helped me to see myself separately to the disorder I was fighting. Our values are completely incongruous. I don’t have all the answers and I’m still learning. That’s recovery and growth.

When we are amidst the throws of an eating disorder, for most of us our world becomes very small. There’s very little room for anything beyond- food, exercise and concerns with these. It’s all consuming and incredibly isolating. But- it’s not really what most people want from life.

Eating disorders restrict EVERYTHING.

Who wants to be 80 years old and look back on their life, and all it’s filled with is fear and anxiety over eating, body image, exercise. None of it matters. If we are lucky to reach an old age I want to look back on what my life was filled with, not an eating disorder. It is never too late to make this change. I don’t care if you have been the underdog to your eating disorder for 50 years, there is always hope you can recover.

My journal has been my haven for my recovery but also exploring who this recovered person is, what her goals, aspirations, values and worth are.

I promise you, my recovered self is not fixated on dietary restraint, exercise or control over shape. My recovered self is loud, doesn’t care for other people’s judgements, grateful for the process of getting from A-B and not just being at B.

That brings me onto my next point. G. R. A. T. I. T. U. D. E…

It is easy when we are having a tough time to focus on the negatives. But one thing I have learnt from recovery is there is always something to be grateful for. Even in the darkest of times when you don’t feel there is anything to be grateful about. There will be. Start small on those days. Gratitude, has really helped me ground myself and shift from the “all or nothing” thinking we so often experience with eating disorders. Black and white thinking is a prominent trait we share. I promise you, if you give gratitude practice a go, it’s very hard to stay in a negative space. I make it a daily practice now. I get it, you think I’m full of crap. I thought the person who suggested it to me was too. I thought it was hippy bull crap and I’d be making daisy chains. No.

Try this…

Everyday for a week, think of at least 2 things you are grateful for. It can be as big as you want or small as you want. Aim to build up to more than 2. Some days this will feel harder than others. It’s these days you need to find things. The way you see yourself and the world around you will improve.

You will discover your life beyond they eating disorder even if you don’t see it now.

But for those who need to hear it again… “You are not your eating disorder”

Recognising small, subtle disordered behaviours, that keep us tied to our ED…

I cooked with my husband last night, various curry dishes. This in itself for me was a milestone, I have always felt the need to completely take control in the kitchen. This was largely so my eating disorder could make shortcuts or calculate everything that was going in. It normally caused me great anxiety to deviate away from my “known” and safe meal choices. This I know is very disordered. But sometimes behaviours and thoughts are trickier to identify and hide from sight.

Once we plated the dishes we had prepared my husband just mixed all his together. Partly because it was completely underwhelming in terms of taste (which in itself would have been devastating to me not so long ago). What I mean by this, if I had allowed myself to eat and then it did not meet the standards or expectations I had for it, I would truly feel irrationally gutted.

This is disordered. I mostly felt like this when I was deep in restriction and giving myself permission to eat was near impossible. I celebrated last night that this bland food that promised more gave me no more than a mild irritation that it took so long to be boring! But there was no emotional attachment or reaction.

However the biggest thing I recognised for myself, when he mixed everything together, you could pretty much say it blew my mind. When I considered doing it, the ED voice really kicked in. And I realised the reason why it has been hard for me to do this. Eating each food item separately, especially when severely restricting gives a false sense of prolonging eating, savouring the food.

It gives a sense of enjoyment of each food, feeling more fulfilled. Which I see now is really disordered. And so, I forced myself to mix my food together. This was probably the first time I have done this in nearly two decades. It felt wrong. But enlightening.

It told me, that there are small things, that often go unnoticed and don’t get discussed in ED recovery. Things we can identify ourselves. I feel now once I notice something is disordered I have to do the opposite. Even if it’s a tiny behaviour or “quirk” that to the outside wouldn’t seem like anything. For my ED recovery it’s the difference of staying in the ED vs eventually being out, free.

I can’t tell you what your own weird tiny disordered things will be, but once you do notice something that, either going against, or stopping causes you anxiety then it’s probably disordered and you can work to change it.

Surviving Christmas diet speak in eating disorder recovery…

I love Christmas. I used to start getting excited for Christmas in September. The air smells different, the trees change and nights get shorter and staying in on a cold winter’s night with a festive movie is magical.

I still love Christmas. But Christmas can be a challenging time for many people especially people with eating disorders or recovering from eating disorders. It can invade every waking second, robbing the joy and replacing it with fear and dread. Let me be clear it is NOT just about food. Eating disorders are not just about food. They are so much more complex than this. People with eating disorders feel so much pressure, and that they cannot share this because it’s not festive or worry about disrupting the joy.

It’s a time of year where celebrations continue for most of the month (covid aside). Even in isolation the social media, the promotions during this time and messages about new beginnings in the new year etc.

Eating socially becomes more prominent. But at the same time people start discussing New Years resolutions, which inevitably involves shitty diet talk. This is so hard for people in the midst of their eating disorder or working hard to recover. Where it’s normally easy to excuse yourself from the bull shit diet speak, or judgement around food it’s harder. Often it can include spending time with people you haven’t seen for a long time (probably not so much this year) but that can be daunting and the fear of comments even when well meaning can be hard! If you are in that situation, try and be kind to yourself and see it as a positive. And the comments such as “you look well” probably are genuine and mean you look well and that you just simply no longer look like you’re dying, it’s not saying you look fat or whatever else your stupid ED tells you.

You are bombarded with conflicting messages, unhelpful quips, comments that even for those of us who are solid in recovery can be really fucking hard. The classic I will have to run this off, I’m going to be so fat, is that all you’re eating, you’re eating so much are all likely. Be ready for them and choose to stay on track. How you respond to the comment is up to you.

I have noticed myself this last couple of weeks, I’ve had to work really hard to check myself as thoughts have slowly crept in about ‘how much I should be eating, moving, what’s not “allowed”’ all bullshit and all because of the time of the year and the inevitable society pressures.

In a way it’s helpful, because although frustrating as it is to be experiencing the thoughts and anxiety return, It highlights there’s still work to be done. Clearly I still have a lot of re-wiring to do. I still clearly have an irrational fear of weight gain, which I thought I was passed. But that’s what it is, an irrational fear. It’s a phobia and it’s ingrained through the years and years of inappropriate reinforcement. It’s not surprising that events ignite these brittle pathways. I have not engaged in behaviours for close to 5 months, but it shows how easily old pathways can be re-ignited by old habits, reminders. Which is why it is so vital to continue to recognize triggers and continue the work.

For me, this means, not allowing myself to compensate for the Christmas period/ holiday (event restricting). Not entering into diet behaviour or allowing myself to be drawn into other people’s diet talk, fears and plans. Not engage in ridiculous exercise regimens because society expects it. I love you Joe Wicks BUT please stop the constant before and after pictures!

Not allowing myself to demonize food because other people are. NO FOOD is bad.

You do not have to compensate for food or inactivity ever. People’s biases around food and exercise, new years resolutions are their business and serve no place in recovery no matter how uncomfortable you feel. Be kind to yourself, ask for support and keep talking. If it helps, set boundaries before the event and if it’s too much to be in control yourself ask a support person with decisions etc.

There are tons of resources online that serve as toolkits/ survival guides for holiday.

The purpose of this blog however is not so much to share tips for how I have managed Christmas or will manage Christmas. Although I appreciated podcasts, vlogs, resources myself to help me. Rather this purpose of the blog is for people in the midst of their eating disorder, or recovering and just a simple understanding. That’s what I have found the most useful. So if you are in this situation, I see you I understand.

If you are a friend or a family member of someone with an ED, my thoughts are it’s tough on you too. Please, think about how you talk about diets, your own fear of weight gain in front of the person. Be their advocate as they may not be able to speak up so divert unhelpful conversations where you can. Maybe ditch the unhelpful comments about calories.

Ask the person (if you are in a position where you talk about the eating disorder) what the eating disorder is telling them. What they are thinking. But be warned you might not like or understand the answer. But if someone does feel comfortable to share this with you, show them support without judging them. No one expects you to get it, we don’t get it most of the time ourselves but feeling supported is huge.

Happy Christmas everyone. Stay strong

Shifting the narrative in eating disorder recovery….

Recovery is millions of little challenges

My husband and I were hiking yesterday. We had hours of trail ahead and in between goofing around, talking about our plans for the week ahead we talked about the last year, 18months. So much has happened in this time, like for many people. We talked about people missed. Career paths, life plans and we made jokes about previous events. One event, now an often feature of his jovial mockery and light hearted goading is one of our darkest moments. Often making a situation that was once very unfunny can flip it on its head, make it more bearable. You see that a lot in the healthcare setting, jokes that someone from a non healthcare background would shudder at, is often daily practice. Why? because it makes pain and darkness more bearable and shareable.

This situation we were joking about was one of my biggest meltdowns, i’ve ever had. We were in New York exactly a year ago. I wasn’t really in recovery at this point, although I was fooling myself I was. We had been taking in sights all day, darting all over the place. I had done, what I did a lot at this time. Bargained with myself. I was “allowed” to eat whatever I wanted in the evening because I had been so active during the day. Fucked up beyond all reasoning, but this is how the eating disorder often works. Often that bargaining never actually leads to “eating whatever you want’ but we were looking for a restaurant that would suit us both. I didn’t have much input in restaurants at this point, so it was usually down to my husband to select somewhere. He talks about how incredibly stressful this was. I have no doubt, it must have felt like he was checking for poison for some medieval royalty. I would quash most selections before they had left his lips. However this particular day, it was 1 week from Christmas, we hadn’t booked. So the stress for him was ridiculous. Before he found a place, we spent an hour with us scanning menus, me rejecting. It got to the point where we retraced our steps and chose one at random that would allow us without a reservation. What came next, I don’t really remember. But he does very clearly.

It was a steak & lobster restaurant. There were no other options. There were chips and meat. That was it. After looking at the menu for all of 30 seconds, I burst into full blown tears, sobbing in a packed restaurant. I cannot describe what was going through my mind at this point. Except it was like the world had just ended. I had built the meal up, I was going to eat. Then I was presented with two things I hate, red meat and shellfish. I was petrified of chips at this point. A menu had reduced a 30 something to full blown tears. Inconsolable, snotty ugly tears. We stayed. ‘HH’ screamed that my opportunity had been ruined bla bla. I struggled through the dinner eating chips. Both of us shocked at how irrational I was. I had had moments like this at home but this was in the middle of New York. It’s obvious now, this was plain and simple fear.

But whilst cringing at this event, we chatted about the narrative now.

My world didn’t end. I didn’t die. I just looked totally mental. Now after lots and lots of little moments, challenges, meltdowns I can laugh at how absurd this moment was.

The point of this, recovery doesn’t happen over night. Recovery isn’t a case of going to bed one night and waking up recovered. It’s full of obstacles and challenges. If it’s not challenging it’s probably not recovery and doing jack shit.

Today, he asked me if I wanted an Ice cream. I heard myself say ‘no thanks’. This is a response ‘HH’ has trained to become my default. I am changing this narrative to ‘Yes, please’. Some days yes please is easier than others. But it felt uncomfortable, spontaneously having an ice cream. ‘HH’ certainly did not approve. This is another moment, challenge towards recovery. It was a world apart to the lobster joint. I felt uncomfortable, I got on with it and used to distraction techniques I’ve learnt along the way after. ( Today was repotting some of my veggies, other times breathing techniques can help) But if I’d said no thanks, it would have been a missed opportunity. Without challenges, nothing changes. In recovery discomfort is action. I don’t think I would sob in a restaurant now, unless the world genuinely was ending. I don’t bargain with ‘HH’ any more. There is no bargaining with an eating disorder, that’s an argument you won’t win unless you decide to do the complete opposite of what it’s telling you.

Useful breathing technique: https://www.cci.health.wa.gov.au/-/media/CCI/Mental-Health-Professionals/Anxiety/Anxiety—Information-Sheets/Anxiety-Information-Sheet—08—Breathing-Retraining.pdf

Food is more than just food.

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

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

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

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

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

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

Navigating recovery…recovery beyond Eating disorder “treatment”

I believe there are many milestones in eating disorder recovery. For starters the first day of entering recovery, this is always going to be the biggest. Monumental. Then after that there are thousands of milestones (some more like marathon check-points). Like the first time we conquer a fear food, and then reach the check point of there not being fear foods. So many. Getting your first period (if you lost it/never had), then its recurrence becoming so normal and boring and moaning about it like the general population. But what about when ‘our formal support’ becomes less required?

For those of us fortunate enough to have quidance, follow a treatment plan or having a coach etc, maybe it helps path the way. But, regardless for the most part, your recovery belongs to you. Own it!

I graduated from “regular recovery support” today. Feel like I have my big girl pants (pun very much intended). I have completed CBT-E, MANTRA and have now reached a point with my therapist (OT) to move to “check-ins” rather than scheduled, regular sessions or following some kind of plan.

I know for some people navigating the world beyond regular support, is scary and daunting. I get it, it means YOU are accountable for the ongoing recovery process. But that’s pretty cool right? You have gotten far enough into recovery to be able to make healthy decisions for your recovery. You’re moving towards full recovery and this is another check-point smashed!! That’s the way I’m viewing it. Part of recovery is learning to “cope” in an informal way, that’s life.

Just because my ‘regular’ sessions are finished does not mean I can’t continue growing my support network or learning. One of the things I’ve recently found to be instrumental to my mental shift is connecting with others who have had similar struggles, are struggling or recovered. There is tons of support, whether it’s real connection, following people’s blogs, podcasts or joining a support group, they all help to validate how we feel and strengthen our healthy self. So I’m not nervous about not having regular appointments. I’m proud I’ve gotten here. I’m grateful. If I can get here, I believe anyone can, because I never believed it at the start.

However, I am anxious regarding the next challenge in my life. Something I think for anyone who hasn’t had an eating disorder finds challenging anyway. That’s getting pregnant, becoming a parent. This is another area I think in medicine that doesn’t get spoken about or shared much. What happens when someone in recovery gets pregnant? Is it wise? Should O&G teams be aware? Do they ask or look for history of eating disorders?

I wanted to wait until I was solid into my recovery and even still I worry. I worry if the child will be small, pre-term, miscarry. Will I stay on track?

For my partner and me, having a family has been something we have always wanted. For reasons not related to my eating disorder, fertility is a difficult issue which I won’t go in to.

We are about to embark on IVF. This is something I haven’t entered into lightly, I’m all too aware of what’s required in the IVF process, the follicle stimulation, multiple hormones. This I’m sure is hard in a normal setting, but for those of us with significant body image issues to begin with, these issues need to be factored into planning. Hopefully help prepare the person for the changes and enable them to remain accountable. Support, hopefully can help to prevent slips.

Next issue, if we are fortunate enough to get pregnant… avoiding energy deficit. Some people experience nausea (both during fertility treatment and then in pregnancy). Hyperemesis gravidarum (aka morning sickness) this is not a good situation for someone with a restrictive eating disorder. Breast feeding post-partum.

Our bodies change throughout pregnancy. This is a fact. Something I am trying hard to prepare for. I feel going through the weight-restoration phase of recovery helps this, perhaps. My body has changed beyond any prior recognition and that’s ok, and I don’t even have a baby to care for and love. Or to explain my pregnant looking belly, aka recovery belly. I like to think that having a child will mean that none of the ‘HH’ thoughts will matter, because that child will be the most important, most amazing achievement I will ever have. But I wanted to share this because people with eating disorders go through pregnancy. It never gets spoken about and I don’t know whether we look for it in medicine. I think people could have help and support. I expect there are many people with eating disorders too afraid to share their struggle with the medical team, for fear of judgement, lack of understanding. What will I do?

Not really sure what the point of this post is, other than I’m happy to be here. I hope if you’re reading this and perhaps your treatment has just ended and you’re freaking out, or you’re starting recovery alone or with help, you can just know that there’s support available. Support doesn’t have to be formal or structured and remember celebrate the milestones. Navigating this is like an ultra-marathon but with no clear finish line.

Some online support groups and resources….

1. Beat eating disorders UK: https://www.google.co.nz/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjxuaHD3a7tAhX2yDgGHUGiCXcQFjAAegQIAxAD&url=https%3A%2F%2Fwww.beateatingdisorders.org.uk%2Fsupport-services%2Fonline-groups&usg=AOvVaw2LpFetlZFjVyKJ6Sg1WWaX

2. Recovery warriors (Australia):eatingdisordersqueensland.org.au

3. Various options US: https://centerfordiscovery.com/groups/

4. EDANZ: New Zealand. Various resources. https://www.ed.org.nz/parent-carer-support-groups

SHOULD, is not a nice word..

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/

Eating Disorder Recovery – Recovery Warriors

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

Reframe negative eating disorder thoughts

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

It was all self critical. Extremely negative.

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

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

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

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

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

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

Quash stigma not fat: ED recovery blog

#Eating disorder recovery SAFEPLACE

#bulimia

Smoke ‘N’ Mirrors

Navigating Work and Recovering From an Eating Disorder.

Orthorexia

“Weigh days” in ED recovery

Journaling #1 ED recovery

Your Weight Is Not Your Personal Responsibility

References:

Vacationing with an Eating Disorder..

You are NOT your Eating Disorder…

Recognising small, subtle disordered behaviours, that keep us tied to our ED…

Surviving Christmas diet speak in eating disorder recovery…

Shifting the narrative in eating disorder recovery….

Food is more than just food.

Navigating recovery…recovery beyond Eating disorder “treatment”

SHOULD, is not a nice word..

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

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