#CBT

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

OCD and anorexia…

OCD and eating disorders…

Statistically people with eating disorders are more likely to experience co-morbid diagnoses, such as depression, obsessive compulsive disorder, anxiety, borderline personality disorder. There’s a lot of research investigating whether they are biologically, genetically connected.

When I was six it used to take me almost three hours to go to bed. I developed obsessive compulsive disorder (OCD). There are many overlapping features of OCD and eating disorders. I’m not sure that my OCD at times was separate from my eating disorder. I think it was like a shape shifter that adapted to fit my eating disorder.

The DSM-5 characterises OCD by negative repetitive thoughts that are intrusive and often result in compulsive behaviours to pacify the anxiety evoking obsessions. Common obsessions include ‘cleanliness, tidiness, numbers and many others.

My OCD was not your stereotypical “super clean and tidy” kinda picture. No it carried many similarities to my eating disorder compulsions but it did not relate to food. It began after several people close to me passed away before I was old enough to understand death or process emotions. I developed an intense fear of anyone else around me dying, or becoming sick. I began engaging in ritualistic behaviours. This involved counting, repeating certain phrases, running on the spot, avoiding certain numbers, turning light switches on and off and many more. I would perform these rituals or act out compulsions until I felt a sense of calm. The common denominator between my OCD and anorexia was the intense dread or fear of something happening if I did not perform X behaviour. (Fear in childhood death, fear from eating disorder weight gain). The only way I could silence my eating disorder voice was through compulsions and rituals.

It took a lot of child therapy to reduce these behaviours and challenge the thought patterns. Exposure therapy, similar to that in eating disorder recovery. I would cut a ritual a week until I was free. (A bit like reducing eating disorder behaviours). The exposures were ranked in order of fear and challenged with support.

But….. even though I was only six, I knew the thoughts were nuts. They were not ego-syntonic unlike the intrusive eating disorder thoughts where I believed my thoughts. For example, with an ED thought I truly believed my thoughts such as I “had to eat X number of calories or purge a chocolate bar” it wasn’t until these thoughts were challenged in therapy I could see they were disordered, I would not expect a friend to exist on the little I was eating, nor would I expect them to purge a chocolate bar. I could see after these challenges how distorted my thinking was around myself. I continue to use this, if I wouldn’t expect a friend to do something then why should I expect myself?

Another disparity between my ED and my OCD, I was far more resistant to giving up my eating disorder cognitions than I was my OCD thoughts and behaviours, even though I was just a child. I can make sense of this, neuroplasticity is much harder as an adult. But I do believe this is a distinction between my OCD and my eating disorder.

I feel it’s highly possible that having the predisposition and the appeasement provided to me by rituals definitely contributed to my developing of an eating disorder.

I believe they are both shape shifters. I can draw separations from the two disorders however there was some symbiosis within. For example, there were aspects to my anorexia that from the outside would be very difficult to draw a distinction from OCD. I had ritualistic cleaning behaviours “I had to engage in” to allow me to eat. I would clean the kitchen, from top to bottom prior to consuming anything. If I was interrupted I would start again. This may have been a part of my restriction, although I think more likely it was a separate entity to cope with the anxiety of eating. I don’t feel the thoughts surrounding this were related to the eating disorder.

Eating with very specific cutlery, is a completely different scenario. People with eating disorders often develop strange obsessions around cutlery. In my opinion (and I am only speaking from experience and talking to others who have had the same weird obsessions) this is very eating disorder driven. It serves several functions in the eating disorder. 1. Using a teaspoon (crazy) is a form of restriction. Small bowls, plates all the same. We have to stop. Using the same cutlery can feel “clean” this is an overlap.

My compulsive exercise is driven by my eating disorder. But personally I believe the compulsions and pathways were ignited and learned in my childhood. I would run on the spot or up and down the stairs for hours to feel my heart beating to feel alive. I imagine, my eating disorder reactivated this preformed pathway and used it. My drive to move when in the depths of my eating disorder was very different to when I was a six year old terrified of mortality but it still pacified my anxiety. The two disorders numb emotions that clearly I needed to find more constructive ways of coping with. My anxiety from my eating disorder was fear of weight gain, I was not afraid of this when I was six. The result of movement however, was the same, it appeased the discomfort short-term and clearly I had learnt this subconsciously as a child. This is just my simpleton thought and explanation. They both distract my brain, when I’m worrying about food or washing my hands, clearly I’m not worrying about the thing my disorders are protecting me from. But neither are healthy.

For me, overcoming my eating disorder has been so much harder than OCD. Again some of this will have been my easier to sculpt paediatric neural pathways, rather than my years of entrenched adult pathways. But I also feel it’s the eating disorder itself. We don’t want to recover, not initially from an eating disorder. This is very unlikely to be the case with someone suffering from OCD. I doubt there’s few people who decide that they want to keep their OCD, or that it’s a ‘friend’.

Cognitive behavioural therapy, has helped me with both. I guess that’s the good news about the two coinciding disorders, they are sometimes treated together. But I think it’s been more beneficial from an eating disorder perspective, because those of us with eating disorders have very distorted cognitions that can take some convincing. Whereas, I know that no one is going to die if I don’t wash my hands 37 times, I know it’s a ridiculous thought even though it causes similar anxiety. But I would have argued until I had no more breath that some of my eating disorder perceptions were not unhealthy. For the previous, it was more a case of changing my relationship with the thought- for example, when I get the thought “everyone is going to die if I don’t wash my hands 37 times” I have confronted not participating in the behaviour and “urge surfing, delaying or distracting” so many times now that I don’t feel the same anxiety and I am committed to not performing the action of washing my hands 37 times. No one has died. My brain knows this. For the latter, I have had to develop an extensive toolkit that is ever growing. When I experience a disordered thought, like; a food is “good or bad” and resultant anxiety I challenge the cognition, food does not carry moral value. And to avoid the behaviour I use a skill from the toolkit, self compassion, opposite actions.

Same same but different….

My eating disorder meant I had to eat the same things, same time, I would chew everything a specific amount of times (this was not OCD). It could easily have looked that way. I would eat in the same order. But these all served the eating disorder and were part of restriction.

I was extremely rigid with my rituals and compulsions. These were common to both.

My OCD did not cause my eating disorder but I strongly believe there is a connection, that is biological, genetic and psychiatric. I do not feel that my OCD diagnosis was important in my recovery from anorexia. I’m not sure I even really discussed it with my therapist but I think it is useful to understand the possible connection as not addressing co-existing disorders may make recovery more difficult. The treatments are similar but with variances. We are all complex individuals and so it’s possible for some not drawing a distinction may be ok in recovery but for others it may require addressing them together and with focus on specific aspects.

One thing I know for sure, the anxiety is never about the donut or the heart beating.

Check these out:

  1. https://www.amazon.com/What-When-Brain-Stuck-What/dp/1591478057 This is written for kids, but it has some really helpful principles
  2. “8 Keys to Recovery from an Eating Disorder” WORKBOOK by Carolyn Costin, this is so helpful it has lots of exercises, to challenge healthy self vs eating disorder self. https://www.carolyn-costin.com/books