anorexia

Why are psychiatrists so ignorant about eating disorders?

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ShameScale

I recently accompanied a friend to an intake appointment at our local eating disorder treatment centre.  The program operates out of a psychiatry program at a major hospital in our city.  It’s a medium sized city, and a fairly well known treatment program which is publicly funded and free to access.

I was completely disgusted by a good portion of what the Dr said.   Sadly, many of the things he said were things I have personally heard from other doctors.   I found it pretty triggering and it wasn’t even my appointment.

Let me share a few thoughts about what NOT to say to someone in recovery from an eating disorder (especially if you are a Dr who is supposed to be an expert!):

  1. Do NOT ask people about their history with traumatic events and then proceed to tell them that their abuse is connected to their eating disorder, but that your eating disorder program does not treat trauma.   This makes absolutely NO sense.  If aren’t willing to help someone address the roots of their coping techniques, don’t bother asking intensely personal information.  It comes across as invasive, asking questions for the sake of personal curiosity rather than to actually help someone.

Instead:  All eating disorder programs and specialists should be willing to help patients cope with the traumatic events they have survived.  If they hadn’t experienced those traumas they likely wouldn’t have turned to eating disordered ways of coping in the first place!  You don’t have to be a trauma expert, you just need to be trauma informed.  Validate!  Believe people!  Let them talk about the links between their traumas and their eating disordered behaviours.   I can almost guarantee that nobody will achieve lasting recovery without addressing the root causes of their problematic coping techniques.  Conversely, do not refuse to allow people with eating disorders to access PTSD services.  Do not forbid patients from discussing addictions either.

People don’t exist in boxes.  Someone often copes with PTSD, eating disorder AND addiction.  They shouldn’t be forced to lie about some things to access services for other related issues.   Services NEED to be intersectional or they are borderline useless and can further stigmatize vulnerable people.

2.  Do NOT shame people about their weight, body shape or the foods they eat.  People of ALL shapes, sizes, genders, races and socioeconomic statuses can suffer with eating disorders.  Do NOT promote restrictive eating by underestimating what a healthy amount of food is.  Do NOT set goal weights so low that someone will still be underweight when they finish treatment. Conversely do NOT assume that everyone who has a BMI over 25 is unhealthy.  Fat people can be healthy.   Encouraging someone who is fat to drastically restrict causes shame and further disordered eating.  All bodies look different, people can be healthy at different sizes.  The goal should be to reduce body shame and increase normalized eating.  This will NOT look identical for each person in recovery.  Do NOT place moral values on food such as labeling certain things as “junk” and “unsafe” or off limits.  Believe me, the person with an eating disorder has enough of these nasty thoughts in their head already.   This attitude needs to start with children from a very young age, where they can be taught that food is not something that makes them good or bad.  Our value as humans is not correlated in any way with the food choices we make.  All people have inherent worth or value, no matter their body shape, size or food choices.

Instead:  Promote body positivity within eating disorder treatment.  Do not assume that all recovered bodies will be a certain size.  Encourage people to gradually learn to return to intuitive eating, and trusting their bodies.   Explain that some people in recovery from restricting eating disorders may be extremely hungry while they restore their weight.  This is normal.   It’s okay to eat slightly more than your meal plan if you are genuinely hungry.   Focusing only on BMI, weight and portion sizes can turn into another type of obsessive compulsive eating behaviour.   Teach people that normalized eating can vary from day to day and that is okay.   You aren’t a bad person or shameful because you ate 3 cookies instead of 2.  You aren’t broken or weird if you are still hungry after a 1 cup serving of cereal.  Meal plans are important in early recovery, but they are NOT the be all and end all of treatment.     Don’t treat people who are thin as morally superior to people who are overweight.  Ideally, don’t make comments on people’s bodies at all.

3. Do NOT assume you can tell whether or not someone has an eating disorder based on their appearance.  If someone is struggling with disordered eating symptoms, they deserve care, help and compassion.  It makes NO sense to only provide services to the very sickest people who are basically on the verge of death.  By this point the health consequences can be severe and the behaviours are SO entrenched it can be extremely difficult to recover.  As with most illnesses and mental illnesses early intervention and prevention are KEY.   Providing services based on how medically unstable someone is only encourages people to compete to see who is the sickest.  It makes people who have larger bodies feel they don’t deserve help or aren’t sick enough to MATTER.  It perpetuates the stereotype that only young, white, rich VERY thin women can have eating disorders.  An eating disorder is a serious mental and physical illness and ALL people who suffer, regardless of race, gender, size etc deserve treatment.

Instead:  Stop using BMI alone as a measure of health.  The newest version of the DSM has removed BMI criteria from the anorexia criteria.  Doctors need to follow suit.  Even if someone is at a BMI of 19.5 or 20, or even higher, they can still be struggling with anorexia. Being weight restored or reaching a minimum BMI of 18.5 is NOT the only indicator of recovery.   Ideally body positivity should be encouraged and fostered at all stages of the recovery process.  Governments need to increase funding for eating disorder treatment to make it more readily accessible to folks who are at risk or at the early stages of illness.   Fight fatphobia and discrimination based on weight (and class) when you see it happening around you.

4. Do NOT make negative comments about food at ALL.  I can’t even count the number of times I’ve heard people say things like “I’m so bad for eating this cake”  or even “I feel so guilty for eating a sandwich instead of a salad.”   Don’t promote fad diets.  Don’t promote cutting out whole food categories. Don’t promote the idea of “clean” eating as morally superior.  Don’t imply that eating a salad is virtuous and eating cake is dirty.  Just stop.  PLEASE.  People around you are listening.  Impressionable people. Young kids whose opinions about food are just forming.   Friends and family members who may be struggling with eating disorders themselves.   This may be controversial, but unless you have a food allergy, there is NO need to obsessively eliminate particular foods from your diet.  Everyone has preferences, but that is NOT the same as conferring MORAL value on food.

Instead:  Remember that food can serve many purposes including enjoyment, nourishment, connection (sharing a meal with friends and family), ritual, celebration etc.  but food’s purpose is NOT to cause shame and guilt.  Be vigilant about situations when food is given a moral value (good or bad, clean or dirty).  If you feel confident, let people around you know that judgmental comments about food are not welcome and can be triggering for those in eating disorder recovery and those who are predisposed to developing eating disorders.

We all deserve to have a positive relationship with our bodies and the food we eat.

How to accept a compliment.

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you-are-beautiful

I went to the dance tonight to celebrate the end of an almost 4 year long legal process.  A 4 year long ordeal of leaving my ex-husband.

I danced.  I felt happy.  I enjoyed the music.  I smiled.  I forgot about my problems.  I lost myself in the moves, the beat and my dance partners.  It was a good night.  Swing dancing is an amazing healer.

Friends and strangers alike knew I was celebrating tonight.  Swing dance events usually include a birthday jam, a song where those who are celebrating something or visiting from out of town get “jammed” inside a dance circle.

Tonight, I celebrated freedom and victory with a jam I’ve waited for for almost 17 years.  It felt incredible.

After the dance, someone I’ve danced with over the years came up to me and started talking.  He told me that 3.5 years ago when I started coming to the dance I looked like “someone coming out of a long illness.”  He went on to explain that I looked healthier now and that I’d changed for the better.  He said that I had been much thinner and looked fragile.

It was a genuine compliment.  He was right.  I was coming out of a long illness and a long abusive relationship.  I was going out as a single adult for the first time since I was a teenager.  He was also right that I was thinner then.  I’ve gained about 10-15 pounds from the low end of the weight I’d been hovering around for about 3 years.  He’s probably right that I look healthier.  I am healthier mentally.

But as anyone who battles an eating disorder knows, compliments can be treacherous.  Any comment about a person’s weight, size, shape or healthiness can be interpreted by the eating disorder voice as an insult.

I tried to be present as he gave me this kind feedback about my health.

But inside my head Ana was screaming at me to get away from the conversation.  Ana was telling me…”he thinks you are fat.”  She was telling me “it’s so obvious you’ve gained weight even a stranger can notice.”  She was telling me “you are fat. you are disgusting.  you have no self control. you are weak. you are shameful.  you are ugly.”  She was having a yelling match in my head as this shy man struggled to explain what he’d noticed.

I’m trying to sit with the compliment.

Factually it is true, I have gained weight.  No, I’m not comfortable with it.  Yes, I’m constantly thinking about restricting and exercising and ways to lose weight.  Yes, I put myself down far more than anyone would realize.

But honestly F#@K Ana.

That man wasn’t telling me I looked fat.  That man was telling me that I look healthier after escaping from an abusive relationship that almost killed me.  He was telling me I looked more alive and happier.  He was complimenting me, even if Ana couldn’t understand.

People in recovery from eating disorders might always interpret compliments about their health or their body in a negative light.  Generally it’s safer NOT to talk about a person’s weight or size.  It can be a trigger and very uncomfortable, especially in early stages of recovery.

But for tonight, I’m happy that I’m still alive.   My body is okay.  It allowed me to dance for almost 3 hours tonight, despite my chronic pain issues.  My body has been through so much.  It’s okay to give Ana a break once in a while and just appreciate the steps I’ve taken towards health and recovery.

Your body is okay too. Whatever your shape or size.  You are beautiful and strong and you deserve to love yourself.

Banish body shame.  It’s okay to accept the compliment.  You are worth it ❤

Firsts.

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<trigger warning for graphic descriptions of self harm and eating disorder>

I’ve been thinking a lot about the “firsts” of my mental illnesses.  We all have memories of the first time we did certain things or had certain experiences, but for people who have chronic mental health struggles over a number of years, not all “firsts” are positive memories to celebrate.

When I was experiencing my “firsts” of mental illness I was a teenager.  I was 15-17 years old and I didn’t have any idea that my experiences were those of specific mental illness, let alone what those mental illnesses might be.  I thought that I was going crazy.  I thought I was the only one.  I was afraid to tell others what I was experiencing internally.  Until I was diagnosed with PTSD when I was 20 years old, most of my “firsts” made little sense to me.

The first time I experienced what would become anorexia I was about 16 years old.  I’ve written about it in another blog post.  I was physically sick and hadn’t eaten for a few days.  I felt mostly better and wanted to go to school.  I remember my mother telling me I had to eat something if I was going to school.  I took a granola bar and started walking down the street to meet my boyfriend at the time and to catch the bus.  I remember feeling light, empty and powerful.  I remember feeling the sense of white, blank emptiness that I now associate with disassociation.  I felt like I could take on the world.  I felt like I could survive without food and that I’d actually be more powerful.  I loved that feeling and I chased after it in various forms for the next 20 years.  I believe this moment is the one I chose anorexia as a coping technique for the sexual and emotional abuse I was living with.  At that time I wouldn’t have identified it as an eating disorder, nor would I have identified my relationship as sexually and emotionally abusive.  It was just a feeling I had, of realizing that disassociation was more comfortable than pain.

I remember the first and one of the few times I tried (unsuccessfully) to purge after panicking about eating.  This I described in another blog post.  I remember crying and sitting shaking on the floor of the downtown public library.  My crime?  Eating a whole cookie rather than half of one.  I remember I had been reading books about eating disorders, secretly, trying to figure out what the heck was going on.

I remember my first panic attack.  I was in Grade 12, 17 years old and extremely ill from anorexia.  I was attending school despite the fact that my weight was well under 100 pounds at close to 5’9″.  I remember feeling driven.  I remember feeling an intensity of moving forward that wouldn’t allow me to slow down or calm down.  I had to keep “doing” and trying to be perfect at everything.  I had to follow all my rules or something terrible would happen.  I remember there was one day I had a math test.  I believe it was Grade 12 Calculus or some other horrible subject.  I had been doing well in school despite my illness.  But that day somehow my brain just wouldn’t work.  I remember sitting in the classroom, the desks were arranged in rows, one in front of the other with the blackboard at the front.  I remember all the numbers and letters swimming around on the paper.  I couldn’t breathe.  I couldn’t think of how to solve the problems because everything was spinning and I felt like I was being crushed.  I felt nauseous and I realized that I was about to cry.  I remember bolting out of the room and into a stall in the girls bathroom.  I remember sitting there crying, shaking and feeling terribly upset that I couldn’t do the test.  My thoughts were racing around and I just wanted to go home.  I remember another student from the class coming in to check on me (it was a male teacher).  I remember being somehow glad she was there even though I was embarrassed.  I made up some excuse about being sick and not being able to write the test.  I think I went home.  I wouldn’t have known at the time that it was a panic attack, but it was and it was probably related to extreme lack of nutrition and just pushing myself too hard on no fuel.

I remember the first time I cut myself as a coping technique for stress.  I was about 18 years old.  I had just started taking SSRI medication for depression and anxiety after about 2 years of fighting with my parents and my doctors.  I never wanted to take medication.  I think deeply and instinctively I must have known that my mental health problems were situational, but that knowledge was too terrifying to face, so I blocked it out.  The first time I engaged in cutting I  used a pair of scissors that I kept in my bedroom.  I used to make just one small cut.  I would do it once a week in the exact same place, just under where the band of my watch lay.  So I could hide it carefully.  It was ritualistic, very controlled.  I don’t remember exactly why I started doing this.  It became part of my routine as I gained weight and somewhat normalized my eating behaviour. I needed something else to help block out the memories of the abuse.

I remember the first time I considered suicide.  I was probably about 17 years old, but I might have been 18.  I remember being at a party at a friend’s house.  Radiohead OKComputer was playing in the background.  Music I always associate with the “saddest of the sad” times.  It was raining outside.  I remember sitting on the couch looking out the back sliding door.  It was dark outside, evening.  The rain was falling really hard and there was thunder and lighting. I felt like I was in a trance.  Looking back I realize this was also an example of disassociation.  I remember feeling incredibly alone and disconnected. I was AT the party but not part of it.  I remember being at home that evening.  My bathroom had green tiles.  Small square tiles with white grout.  I remember just sitting there staring at my razor.  Thinking about cutting myself, thinking about dying and ending my life by opening up my veins.  I just sat there for a long time thinking about it.  The images of the green tiles and the emptiness of that moment are burned into my memory.

I remember my first flashback.  I was 18.5 and with my first love, my first real connection after the abuse and the severe anorexia.  I remember we were in my bedroom and we were kissing.  It was consensual and I wanted to do it.  He was lying on top of me. I think he might have been about to unbutton a piece of my clothing or something like that.  Suddenly I was crying and shaking and it wasn’t him there.  It was my ex boyfriend, who had so many times taken off or unbuttoned my clothing when I’d clearly said now.  It was him on top of me and I was afraid.  I had no idea what a flashback was, I didn’t know I had PTSD.  I just had an intense physical reaction to what was happening.  My boyfriend stopped immediately.  I remember him leaving the room briefly to give me space.  I remember feeling scared and embarrassed.  I don’t really remember the explanation I gave to him.  Some of my memories are less clear, but I think over time I had told him that my last relationship had been difficult.  I don’t think I fully understood myself at that time that it had been abusive, and that this type of reaction was a normal one for survivors.

I remember the first time I cut myself deeply enough to need stitches.  I was 20.  I was at university.  I remember buying the craft knife at the university book store. I remember walking home.   There was  a bridge on the campus and for months I thought about jumping off it every day.  I knew that I was going to cut deeply.  It was planned and premeditated.  I remember disassociating and thinking only about the injuring.  I remember wanted to make sure it was deep enough to need stitches.  I remember walking to the hospital which was on the campus.  I walked across a field to get there.  It was May or June.  I remember the doctor stitching up the wound.  It was a medical student and I remember feeling afraid.  I remember the resident coming to check the work and commenting that the stitches were incorrectly done.  I remember wondering why the resident didn’t fix them, but I assumed that because the wound was self inflicted they thought I didn’t care about scars.  In the end that wound healed badly and caused me chronic pain until it was fixed about 7 years later by a plastic surgeon at that same hospital.   I remember feeling nothing.  I remember feeling nothing about the injury and having no emotional or physical reaction until the day I went to the health clinic to have the stitches removed. I fainted when the doctor took them out.  My body felt the trauma suddenly and all at once the disassociate wasn’t there.   From then on I always took my own stitches out so I could control the process and do it in a way that I would not feel as much pain.  The ritual of the whole thing was an important part of the process of disassociation for me.

It’s a sad list.  Really sad.  Because some of these firsts are clearly in my mind that pleasant memories I would like to remember.  The way that PTSD stores traumatic memories and erases positive ones is deeply frustrating.  Because the long term consequence of disassociation is memory loss, and rarely losing the memories I wish would disappear.

Picture was drawn in September 1999

 

 

 

Body Positivity is a Mystery

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<trigger warning for those with eating disorders>

This picture was taken 5 years ago.  I haven’t owned a scale since.  To me, a scale is an actual weapon that only causes damage and pain.  I can’t be around them.

Ironically, when I first became anorexic, I never weighed myself.  I didn’t own a scale and anorexia wasn’t about achieving a certain weight or ideal of beauty.  It wasn’t about how I looked, it wasn’t about my body.  Anorexia was a complex and deadly form of disassociation, which over time turned into equally deadly obsessive compulsive disorder.  So my eating disorder was not about losing weight, but losing weight was a side effect of my eating disorder.   This is a really important thing for people to understand.

Over time though, sexual assault and anorexia F#@ed up my relationship with my body.  And as a woman, patriarchy and ideal standards of beauty and thinness began to impact me.

As I began to “recover” the first time (I was forced to gain weight),  I was terribly uncomfortable with my body.  I equated safety with taking up less space, being smaller and following my strict food rules.  Anorexia means that I feel extreme levels of anxiety when I break my food rules.   Today, in imperfect recovery, I have fewer rules and more good days, but ultimately, the terror remains.

The terror of becoming “fat” and being out of control and unsafe.

I’m going to admit something terribly un-feminist.  Even though I read blog posts about body positivity and I fundamentally hate fat shaming, I am puzzled by larger, rounder bodied and fat people.  I’m not judging them.  I don’t think they are weak or lazy, or those negative stereotypes that the media forces down our throats.  I’m just puzzled and curious.  I really honestly want to know “how is that fat person comfortable in their skin?”  I want to know because if I could figure that out, maybe I could accept myself.

I’m tortured by the feeling of clothing being tight on my skin.  Some days I can’t wear certain clothes just because of the way they touch me and make me feel “fat.”   So how do many people I know, who are rounder and love themselves, achieve this self love?  I’m struggling just to tolerate my body.

I’ve been in told in therapy that “fat” isn’t a feeling.

That “fat” is a code my mind has made up, as a cover story for real underlying feelings.  Objectively, my body is not fat, large, or round.  It’s also not unusual, it’s not disgustingly ugly, it’s not misshapen or weird.  It’s just a body.  Most people would say I have thin privilege and that I’m ridiculous for thinking I’m fat.  And even if I were fat, that would be okay.  I believe that intellectually, about other people.  I’m not judging others, I am holding myself to a standard I would NEVER apply to a friend or even a stranger.  I love your body, I will fight for your right to body positivity no matter what your shape is.  But I hate my own body.

“Fat” is not a feeling.  I think the feelings I have are shame, sadness, anger, grief, guilt, fear and many others.  But when I feel “fat” it’s not about my weight, any more than my anorexia was originally about my weight.  I was never fat. “Fat” is about the shame I feel as a survivor of sexual abuse.  “Fat” is about feeling my own body betrayed me.  “Fat” is about me blaming my body for the abuse.  “Fat” is me thinking that if I had no body I’d be safe.  “Fat” is my fear of being assaulted again.

I never weighed myself.   When I was in treatment, they weighed me and I stood backwards on the scale.  After leaving treatment I continued this practice at doctors appointments.  A few times over the years, I knew my weight.  But whatever the number, I was unhappy.  The number was never okay.   At various times I had F#%ed up goal numbers, but they were not based on anything other than pure magical thinking.  And they never correlated with my actual healthy weight range.

In 2011, I was struggling with abuse in my marriage.  I was in school and I was struggling with that too.  As I would take the bus home from school, I sometimes snuck into a store and used the scale there to weigh myself.  I’m not sure why I started doing it.  But my OCD anorexia mind told me it would keep me safe and comfort me.  I did this for probably a month or more.  I was consumed with guilt and shame.  I never told a soul.   Then one day I decided it would make more sense to buy the scale and take it home, to avoid the shame of sneaking into the shop.  I hid it and I never told anyone I had the contraband item.

Big mistake.

It was the first time I’d owned a scale since I developed anorexia.  Within a few months of owning it I was suicidal.   The thing about OCD, is if you give in to it even one little bit, it will take you for a ride, a hellish ride.  First I started weighing myself once a day, first thing in the morning.   Then, gradually I started weighing myself at night too.   And before I knew it I was weighing myself 8-10 times a day.  It was out of control.  And it got out of control in a matter of a few weeks.  I was controlled by that scale.   This was at the same time when I was receiving ECT treatments, I wasn’t eating very much because I felt quite ill.  My weight dropped and because I had a scale, I obsessed about it.   Then when the ECT was finished and I began eating more normally again, I began to PANIC about the weight gain.

Normal, intellectual, reasonable thought of someone without an eating disorder:  “I was sick, I lost weight and it was unhealthy, it’s normal and healthy that I’m gaining it back”

Anorexia: “You are weak, you are “fat”, you are out of control, you are ugly, you need to stay at this number on the scale or something bad will happen”

In the end, the suicidal thoughts became so overwhelming that I decided to get out.

I took a hammer, I went into the garage when nobody was home, and I smashed the hell out of that scale.  I smashed it until it was in pieces.  It was surprisingly sturdy and difficult to break.  I was sore and sweating from exertion by the time it was destroyed.   And I felt empowered.

Five  years later and I’ve never owned a scale again.   Sometimes in weaker moments I will weigh myself on a scale at a friend’s house, or in a store.  But I know that this practice is self destructive and only gives Ana ammunition to destroy me and shame me.

Scales are for fish.

I will continue to admire the folks around me who embrace their bodies of all shapes and sizes.  I will continue to be mystified and curious about the concept of body positivity.  I will continue to strive towards true recovery from anorexia.

True recovery goes so much further beyond weight restoration.   True recovery means that the scale is powerless over me.  True recovery means I can be comfortable in my clothes.  True recovery means that food is nourishment and enjoyment and doesn’t have  moral value.  That my weight does not mean anything about my self worth.  True recovery is freedom from shame and self hatred.

I may “look good” but don’t be fooled, Ana still runs my life.

 

 

Depression meets PTSD. Crash.

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raw-chicken

I’ve realized over the past three years that depression is often more of a secondary problem for me.  It’s very situational and very linked to PTSD.  By the time depression flares up, it generally means that I’ve been coping with PTSD triggers for too long and I’ve started to crash into exhaustion.  Depression sometimes means feeling literally nothing, while PTSD can mean feeling everything and things that are from the past vaulted into the present, clear as day.   This can be a confusing progression.

Lately it’s hard to tease out whether I have a whole host of mental health diagnosis or just one (PTSD) causing a host of symptoms.

Abuse triggers can lead to negative feelings about my body which can then trigger my good friend Ana…yes, PTSD comes first and anorexia is a symptom.   For me anorexia is mainly a series of obsessive compulsive thoughts and behaviours which are linked to extreme anxiety around changing my food rituals.   So anorexia comes first, and OCD traits follow.

When I have a lot of PTSD symptoms and flashbacks, I start to have trouble sleeping and I have vivid nightmares.  Sometimes I wake in the middle of the night to a full panic attack.  Flashbacks can lead to panic attacks during the day as well, and also to anxiety in crowds and enclosed spaces.  So PTSD comes first, and anxiety and panic symptoms follow.

At the end of the line comes depression.  DEPRESSION.  It feels so heavy.  Depression to me leads from coping to constant suicidal and self harm ideation in what seems like mere seconds.  For me, suicidal thoughts are often the first real indicator that I’ve slipped into depression again.  This may seem backwards, but for me the most severe symptom tends to come right at the start, even if I’m depressed for only a few days.

When I’m depressed I feel like I’m walking through a thick soup of fog.  Every fibre of my being hurts and feels heavy and leaden.  Sometimes I have to lie down after just showering and getting dressed in the morning because I feel too exhausted to continue with the day.  When I’m depressed I have no energy.  I want to crawl into bed and hide.  Unfortunately, I’m a single parent and I have a full time job.   It’s not an option just to crash.

So I keep going, but the time crawls by.  I feel unsure if I can get through the day.  I feel unsure if I can stay safe, and resist the negative thoughts.  My self esteem crashes.  I start to feel a lot of feelings from the past.  Or maybe that is backwards, maybe I feel the feelings from the past and it triggers depression.

When I feel out of control of important aspects of my life, I am triggered and I think about suicide.  This is the way my life is.  It’s been this way since I was 17 years old.   It’s both normal to me, and completely terrifying every time it happens.

The depression always lifts and these days it lifts more quickly than it ever did in the past.  The lights come on again, I see the world clearly and not through a haze.  I feel connected and I feel like I am competent at some things.  When I’m depressed I feel alone and I feel utterly worthless.  I feel like a burden and a problem and someone that people I know put up with, rather than care about.  I have trouble making small talk.  I spend a lot of time silent.  I feel an immense amount of social anxiety and discomfort in social situations, especially those involving food.  Depression, anxiety, anorexia, PTSD….it’s a perfect storm of misery.  I’m caught in the middle of a storm of symptoms and I don’t know when they will abate.

Right now I’m triggered because I’m worried about my children.  I’m triggered because of the way my ex-husband treats my children and me.  I’m triggered because this is the time of year, 3 years ago, leading up to my physical separation from him, when things were at their most tense and scary.

I’m triggered today because my daughter told me that her father’s avatar/icon for me on his phone is a piece of raw meat.  Raw chicken.   The father of my two children sees me as nothing more than a piece of meat.

Fuck.

 

I don’t care if it hurts, I want to have control…

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20160522_220818[1]“I don’t care if it hurts, I want to have control,  I want a perfect body, I want a perfect soul”

-Radiohead

One of the worst parts of living with anorexia is also the part that is the most difficult for others to understand.  Body dysphoria or distorted body image.

In the context of an eating disorder, and in my own case, this basically means that I’m never really sure if I’m seeing my body accurately or not.  When I look in the mirror sometimes I see a lot of things I don’t like.  I don’t like the majority of the middle of my body for example.  Lots of people can relate to that.  But for me what I see in the mirror can sometimes change dramatically from one day to the next.  Sometimes I look at myself and I can see the parts of me that are slim, sometimes thin even.  But when I’m stressed, upset or triggered I see myself as big…too big…taking up too much space.  I hate the way certain parts of my body look and feel.  I get upset at the feeling of clothing touching my body and I sometimes have to change my clothes a few times in the morning before I feel okay to go out.

It’s important to know that 90% of this is not about how I look to other people.  It’s not about vanity.  It’s not about wanting to look like a model in a magazine or an actress on TV.  It’s not a life style choice.  It’s not a choice, period.

Distorted body image and body dysphoria are symptoms of many eating disorders.  Eating disorders are medical illnesses.  You don’t have to “look sick” or be extremely thin to be medically at risk from an eating disorder.

Sometimes I want to scream because if I could get rid of Ana and live a “normal life” around food my days would look very different.  I don’t want to waste even one more minute obsessing about my fat stomach, or how much I should or shouldn’t eat.

I’ll tell you something about Ana…she is a total bitch.  She is also incredibly boring.  Probably the most boring person I’ve ever met.  Ana is abusive too.

Who is Ana?  She is my eating disorder.  I personify her and I experience or imagine her as a young girl, maybe about 15 years old, with dark hair and pale skin.  She never looks happy and she is never satisfied.  She’s often full of rage and full of anger and she seems to want to destroy the both of us.

Ana talks to me like this:

“Your stomach is fat. You are out of control.  You are so disgusting. You don’t even deserve to be alive.  You probably shouldn’t eat very much because it’s the only way you will feel better.”

Ana lies. Ana is cruel.  I’ve been living with her for almost 20 years now and she rarely gives me much of a break.

Because of Ana I have a hard time remembering what it is like to eat and feel relaxed, just enjoying the flavours.  I have a hard time imagining eating without obsessive thoughts and rituals.  Ana has this idea that by controlling food and controlling the size of our body she will solve all our problems and make us feel in control and safe.

Ana wants to be safe more than anything.  Unfortunately, she is young and she doesn’t know that controlling food makes her MORE at risk, more vulnerable and certainly more unhappy.

If I could live one day without Ana…

  1. I would get SO much done.  I’d have more energy because I’d be eating more regularly and more healthfully.
  2. I’d be able to actually concentrate because my body would have all the energy it needs AND my mind would be de-cluttered and not distracted by obsessive thoughts about food and weight
  3. I’d be able to relax and enjoy social time.  Until you live with Ana you never realize how much of society centers around food
  4. Did I mention how much more energy I would have?  Listening to, or fighting off Ana’s abusive inner monologue takes so many spoons.  It leaves me exhausted and on bad days depressed and hopeless

But even knowing all this intellectually, I have a hard time letting Ana go.  She does sort of keep me company, and she does sometimes give me the illusion that by controlling food, I’m controlling my life and managing overwhelming problems.

At the end of the day the truth is that Ana was born during the time I was being abused as a teenager.  Ana promised me things, and she deceived me into thinking that if I was smaller and took up less space I’d be safer.  But I wasn’t safe, I almost died.  And then when I was in imperfect recovery, I was abused again and again.

Ana doesn’t keep me safe.  Eating disorders have the highest mortality rate of any mental illness, especially among young woman.  They aren’t a choice and they do destroy lives.

I hope one day Ana will leave me alone.  I hope I will be able to look in the mirror and like what I see.  I hope  I will be able to eat without fear and guilt.  I hope I will pick my clothing based on what I like and not what will allow me to tolerate the body distortions for that day.

I still have some hope that I will let Ana go, instead of fumbling along in imperfect anorexia recovery forever.

Love letter to my body

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April 22, 2004

To My Body,

I resent that you make me so uncomfortable.  I hate it when you trigger me. I hate it when you feel unsafe. I’m tired of feeling unsafe.  I wish you would just disappear or leave me alone. I don’t like it when you feel fat and dirty. I resent that you have power over how I feel. I’m fed up with you. You’ve caused me so much pain and suffering. I’m angry at you for making me feel ugly and unattractive.

I hate it when you feel too big and out of control.  I hate it when you feel too small and out of control. I hate it when you feel average. I want you to feel average. I want you to be a safe place to live. I resent that I can’t leave you behind.

I’m angry that you attracted abusers to me. I’m angry that you allowed yourself to be abused. I’m angry that you didn’t run away or fight back.  I’m tired of blaming you. I’m tired of not being able to forgive you.  I hate it when you cause me painful memories. I resent that you remember everything. I resent that I can’t replace you. I hate it that you feel dirty and broken. I want to be able to wash that feeling away.

I hate that you’ve had so much control over my life. I’m tired of you getting in the way of my happiness. I’m angry at your scars. I’m angry that you’ll never look normal. I’m angry because you make me hate myself.

I feel sad that you have been so badly hurt. I’m sad that you were violated. I feel awful because your boundaries were disrespected. I feel disappointed because you are permanently damaged. I feel hurt because you have not been respected. I feel sad because I have caused you so much pain and suffering. I feel awful because I blame you for everything. I feel awful because it wasn’t your fault.

I want to be able to forgive you. I feel afraid that I will never forgive you. I feel afraid that you will never heal. I feel afraid because you are vulnerable. I’m afraid I will abuse you again. I’m afraid someone else will abuse you again.  I wish I could protect you. I wish I could keep punishing you. I’m afraid that you will never feel whole again. I’m afraid of your suffering.  I feel awful because I know you are suffering.  I feel awful because I have never given you the chance to heal.  I feel awful because I don’t know if you can heal.

I’m scared of you.  I’m scared of the way you look.  I’m scared of the way you feel. I’m terrified because of how powerless you are. I’m terrified of how powerful you are.

I’m sorry that you have been abused. I’m sorry that I couldn’t protect you.  Please forgive me for the years I’ve spent abusing you.  Please forgive me for torturing you, scarring you, poisoning you and starving you.  I didn’t mean to destroy you.  I’m sorry that I still want to destroy you.  I’m sorry for all you’ve been through.  I’m sorry that the past cannot be erased or forgotten.

Please forgive me for not protecting you. I’m sorry that I don’t respect you. I’m sorry that others have not respected you.  Please forgive me for blaming you.

I’m ashamed of you, I hate you and I’m sorry.  I wish I could make you disappear so you wouldn’t be hurting anymore.  I wish I could take away your pain.  I wish I could learn to respect you.  I’m angry and sad that I feel so resentful.  I’m tired of being ashamed.  I’m so sorry for all these years of abuse.

I love you because you remind me that I have survived.  Thank you for the pain, thank you for reminding me that I’m alive. I understand that you are hurting. I want to let you grieve.  I forgive you for being sensitive and still in pain.  I understand that you need time to heal.

Thank you for not giving up on me. Thank you for giving me a second chance and a third chance and for not abandoning me.

I understand your pain. I hope that one day I will begin to forgive you.  I’m angry because I don’t trust you and because you don’t feel safe.  I wish I could learn to trust you. I hope one day you will feel safe. I feel sad because you don’t feel like you truly belong to me.  I’m sorry I haven’t forgiven you.

I’m angry that you are still alive.  Thank you for still being alive. I love you for that.  I hope one day you can find peace and safety.

-Me