Why are psychiatrists so ignorant about eating disorders?

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.

All mental health care, all health care, needs to be TRAUMA INFORMED CARE.

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I’m feeling frustrated about the barriers to receiving high quality, publicly funded, trauma informed mental health care.  Especially the barriers faced by trans and gender non-conforming folks.

I know that I’m blessed to live in a country that has free universal health care, but we still have a two-tiered system.  Psychological care, social work and counseling that happens outside hospital settings is fee-for-service.  There are many barriers for those without finances or work place insurance in terms of accessing mental health care.  Based on my own experiences, I believe that medication alone should almost never be the first line of treatment for mental illness, and that medication should never be used without corresponding counseling of some type.   This does not mean that I’m anti-medication or anti-choice or even fully anti-psychiatry.  It just means that I see mental health as more than just a chemical imbalance in the brain.  It means that I know that supportive, validating counseling can be helpful in treating most illnesses.  I highly value feminist based counseling, intersectional approaches, peer support models and any type of counseling where the patient has a say in what happens and is treated like the expert in their own lives.

I’m personally quite negatively biased against cognitive behavioural therapy.  That does not mean that I don’t think it has a place, or that it can never be useful.  I believe it can be helpful with certain types of issues, such as OCD.   But CBT leaves a LOT to be desired in relation to trauma therapy.  It focuses too much on the individual thoughts, feelings and behaviours and too little on trauma, societal oppression and practical barriers.

When I was younger, and I first entered into the mental health care system, my parents found a clinic and doctors that supposedly were experts in the field of eating disorders.  Now, maybe they were good doctors, but I can say with absolute certainty that they were not trauma informed.  I don’t really remember every being asked exactly WHY I had developed anorexia, or if anything had happened to me.

I’m not an expert, by any means, but I know that young people rarely (if ever) develop eating disorders and self harm just on a whim, out of the blue.  Generally eating disorders are symptoms of a larger problem, generally eating behaviours are coping techniques to deal with something.

I was a smart teenager.  I knew to some extent why I wasn’t eating.  I had learned that it was an effective way to zone out, feel lighter, feel empty and take up less space.  I became addicted to that feeling of zoning out, it helped me cope with the sexual abuse I was experiencing.  It wasn’t about my looks, it wasn’t about losing weight and it wasn’t about existential angst (per se).   I’m not sure if anyone actually ever asked me why I wasn’t eating.  And after a certain amount of time had passed, it became irrelevant to everyone.  Nobody cared why, they only cared about me eating so I wouldn’t die.  I didn’t believe I could die.   I’m not sure I REALLY cared if I died. I think I did at that time, but I certainly didn’t care by the time I started taking anti-depressants.  I pretty much welcomed the idea of death and started to think about suicide at 17.

These psychologists I went to see worked from a CBT model.  I remember being 16 and sitting in the psychologist’s office while he drew diagrams of how thoughts impacted feelings which impacted behaviours which further influenced thoughts and feelings.  I quickly picked up on the pattern of it.  I realized that a very specific set of responses were the desired outcome.  I followed the pattern and started saying what he wanted to hear.  I didn’t internalize any of it.  It became a game to me, not a game to manipulate or hurt anyone, but a test to see if I said what was expected if I’d be allowed to go back to school and stop missing music class for the appointments (which to me appeared pointless).

Fairly soon after that, I became physically starved to the point my brain wasn’t really working rationally anymore.  The physical side effects of the disease confused my brain and the restricting and exercising became obsessive to the point of OCD.  The behaviour self perpetuated and I lost track of why I started doing it.  I lost track of what happened to me.  I lost track of the abuse.  I lost track of everything.  I felt panicky most of the time.  I was always cold.

When someone is that sick, no type of therapy is going to work.  Eating is the only treatment.  I went to an inpatient program, started the process of weight restoration and my mind gradually cleared.  I don’t remember being asked in treatment why I starved myself to the point of near death.  I think people were relieved that I was eating and that I returned to some level of semi-normalcy.   I was still thin.  I still had strange eating habits and anxiety around food.  I still avoided eating with most people.  But I was well enough to “pass” as recovered.

I began to recover some memories around the age of 18.  But they weren’t concrete at first.  They were flashbacks, physical reactions, nightmares.  I remember talking about it indirectly to my boyfriend at the end of high school.  Telling him that something had happened with my last boyfriend.  I don’t remember if I shared many details.  I think the idea was only slightly formed in my head.   I didn’t connect the dots and fully disclose until I was 20.

Then I was thrust into the psychiatric, medical model.  I was drugged and drugged and drugged more.  The worse I got, the more drugs were given.  I was medicated to the point I could barely stay awake during the day time. I felt foggy.  I gained weight.   I was diagnosed with PTSD, but I still didn’t receive trauma informed care.

I did an inpatient program for PTSD.  It helped a LOT.  I learned a lot.  But I couldn’t fully actualize the learning because I was on too much medication and I was in an abusive unhealthy relationship.  I knew by then that the trauma piece was at the centre of my struggles, but I didn’t fully comprehend that my current situation was a major factor.

All this to say, that my life story is a testament to the perils of practicing medicine without considering the impact of trauma on physical and mental health.

I’m so passionate about looking at the roots of why people cope in the ways they do.  What societal circumstances and traumas caused them to cope in the ways they do?

Now I’m a parent.  My children struggle with anxiety.  My younger child is transgender.  She has secrets.  There are things she won’t talk about to anyone.  She struggles with focusing sometimes.  I see a lot of signs of trauma and of the impacts of things she has lived through.  Experiencing transphobia in and of itself is trauma.  Being misgendered, people using her old name, being treated as less than a real girl, being told that her mom is crazy for “forcing her” to be a girl….I could go on, but it’s a lot.  A lot for a child.  Rejection by a parental figure is one of the clearest predictors of mental illness in trans children and youth.  Acceptance is the highest predictor of mental health.

Again.  It’s not rocket science.  Of course a child will feel safer if they are accepted.

Now I’m the one trying to find the doctors, trying to access the care, trying to get referrals, wait on lists, be taken seriously.  20 years later, I’m still fighting to find a mental health care provider who truly understands the impact of trauma on a child and who is willing to practice trans positive, trauma informed care.  I don’t want her forced into CBT.  I don’t want her to be medicated.  I want someone to help her feel safe enough to express what is on her mind.  I want someone to hear why SHE uses the coping she does.  I don’t want doctors to guess and assume.  I don’t want them to misdiagnose her as well as mis-gendering her.

She deserves to be heard.  I don’t want her to be writing a post like this in 20 years.

Kids will say what they think adults want to hear.  They may do it consciously, or unconsciously or for their own reasons.  They do it to please, to stay safe, to feel a sense of control and many other reasons.  It takes a special type of doctor or counselor to help a child feel safe enough to tell their truth.   Because after enough time hiding, even she will be confused about what her truth is.

Mental health care for children should be free.  The practitioners should be trauma informed.  There should be enough funding that kids can access the care they need without lengthy wait lists.  There should not be a two tiered system where those who can pay can access things those in poverty cannot.  Poverty is a risk factor as it is, without it also limiting access to care.  Ideally there should be a system that is easier to navigate, where parents don’t feel they are fighting and advocating to the point of exhaustion.

Mental health care is a right, not a privilege.

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Photo: https://makingmomentsmeaningful.blog/2017/04/13/trauma-informed-care-values-youth-worker-values/

How to accept a compliment.

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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 ❤

Body distortions.

I’ve struggle with distorted perceptions of my body since I was 9 years old. I vividly remember the first time I felt hatred towards my body.  I was 9 and I was sitting on the floor in the upstairs hall of my parents’ house.  I must have been getting ready to get into the shower.  I was sitting with my legs out in front of me and all I could think about was how fat and ugly my stomach was.  I thought it looked disgusting.

I remember during my years as a dancer how much I envied the other girls who were thinner and had more delicate frames.  I was always cast in the role of the boy in the group choreography and I assumed this was because I was the largest, tallest and least delicate.  Intellectually I knew some of the girls were younger and hadn’t gone through puberty yet, but emotionally it hurt.  I didn’t want to be in the boys costume, pants, vest and button up shirt. I wanted the flowing dress.  The main reason was because I assumed my body shape was to blame.

I remember feeling slightly more confident in my body for a few years, at the beginning of high school.  My style changed fairly dramatically over the years, from dresses, to jeans and baggy sweatshirts, to grunge plaid shirts and doc marten boots, to short kilts and boots, to hippy long skirts…in high school I wore skirts and dresses the majority of the time and I never felt comfortable in shorts.

When I was sexually abused, I started linking my female body with being assaulted.  I wanted to take up less space.  I wanted to disappear so I couldn’t be abused.  I changed my style again, and stopped wearing skirts and dresses and more feminine items, expect for special occasions.

It took many years for me to make the link between being abused and hating my body.  I believed all the negative thoughts Ana was screaming at me.  I believed I was fat, even when I was deathly thin.  I saw things that weren’t there.  I struggled with body dysmorphia and distorted body image, never seeing myself as others saw me.  I became so used to this that I stopped questioning why it happened.  I became increasingly invested in hating my body and blaming my body for being abused.  I forged an even stronger link by engaging in severe self harm for many years and abusing my body by overdosing and attempting suicide.  All my destructive behaviours distracted away from the root causes of my eating disorder and self harm.

I remember the moment the link became crystal clear to me.  Up until that moment it was a complete mystery to me how my view of my body could change so drastically from day-to-day.  One day I might see myself as thin, or even worry about my weight and health and the next day I’d wake up feeling obese, disgusting and unwilling to eat.  I had a hard time intellectually believing that it was impossible for my body to change that much over night.  I tried to control the dysphoria by altering my eating habits and/or exercise.

Around 2011-2012, during the years leading up to me leaving my ex-husband, I had a sudden realization.  My weight was low towards the end of 2011, partly due to the ECT treatments and lack of appetite and partly due to Ana and depression.   I remember feeling like I’d lost too much weight.  I remember feeling concerned about how low my weight was (this was during the brief time period I owned a scale).  I went to sleep one night and my ex-husband touched me sexually when I was asleep and drugged.  Quite likely after I’d said no while awake.  I remember us fighting about it in the morning.  I went into the en suite bathroom and got ready to shower.  I remember and overwhelming feeling of being fat. I hated my stomach. I felt massive and ugly.  I wanted to harm myself and restrict food.  I felt disgusting and shameful.

Then a light bulb went off in my mind.

Wait a minute, just yesterday you felt you were too thin.  Just yesterday you were worried about your weight being low. It’s impossible that you have gained that much weight over night.  These self-destructive thoughts are linked to being assaulted and to the argument.  You feel fat and dirty and shameful BECAUSE of what happened.  It has nothing to do with your weight.  Your weight hasn’t changed.

Things started to shift for me after that realization.  I suddenly had a clear intellectual understanding that I needed to try living alone before giving up and completing suicide.  I realized that I hadn’t truly “tried everything” to recover because I hadn’t tried removing myself from my marriage.  I think this realization saved my life.  I began to slowly get stronger, to seek different types of help (from a rape crisis centre) and to talk to a few trusted folks about what was happening in my marriage.

It took me a full year to get strong enough to leave.  But the leaving started with that realization.  For a moment, I stopped blaming my body and myself and started blaming my abuser for my ill-health.

In the last two days I’ve had some incredibly frustrating text interchanges with my ex-husband.  Trying to co-ordinate co-parenting with a narcissist is impossible.  It is like pushing a spiky boulder up an icy hill, where you are blamed for the ice, the spikes and for not succeeding in getting the boulder up the hill.

Yesterday, Ana was screaming at me.  Ana did NOT want me to eat.  Ana was telling me I was fat and I’d gained too much weight.  Ana was telling me to hurt myself.  Ana was making me paranoid that my ex could see things on my computer, or hear things we were talking about at my house.  Ana was activated and was not letting me rest.  Noises startled me, I had a hard time relaxing to sleep.

All of this happened because of a 5 minute text exchange with him.

Co-parenting with an abuser is enough to make anyone miserable.  But I need to remember that my body is not to blame.  In fact, the healthier I am, the stronger I can be at resisting his abuse.  I need to be healthy to take care of my kids and protect them as much as possible from his lies.  Ana tells me to hurt myself, to shrink myself, that it’s my fault.  But Ana lies.

I’m willing to bet that if you have an abusive voice in your head, it is lying to you too.  Ana never makes us stronger.  We are not to blame for the abusive patterns of another person.

I read a quote once…

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This was certainly true in my case.  I realized that hurting myself was not the way out.  There was another way, a sometimes more difficult way, but a more productive one!

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the truth is hard.

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I owned a set of fridge poetry magnets when I was 15.  They were stuck on the fridge in the house where I lived with my parents.  When I was 15, I wrote this poem with fridge magnets about being sexually abused:

Time together

Alone with thy soul

There is always my body.

 

I smile at nothing

But desire

Fire craving winter.

 

Take when you want.

I could never

Disdain it enough

to break your heart.

 

the truth is hard.

In my 15 year old mind it was clear what the poem was about.  It was direct, it wasn’t even thinly veiled.  The double meaning of the word “hard” was intentional.  To me it was a message, it was a cry for help.  It was an attempt to communicate that all was not well.

Reading back to my journal from 1996, it was clear that I knew something was wrong.  I can hear myself trying to justify X’s actions, trying to defend him, trying to believe that everything would be alright.  I can hear myself blaming myself for not being comfortable.

Less than 1 month into the relationship with X:

May 2, 1996

He moves very quickly though, and is very persuasive when he wants to be.  That worries me a little bit, because he’s very forceful. I think that if I said no and meant it he would respect my choice…X turns into this totally different person when we are alone. He talked me into going under the covers.  At first I felt really uncomfortable…he can be so different, his different personalities are very drastic.  Like Dr. Jekell and Mr. Hyde…it worries me a little…the intensity of it scares me.

May 7, 1996

I’m not sure I understand X. He can’t seem to behave in public. He always wants to be physical with me, even when it isn’t appropriate.  I’m going to have to tell him that holding hands and kissing are OK in public, but anything farther isn’t.  He also doesn’t always stop right away when I ask him to. It’s as if he doesn’t believe I actually want him to.  Then he apologizes a lot after and seems to feel guilty, but he does it again…I’m sure after I talk to him he’ll act more appropriate.”

I wrote a lot about how it was my fault that I wasn’t comfortable.  I wrote about being too worried about other people’s opinions of me. I wrote about being seen as “Ms. Perfect” and struggling to live up to those ideals, especially when I didn’t see myself as perfect at all.  I wrote about the sexual relationship as a conflicted way to challenge people’s ideas that I was perfect, but really I was filled with guilt and shame about what was happening.  I couldn’t possibly be “Ms. Perfect” because if people really knew what was going on between X and I in private, they would be ashamed of me and hate me, the way I hated myself.

Looking back on it, I blamed myself for the abusive behavior of another person.  I thought that I was doing something wrong.  I thought his parents would hate me, my parents would hate me, my friends would hate me, and that generally everyone would think of me as a slut if they knew the truth.

So I didn’t tell anyone.  I didn’t tell anyone for 5 years after the abuse ended.  When we broke up, we started being “friends” and I fell into the deep abyss of anorexia.  The whole trauma which set this into motion was essentially erased, my hurt abused self was replaced by a frail skeletal figure, drifting though the halls of our high school, detached from everyone.  In order to make the abuse disappear, I tried to disappear.  I almost succeeded.

5 years later when I met my ex-husband, I fell into the same patterns.  I convinced myself it was my fault.  It was my issue that I wasn’t comfortable with the sexual stuff.  If I tried harder and was less depressed he would change his behaviour.  I blamed myself a thousand times more than my abusers every blamed me.  I abused myself a thousand times more than all of my abusers combined.  This is what trauma does to a young person.   By the time I even considered talking about the abuse, I was already caught in a second abusive relationship.  I never really had a chance to heal.

It wasn’t my fault.  I believe that abusers see vulnerable people like me a mile away.  They see us and they target us.  They know that we are less likely to fight back.  They know they can exploit our tendency to blame ourselves. They know they can build empires of abusive lies on the backs of our low self esteem and desire to please.

It wasn’t that I didn’t know I was uncomfortable.  It wasn’t that I didn’t know I wanted the sexual abuse to stop.  It wasn’t that I didn’t recognize that my boundaries were being pushed past and ignored.

It was that I blamed myself for the transgressions.  This was due to a mixture of the abusers gaslighting and confusing me, and my own lack of self confidence and self esteem.  My desire to please others was pre-existing and abusers knew they could use it to their advantage.

I didn’t scream or fight back because I believed it was my fault.  I felt so much shame, that I didn’t want to create a fuss.  I wanted to disappear and be invisible.  I turned to anorexia as a coping technique and a way to take up less space.  I tried to shrink my guilt and shame.  I tried to decrease the dirty feeling, by decreasing the size of my body.

I blamed my body because in my teenage mind, if I didn’t have a body I wouldn’t have been sexually abused.

 

 

 

What does “fully recovered” mean?

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I’ve been reflecting on what it means to be “fully recovered” from an eating disorder.

The best books I’ve read on this subject are “Life Without Ed” and “Goodbye Ed, Hello Me” by Jenni Schaefer.   These books promote the message that it is possible to be “fully recovered” from an eating disorder.  They give me hope that anorexia isn’t something I will have to struggle with for the rest of my life.   I’ve read the books at various times when I’ve felt overwhelmed or hopeless and they have always helped me stay positive.  I truly admire the author’s dedication to having a life free from ED, or in my case Ana.

But if I’m 100% honest with you, I’ve never even TRIED to be fully recovered.

I’ve been in imperfect recovery for years.  At times this has meant being at a healthy weight, but still struggling with unhealthy thoughts and habits related to food and restricting food.  At times, this has meant slipping back into controlling my body,  purposefully eating less and obsessing about taking up less space.  I know how imperfect recovery works.  It keeps me “functional” and sometimes even “looking healthy,” but inside I am never truly free.  The thing with imperfect recovery is that Ana still controls my life to varying degrees, depending on how much I’m struggling.

It’s not possible to tell by looking at a person whether or not they have an eating disorder.  Being at a “healthy” or “normal” weight means nothing.  Being at a “healthy” weight doesn’t even mean a person is medically stable or in recovery.   In my current situation, my weight is higher than it’s been in  years, but my eating disorder is causing me MORE trouble, not less.  I feel exhausted mentally and physically most of the time.

I’ve been in hospital treatment programs in the past.  Inpatient programs where I was “forced” to eat large quantities of food.  I was supervised after eating, a staff member watched me to make sure I ate all of my meals and snacks.  I followed the rules because I had to, even though I was there voluntarily, I was able to comply because it was required.

But let’s be honest.  I never attempted to be fully recovered.  I have never, in 20 years, been even willing to CONSIDER giving up Ana as a coping technique.  I’ve used it to varying degrees at various times, but I’ve never committed to letting Ana go.

I stayed in treatment until I was functionally recovered.  Until I could eat without panic and physical discomfort, until I could have the energy to get through a day, until I could think more clearly and re-engage in life.  Then I discharged myself every time.  I wanted to be healthy and eat, but I didn’t want to gain too much weight or give up my obsessive compulsive thoughts and habits.  I wanted to be in control, even of the recovery process.  I told myself I could do it by myself, I could do it my own way, I didn’t NEED the program.

I was told again and again that I needed to follow a meal plan and eat mechanically for at LEAST a year before trying things on my own.  I was told again and again that I needed to gain to my goal weight and maintain it for a year in order to recover.  I was told again and again that I needed to stop controlling food and my body in order to heal.  But what did I do?  I poured out my juice when nobody was looking.  When I got out of treatment I stopped drinking juice altogether because it was unnecessary!  I cheated in a million little ways.

When I was younger, I thought I knew better.  I thought I could do it on my own.  I thought I could let go of the horrible life threatening aspects of Ana, but hold onto the comforting habits that kept me slim.  I thought I would be happy about 10-15 pounds below my “goal weight” and that I would be medically stable.  I thought Ana and I could dance together this way forever.  I thought I could have Ana on my terms, not hers.

But I’m not a teenager anymore.  I’m pretty close to my “goal weight” now, but I feel worse physically than I have in years.  I can’t push my body the way I used to.  I get migraines, physical body pain, exhaustion and lack of patience.  I don’t dance with Ana anymore…instead we are plodding, dragging through life, in a way that has very little meaning to me.

Because I have never embraced “fully recovered,”  I have instead remained sick.  Because let’s be honest about this too, if Ana is driving, I’m sick regardless of my weight.

For a long time, imperfect recover was enough for me.  It was such an improvement, I was proud of myself.  People stopped bugging me about gaining weight.  I was able to eat most things without panic.  I was able to eat around other people.  I was able to attend social events.  I was more relaxed.

But even at the BEST of times, there were always rules, calculations.  I always felt that I deserved to eat only as much as I needed to survive each day.  Never more.  I wasn’t starving myself literally, but I was starving my soul.  I was depriving myself of more than food, I was depriving myself of joy, connection and abundance.

Recently the stress in my life has been almost more than I can bear.  I’ve been waiting for 5 months for the outcome of a year long family law trial.  I’m waiting for a stranger to decide the future of my children.   Many important aspects of my life are quite literally out of my control.

I struggle daily to accept my body at this weight.  I struggle daily feeling like I am too big, seeing parts of my body as fat, living with body distortions and hating myself.

I struggle daily with the lack of control and the waiting.

And quite honestly, I CHOSE to let Ana start driving again.  I saw it as a necessary evil, to help me keep functioning and keep moving forward through each day.  I opened the door and let Ana right back in.  I welcomed her. I almost felt happy that I had a way of modulating and distracting from the unbearable stress.

I changed a few things here, a few things there.  Nothing drastic, but small changes.  I felt okay about it.   Maybe I could lose just a few pounds.  But it isn’t really about the weight, though I might say that it is.  It’s all about feeling in control of my body and thus, my life.

Irrational.  Magical thinking.  Self-destructive.  Self-punishing.  Illogical.

But even though I’ve let Ana drive many times before, always with varying degrees of disastrous results, I STILL believe deep down inside, that she is my friend who will NEVER leave me.  I love Ana for getting me through years of sexual and emotional abuse.  I love Ana for never letting me down, for always being there.

But Ana is an abusive partner.  She isolates me.  She makes me say no to eating dinner with friends because she makes me ashamed and afraid to eat in public.  She makes me tired from restricting food.  She makes me impatient and she makes me struggle to connect with those around me.  She helps me to disassociate by numbing out through the physiological effects of semi-starvation.  Ana is abusive even when I let the door open a crack.  Ana is abusive even when I’m not emaciated.  Ana is abusive even when you see me eating.  Ana is abusive right now.

Ana tells me that I don’t deserve to eat.  That I don’t deserve to take up space.  That I’m bad or weak for needing food to survive.  Ana tells me that the high of restricting food means I’m strong.

Ana lies.  She lies like any abusive partner.  She gaslights me.  She lulls me into thinking she is caring for me while she is trying to destroy me.

Today, I am at the stage of contemplating full recovery.

When Ana drives, I eventually feel like life is not worth living.  I can’t imagine living another 20 years this way.  Half living, half dying.  I’m tired.

To me, full recovery means more than changing my eating habits.

Full recovery means letting go of giving meaning to food.  Letting go of believing my food intake or weight has anything to do with my worth.  Letting go of trying to control my body as a means to feel safe in this world.  Letting go of believing that being thin will protect me from being raped again.  Letting go of trying to disappear to stay safe or avoid hurting anyone.

Fully recovered means eating when I’m  hungry and stopping when I’m full.  Fully recovered means going out to dinner with friends, even if I ate lunch.  Fully recovered means eating lunch daily. Fully recovered means eating 3 cookies.  Fully recovered means breaking all my food rules, even drinking juice!  Measuring nothing, counting nothing, giving food no value other than nutritional.  Fully recovered means not cheating, by holding on to “just one or two habits.”   Fully recovered means committing to staying alive until my natural death.  Fully recovered means learning to like myself, then learning to love myself.  Fully recovered means reconnecting with the world, trusting myself and opening myself up to others.  Fully recovered means healing from years of abuse, by self compassion rather than self hatred. Fully recovered means accepting my natural body shape, no matter what size that turns out to be.

Fully recovered means letting go of fear.

I hope fully recovered means living with joy.  I hope that one day I will experience fully recovered and it will be wonderful.

Today, I still feel lost and stuck in survival mode. If you have tips for finding “fully recovered” please share them in the comment section below.

Meet Ana.

These pictures are of a cartoon girl called Emily Strange.  If I could draw a comic book version of Ana, she would look something like Emily Strange.

Ana isn’t just my eating disorder personified.   Ana isn’t just a nickname for anorexia.  Ana is another part of me.  I experience Ana as an angry teenage girl.  She isn’t just me as a teenager.  She has long straight black hair and very pale white skin.  She has dark eyes which are usually downcast.   Her fists clench when she is angry.  She wears hoodies, dark clothes, army boots and skirts.  She is slim and looks like she could sneak around very easily, light on her feet and quiet.  She is filled with anger and yet she doesn’t take up much obvious space.   Ana is my inner child.  Ana is my alter ego.  Ana is my eating disorder.  Ana is self harm and suicidal thoughts.  Because Ana is a scared, teenage girl.

Ana is the part of me that doesn’t trust you.

Ana is the part of me that wants everything or nothing at all.  Complete loyalty, or no friendship.

Ana is the part of me that feels like nobody believes me.   Ana doesn’t feel heard and when she is angry, she hurts me rather than expressing herself assertively.

Ana acts out, but that’s because she’s  young.  She’s probably only 14 or 15 years old.  She doesn’t have life skills.  Her anger is a mask for fears she is too afraid to share.  Her prickly exterior is a mask hiding deep vulnerability and shame.

Ana feels worthless.  Ana feels helpless.  Ana feels like punishing me is the only solution to these feelings.

Ana acts like a complete spoiled, controlling brat, when she really wants to be rescued.   She makes unreasonable rules rather than admitting she is afraid.

Ana craves safety, yet acts like she does not need protection.

Ana blames herself for being abused.   Ana feels responsible and wants to protect me by keeping me alone.  Ana tries to push people away with self harm, suicidal thoughts and eating disorder behaviours.  Ana thinks if we are smaller and take up less space we will be safer.

Ana is me.  At least she is a part of me, but I don’t know how to make peace with her, forgive her, accept her and come to a truce.  I don’t know how to integrate her, so that we become just one adult person again.  I’m not sure how to soothe this angry child inside of me.  We lack compassion for each other and for our younger selves.

I hope one day I can truly feel that Ana deserves forgiveness for hurting me.  And that she can forgive me for not protecting her.

Calories on Restaurant Menus: a Rant.

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When Ana and I first started hanging out together, I used to go to the bulk food store and buy candy.  Specifically, gum drops and red licorice bits.   I used to drink diet coke and eat twizzlers licorice from the 7-11 on my way home.  I used candy and diet pop as a replacement for proper nutrition.  I would bring exactly 5 gum drops to school and I would eat them slowly, while sipping diet coke and pretend it was a meal.  Those gums drops and the occasional licorice were some of the only treats allowed into my strict food rituals.  I loved that candy.

Then one day, the bulk food store started posting nutritional information on the lids of their bins.

And I never ate those gum drops again.  In fact, I stopped eating candy.  I mostly stopped shopping at bulk food stores!  Something that had been considered “safe” was suddenly off limits and forbidden.  The only reason?  Because I now knew exactly how many calories were in that licorice piece and 5 gum drops.  I was devastated and angry.  Why did the store need to post the caloric content of the gum drops?  Why?!?

When I was an inpatient receiving treatment for anorexia, I was encouraged not to read food labels, not to look at calories.  I was encouraged to eat based on my body’s cues, or even mechanically an appropriate amount to sustain health.

For the most part, I did this for years.  When my children were diagnosed with severe and life threatening food allergies, I was forced to confront food labels.  I was forced to read all the ingredients and check carefully for potential allergens.  I struggled with this, because again my eyes could not avoid seeing the nutritional information, calories and fat in the items I was consuming.  But I did it for my kids health and safety.

Recently, the government has decided that it is mandatory to post nutritional information and caloric content right up on the menus of all restaurants.

I was furious!  This is so incredibly triggering for many people with eating disorders.

I absolutely did not want to know exactly how many calories were in the Starbucks cookie I was having for a snack.  I did not want to know how many calories were in my caramel latte.  I just did not want this information.  I don’t want it!  I will never want it.  Because once I know it, I can’t “unknow” it!  This information is not useful to my life.  It does not make me healthier or happier.

On a good day, the information won’t change the choices I make.  But on a bad day, a day when Ana is in the driver’s seat…

Suddenly I’m struggling over deciding what snack to choose at Starbucks.  Suddenly I’m ordering a black coffee, rather than that cinnamon latte.

On a bad day, nutritional information and caloric content listed in large ominous letters on the menu in front of me, can put a dark cloud over my enjoyment of that snack or meal.

I understand that nutritional information must be available at restaurants.  It should be available for those with food allergies or sensitivities or religious dietary restrictions.  It should be there for those with diabetes.  It should be there for viewing ON REQUEST!  But does the caloric intake of my Starbucks beverage REALLY need to be right in my face as I attempt to order?

I think the answer is no.  I go to Starbucks for a break.   I go there to relax.  I go there to treat myself and rest from the stress of my life.  I don’t go there to have an extended and upsetting debate with Ana.

I just want to drink my coffee in peace!

It’s not for attention, it’s a serious mental illness.

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As we approach National Eating Disorders Awareness Week (Feb 1-7), I’ve been thinking a lot about my own eating disorder.  I’ve also been thinking about some of the common misconceptions there are about eating disorders.

One of the myths surrounding eating disorders, that I will discuss in this post, has two parts.  The first part is that eating disorders are  the same as dieting and are about being thin.  The second part follows, that they are about getting attention and meeting societies/media ideals of beauty.

I’ve struggled with anorexia for 20 years.  In my own experience, anorexia bears no resemblance to “normal” dieting that most people engage in at some points in their lives.  It is a serious mental illness, with severe physical and psychological impacts and side effects.   In my experience, anorexia was not about being thin, at least not at the beginning.   It certainly was not about getting attention, or competing with media ideals.  A good portion of anorexia was about disappearing, taking up as little space as possible and was fueled by intense shame and embarrassment, NOT the desire for others to notice me.

I went to, and go to, great lengths to hide my anorexia from others.  In fact, there are large aspects of my eating disorder I’ve never spoken about to anyone.  I rarely talk about it in therapy, I almost never disclose details to friends and family and I tend to keep it secret mainly due to shame and guilt and fears that others will view me as stark, raving mad…if they really knew.

After struggling with anorexia for 20 year, I have osteopenia.  This means that I have low bone density for my age.  I had low bone density before I was 30 years old. This is a common physical impact of eating disorders.  I’ve struggled with low iron levels which causes low energy, dizziness and fatigue.   As I age, I find I have less tolerance for restricting food.  I get dizzy, tired and have trouble focusing.  Symptoms I didn’t experience as a teenager.

But I’m lucky.  I have friends who have had heart attacks, passed out daily due to low potassium levels, lost all their teeth due to purging, have had broken bones due to osteoporosis and those who have lost their lives.  Eating disorders kill.  These people didn’t die because they wanted to look like the models in magazines and the stars in Hollywood.  They died because they couldn’t escape from a serious mental illness.

People who have eating disorders aren’t vain.  They aren’t making a choice.  Anorexia isn’t a lifestyle choice.  It’s a serious mental illness.  It’s often a coping reaction to experiencing abuse, trauma or extremely stressful life circumstances.

Anorexia isn’t about getting attention.  When I was at my sickest, I would rarely eat around other people.  This led to social isolation, rather than attention seeking.  I saw friends and family less, I spent a lot of time alone in my room. I would eat either before my family got up, or after they had finished in the kitchen.  I avoided social occasions where food was involved (in other words ALL social events).

I was deeply ashamed about the majority of my eating disorder behaviours.  I still am.  When I look back on those years, I feel the need to apologize to everyone I knew back then.  I want to apologize to them for making them look at 85 pound me.  A skeleton in a skirt, drifting through the halls of our high school like a shadow.  I feel embarrassed.  I know that I looked awful and that I scared a lot of people.  People who cared about me and were worried that I might die.  But quite honestly, I didn’t even really believe that I was sick.

I felt like I was living on autopilot.  I felt driven and I couldn’t stop.  I couldn’t slow down.  I didn’t exercise at the gym, but I used to walk long distances.   With the amount I was eating even daily activities were over exertions.  I had so many rituals it was amazing I could keep track of them all.  I would measure my food, eat certain foods only on certain days, eat or drink certain things only at certain times of days.  I drank a lot of coffee, tea, water and diet coke.  I drank fluids to avoid eating, but I was later told that staying hydrated was probably a good part of why I had so few negative side effects at my lowest weight.

If you had asked me, I probably wouldn’t have identified myself as someone with an eating disorder. I was confused.  I didn’t even know what I was doing or why.  All I knew was that suddenly food was my enemy and I felt that I could survive on almost nothing.   The anorexia always had an obsessive compulsive quality to it, the rituals were designed to keep me safe, not to alter my weight or physical appearance.  I was never trying to lose weight.  I was trying to control my trauma, my body and to numb out my feelings.

In the warped and bizarre world I lived in, slicing my half a banana into exactly 11 slices on my 1 cup of cereal kept me safe.  In that world, I could buy a cookie on Tuesday and Thursday only. I had to break that cookie into exactly 4 pieces which I would eat at specific times over the course of that day.

I used to go to the library sometimes after school and read books.  I remember one day my willpower failed and my hunger won. I ate my whole cookie at once.  I panicked.  Extreme panic.  I don’t know exactly what I thought was going to happen, but it was terrible and  I couldn’t undo it.  I knew from reading books that bulimia existed.  It was something I’d never explored, I never really ate more than a small amount at a time.  But somehow on that day, that cookie felt like a binge. I felt like the world was going to fall apart because I’d broken my ritual.  I went into the washroom at the library and tried desperately to make myself sick.  I wasn’t able to. I never have been able to (probably a good thing).   I remember crying and panicking and not knowing what to do.  Eventually I must have just gone home.  I remember feeling so very alone.

I’ve never told anyone about that, because of the intense shame I feel about behaving so strangely, in a way that I can objectively see makes very little sense.  This is why I don’t believe that anorexia is a cry for help, or a plea  for attention, because the majority of it happens in secret.   Sometimes I’ve been reluctant to share details about my eating disorder because I don’t want to trigger others or give people who are not in recovery ideas about behaviours.

Objectively, I can see that anorexia doesn’t make sense.  I can see that my obsessive compulsive habits, rituals, and rules don’t make sense.  I can see that they don’t make me safer or protect me. I can intellectually understand the health risks of not taking care of my body.  In my mind, I know that eating normally and being at a healthy weight would improve my mental health and that nothing bad would happen to me.

But Ana, spins a different web of lies in my head.  The fear of what could happen, the anxiety drives the OCD cycle of obsessive thoughts leading to ritualistic behaviour related to food.

I actually see Ana (my eating disorder voice) as a separate person.  I have a visual image of her in my head.  I experience her telling me things and I feel I have to listen.  She’s angry.  I know she isn’t a good friend and the majority of what she tells me (if not everything) is a lie.  But I feel some strange loyalty and attachment to her.  It’s hard to let her go.  I sometimes feel like I’d be lonely without her.

Eating disorders are serious mental illnesses.  You don’t have to fully understand my experience, in a way, I’m glad if you can’t understand it, because it means you haven’t lived through something similar.  But the stigma and myths about anorexia and other eating disorders need to be challenged.  People with eating disorders need your compassion and they need specialized, accessible and trauma informed treatment options in their own cities.  There is a woeful lack of eating disorder treatment available and people die while waiting for treatment.  Ending the stigma and increasing public education about these serious illnesses can help change this situation.

 

 

 

 

I’m triggered.

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Being triggered is exhausting.

It feels like being in a constant state of fight or flight.  It feels like panic.  It feels like a reduced ability to think clearly and stay calm.  It feels like fog, a buzzing in my ears.  Everything sounds too loud, lights are too bright, smells too strong.  My clothes touching my body make me feel disgusting, fat and out of control.  Ana is screaming at me not to eat, while another part of me is saying that not eating will make me more panicked.  An internal war begins.  I feel like I’m in danger.

If someone tells me to “calm down” or “not worry,” the panicked feeling turns to desperate anger and I find it hard to keep it hidden inside.

If the trigger goes on for a long time, especially if it is combined with actual real life danger or stress, I eventually become exhausted.  I am desperate for the uncomfortable feelings to pass.

And in the desperation I always begin obsessing about self harm and sometimes suicide.  Intellectually I know that this doesn’t make sense, but it’s my brain’s default setting for  TOO MUCH STRESS!  I learned about 4 years ago that my suicidal ideation is a red flag, it’s a signal from my brain that I need to reduce my stress ASAP.  It’s not really about dying, it’s about ending the horrible painful, out of control panic feeling.  NOW.

My main ways of coping with self harming thoughts and suicidal ideation is by trying to tune out.  I do this mainly by surfing the internet, checking facebook, texting, checking my phone and also by blogging.  I find that technology is a good way of tuning out the self destructive thoughts for a while.   So sometimes, when I’m checking my phone too often, even if it annoys you, even if it seems impolite, try not to judge, I might be coping and distracting myself from negative thoughts.

Another great way of coping with triggers is exercise.  Before I developed arthritis I used to cope by running.  That was amazing.  I miss it so much.  Walking can help, getting out into nature can help, dancing can help, moving my body and letting some of the pressure release.   But when I’m at home, my go to coping during the evening (the most difficult time of day for self harm urges) is texting and internet time.

It’s hard to explain triggers to people who don’t have PTSD.  People who live with panic attacks or generalized anxiety can understand parts of it.  But PTSD triggers are a little different somehow, because they are connected very tightly with actual bad events which have happened in a person’s life.  It becomes very difficult at times to distinguish between immediate stressors in day to day life, and abuse/danger/violence.

Triggers can also be emotional.  For example one of my main triggers is feeling like I am not being believed, or even might not be believed when I’m speaking my truth.  Another is feeling like I’m going to get into trouble for doing something which is reasonable and not generally perceived as negative.  These feelings are related to gaslighting, emotional abuse and systemic/systematic institutional abuse and neglect.

When I’m triggered what I need is to get grounded as quickly as possible.  If I can’t get grounded then what I need is to keep myself safe and as calm as possible.  Sometimes this means that I want to be at home, be alone, or be with people I feel safe expressing myself with.  Staying safe sometimes means spending hours online after the kids are asleep, or lying in bed all evening because I don’t trust myself to make safe choices.   I’m not being lazy, I’m protecting myself in the best ways I have learned how.

Sometimes when I’m triggered I disassociate or space out.  I might seem emotionally distance or cold.  I might be more emotional, or my emotions might seem out of proportion with reality.  That’s because they are!  They are a reaction to reality PLUS the past trigger related to abuse and violence.

I know I’m not doing a perfect job at life when I’m triggered.  I constantly worry that others will judge me because my capacity to perform at my highest level is reduced.  My brain will literally shut down, I will have problems remembering things, trouble finding the right words under pressure, I might cry or freeze up, grow silent or suddenly angry.  I might be impatient with the kids when they haven’t really done anything wrong.  I might snap at those close to me, or not be as kind as usual.   I don’t mean to.  Believe me my level of guilt is so high that it contributes to the problem!  I know I’m not acting “normal” but I can’t help it.   Sometimes I need space to get grounded, sometimes I need others to remind me that even though it’s difficult I’m doing my best and that is good enough.

If the triggers are entirely related to the past, and no danger exists in the present, for example during consenting sex, it helps for the other person to remind me “you are safe right now, it’s 2016, you are with _____, nobody is going to hurt you”

If the triggers are related to the past, but there is some threat in the present moment, it helps to acknowledge both sets of feelings are real.  Yes, this situation reminds me of the past, that is difficult and scary.  Yes, there is some threat in the present and that is scary too.   I  might need to get grounded FIRST and then brainstorm solutions to the present situation.  Sometimes self care can play an important role in grounding.

PTSD is invisible, triggers are invisible, all this is happening inside my brain and my body is reacting.  It sometimes feelings as if the past is happening all over again.  Especially when triggers lead to flashbacks.

Please understand I’m doing the best I can.  PTSD is a difficult illness and because it is invisible it can be hard for others to understand.

Compassion helps triggers.  Everyone deserves to feel safe.  But when you live with PTSD, feeling safe can be like searching for the proverbial needle in a haystack.  When you aren’t quite sure what the needle looks like, or if it is REALLY in the haystack!  You aren’t even sure exactly why you need the needle and what you are going to do with it when you find it!

Yes, life can be confusing.  Triggers can be confusing.  PTSD can be confusing.

Tonight I’m confused, but I’m coping as I write.