Ah yes, accepting the full catastrophe of life. This is one main thing I struggle with somewhat regularly. This series of yours has been brilliant!

I just wanted to say thank you for this series you're doing, Carrie. It makes me feel SO much less alone in the world.

Yeah, thanks for the whole series Carrie! Really helpful.

Life does seem simpler if it's just about food and exercise and that's it. But it also makes life so much more limited and, well, boring.

It means living.

I totally agree about the 'simple life' thing...

I have always described my anorexia nervosa (AN) as being about 'control' - because when I tried to let go of anorexic behaviours I felt 'out of control' - of my emotions and my life. My AN was not about (e.g.) controlling people around me. I actually felt guilty about how much my AN impinged on the lives of those around me.

I know that many view the late Prof Arthur Crisp's hypothesis of AN being a 'fear of growing up' as outdated, but I have always identified with his hypothesis. During adolescence/young adulthood, aside from changes in body shape and size, life does become much more complicated. We endeavour to develop a sense of personal identity, consider moving away from family, have academic pressures etc.

AN becomes an identity AND it becomes a ritualised way of living, all of which feel 'safe'.

Wow Carrie
Great description, thankyou

I hated that feeling that I was going to die. Wanting to so much and just knowing that it was going to happen soon. It had to happen soon cause I just couldn't take it anymore.

@Cathy UK;
I really relate to what you are saying, insofar as it resonates with what we see with our kid. And it strikes me that your Prof's idea is not wholly without foundation.

Because a person who is suffering from a disease doesn't "experience" the biopathophysiology of the disease process - they experience their LIFE. You can get as "meta" as you want and understand that "[my internal] map is NOT the territory", but day to day, each of us thinks, feels and behaves from within ourselves; in this way, the map IS the territory, if you get what I mean.

The problem comes in when clinicians treat the experiences as if THAT's the target for primary treatment. LOTS of people find [change, friendships, adult life, high school, developing an identity outside of as your parents' kid, etc.] stressful. LOTS of people also trip into all kinds of maladaptive ways to cope with stress. So the questions become: What's the difference that makes the difference for people who develop ED (or substance abuse, or emotional dysregulation etc.)? Is this strictly behavioral, or is there a biological component? And very importantly - Are there physiological abnormalities that need correction?.

This, I think is one of the most useful contributions that Marsha Linehan makes in her DBT model. She stresses prioritizing behaviors: First you have to intervene on anything that compromizes health/safety. Then on anything that interferes with treatment. Then on quality of life issues.

One cannot expect lasting recovery from ED without dealing with the stressors and experiences of the person. But unless one deals with the health and safety issues FIRST, further progress is moot. It just ASTOUNDS me that clinicians who would NEVER expect progress with a bi-polar patient who is currently having a psychotic episode, or a drug user who is actively high, expect progress with an ED sufferer who is currently 'using'; in each case, there is active brain malfunction (encephalopathy), but only in the case of EDs is psychodynamic therapy expected to work.

What is so incredibly useful for me, in reading Carrie's posts and your and others' comments, is the insight into that experience. I am really appreciative of being able to have that window. Thanks so much for this Carrie. You've provided a "road map" that can help us care-givers get out the wrecking crew and pot-hole teams!

This series has been awesome. When I was in deep with ED, I watched the Food Network. You are right. You become fixated on food. Thank you for sharing.

My own life has been full of catastrophe lately, but for the first time, I want to face things head-on and "keep it real." I am tired of living in my contrived ED world. I feel like I've missed out on so much in life by cutting out everything that conflicted with my ED rituals that now I would rather take the bad with the good than have no good at all. Beautiful post, Carrie.

@IrishUp:

Thanks for the feedback... You make a really important point about the 'person suffering the disease process experiencing their life - more so that the disease process per se'. Anorexia nervosa (AN) definitely 'screws the mind up' and distorts thinking.

I also agree with Linehan's logic and your analogy regarding AN as 'using'. My own psychiatrist has always been very clear that AN changes one's personality and thinking style, and that starvation and its related devastation must be addressed before therapy for any underlying issues are addressed.

Despite my acknowledgement and personal experience of AN as being a disease in itself that is related to the effects of starvation on brain function, I do not attribute its onset (in my case) to simple dieting/food restriction alone. I restricted food and over-exercised at the outset to relieve overwhelming anxiety and depression as an 11-yr old, in association with some of the issues I described in my earlier comment (+ other issues, including trauma). AN 'numbed' the anxiety and initially relieved the depression. That's why I stuck in the illness, until it took over of its own accord.

In order to recover, in addition to tackling the starvation part and gaining weight, I have had to tackle the issues that triggered the anxiety and depression at the outset. Had I not done this I would (yet again) have relapsed into AN.

For some people AN may be a disease of simple starvation, the symptoms of which reverse with re-feeding, but for others that simply isn't the case. I am therefore strongly opposed to the idea of attributing all psychiatric symptoms to undernutrition in those who have underlying triggers and co-morbid disturbances.

@Cathy - I hope I didn't sound like I think that all AN or ED syptoms are simply the physical effects of starvation. My best guess is that this scenario fits very few people. In our kid's case, she was having HUGE stresses in her first year of high school. She already had an anxious/ avoidant personality type, and perfectionism (though it manifested itself paradoxically). In US culture in particular, it's a very short step from feeling "I don't fit in" to "If only I were thin(ner), THEN I would fit in." Once she dieted, she began to experience how well AN "worked" on so many levels for her. So her personality traits and issues were already there. And as we are finding out, ED is her "go-to" thing when the going gets tough.

Refeeding alone just doesn't cut it. Necessary - yes, sufficient - NO! not by any stretch of the imagination. Musn't muddle the two.

THAT SAID, when she's in negative energy balance or eating dysregulated, not only is progress stopped, but she loses skills and abilities she has previously mastered, right in step. She can't acquire new stuff, and regresses. Her behavior becomes very OC, her thinking becomes highly split rather than nuanced, she can't handle social situations at ALL, in short, her traits all become exponentially exacerbated to the point of pathology (where this means interfering with ability to do daily activities & meet responsibilities). And these observations ARE the primary effects of starvation, not just for her, but for lots and lots of humans. Individual results may vary, of course ;)

@IrishUp:

Thanks for the (second) response. I'm really sorry to hear of your daughter's experiences, but pleased she has such a knowledgeable mother :) I hop;e your daughter is 'on the mend'.

I totally 'get' what you say about nutrition. I know that I will always need to eat as would someone with (e.g.) type I diabetes - i.e. regularly and adequately - and ensure an adequate blood glucose concentration. Even inadvertent weight loss through illness can trigger maladaptive eating behaviours.

Apart from the psychological influences of good nutrition, also important are the physical/physiological/metabolic effects - on endocrine function, organ system function and bone metabolism. My bone density has increased significantly with weight gain, which is a real motivator for ensuring I continue to eat well.