On Triggers

When I was taught about avoiding ED triggers in treatment, I learned a lot of the usual: stay away from fashion magazines, the crazy aunt/sister/cousin/uncle who's always on a diet, throw out your "sick" clothes, etc. All of these are very good things to do, and I've made changes in all of these areas in my life to avoid being bombarded with the same messages that I'm trying to convince myself aren't true.

Where I'm at in recovery now is a little different from when I was first hospitalized almost 9 years ago. Sure, my body image may take a hit if I look at a fashion magazine, and nothing sets my teeth on edge quite like discussion of what I "should" be eating. It's irritating and uncomfortable, but it's not triggering. It doesn't make the ED sound all rosy and happy and maybe breakfast really isn't such a good idea after all.

This is not to say that I'm without my triggers, however. They're just a lot different than some of the ones I learned so long ago.

My biggest trigger, without a doubt, is anxiety. The more anxious I get, the more I feel compelled to return to my routines and rigid ways of living. It makes me want to do an impromptu ultra-marathon and run until I'm too physically exhausted to be wound up and anxious. It's what ultimately prompted this last relapse: heaps of unchecked anxiety that I "managed" by exercising and creating more and more rules for myself until I was sucked back in.

I've been making a lot of progress recently with feeling more free to eat when I'm at home. The AN isn't gone, but I can exhale just a little bit. I don't get the insane metabolic hiccups anymore (as in needing nearly twice the daily recommended intake just to maintain), and my body is beginning to trust that food will be there again in a few hours. Part of the exhalation is my routine. What I do, when. Particular combinations of foods. Even just the types of food that are generally on hand. When I arrive in a different environment--even a comfortable, different environment--I get all shook up. And those nagging fears creep back in, fears about whether I'm eating too much in general, I'm consuming too many "added sugars," I'm exercising enough, what will be served in a few hours.

Right now, it's a fine line between finding security in the routines that I psychologically crave, and not getting so wrapped up in them that it ends up hindering my recovery. These routines do help dramatically decrease my anxiety, which then helps me stay in recovery. On the other hand, if the slightest deviation in my routine causes me to freak the hell out, this isn't good, either.

I think tackling my longstanding anxiety and depression will be one of the last major hurdles for me in recovery. I'd love for it to be short and easy and simple, but I have a strange feeling that's not going to happen. But until I do, those triggers will always be waiting for me.

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Special K said...

I am in spain, and I have been trying to recognize my need to feel as if I have to hold everything together...my biggest yuckiest moments come when I feel that I SHOULD do something, or my expectations of something SHOULD be this way or that way...I should NOT get lost. I should ALWAYS be polite. What a great post!
email me when you get the chance.

Katie said...

My biggest trigger is feeling helpless or hopeless, because I automatically start looking around for something I can do to 'improve' the situation, and that something always seems to be restricting to distract/numb myself. It's not a conscious decision, it just seems to happen, but there's a definite pattern. One thing that has helped me avoid that this time is keeping a relapse prevention plan on my blog and looking at it at the end of every month. I have a list of my triggers there, and I check through them to see if any of them are bugging me at the moment, then I go through a list of early warning signs of relapse. It's been more helpful than I would have imagined. I am physically recovered and now working on my anxiety and depression in therapy and it is hard, but I think it's going much better now than it did while I kept slipping back into restriction every time I got a bit freaked out. Good luck Carrie, I'm glad you're doing well :)

Cathy (UK) said...

It's really interesting to 'compare notes' on the issues that help or hinder full recovery from anorexia nervosa.

Like Katie, helplessness and hopelessness are big triggers for me - and they always have been. Another trigger is feeling that my life is unpredictable or chaotic. That feeling turns me into the queen of rituals...

I have never read fashion magazines (I prefer Science/Technology/Wildlife magazines) and have never felt triggered by others' weight or body shape.

(Actually, can someone please explain why so many girls/women with EDs find images of thin women triggering? I am genuinely interested to know....)

In terms of food issues - like counting calories/fat/protein/carbs etc., which I used to do incessantly... those days are long gone. All my frenetic gym exercising has stopped and I'm (sort of) satisfied with a brisk walk 3 times each week - except when I am very stressed and have the urge to exercise myself 'to smithereens'.

However, I will never be able to live without rituals and routines. I have now developed a suduko and crossword ritual that I 'must' do at the same time every day. Although I no longer consciously restrict food, I have a lot of food rituals which I had from a young age (pre-anorexia). These rituals are anxiety related. I am still slightly underweight but I cannot bear the sensation of fullness. I also have contamination issues (OCD) and worry about food contamination.

Gah, I sound so neurotic :(

Great post as usual...

Cammy said...

Sometimes, Carrie, I really almost believe that you pull thoughts straight out of my head. I definitely relate to this. I am doing well, food-wise, at home, but take me out of my native habitat/schedule and it all goes to hell. Major anxiety, and a strange just plain "unsafe" feeling about missing the usual time/location/type of food. I think this is the kind of thing that can only be overcome through gradual but persistent exposures, honestly. Just be patient with yourself. For me, it helps to remind myself that breaking the ritual once does not mean you can never have it again. Going out to lunch, dinner, etc can be a trial, in some ways, but remember you can always have your usual again tomorrow, and the next day, it's not as if that is being taken from you permanently. I know that dealing with it logically is way easier said than done, I'm in the same boat, but hang in there! You can do this.

As far as triggers, besides the change-in-routine issue, a big thing for me is to hear "normal" people talking about behaviors that, if I did them, would be attributed to the ED. For example if someone says they just "forgot" to eat lunch, or only felt like having X for dinner, that really gets to me. Maybe because I'm still on a MP and resent the fact that other people are "allowed" to eat less without judgment. Maybe because I've worked so hard to resist behaviors like that, and it bothers me that maybe meal-skipping and such is really a part of normal life and I am like the girl in the bubble that has to be overinsulated from that because of my disease. In recovery but still not normal, I guess. Maybe because I still just don't understand having such a fluid relationship with food?

Thanks, as always, for the insights!

Carrie Arnold said...

Katie and Cathy,

I think feeling helpless is closely link to my anxiety. I feel the most anxious when I have to deal with things I can't do much about. Then the depression kicks in, and soon I'm telling myself that at least I'll feel a little better if I start losing weight. Um, no, not quite.


The triggers with the magazines, etc, has to do with (I think) comparison and perfectionism. For me, I would feel very inadequate next to these idealized images, the same when I felt inadequate when I would get a bad grade at school. The first would trigger that voice inside my head telling me I was gross and lazy and that I needed to exercise more and lose weight, and the latter would trigger thoughts that I was stupid and worthless and needed to study more. Odd that the first half of that trigger sequence has pretty much resolved itself, but the second? HAH!


I often read your blog and wonder if we were separated at birth. ;) You're right about the persistent exposures. Each time I have gone visiting friends for the weekend I have coped better. Last weekend, I was in NYC and it wasn't easy, but I also didn't lose weight, either.

And the people who talk about forgetting to eat? I want to smack them, too.

Take care!

Kim said...

Great post, as always. I related quite a bit, as always :) In general, the "usual" triggers don't trigger me anymore. If I hear about a diet, or what someone eats or weighs, I am irritated, at worst (and, sometimes, I just don't care at all, which is huge progress for me). Like you, anxiety/depression remain triggers for me (and I tend to get anxious, then depressed, when my expected, predictable routine changes). When things feel "off," I know that following some eating rules will make everything seem orderly and OK again. I really love routines, and I feel like they assist in my recovery a GREAT deal. It's hard for me to use routines healthfully for a long period of time without them becoming somewhat confining. I feel like I have to stay on top of when it's time to change up something. And I have to think hard about whether a routine is a necessary or unnecessary crutch. It sounds like you're doing some great work in finding out what works for you. I think realizing that anxiety is a trigger and knowing how to quell anxiety in daily life (without getting nutty about it) is what it's all about.

I Hate to Weight said...

my biggest trigger is unhappiness. which can lead to a lot of anxiety. i'm learning that talking about things helps a lot, but i'm so bad at that.

i'm traveling a lot and do pick up magazines. they can set my mind askew, indeed. time to go back to books.

anxiety and depression. anxiety and depression. grrrrrrrrrrr

Jessie said...

I could completely relate to this post. For me anxiety is a huge trigger as is depression (similar to the helpless/hopeless feelings some other people talked about). When I'm severely depressed, I feel like it's just too hard to try and leave behind the "safe" and "normal" patterns of restricting. It just takes too much energy not to do these things. And I'm glad I'm not the only one who has triggers besides diet talk and fashion magazines--I'm actually pretty good at not being triggered by these things.

I like what Cammy said too about knowing that you can always do the ritual tomorrow, etc. if you have to break it once.

Angela said...

Anxiety is also a big trigger for me. The need to fell that I can contro something when the rest of my life feels out of control. I used to be addicted to fashion magazines. I definitely stay far away from them, as I compare my body to everyone else's.
Great post, and glad to hear that you are doing well:)

Sarah at Journeying With Him said...

Carrie, I am with you on this one. I've noticed that my "bad body image days" seem to correlate with days when I'm stressed about something out of my control. Actually, I should say that my husband figured this out and pointed it out. He's totally right. Also, I have the hardest time eating when things are stressful. I'm going to write about this on my own blog, but the last few weeks have held THREE different 4-7 day trips for me. On the first (the most stressful) I did not do a good job of eating. I learned to cope and did 100% fine by the 3rd, but it was my first "slip" in months.

It SUCKS that ED behaviors can sneak up, seem logical, and feel like a subconscious decision instead of something you are deliberately choosing. That's why vigilance and attention to your habits, a meal and exercise plan, and constant reminders that you CHOOSE your behaviors are recommended, I guess.

Lily Jane said...

I definitely agree with this post. I just wish I knew when things were going downhill for me, though. No matter how much therapy, help, etc I've gotten for the ED, the negative thoughts are ALWAYS there, it seems. :| I never know if I'm running too much, eating too little, and what I'm really feeling. :( Maybe one day I will recognise it?

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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