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

Social media and eating disorders…

Social media is part of our every day life.

For some people their work relies upon social media. It has so many roles and uses in today’s society.

Social media can be helpful to us in our recovery, but it can be a minefield. I actually removed myself from most social media accounts early in my recovery. I don’t believe there is a right or wrong solution to this, but I believe an awareness of the impact social media has on you personally and whether it is helpful or detrimental in your recovery is the most important question. Your motives for following particular accounts, whether they serve you, or your eating disorder.

If you look for it, there are tons of recovery orientated social media platforms. But, it’s not always easy early on to identify motives of some and whether they are 100% pro-recovery.

Some platforms, target our vulnerability. Ads, pop ups etc all follow your history and if you are trying to move away from certain paridigms it can be really hard being constantly reminded about the latest fad-diet or exercise programmes etc! You get my point. Equally you can’t control what people post/ talk about. Your friends, family and colleagues may post things that are particularly sensitive for you. So sometimes taking some time away from this can help at least until you are in a stronger place.

Social media can be anxiety provoking, for those in lockdowns, isolation the conflicting and unhelpful messages can impact upon mental health. It’s not surprising around the world the new diagnoses or relapses of eating disorders that have occurred during the pandemic. Social media I believe plays a large part in this. Adding to pressure around health, diet and exercise. As well as the change to routine and access to normal resources. Knowing that not everything on social media is real, or as it appears on there I think can help.

I am glad I didn’t grow up in the ‘Tik-Tok’ era, and facebook/ instagram was only really around when I was late teens. I feel for teens and young people now with the pressures of social media. This really worries me for future of their health.

It’s the time of year where the diet and fitness industry try their hardest to sell their products. So social media is swamped with diet culture and all the shit that goes with it. I am now in a place where I can mostly see this for what it is, selling a product. This industry generally targets a vulnerable population too, people like myself. However I am aware of it, and I’m aware of the impact it can have on me. I will not be deleting my social media accounts this year. Last year I needed to, to escape this onslaught. Instead I am using my social media to promote the ‘fuck it diet attitude’, following positive influences that are pro-recovery. If an ad pops up, I will simply reject it. Friends, family and colleagues dieting that’s up to them, I can choose to ignore this. But if you are in a place where this is going to be damaging to your recovery, a social media holiday can help. I found it quite liberating and realised how reliant upon social media we are. Returning to social media has been a big test in my recovery.

SHOULD, is not a nice word..

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

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

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

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

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

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

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

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

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

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

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

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

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

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