Showing posts with label Bulimia. Show all posts
Showing posts with label Bulimia. Show all posts

Thursday, 14 April 2016

ED Recovery

I've typed this sentence countless times over the last two months, and then deleted it. I want to tell you that it's because everything has been going so well that I have nothing say. But that's not the case. The truth is that I have been struggling for the last few months, and I haven't wanted to admit it to anyone. More and more I have been hiding behind that familiar mask, the forced smile and throwaway words when someone asks how I am. That voice in my head, that darkness, convinced me that if I opened up to people they would turn away. That my friends and family are sick of my problems, sick of the burden of having me in their lives. Maybe that's true, I'd understand, but not talking about it isn't getting me anywhere.

I was discharged from an eating disorder unit last August, after 9 weeks of weight gain and various therapy groups aimed at breaking the hold my ED had on me. I gained 11kgs during my stay as a result of a high calorie diet and a largely sedentary lifestyle. The first few weeks at home were difficult and I lost a few kilos, but for the last four months I've maintained the same weight. Which is good for my body - I am healthier than I have been in years. Outwardly, I am doing great, at least that's what people keep telling me. Inside is a different story.

Recovery from an eating disorder is not just about gaining or loosing weight, in fact I would say the numbers on the scale are the easy part. Here I am, a healthy weight with everyone around me commenting on how great I look, and I feel like someone has taken my brain and shoved it inside the Stay Puft marshmallow man(Ghostbusters). In the eight months since my discharge I haven't been able to look at myself in the mirror. The most I can manage is focusing on one body part so I can check how fat it looks in whatever I'm wearing. Then more often than not I will go and change. I live in pajamas or tracksuit bottoms for most of the week - today for example, I walked my dogs in my pajama top and a pair of ugly grey tracksuit bottoms, that were inside out. And then I went to the shop, in the same outfit. This isn't a rare occurrence either, some days I just stay in my pajamas; I'll do the shopping, walk the dogs and even go to therapy in my pajamas. It's not that I'm lazy, or haven't done the laundry. It's because I am so deeply ashamed of my body that I can't stand to wear anything that might draw attention to just how fat and revolting I am. I would rather be seen in a pair of Harry Potter pajamas, than a pair of leggings. At least when it was colder I could hide myself under big jumpers and frumpy coats. What am I going to do when the summer arrives?

I wish I could like my body, or just accept it. I wish I didn't want to cry every time I shower or have panic attacks in changing rooms. I wish I could look at a magazine or watch TV without comparing myself to every female on it, berating myself for being lazy and weak. I wish I wasn't compulsively rubbing my collarbones as I type this and telling myself how much better it was when they were sharper and more defined.

When I was in hospital they told me recovery would take a long time, but I didn't really comprehend what that meant. I thought eating would be the hard part, that once I stopped crying over mashed potatoes I would be at the end of the process. In reality, that was just the beginning. This is the hard part, this is when you really have to work. It would be so much easier to fall back into the same pattern of restricting and purging than to try and accept myself the way I am now; to separate my self worth from the numbers. It seems like an insurmountable task to me, and I have no idea how to accomplish it. Perhaps wearing actual clothes to walk the dogs is a good place to start?

Wednesday, 6 January 2016

Treatment Part Two

In January 2015 I entered a private residential facility for treatment of my eating disorder. After a lengthy assessment with the consultant, I was diagnosed with EDNOS - eating disorder not otherwise specified. Another ridiculous sounding disorder, bloody psychiatrists. Basically, I engaged in behaviours attributed to bulimia and anorexia nervosa, but didn't tick enough boxes on either side to fit neatly into one box. Boxes are very important to most mental health professionals; once they can give someone a definitive diagnosis they can use the 'one size fits all' treatment plan that has been recommended for that disorder. I have found this to be particularly true of private psychiatrists; you stop being an individual and are completely defined by your diagnosis. You are no longer Lisa, a 30 year old woman with unique life experiences, beliefs or feelings; you are Borderline Personality Disorder and everything you say or do is because of it. You don't hate the taste of mushrooms, you are anorexic(I'm not exaggerating, I had to have 3 meetings in hospital in order to have 'no mushrooms' written on my chart).

When I entered the facility in January I was terrified, but I also knew that I needed help. For me, there is always a conflict between what I want and what the eating disorder wants. It is not as simple as asking for help and embracing it; my eating disorder had become the one thing I could depend on in my life. When everything around me, and inside me, was spiraling out of control, I would use food and weight to anchor myself to the world. So while I voluntarily agreed to treatment, a part of me wanted to cling to my ED, because I was afraid of what would happen if I gave it up. Better the devil you know...

The first priority in any ED programme is to feed the patient, a starved body and mind is not able to engage in the therapies used to treat the psychological side of the disorder. That first day, it took me an hour and a half to eat my half portion of dinner. With every morsel that passed my lips the ED voice grew louder and louder. The rage, disgust and shame were all consuming; I remember nothing else of my first week there. During the day we would have group sessions - Art therapy, craft groups, CBT based groups, nutritional therapy, interpersonal therapy etc; and in the evenings we had weekly individual therapy sessions. Any free time between groups and meals was spent in a communal living room, hiding away in your room was not permitted. Bathrooms were locked for an hour after meals, condiments and spices were restricted, as was liquid intake. We were weighed twice a week, had our bloods checked daily at first and then twice weekly, and we were not allowed to leave unsupervised until the consultant was satisfied that we were committed to the programme.

My referral to the programme had included a detailed history and description of my diagnoses, and I had discussed my BPD during my initial consultation. However after about two weeks the consultant began to question, and eventually dismiss, the BPD diagnosis. The characteristics and behaviours I exhibit that are attributed to my BPD did not fit into the ED mold. So it was simply ignored, and I was now EDNOS. Unsurprisingly, I repeatedly stepped over this new line; and while my actions and thoughts were ignored in terms of my treatment, they had to be dealt with on a practical level. So for the 40 days I was in the facility, I never left the house unaccompanied or ate so much as a biscuit without a nurse present.

Some of the therapies proved quite beneficial to me and none more so than my individual sessions with a CAT therapist, whom I still work with. I met wonderful people, staff and patients alike. I gained some weight and my health improved. I self-harmed and attempted suicide, and on one occasion absconded. I learned about portion sizes, healthy diet and how to make banana bread. But when I was discharged, I returned home and immediately began to restrict again. Suddenly alone for most of the day, I found I didn't have the willpower, and if I'm honest, the desire, to eat without supervision. We had been taught to weigh everything we ate; on my first day home I dutifully weighed out 40g of porridge and cooked it with water. On my second day, I weighed out 35g. My third, I decided the bowl looked too full and threw several spoonfulls into the bin. And so on and so forth until there was no porridge.

My relapse occurred so quickly, and totally, that my depression worsened. I had let my family and friends down, I was a failure and I was weak. Worse, now I was a fat failure. There was nothing I could do, or was willing to do, to make amends with my family but I could do something about my weight.

Just like that, I was back at the beginning. Within a few weeks my weight was back to where it was before treatment, food and numbers were the sole focus of my life, and my depression pulled me lower and lower. I had been discharged at the end of February, and on the 31st of March I turned 30 and tried(poorly) to cut my wrists in a pub toilet. I had given up on myself and given in to the hunger and darkness.

Sunday, 20 December 2015

Oh Christmas Tree...

I love Christmas dinner. Turkey, ham, stuffing, potatoes and especially Brussels sprouts(they are little balls of vegetable joy, you're weird if you don't like them). For the last three years I have been in charge of making dessert, and I love pouring over recipes looking for something new and challenging to make. I see the meal as a marathon, not a sprint, and happily languish at the table for two hours, eating more meat as soon as there is room in my stomach. I look forward to Christmas dinner for 364 days; typing this I have visions of roast potatoes dancing in my head.

In four days my favourite meal will be in front of me, in all its festive glory. But this year instead of excitement, I have a growing sense of fear. I'm afraid because I have not kept a Christmas dinner down for nine years. Every December 25th I eat whatever I want, and then immediately excuse myself so I can go to the bathroom. If I eat a second plate, I'll return to the bathroom, dessert too. I think I spend more time throwing up food over Christmas than I do eating it. When I should have been enjoying time with family, laughing at terrible jokes from crackers and savouring the moment, I was instead focused on drinking enough water while I ate. Or worrying about how long food had been in my stomach, because I couldn't leave the table without interrupting a conversation. While everyone relaxed in the living room post meal, I worried that I hadn't fully emptied my stomach. Christmas Day was another thing I gave up in my pursuit of the perfect body and sense of control.

My recovery is still in it's infancy; I throw more toast in the bin than I eat, and that's with a Valium to keep my decrease my anxiety at meals. Food is still the moat important thing in my life, although now the focus is on eating it, not running from it. I'm too ashamed to tell you how often I think of giving up, it would be so much easier. So I take it one day at a time, one meal at a time. But I want Christmas Day to be different; I don't want to think about food at all on the 25th. I want to think about fairy lights, paper hats and Monopoly. I want to eat my Christmas dinner, and then a mince pie and feel no guilt. I am determined to have one day off from being a neurotic mess, and what better day than one I used to adore.

Tuesday, 24 November 2015

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.

Friday, 20 November 2015

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.

Wednesday, 11 November 2015

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.

Tuesday, 3 November 2015

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.

Thursday, 29 October 2015

Addicted

Shortly after getting my tooth removed, my weight loss plateaued. Purging and laxatives will only get you so far, as neither is very effective in terms of calorie control. The latter has absolutely no affect, by the time the laxative takes effect, what you have eaten has already been digested. There was a treadmill in the house, so I decided it was time to bring exercise into the equation. I was never into sports; I even managed to avoid PE class for most of secondary school. I was incredibly unfit, and a smoker(the more you smoke, the less you eat!) so in the beginning I struggled with a fast paced walk. Logically, I can see that this was to be expected: a smoker who lead a sedentary lifestyle and wouldn't even jog for a bus. But in my head, my laboured breathing and aching thighs were proof that I was still overweight. So I walked, then jogged and finally managed to run for 5 minute intervals.

Nothing happened, other than an increase in my lung capacity. But who really cares about lungs when your thighs touch? I needed to take it up a notch. I joined the gym and started doing weights, in addition to increased cardio exercises. I rowed, crunched, lifted and stepped until I was weak at the knees. I hated every second of it, I cried more than once in the locker room as I sat there heaving and sweating. My sole motivation for going was weight loss; to quiet the voice in my head that constantly remind me how disgusting I was; how weak I was; how pathetic. Unfortunately, my years of exercise avoidance meant that I knew nothing about it. I had assumed working out would equate to weight loss, it was basic physiology as far as I was concerned. I don't think I can really convey the devastation I felt when the number on the scale barely dropped. All of that effort, all of the pain and the early mornings has been for nothing. I was clearly eating far too much, I wasn't being strict enough when I was purging. It never crossed my mind that perhaps there was another reason I hadn't lost much weight. For the first time in my life I had toned and ever so slightly muscular arms. My calves and thighs were like rocks, and I could run at a steady pace without gasping for breath. Looking back, it's possible that the reason I didn't loose weight was because I had converted some of my body mass into muscle. Possible. But I couldn't see that at that time; it was just more proof that I was a failure.

I immediately quit the gym, if it wasn't going to help me loose weight I wasn't interested. Around the same time, I was experiencing some difficulties in work. I won't bore you with the details, but the situation was causing me a great deal of anxiety and stress. I knew of only two ways to cope with distress - self harm or weight loss. I chose the later. Within a few months I was purging up to 15 times a day, mostly in work. The saddest part is, I wasn't even indulging in delectable delights. My idea of a 'binge' was 4 rice cakes. By now my eating disorder had become my primary focus; what to eat and what to purge; what I could eat and when I could eat it; what lies I needed to tell to keep my secret; which pharmacy was next on the laxative rotation. I was like an addict, jonesing for my next fix and using my ED behaviours as a crutch when anything difficult or distressing happened. Focusing all my attention on food and weight also meant I could disconnect from my disintegrating emotional state.

As I have said before, I have struggled with depression for more than half of my life. It should therefore come as no surprise to you that as my ED spun out of control, my BPD characteristics reared their ugly heads again. Mood swings, irritability, depressive episodes, insecurities, impulsivity...not to mention the long list of dysfunctional thinking styles. For good measure, my body decided to join the party and began protesting my treatment of it. I'm not going to sugar-coat anything, so prepare for the ugly truth. My bowels no longer functioned on their own, I was completely reliant on laxatives and enemas. My teeth and gums ached constantly, and part of one of my front teeth broke off. Despite being on the pill, my periods became irregular. The skin on the knuckles of my right hand were so raw from rubbing against my teeth that they developed scar tissue - if I get too hot or cold my knuckles turn red and angry. My concentration waned and I was constantly irritable. My lows dropped even lower and my interest in all other aspects of my life dwindled. The acne I had suffered as a teenager flared up. I was permanently tired, and when I wasn't in work I was lying on the bed.

But what about the rest of my life? My boyfriend, family and friends? They were all secondary to my eating disorder, I no longer hesitated if I needed to lie to them to keep my secret. I had enough experience with mental health problems and knew myself well enough to know I was in trouble. But I couldn't risk losing the ED, it had become more than just a way to change my body, it was my best friend. And I wasn't willing to give it up for anything, or anyone. Even myself.

Wednesday, 14 October 2015

Phase Two

In 2012 I was 27 and I found myself single for the first time since I was 19. I also found myself in need of a new place to live as the apartment I shared with my sister was being sold. Happily, a casual friend of mine was also seeking a roommate so we rented a house together for a year. Before I get to the boring serious stuff I just want to say that I loved living in that house. Other than the fact that it was colder than the North Pole for the entire year, and that the shower mostly just dribbled water on you, it was a pretty fun year. I laughed all the time, made brownies in mugs, drank far too much wine and definitely ate too much Chinese food. But the best part was my roommate, who went from someone I saw on nights out, to one of my closest friends. Also one of my most understanding and patient friends, who never gave up on our friendship, even when I was so lost in my illness that I couldn't even be counted on to meet for coffee. Hell, she is still tolerating my unreliability while I struggle with my compulsion to be anti-social. So despite what I am about to divulge, that year of my life was a pretty good one.

At the beginning I struggled with my new single status. I was a serial monogamist, because without a boyfriend I had nobody to validate me, or make me feel loved. Even when my relationships were breaking down, and both parties were miserable, it was better than being alone. Even though I knew I could never be good enough for the other person, knowing they had picked me meant there must be something acceptable about me. So when I found myself without that emotional crutch, I floundered, desperate to find some way to avoid falling back down into that black hole. For the first few months I was single I threw myself into the dating game, or more accurately, the one night stand game. Just as I had done in college, I used sex to make myself feel wanted. I tried to tell myself it was all fun and games, the single life, but it started to eat away at me. The short term feeling of being wanted by someone paled in comparison to the self loathing and remorse that lingered for days afterwards. I needed something else, anything that would separate me from the emptiness and sorrow.

I had at this point been making myself sick on and off for 5 years. I knew that purging could lower the intensity of my emotions; I also hated my body and still felt massively overweight so the most logical step in my mind was to throw up more often. At first it was once a day, after my dinner. It was perfectly reasonable and safe in my mind, like being on a diet. Then I turned my attention to what I was eating during the day, low calorie soups and rice cakes entered my life. I started walking to and from work, just to get fitter. Weekends were different, because by Friday I was so miserable I turned to the one thing I knew would comfort me, food. You might be wondering why I kept on throwing up and dieting if I was still so unhappy. Immediately after purging I would get a burst of pleasure, many bulimics experience a 'high' after throwing up, which is one of the reasons relapse is so common. That high is addictive, it's like taking ecstasy, but the effects wear off much faster. The other reason is that in that moment, choosing to make myself throw up, I felt in control. For most of my life I had always felt somewhat powerless, bulimia made me feel like I was finally in charge of something, I wanted to loose weight so I was choosing to do this to achieve my goals. That feeling of being in control is just as addictive as the high. No matter what is happening in your life, you know you can do this one thing of your on volition. So I kept throwing up, and then I would binge on sweets and take away at the weekends, and throw it all back up of course.

The bingeing and purging unsurprisingly started to affect my digestive system, so I started taking OTC laxatives once a week. Very quickly I started taking the laxatives everyday, convinced that they would aid my weight loss. When the laxatives stopped working, I turned to micro-enemas instead. One a week turned into twice a week and then before I knew it I was using them every second day. I never worried about what I was doing,In my mind I was completely in control of the situation and I told myself that once I reached the right weight, I would stop.

I had always been insecure about my body, but suddenly my weight and size were all I could think about. All day, everyday, I would pull at the softer parts of me; stare wistfully at other women and their perfect figures; stare for an eternity at the millimeter gap between my thighs. IF I wasn't thinking about my weight, I was obsessing over food. What I had eaten, what I wished I could eat, how many calories were in that apple, what was eating later before I purged, what would I binge on at the weekend...It never stopped.

When I moved out of the house at the end of the year, I couldn't go a day without throwing up. As often happens with bulimia, my weight had stabilised, but I kept telling myself if I just stuck with it, it would start dropping again. At this point, other than a sluggish digestive system, my health wasn't being affected by my behaviour. Which, as I repeatedly told myself, meant I wasn't bulimic. So it was fine, according to Wikipedia, and we all know Wikipedia is the most reliable source of information on the internet. So in April 2013 I moved in with my boyfriends family, and I was 100% fine, other than being too fat.

Monday, 12 October 2015

Food Equals Soothe

As I said previously, I had always believed my problems with food began when I self-induced vomiting for the first time. IT was only during my last hospital stay that I realised my distorted relationship with food started when I was a child.

According to compassion focused therapy (yes that's a real thing, and harder than it sounds), we have three main regulation systems for our emotions and thoughts: Threat, Drive and Soothe. Threat(Anxiety/Anger/Fear) is basically your fight/flight system, when we feel a threatened in some way this system kicks in for protection. Drive(Excitement/Motivation/Achieving) is when you are trying to obtain a resource or incentive, and Soothe(Happy/Safe/Kindness) is when you feel content, protected and cared for. We move between the different systems as we go about our lives, and we can quickly jump from one to the other.

For example, imagine you have to prepare a group presentation in work, and whichever team has the best presentation wins €100 each. You will most likely be fully in drive, focusing on the task at hand and the end goal - the €100 prize money. But what if Larry, who you've never really liked, starts to take over the project, refusing to listen to any ideas but his own. And Larry's ideas are terrible, really terrible. So not only will you not win the cash, your boss will probably think you had something to do with that sorry excise for a presentation. So your brain goes into threat mode, your self-preservation kicks in and you snap at Larry to let other people talk. Assuming Larry concedes, you will flip back into drive and start firing off counter ideas. Although you may keep one toe dipped in threat, just in case that damn Larry doesn't tow the line. So, Drive->Threat->Drive.

There are plenty of online resources about CMA, which explain it a lot better and more accurately than I just did. But hopefully you get the basic concept. How is this relevant to my ED? Excellent question Cyberspace, so I'll get back to the matter at hand.

My earliest memory took place when I was three. I was running down my grandmother's garden, being chased by her dog Daisy. I don't remember running headfirst into an apple tree during said chase, and splitting my forehead open. I definitely don't remember being brought to hospital and getting 8 catgut sutures, while bawling my eyes out(understandably). However I do remember being handed a Cadbury Flake bar. So I have fear of the dog(threat) followed by yummy chocolate(soothe). You're probably rolling your eyes at me, its just a dog and a Flake, although Freud could probably have a field day with it. As far reaching as it may seem, that moment was pivotal in my life.

When I was a child my house was a very scary place to be, my parents nasty separation being just one example. At all times I had a certain level of anxiety and fear, just waiting for the next attack, constantly in threat mode. Luckily, I spent a lot of time with my maternal grandmother, Joan. From the moment I was born she looked after me when my parents couldn't, and even as a teenager I stayed in her house regularly. My grandmother was the one person in my life who made me feel safe, her house was my safe haven, it was the one place my soothe system was activated. And like most grandmothers back then, she spoiled me rotten, in the form of sugar. My grandmothers house meant red lemonade and 10p bags of jellies, it meant 20p coins to spend in the newsagents. It was sitting up late with her watching Coronation Street, eating pink wafers. Tiny Mars bars or ice cream between wafers if I was good. Homemade jams, stewed apple and rhubarb with custard...Food meant I was wanted and that I was being rewarded. When she got older, and couldn't get up to make breakfast, she would leave out cereal bowls filled with pink and white marshmallows for me and my sister. Nothing could make a seven year old and ten year old happier than watching cartoons while eating a bowl of marshmallows.

When my dad left home my mother would sometimes bring us with her to the pub at the weekend. In exchange for our good behaviour my sister and I would be gifted with a £5 note to spend in the shop next door. We would sit quietly in the corner, surrounded by inebriated strangers, safe in our little sugar bubble. When I was eight or nine I started stealing money from my house. It started out with 5p from my mum's purse, or if the man she was seeing was over, I would rob every coin from his coat pockets. I also got pocket money from my dad, £1 every second week I think. If something particularly bad happened at home, I would take my money to the sweet shop near my school and buy flying saucers and red licorice whips to cheer myself up. I'd buy 100 cola bottles and eat them until I felt sick, because with every jelly I thought less and less about whatever had happened. Because in my little mind, I subconsciously associated sweets with the one person who made me feel unconditionally loved - my grandmother. So if I couldn't be with her, I would try and replicate that feeling of safety and contentment with food.

When I moved to a new house and school at eleven things got even worse. My shy, bookish and slightly weird personality did not fit in with my new classmates, or my family. Now I was miserable in school and at home, so almost everyday I would spend my bus fare in the nearest shop and walk home. The combination of a long walk and the limited amount of food I could buy with my bus fare meant my weight stayed the same. At home, it was toast. I would sit in the kitchen alone every evening, watching TV and secretly munching away. Food was not just something I needed to live, it was a way to push down any thoughts or feelings that were too intense, or a way to try and fill up the growing emptiness inside of me. At the time I didn't think that there was anything wrong with my relationship with food, but I deliberately used it to comfort myself.

By my mid-teens I had, for the most part replaced food with self harm. A slice of cake had nothing on the sting from a fresh cut, in terms of dealing with distress that is. The cake obviously wins the taste test. Using food as a coping mechanism is not specific to people with eating disorders, or personality disorders. I would go so far as to say that most people have turned to food for comfort at some point in their lives. Whenever there is a break-up scene in a chick flick, ice cream and/or chocolate will inevitably appear. It's perfectly normal to eat Nutella off of a spoon after a really shitty day at work. The problem occurs when you think the only way to feel better after that shitty day is a spoonful of Nutella. It's when you realise you're standing in your kitchen holding an empty jar and panicking, because now you have to feel emotions. It's when you never think of food in terms of nourishment, or family, or celebration, that's when it's a problem.

So while my eating disorder first manifested when I was twenty two, my maladaptive relationship with food started about 19 years earlier. Which makes changing my beliefs around food and eating even more fun. Rather predictably, I now have an overwhelming urge to go and buy cake, in order to block out the memories I recalled for this post. But I'd probably just throw it up, so why waste good cake?

Tuesday, 6 October 2015

Bulimia

You might be wondering why, after writing so many posts about my mental health between the ages of 12 and 19, I gave brushed over the next 10 years of my life. From 2004 to 2014 I lived the same life over and over again. I would have a period of being well, then the depression and mood swings would return. I would self harm until eventually I ended up in A&E; be referred back to a psychiatrist; take more medication...round and round and round. Some of the characteristics attributed to my personality disorder were always, and will always be, active. There were however, three significant events during that time that I want to talk about. The next few posts will focus on one of them - the beginning of my eating disorder.

Whenever I have been asked when I started engaging in eating disorder behaviours, my answer is always: when I was 22. At the time I was in a stable relationship, working full time and through a combination of therapy and new medication I had been stable for a few months. I was also very overweight, and that is not an exaggeration or my eating disorder talking. The medication I was taking increased my appetite, and I doubled my portion sizes for every meal. Then my moods started fluctuating again, and instead of facing it I tried to pretend it wasn't happening. Then I started eating whenever my mood would dip to cheer myself up. I have always loved food, so in the short term this strategy was effective. I was filling that hole inside my heart with cake...and chocolate, and sausage rolls and...well you get the picture. As a result, I started gaining weight. But again, instead of facing it, I ignored it, and my weight skyrocketed.

I only have one picture of myself at my heaviest; in it I am wearing an outfit I'd had for a number of years but, as I had almost doubled in size, the flowing baby-doll top was now skintight and bursting at the seams. I don't know how I managed to ignore what was quite literally right in front of my face, but until the day I saw that picture, that's what I did. When I saw that photo, I was horrified and repulsed. My mood plummeted. I became depressed, my mood swings worsened and my fingers were itching to pick up something cold and sharp. I made half-hearted attempts to exercise, but after a few days I would always give up. I just didn't see the point in trying.

I was in the toiler in work one day, hiding in a stall trying to get control over a sudden onset of tears. I had just finished lunch, all I could think about was cutting, and out of nowhere I decided to stick my fingers down my throat. After several minutes my throat was burning, my knuckles raw from my front teeth and my stomach ached from the violent retching. It felt wonderful, that addictive combination of a silent mind and pain. So I started throwing up every lunchtime to help me get through the afternoon. All too quickly, once a day wasn't enough to quiet the tirade of abuse I lashed myself with every waking moment. As I ate breakfast at work it was easy to add it to the purge schedule. I quickly learned the tricks of the trade - ways to ensure I emptied more of my stomach. I didn't see the harm in what I was doing; I had plenty of extra fat to keep me going and really, it was just like taking a Xanax. More importantly, I wasn't self harming right?

I couldn't, or wouldn't, see any connection between making myself sick and self harming. They were completely different, the vomiting wasn't doing any harm. In fact, the vomiting was helping me. My clothes slowly started to become looser, I was actually loosing weight. It was just a diet, and like any diet you had to stick with it. So I started throwing up dinner, as much as I could without alerting my boyfriend. I never questioned why my 'diet' had to be so secretive, but it did. I knew I had to keep it to myself, or it might be taken away. By this point I couldn't go one day without throwing up, I was completely addicted to it. Even when my boyfriend discovered what I was doing, I wouldn't stop. I finally had a way to manage my emotions, to block out my thoughts, and nobody was taking it away from me.

Over the next few years, until about 2012, I would go a week or two without throwing up, but I always went back to it. I had lost a lot of the weight I had gained, and as often happens with bulimia, I hit a certain number on the scales and stayed there. It didn't matter though, the weight loss had always been a bonus. The purging gave me control; it was the only thing in my life I felt like I had any control over. But more on control later.

So that's how it started. Or at least that's what I thought. The thing about eating disorders is, they don't normally spring up out of nowhere in your twenties. The behaviour, the purging, started in my twenties. But I have come to realise that my relationship with food had been distorted long before that.

Wednesday, 16 September 2015

Mirror, Mirror

I'm stepping out of the past for this post and bringing you into the present, something I had never intended to do when I began this blog. It has always been my intention to share my story chronologically, in the hopes it might help others who have had similar experiences. I will return to that, but today I need to help myself with my blog, so forgive me for the inconsistency. I need to release some of the words buzzing incessantly inside my head, before they drive me down paths I don't want to travel.

I have been out of hospital for six weeks now, following nine weeks as an inpatient on an eating disorder unit. This was my second time in an ED programme, having spent six weeks in a private residential facility in January of this year. The first one didn't work out, obviously. When I entered the hospital in May I was just 1kg above my lowest weight, and had attempted suicide two days before. I was a voluntary patient; the combination of my ED and year long depressive episode had physically and mentally exhausted me to the point that I knew I had to get help, or die.

The programme on the ED unit had two objectives: weight gain(or loss if needed) and to help you take back control from the ED, on a psychological level. The later was done through group work on self esteem, nutrition, cognitive behavioural therapy etc. The weight gain was achieved through that revolutionary concept called eating. Each individual was given a meal plan, depending on their admitting weight and physical health, and if necessary this meal plan would be changed. Anyone who was underweight would, when physically safe to do so, be put on a plan that had an expected weight gain of 0.8-1kg a week. We were weighed twice a week, and if the average had not increased week to week, you would be moved up a meal plan. The higher the meal plan, the higher the calorie intake. We had three main meals, and three snacks a day - the size of your meal or snack depended on your meal plan, but all meals and snacks were eaten under nurse supervision and they were not optional. I remember the first desert I had to eat, a chocolate muffin covered in chocolate sauce. You think you can't get any lower, and then you find yourself sobbing over a cake. If you don't have an eating disorder I imagine that sounds completely ridiculous, but if have or had one, you understand how much I hated that brown blob.

So you had to eat what they gave you. Even if you really hated eggs, unless you had an egg allergy approved by the dietitian, you were eating those eggs. Bathrooms were locked after meals and snacks; fluid intake was monitored; all condiments were rationed; fruit intake was restricted; high calorie milkshakes were used if needed. In short, they had the weight gain process down.

So I gained weight, about eight kilos. I was still slightly underweight, but no longer in danger of my body eating my organs. Objective one completed. Objective two was a whole different story.

I have always hated my appearance. I honestly don't remember ever liking what I saw in the mirror, even as a child. They used to say in the hospital that if you stared at your finger for long enough you would find something wrong with it. I didn't need to stare at it, I could list three things wrong with it without even thinking. The part I hate the most is my face, I've spent countless hours daydreaming about plastic surgery. I used to cry at those television shows were they gave people who felt ugly new faces. I would have done anything for a new face. But, until I win the lottery, there isn't much I can do about my face. Other than use layers of make up to try and detract from the worst of its flaws.

Coming in a close second for most hated part of me, is my body. The entire thing, from my chin to the top of my toes. I could fill the screen up listing all of its flaws, but that's not going to be fun for anyone. But trust me, there is not one part of it that I like. Or tolerate. But unlike my face, I can change my body. Or at least the size of it. So that's what I did. If I had to be ugly, I could at least be thin and ugly. That way I could blend into the background, the smaller I was the less people would notice me. And if they didn't notice me, they wouldn't see all of my defects. So I became bulimic (there's more to it than that, but that's for another post), and then anorexic. Then eventually it was 'eating disorder not otherwise specified'. Which basically means I was a bit anorexic and a bit bulimic. Or, in my head, I wasn't disciplined enough to even have a real eating disorder.

So my weight dropped, stabilised, dropped, stabilised...and then went all the way down. Other people would tell me I was too thin, or that I was underweight, or my BMI was too low. I knew they were all lying, all I had to do was look in the mirror and I could see how fat I still was. Most people don't believe me when I say that, they don't understand it when I tell them I am still overweight. I don't understand how they can look at me and not see that I still need to loose weight. At my lowest weight, I knew I still had so much weight to loose. When I admitted myself to hospital, I did so knowing I would come out grossly overweight. But I had to make a choice between gaining weight and dying, and in that moment I picked gaining weight.

Since I have left hospital I spend 90% of my time in jeans, tracksuit bottoms and baggy tops. Everything must be loose to hide my chubby thighs, thick waist and protruding stomach. I have worn make up and put on dresses on three occasions, and each time I wanted to claw my skin off because I felt so self conscious. I have not looked at myself fully in a mirror in months. I can't look down at myself in the shower, I can only focus on one body part at a time or the pain inside threatens to swallow me whole. I have to accompany my boyfriend to a work event this weekend and I have already started to panic about what to wear - tracksuit bottoms are not an option. I didn't even own tracksuit bottoms until I was in hospital, now they are my favourite thing in the world other than pajamas. I am embarrassed when I see people I know, because somehow I know all of these gorgeous women, who always manage to look amazing on nights out. That's how I see them anyway, I'm not one to assume to know how they view themselves.

So here I am, I can eat food now. But getting dressed makes me cry. If someone else told me they couldn't think of one thing they liked about their body, I would want to hug them and I would hurt for them. But it doesn't work on myself. I'm not sure I will ever complete objective two, but maybe someday soon I can think of one thing I like about that finger.