Insight

Over the last year I've spent a lot of time trying to explain my eating disorder to family and friends. To most people, risking permanent medical problems, and even death, in order to loose weight is incomprehensible. They don't understand when I tell them that I am fat. They assume I am fishing for a compliment, or reassurance. The reality is, you could tell me a million ways that I look fine, and I will never believe you. I can't believe you, because people lie. I know this because I lie, all the time. I lie to therapists, doctors, my family, my friends and to myself. It's much easier to keep quiet, wear a mask, than show people the ugly truth. But I want to help people to understand eating disorders, that's one of the reasons I write this blog. Understanding the problem is the only way to find a solution, or at least do damage control. Today I found myself in a difficult situation, but I am hoping I can use it to bring you inside my head a little bit.

I was discharged from my last hospital admission in July. On my last day I had a final weigh in and this, along with other information, was sent to my GP. I was to attend my GP monthly for physical monitoring, and my GP would then share the results with my psychiatric team. Two weeks after discharge I had my first visit, and in the space of two weeks I had lost 2kgs. As soon as my eyes took in the number on the scales, I felt dizzy with relief. That abusive, hateful voice in my head was blissfully silent for the first time in months. My doctor was less than pleased; a gentle but stern lecture followed and I promised to try harder. The following month, my weight stayed the same. As my GP explained the importance of reaching and maintaining a healthy weight, I was being torn apart on the inside. I was a failure, I was weak, I was fat and ugly. As soon as I left I started sobbing. The noise in my head got louder and louder, until all I wanted to do was rip myself apart, tear flesh from bone and let all the pain bleed away.

So I stopped going to my GP. My psychiatrist warned me that if I didn't go and see her, he would have me weighed in the clinic. I assured him I would go, but every time I picked up the phone I was overcome with fear. I am 30 years old and I am completely and utterly terrified of the scales. I won't even keep them in my house, which is unusual for someone with an eating disorder. Today I had to attend the clinic for a weigh in, after ignoring repeated requests to see my GP.

I woke up at 4 this morning, my appointment was at 9.30. For five and a half hours I sat in my kitchen, staring longingly at a glass of water and the coffee machine. I was thirsty and my mouth felt like it was full of cotton(a side-effect of my medication), but not a drop of liquid passed my lips. I was hungry, and I am supposed to eat within half an hour of waking. I threw my bowl of porridge in the bin. At 5 I took my dogs for an hour long walk, after which my head was throbbing. But I still couldn't drink anything. At seven I had a shower, after debating for an hour how much moisture my skin would absorb and if it would have a significant effect on my weight. I dried my hair until it felt like straw, because wet hair weighs more than dry. Clothes were next. Despite the cold, a string top was a definite and a bra was out of the question - I couldn't risk the 0.05kg. I always wear leggings for weigh ins, no excess fabric to tip the scales. But just in case I pulled out every pair I owned to find the lightest pair. This took about twenty minutes because plain leggings tend to weigh the same amount. But I found an old, worn out pair that are almost see through at this point. Ankle socks, obviously. I ran the hair drier over my hair again, just to be sure.

I was freezing in my worn out leggings and string top, but shivering burns calories so I threw on a jacket and headed for the clinic. I don't remember the 5 minute drive, all I was thinking of was numbers. I'm pretty sure I didn't check my mirrors once and my legs were shaking so badly I couldn't change gears properly. Thankfully, or regretfully, I arrived safely. In the waiting room I ran through every 'bad' thing I had eaten in the last 3 months. I ran my hands over my hips, feeling the flesh where there used to be bone. I moved in my chair, noticing how it was no longer painful to sit on a hard surface. I flexed my arms, stretching the muscles that were growing back where they used to be so beautifully wasted away. I pulled at my face, my neck, pinched my thighs. All the while feeling more and more disgusted and ashamed of myself. I had thrown away all that hard work, for nothing. I had given up when I was so close to being the perfect weight. People were laughing at me, the fat girl who says she has an eating disorder.

As much as I pleaded with the universe for the number not to have changed, I knew it had. Logically, I had been eating relatively healthy, high protein diet and combined with long, vigorous walks with my dogs meant I was slowly rebuilding muscle tissue. I knew my weight would be up, that was after all the goal right? But when I stepped on those scales, and saw where the pointer stopped, all reason went out the window. For a split second, everything inside me froze, and then my brain exploded into action. If I just cut myself a little bit, it would help. No, maybe we need to binge and purge? Definitely not fatty. Back to self-harming...no I'll get caught. I couldn't think through all of the screaming in my head. I hung my head as I left the clinic, certain the nurses were thinking I was a time waster. I didn't need weigh ins, I was a heifer. I had to roll down the windows to make it home safely, the rain pelting down was the only thing keeping my mind present enough to steer.

I wanted to crawl into bed when I reached home, curl into a ball and cry. But the eating disorder had other plans. I didn't deserve to lie down, we needed to plan. Check my new BMI...19.3? Ten minutes of staring in horror at the big, green HEALTHY WEIGHT on the screen. Another ten minutes of using online calculators to figure out how I could lose 2kgs in the next two weeks...twenty minutes checking how many calories are in apples, bananas, oatcakes. Then a walk in the rain with the dogs while looking at apps that calculate how many calories you have burned. Off come the leggings and on with my standard uniform of baggy jumper and tracksuit bottoms.

Finally, three hours after my weigh in I stopped. I had hidden my lumpy, hideous body under shapeless clothing, I knew what I needed to do to get back in control of my weight. Now I could sit and replay the moment I looked at the scales over and over in my head. That's about as good as I am going to get today, but the majority of my day will be spent obsessing about food. Ruminating over every morsel I ate recently, or that night I had wine, or how twice last week I only walked for 7 kilometers.

Maybe none of what I just described will make any sense to you, or maybe some of it will. I don't know anyone who enjoys being weighed and I know plenty of people who avoid the scales as much as I do. But I think the main difference lies in the intensity of our reactions to the situation - you might decide to eat less carbohydrates or work out more, I'll figure out how I can starve myself without anyone noticing.

Treatment

I was discharged from hospital at the end of September 2014, after 8 weeks. During my stay, I had discovered the addictive high of starvation, self harmed repeatedly, and attempted suicide. At times my despair reached such devastating levels that I took to hiding in the tiny wardrobe in my room; this happened so often the consultant had to issue a note to the ward staff that I was allowed to use the wardrobe to manage my distress. At one point he suggested I purchase a cape, to offer comfort when I was out of my room; thankfully I had just enough sanity left to decline the recommendation. Sobbing in wardrobes was one thing, creeping around a psychiatric wars in a hooded cape was a bit to Phantom of the Opera for me.

When I was discharged, I was not 'cured'. My depression hadn't lifted and my eating disorder was stronger than ever; but as is often the case with BPD patients, they simply ran out of patience and solutions to my problems. In my experience there are two reasons why this happens. One is that the doctors and nurses begin to suspect you are lying about, or exaggerating your symptoms. The idea that lying is a characteristic of BPD is not universally accepted by professionals, and it is my biggest problem with my diagnosis. I have never exaggerated about my emotional state, thoughts or destructive urges. In fact the only time I have lied about my depression, is when I want to leave A&E and avoid a psychiatry referral. I have lied because I know the nurse sitting opposite me thinks I am a nuisance; or to stay out of hospital. Certainly not to seek attention or acquire a ticket to a mental hospital. Disclaimer: when it comes to my ED, I lie more than a banker at a tribunal. More on that later.

I returned home, back to the very kind and tolerant embrace of my local mental health team. Over the next few months I attended a day hospital as an outpatient, ended up in A&E six times for serious self harm injuries and more suicide attempts. I barely slept, barely ate...time kept moving but I remained rooted in the same painful spot. Large portions of my life during that time are lost to me, perhaps because I didn't have a life to remember, I just existed. Moving reluctantly from one day to the next with no destination. The only thing I had in my life that I could cling to was my new friend, restriction. That's what I remember most from that time, restricting all day until my boyfriend came home, and then throwing up after dinner. I structured my days around what I could eat, what I would purge and perfecting the art of lying so that nobody knew the full extent of the problem. Because it wasn't a problem, it was the only thing that got me through the day. If it wasn't for my eating disorder I would have been dead already. It was the only thing I had that brought me any peace, and I felt fiercely resentful of all attempts to take it from me. As I've said before, it became my best friend.

Sure my new BFF came with some downsides; I was cold all day, everyday. My joints ached, my skin and hair was dry and my gums throbbed from all of the acid. Then my white blood cells started dropping, and dropping and dropping...when it was decided that my immune system was compromised, my doctor took charge. I was once again referred for treatment of my eating disorder, but this time it was to a private residential facility.

I was, I am.

Before I delve into the next part of my story, I wanted to give you more of an insight into the ball of neuroses that is my mind. But I wanted to do so with as much honesty as possible; no re-written sentences and deleted words. During one of my sojourns in a psychiatric facility, I did a stream of consciousness writing exercise. We were asked to write two pieces; the first as the person we were before our current mental health difficulties took hold, and the second as the person we were in that moment. I pulled the two pages out recently for the first time since I wrote them, and my beliefs about who I am have changed very little since that day. So I am going to share them with you, in the hope that you might better understand how I ended up where I did; or that you might see something of yourself in it and know you aren't alone in your thoughts. Bear in mind that I wrote this without thinking, so forgive me for the poor quality.

Then and Gone

I am a quiet, introverted girl who enjoys the simple things in life. I love curling up with a book. I like clean bed sheets and hot showers. I like holding my boyfriends warm hand and his lips on mine. I like talking to my sister and my dad, even though they are far away sometimes. I love crisp Autumn evenings and pumpkin carving. I love cold Winter days and bright Christmas lights. I love deeply and openly and I am not afraid to trust my heart. I educate myself in my spare time to exercise my brain. I like to cook and delight in food; a cold glass of rosé wine with a friend over a trivial joke or a deep conversation. I care about others and can put their needs ahead of my own. I laugh often. I want to see my friends. I listen to music. I love to watch movies for hours and discuss them at length. I make jokes, I work hard and am happy making my house a home. I like walking in the evening and then cosying up on the couch. I am friendly and can talk to others, and even though I'm weird, people like me. I have had some bad times in life but I have fought back and I am winning.

Now

I was born to parents who hated each other for most of my life. My mother tried to leave me when I was one. My father left when I was seven and then I became the hated one; the symbol of all that was wrong in my mothers life. She remarried when I was e;even and he didn't want me either because I wasn't perfect. At school I was the freak, at home I was the unwanted and in my head I became the ugly one. At eighteen my mother and sister left me and I was alone. At eighteen I tried to kill myself for the first time and I was sad when I failed. I have never been enough for my parents, I needed to be replaced with others. I have hated myself for as long as I can remember. I am lost, broken, disgusting. I am damaged goods. I have been beaten by woman and man for my crimes. I hurt people. My life is a series of failures with no end. I cannot remember what love is. I find no pleasure in life. I remain only to not hurt the few who still love me, but I am unworthy of their love. I am a waste of space, I am destined to die and I despise myself. It is all my fault.


When I had to read them out, I cried for the person I had lost. Grieved for her. I no longer mourn who I used to be, I have long since accepted that the old me is gone. Which is probably sadder than anything else I have written.

Anorexia

In June 2014 I tried to hang myself; the depression, self harm and constant purging had become too much for me to bear. I have written about that attempt before, so I won't go into it again. Eight weeks later I was admitted to a psychiatric hospital, for treatment of depression and an eating disorder. However as I was a danger to myself and at risk of self harm I could not be placed on the ED ward. Instead I was on a general ward, and other than a handful of meetings with the incompetent nurse who rang the ED programme, left to my own devices with regards to what I ate.

Restricted to the ward, with all sharp objects out of reach, I threw myself at the mercy of my eating disorder. The despair had eaten away at me, I was a shell of a person. I felt like I was walking around with a black hole in my chest, that devoured all the light from the world. MY mind was always racing, from one self-abasing thought to the next, faster than I could blink. I would have done anything to stop the pain, even if it was just for a minute. The part of me that belonged to the ED offered up a solution. If you loose weight, you won't be so worthless. Worthless, and fat and repugnant. If you skip that meal, it will be quiet in your head for five minutes. The hunger pains took the edge off my self harm cravings. Skipping meals and secretly vomiting made me feel like I was taking some control nack from the doctors and nurses.

I started to loose weight, but it wasn't enough for that voice. Every time they weighed me it would whisper, 'So close, just a few more and it will stop'. The truth is, that goal weight will always be just out of reach. Because you can always try harder; because you ate that piece of toast on Tuesday; because you just have to look in the mirror to see that you're still fat.

The more weight you loose, the more behaviours you engage in, the stronger the eating disorder gets. It's like a leech, draining your body to feed itself. While you waste away inside, it thrives. I could no longer look directly at myself in the mirror, or look down in the shower. The sight of my stomach or thighs made me want to tear into my flesh, to punish my weakness. I stopped eating altogether for a few days, because I knew that I could. The less I ate and weighed, the more I hated myself. I think most people have been self-critical, more than once, and for some people it could be a regular occurrence. I don't think I've met anyone who thinks they look perfect all the time; I mean rarely anyone looks good swimming underwater, except that Nirvana baby. But for me, I don't even have to be looking at myself to be critical. I just need to be awake, and even then, I regularly dream about how grotesque I am. Right now, as I'm typing, that little voice is whispering to me about how doughy my thighs feel when my legs are crossed. And how rounded my wrists look, and my pudgy fingers. I'll stop there, but you get the point. It never stops, not even when I get so hungry I can barely stand. But it gets quieter, when I do what it says.

I said before that one of the reasons I started restricting was because it gave me a sense of control when I felt so powerless. In reality, the eating disorder had all of the power. It was stronger than me, that little part of me buried under all that shit and hurt, and if I'm honest, I didn't but up much of a fight. Because there was one other reason to give in, the distant hope that if you push it enough, your body will perish.