Self-Esteem

I haven't blogged in months. I would love to tell you that I was too busy living life to talk to a computer screen but the reality is much more mundane and predictable; my depression and mood instability had improved, and I was too afraid to write as a (mostly) mentally competent person. Poor writing and bad grammar can be excused when you are cognitively impaired, but I discovered I lack the mental fortitude/balls to be judged as a functioning human being.

Luckily, for nobody, I am once again cocooned in the familiar blanket of depression; albeit a milder manifestation than its predecessor. So to the keyboard I return, for better or worse.

Over the last year I have done a lot of work with my therapists to address and, in most cases, move past events in my life that have contributed to my being an emotional equivalent of a broken condom. Yet my core belief system remained unchanged. No matter how many 'Mother hates me' sessions I had, I still couldn't look myself in the eye. And then I realised that I was missing something - self-esteem.

Let me be clear, I absolutely do not think that everyone else is walking around full of pride; dignity oozing from their pores like cheese from a perfectly stuffed pizza crust. I believe most of us have some level of insecurity, and if you don't, you're probably the next Ted Bundy. Or Tom Hardy. But I've come to realise that my self-deprecation is yet another maladaptive coping mechanism I lean on. And I have no idea how to overcome it. I looked through every page of my stupid (and useful, whatever) DBT folder and there is nothing on self-esteem.

So I googled self-esteem, and there was one exercise that appeared on nearly every page - List things you like about yourself. Reader, I laughed. I was first asked to list what I like about myself in 2004, during group therapy. I had nothing, I handed up a blank page. During my last admission, in August/September 2015, I was asked the same question; after 9 weeks I had nothing. Yesterday I tried to think of three things I like about myself, I have nothing.

If I tried to think of three things I don't like about myself? No problem. Although I think that's the case for many of us. Not that we can't think of our positive attributes, but that it is much easier to highlight our flaws. Personally, would much rather you ask me for a list of flaws, I'm comfortable and well-acquainted with those. But listing all of my disparaging beliefs would be rather long and boring, so instead I will consider my thoughts over a one hour period.

The purpose of this isn't to elicit sympathy,but rather to acknowledge the impact of low self-esteem and hopefully garner some much needed advice.

I have picked this hour for several reasons; first, it's the present, so my memory isn't required; second, I'm alone, thus removing the possibility of outside interference. Finally, nothing massively life altering or heart breaking has happened today. Yet. There's always time for life to be a dick.

I am constantly amazed and disgusted by how naturally pessimistic my outlook is.

You're an attention seeking whore for posting this.

Your hands are dry. and masculine.

Stop wondering what will happen next, you stupid whore.

Everyone already hates you, this is just adding fuel to the fire.

your thighs are touching, you fat cow.

You're fat now and you still don't have boobs. lol.

Waste of space.

Useless.

Your dogs hate you.

You're fucking ugly.

They literally hate you, they want Alan.

that sigh means Loki hates you.

You type too slow.

seriously stop rubbing your dry claws together.

Your hair is greasy.

You are the ugly friend.

You are a waste of space and money.

Remember money? It's that thing you don't have. Because you're useless.

Genuinely, everyone hates you.

Yes, even them. Remember they didn't reply to you tagging them on a comment on FB? It's because they hate you.

Ooo you're the pity friend! Familiar role for you, loser.

Seriously, your dogs hate you. They won't even cuddle you.

ooo remember how you got fat? That was hilarious right? No? Because you're disgusting now?

They all laugh at you. You know that, right? You don't really fit it, pity invite for one!

Fuck you are pathetic. Can't even afford a cup of coffee.

Also, fat now. FYI.

how's the new career going? Not great? Figures, right?

And nobody wants you there? Because you're fat and ugly maybe?

Remember when you could skip food all day? Willpower eh? None left no?

Oh hey, and you're fucking boring. Go on, discuss the presidential debate, with specifics... No? Global Warming? Property? EINSTEIN?

Literately nothing.

Just visualise your thighs touching off of each other. And your hips getting padded. And your face being plumper.

Good times right? No? Oh fuck... it happens every time. I remember the truth - I'm stuck with this face and brain.


Okay, I gave up after 24 minutes. Mostly because my mind was racing and I couldn't type fast enough.

So that's 24 minutes of me sitting in a chair in my living room, incident free. Just me being me. Fuck I hate me.

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?

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.

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.

Going out

I don't expect anyone to understand what I'm about to say, although I think a few of you will identify with some of it.

Yesterday I almost self-harmed, which would have been the first time since I was in hospital in July. The urge was so strong I had to walk out of my house, because only a small part of me wanted to resist. The thing is, if I had given in I would have felt better instantly. Cutting myself is the quickest way to regulate my emotions, and it is guaranteed to work every time. It only takes a few seconds, and in a house you are surrounded with suitable tools. Not self-harming was obviously the 'right' choice, but my sadness and pain remained, until I eventually gave up trying and curled into a ball on the couch.

Your probably thinking something awful must have happened to cause such distress, but that wasn't the case.

A friend of mine is having birthday drinks this evening, and kindly invited me. I was excited to go, because she is a wonderful friend and I haven't seen her in a while. My usual anxiety around social occasions and leaving the house aside, I foresaw no difficulties with going. Until yesterday, when I started to think about what I would wear. Before going further I should point out that one of the 'coping strategies' my therapist has put in place is that I have to choose outfits for social occasions in advance. This is in order to avoid an hour spent changing clothes with increasing frustration, until I eventually end up in tears or refusing to leave the house. This strategy has worked in the past, so I went ahead and started looking through my clothes.

Since leaving St.Pats, my weight restored to a healthier number, I have struggled with my body image. Anything that draws my attention to it sets of a tirade of judgmental thoughts and feelings of intense shame and disgust. So things like walking, sitting, bending over...breathing...I essentially feel ashamed of and repulsed by my body from the time I wake up, until I go to sleep. Even then I sometimes dream about muumuus and heavy duty mobility scooters. Things got even worse after my last weigh in. Showering usually ends in tears, I've thrown out piles of pajamas because they had elasticated waists and I can't bear to be touched by anyone, lest I see the revulsion flicker in their eyes. That being the case, I wisely decided, or rather that masochistic ED voice decided, that I should start out by trying on a tiny pair of shorts. I know that these shorts are a size 6/8, I also know that they are high waisted, which I hate. But when I was at my lightest, they were gloriously baggy on my things and the material at the back sagged divinely where an ass should be. But that was 11kgs ago, I KNEW they would not fit the same. So of course I put them on. And that was that, my ED exploded back to full force.

Since short-gate I have been a ball of misery; I am still wearing, and slept in, the clothes I put on yesterday morning. I have seriously considered taking everything that isn't loose or over-sized out of my closest and burning it(then the rain started, stupid rain). The thought of going out, facing people, showing them how enormous I have become is terrifying. I want so much to see my friends, but I can already feel the mocking glances as I stand next to these beautiful women like some sort of before and after advert. That voice keeps telling me over and over that nothing I do will make me look any better, so what's the point in trying?

When I sat down to write this, my hope was that I would be able to look at the situation more rationally, once all the emotion was laid out in front of me. No amount of words can change how I feel about myself right now, my own and yours will fall on deaf ears. But there is a whisper, very faint, that if I let the shame and fear control me today, it will only strengthen their control. I'm still not sure what I am going to do, although fashioning a dress out of an industrial bin bag is currently the number one outfit choice. Maybe with a belt to jazz it up?

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.