One of the hardest things for me to adjust to in recovery was all of the spare time and energy I had.  When I was in the depths of ED, I spent all my awake time perseverating about how much I ate, how much I exercised, what I weighed, and how much I hated life.  I could distract myself for brief periods--maybe for a few pages of an unusually good book or during a movie scene--but the ED always intruded.  This dragged me back to going over and over these things in my head.  Literally, these thoughts were my life.

As they receded, I often felt my brainpan was going to collapse without the constant pressure of those thoughts zinging around.  The obsessive thoughts lessened somewhat as I reached a healthy weight, but they still occupied freaky amounts of my time.  I didn't enjoy obsessing about every little thing, but I didn't know what else to do.  One of the things that left me so vulnerable to relapse was the fact that I didn't have anything to take the place of the ED that had occupied my thoughts for so long.

I found writing to be so helpful not just because it helped me sort through my thoughts, but because it provided me with something to do.  For the first time, I had something much more interesting, enticing and absorbing than the ED crap to think about.

I slowly began to find things that were not only more interesting to think about but could also be totally absorbing when I actually did them.  That's what I loved about mountain biking- I literally could not think of anything besides not crashing.  I hated the constant threat of danger, but I loved the challenge and the total mind-absorbing nature of it.  It's one of the main reasons I fell in love with cycling- I could daydream but the task at hand still demanded almost all of my attention.

I still struggle to clear my head while writing at times.  I'm aware that this is pretty normal, but I get a little more peeved when it's ED stuff creeping in rather than more normal, I-need-to-run-the-dishwasher kind of stuff.  And if writing doesn't do the trick (and I have some free time, which is becoming an increasingly rare phenomenon!), I can get involved in a good book as reading is another major passion of mine.

Finding my passion for writing didn't enable me to recover--there was a lot of hard work and therapy and facing my fears about food one at a time and meal after meal after meal.  But it's one of the best motivations to stay recovered.  Then I can actually get absorbed into books and projects and bike rides.  When I'm malnourished, all I can think about is food.  Now that my brain and body are (mostly) healthy again, I can focus on bigger and better things.

This quote from Around the Dinner Table has to be THE BEST explanation of the saying "An eating disorder is not about the food."

It's often said that it's not about the food, it's about the feelings, but it really is about the food, it's about eating no matter how you feel.  That's what recovery is.  And finding a new way to deal with feelings.  I guess that's sort of like telling an alcoholic that it's not about the alcohol, it's about the feelings that lead you to drink!  You still have to eat or stop drinking either way.

Yes, this.  This is exactly it.  No, an eating disorder really isn't "about" the food, but you also can't ignore the food at any point in recovery, whether it's at the very beginning or you've been doing well for years.

All the latest eating disorder-related (and not always that related) news, research, and other interesting tidbits in one spot. I trawl the internet for the best links so you don't have to.

As always, if you have something you might like to see in the smorgasbord, email me at carrie [at] edbites [dot] com!

Told to eat its vegetables, Americans order fries

Eating disorders: The hidden health crisis on campus

What I Eat: Around the World in 80 Diets

Psychological and behavioral risk profiles as they relate to eating disorder diagnoses and symptomatology among a school-based sample of youth

Don't believe everything you feel

Differentiating purging and nonpurging bulimia nervosa and binge eating disorder

Dance your PhD: How does your brain analyze incoming visual information? (Nothing to do with eating disorders, I just thought it was neat!)

Addiction & Learning: More Than Glutamate and Dopamine

A brief introduction to stress disorders

Refusing to ruminate

Treatment of emotional dysregulation in full syndrome and subthreshold binge eating disorder.

Eating disorder counsellors with eating disorder histories: a story of being "normal

H3 Receptor Miniseries: The histamine H3 receptor and eating behavior.

An examination of the impact of the Maudsley Collaborative Care skills training workshops on patients with anorexia nervosa: A qualitative study.

I'm at the point in recovery where feeling full after a meal is pretty normal.  It doesn't usually evoke any sort of odd emotions in me.  I don't get anxious, obsessive thoughts about how long I need to go without eating to "make up for" my last indulgence, or needing to engage in compulsive behaviors (exercising, purging) to undo the "damage" caused by my eating.  I still have conflicted feelings about needing to eat, but they almost never get in the way of my actually eating.

Still, sometimes when I get really anxious, feeling full starts to feel rather uncomfortable.  Times like, you know, now.  I mentioned the other day that I have been really stressed and exhausted lately, and although today wasn't quite as bad, I think the effects are rather cumulative.

I've learned (from years of experience) that anxiety messes with my hunger/fullness cues.  What often happens is one and/or both of the following: either I don't get hungry or I get really full, really fast.  Tonight, after my evening snack, the latter happened.  I know it's my physiological reaction to anxiety and not the amount of food I ate, which is a big step forward for me.

What used to happen was that this increased feeling of fullness would make me even more anxious and paranoid about eating because all I could think about was how full I felt.  It's not as bad as when you're nauseous and all you can think about is how awful you feel, but it's along those lines.  So yes, I focused on food and usually planned on restricting so I wouldn't have to feel so full.

Thus the vicious cycle begins.

I'm probably never going to stop being an anxious person.  I did meet with a new psychiatrist this week and got a prescription for lorazepam (trade name Ativan) to help with those really pull-my-hair-out moments.  I've come close to taking one numerous times, but I haven't had to take one since I got the prescription yesterday.  But even with meds, the anxiety is here to stay.  The SSRI I take helps with the really bad anxiety-induced nausea (as well as the depression), but I still get queasy a lot when I get upset.

It's hard to become so self-aware and have to develop an entire inner dialogue (what- you don't have discussions with yourself?) around talking myself off a mental cliff.  It's exhausting.  I really wish I didn't have to do it, or devote so much energy to staying on the same psychological level that so many others seem to gravitate to so easily.  But the situation is what it is.  My old therapist would tell me that this is when radical acceptance comes in handy--accepting that this is what I have to do, and yes it is unfair, but what are you going to do about it?

So yes, I'm full.  And yes, I'm uncomfortable.  But I have to remember that what's making me uncomfortable really isn't the food, it's the anxiety.  That's what I need to work on and deal with, not how much I'm eating.

Well, one of you asked, so here's a picture of me.  It's a self-portrait by Blackberry, and I'm in my white bakery trucker's hat. ;)

My life has been more than a little chaotic and stressful lately. This explains a lot of why I haven't been blogging quite as much over the past week- by the time I actually sit down at my computer to blog, I'm often too tired to put a sentence together.  I'm taking some pretty big steps in my life, and it's draining me.

So what am I doing?

Yesterday afternoon, I put an offer on a condo.  It's about 15 minutes from my parent's house.  I had a really cool townhouse all picked out, but I crunched the numbers and realized that finances would be way the hell too tight for comfort.  So I reluctantly abandoned that townhouse and found something quite a bit cheaper.  Here are some pictures of the inside (I'm not showing the outside for privacy reasons- if you want to see, send me an email and I'll send you a photo):

I ate lunch at Panera today, and there was something new on the menu: calorie counts.

It didn't mess with my head as badly as this prior experience, nor did it rattle me for very long. It annoyed me and upset me a bit, in no small part because I wasn't expecting it.

The calories were listed on the right-hand side of the menu, next to the price. The description of the food was listed on the left. When I was deep in the ED, I would have picked everything out beforehand if I couldn't weasel my way out of the occasion, so I could make absolutely sure I wasn't eating one single calorie more than I had to. I would have asked for the chips (if my meal came with that--it threw people off my trail) and saved them "for later," neatly disposing of them when no one was looking. Early in recovery, I would have made a minimal attempt to ignore the information, and then have found the lowest calorie item and ordered that. I would have gotten the apple or the carrot sticks as a side dish, but I would, in fact, eat these.

I was able to be much more calm and rational. Instead of finding the item with the lowest calories and then deciding if I would order that (as long as I didn't hate anything integral to the dish), I looked at the different dishes and then checked the calories.

In an ideal world, the calorie information would just be numbers, like the metric tons of methane produced by flatulent bovines. "Party facts," my undergraduate advisor called them. But over a decade of an ED means that facts aren't just facts. They're very emotionally charged facts. They're not just numbers, nor are they going to BE just numbers any time in the near future.

Given that fact, I did the next best thing: I tried to make the (irrelevant) information as small a part of my decision as possible. I did order a yummy entree salad with a hunk o' bread on the side. It fulfilled my meal plan requirements. The number was also within the "acceptable" limits. Was there something else on the menu I might have liked more? Probably. Were the calories a factor? Yep. Were they the only factor? Not really.

The big difference wasn't that I overcame my calorie-counting compulsion* and felt the shackles fall from my ankles. The difference was that I could be much more rational and healthy about my decision-making process. I could focus on what I might want to order AND the calories. Usually the first factor was almost completely ignored. As long as I didn't hate the lowest calorie item, that was what I ordered. I freaked out and all semblance of sanity went out the window. This time, it didn't. This time, I was able to step back for a second, take a deep breath, and do what I needed to do.

*I get obsessive about numbers in general- the OCD and the AN pretty much fed the compulsive counting.

I was catching up on some blog reading just now, when I stumbled across this wonderful post from Nattie about all of the ironies in recovery. I can't improve upon what she wrote, so I won't. I'm just going to cut and paste what she said:

So yes. I've mentioned in previous posts that TNT talked me into joining an online dating site, and that the wonderful folks at Jezebel interviewed me about it.

Thus far, the dating thing has been a bit of a disappointment. I went on one date, which led no where. Other than that, I have pretty much zero response. Well, there was the one 52-year-old who contacted me with a message that said "UR Pretty. Wanna go out?" Needless to say, it wasn't that hard to turn that particular offer down, even knowing there weren't any waiting in the wings.

I've pulled back a little bit- I still check my account, but I'm not as...how shall we say...enthused as I was at the beginning. I haven't given up entirely, but I'm feeling more than a bit pessimistic about the whole thing. Part of me is relieved because this dating thing is so damn stressful, and not really from an ED standpoint.

What stresses me out the most about dating is the spending money issues. Long before I restricted food, I restricted spending money. This hasn't been all bad--I have money saved up for a down payment on my first place--but it's more of the mindset that's problematic. I feel tremendously guilty for spending money. Some of you have paid witness to my recent Twitter recriminations about $1 in overdue library fines. I remember going to the mall with my friends in high school, and I almost never bought anything. I had two part-time jobs at the time (in total, I worked about 20 hours a week), so it wasn't like I didn't have the money. But I hated the idea of spending money.

My one area of weakness is books. But other than that...

Dating costs money, and that stresses me out. Yes, money is tight because of my recent transition to full-time freelancing, but it's not the math that's stressing me out. It's the idea of spending money, or doing something different, that really freaks me out. I equate spending money with guilt.

Both of my parents were frugal before it was cool to be frugal, and I know that played into it. But neither of my parents seem to have this guilt-ridden relationship with spending. To me, spending money brings up the same kind of guilt as eating used to.

Dating has thus been a very complicated, interesting process. It's brought up way more issues than I even thought it might. From a recovery standpoint, I'm doing okay (well, based on one date I'm doing okay). That's been the least of my concerns, oddly. But we shall see what happens.

Earlier today, Laura wrote that insight and eating disorders might be overrated. In many senses, she has a point. Often as a patient, therapists and treatment providers would ask me why they thought I was going downhill but made no real move to stop me from going downhill. "What's really bothering you?" they would ask me. "I dunno," I would say. I felt guilty about slacking off on exercise, so I tried to make up for lost time. I felt I ate too much, so I started cutting back. "No, no," they responded. "What's underneath that?" "Um...I dunno." And my task for the next week would be to figure out what was really going on. That, and try to cut back on the exercise.

No kidding.

Often, I had insight--or at least enough insight to start parroting back to my treatment team what they wanted to hear so they would stop asking me such asinine questions. Insight wasn't really my problem. I knew I had issues with depression and anxiety and perfectionism that was a big part of my eating disorder. I could talk to you at length about obsessions and compulsions and neurobiology and all of that. Still, I remained afraid of eating and entrenched in my eating disorder.

No amount of insight would have gotten me better. I wavered between extreme denial and anosognosia (I'm fine, there's nothing wrong) and pretty good insight. But insight is as insight does. I didn't stop being afraid of food until I was forced to eat 5-6 times every day, and do it over and over and over again. I'm still wary around food. But I'm not terrified of it. That wasn't insight. That was eating.

My insight often frustrated me. I knew that starving and overexercising and purging were ruining my health and making me miserable. Yet I also knew that stopping would make me more miserable. I knew that my symptoms were helping me deal with unbearable anxiety and depression. And what of it? I knew all of this, and I had been taught that this knowledge should have been enough. It wasn't. That's where I often got frustrated and gave up.

I'm not anti-insight, though. I think developing insight is a very important part of the recovery process. I haven't found much use in finding insight into why my ED developed--I know that I used my symptoms to self-medicate for anxiety and depression, and that explanation is fine for me. I know others have found such insight very useful, and that's great. What I have found insight very useful for is relapse prevention.

Eventually, I came to realize that very stressful situations--exam time at school, applying for jobs, moving, family issues--were major ED triggers. My brain could only cope with so many stressful things at once. Since recovery was stressful (and, in my eyes, often stupid and therefore optional), it was the first thing to get jettisoned. Enter relapse, stage left. It took me a long time--remember, I have a very thick skull, osteoporosis be damned--to realize that in these times of stress, when I felt that therapy and eating were the last things I had time for, therapy and eating needed to be at the top of my list. (I'm still not very good at this, to be honest.)

Now, with TNT, I'm working on developing insight into the depth of my negative self-talk. I often don't realize that I'm engaging in such self-hatred because it's such a part of my inner monologue that I don't think about it. And then developing insight to see the subtle ways it plays into my ED thinking. If I usually think of myself as a lazy pig, then it's not a hard leap to see how restricting food (negating the "pig" bit) and increasing exercise (negating the "lazy" bit) might make me feel better.

Of course, feeling like a lazy pig doesn't mean I am a lazy pig. I understand how that applies in other people, but I don't have much insight into why that wouldn't apply to me.

So yes, insight. It is useful, and it can be a good goal. But it often isn't enough to get someone over the initial hump of moving towards recovery. For me, it took having no other choice than to eat. Others have found different ways and different motivations. Insight can be a part of that, too. But I have found insight more useful later, after my thinking had cleared a bit, when I can look back at the craziness and be more rational about what the hell I had been thinking.

I realize this is a good thing, being busy with lots of other things that have nothing to do with my eating disorder. I filed three stories in the past 24 hours, which was a measure of vague insanity. Tomorrow is my day off after working through the weekend, and then about 12 hours each on Monday and Tuesday.

What were the stories? You can see two of them online:

Cheating yeast help group (you may have to register to see this story, but it's free!)

Social network predicts flu spread

In the last story, I got to use the words "trendspotting," "hipster," and "fashionista," which has to make this piece one of the coolest things I've ever written. And definitely the coolest thing I've ever written with an 18 hour turnaround time.

It felt good to be so busy with my science writer-y life. To have confidence that I am not only capable of writing stories but capable at making a living writing stories. I knew I could write about science. I knew I loved to write about science. But I didn't know if I could do this writing well enough to make it my career.

With every frantic email to editors and every story possibility that I evaluate, I'm realizing that I do actually have the chops to do freelance writing for a living. It's hard work. Harder in some ways than I really thought it would be. But when world-famous scientists give you their cell phone number for an interview, or you get to use the word "hipster" in your story, or your editor thanks you for convincing him to run your piece after he initially turned it down, it is all worth it.

Days like these past few days are when I know anorexia has beat a steady retreat. I still have the always-present body dysmorphia, the sky-high anxiety (am talking to my psychiatrist about this next week), the not-always-so-stable moods. I still sometimes think about how much better I would feel if I could exercise the jitters out for, oh, several hours a day.

But that would bite into my writing time. A malnourished brain can't be juggling phone calls and questions and scribbled Post-It notes. It can't fact check. The anorexic thoughts may still be present, but they are no longer welcome. They finally feel like they originate from that diseased part of my brain. Which they always did, it's just that I was unable to recognize it. Or maybe my entire brain was diseased and ill with AN so that there was no way to distinguish my own thoughts and my AN thoughts.

It's odd because recovery usually happens so slowly that you almost don't even notice it, but these slow changes add up. And then you look around and realize that life looks completely different.

Not as a writer, though. I was interviewed by the fantastic Anna North on the subject of eating disorders, mental illness, and dating. I think the article turned out really good. My friends Tiptoe, Meggy Wang, and Sarah Ravin are also featured.

Check it out here:

The Delicate Balance of Dating and Mental Illness

Those three words have been the curse of my life. If I had to identify one thought that has plagued me for as long as I can remember, that has to be it. The feeling has always been with me. No matter what I do or how hard I try or how much I achieve, I never feel that I have accomplished enough.

I used to think that if I could just get one more good grade or lose one more pound or get one more pat on the back, then I would finally fill up my "enough" deficit. I've had enough therapy to realize that there is no amount of achievement that will ever make me feel good enough. I was lucky in that no one made me feel this way. My parents never criticized my report card or told me to try harder. They never pressured me to achieve academically--in fact, I think they would have loved for me to bring home a "B" just so I would see that it's not the end of the world.

I look at my resume, and all I see are people who have done more. It's what psychologists call "upward comparison," when a person compares him/herself to those who are somehow "better off." The wide world of the internet, the fact that I have freakishly successful friends, and my own abysmal self-esteem means that I perceive many people as being more successful than I am.

There are a lot of really amazing, cool, brilliant, successful people out there. In many ways, it's inspiring and I feel honored just to be allowed to listen in on some of these people's conversations. These conversations also make me feel tremendously insecure, because my Inner Critic voice is blathering away in the back of my skull that "I suck, I suck. I don't have get paid to blog about science. I haven't won any awards. I haven't gotten any feature-length stories. Therefore, I suck."

I am aware that I'm measuring myself against Pulitzer Prize-winning veterans of science writing. And I still feel that as a newbie to the field, that I'm never going to measure up.

This "upward comparison" helps explain why I get so distressed sometimes at seeing images of freakishly thin women. It's not so much the thinness, but the achievement of thinness that gets me. The thinness itself is irrelevant. But the fact that someone has "achieved" something I haven't really tortures what little there is of my self-esteem. When I get depressed, these "I suck" mantras only get louder and more constant. My initial attempt at losing weight was a way to make these mantras shut the hell up. I just wanted to feel better.

And, like so many other things in my life, I never felt like I had lost enough weight. There was always someone thinner or sicker than me.

It's a shitty way to go through life, in this frenetic quest to achieve something, anything, just so you can feel good about yourself. And the achievements, when they come, do give a momentary rush. Just as quickly, the rush is gone. Only now, the bar has been raised, the achievement itself has been discounted and brushed off, and nothing less than the past achievement will be tolerated. The demands go up and up and up.

This is one of the mindsets that still leaves me paralyzed and unable to really move forward. I can't imagine ever feeling like a success. I can't imagine looking over my resume and feeling satisfied. I get frustrated because I know I have accomplished what looks like a lot of things to outsiders. It just doesn't feel that way. Nothing is ever good enough. I want it to be. I want to feel successful and satisfied, I just can't figure out how.

This is your weekly Sunday Smorgasbord, a collection of links, research, news, and reviews from around the ED world. I trawl the web so you don't have to!

Does dieting pollute us?

Cuddle your disorder: German companies offer mental illness plushies. I have numerous Giant Microbes, but I can't quite see these having the same commercial success...

Eating disorders, obesity and addiction

Mice show heritable desire for exercise

Problems of genetic determinism on behavior

Five ways to find joy in moving your body

When an eating disorder reappears

Art that makes you feel good: dopamine crystals.

The latent structure of dietary restraint, body dissatisfaction, and drive for thinness

A moving video statement about taking back your life from your ED

Anxiety in the workplace even affects neuroscientists

The incidence of anorexia nervosa in Netherlands Antilles immigrants in the Netherlands

Gender differences in outcome of eating disorders: A retrospective cohort study.

Today is September 11th. If you live in the US, it's pretty hard to escape this fact. There are memorials and retrospectives and all manner of remembrances.

On September 11th, 2001, I had dropped out of college the week before, too weak to continue my studies. I was miserable, depressed, and hoping to die. My blood pressure was essentially non-existent. I was contemplating entering treatment, but too apathetic to really care. I was at my absolute lowest weight.

I remember wishing I was in those burning buildings and crashing planes because those people probably wanted to live. I remember wondering how many calories I would have burned if I had to run down from the 86th floor, or whether I would have just jumped. Just as the Twin Towers were collapsing, so was my life.

I entered treatment on the 14th. I was trying to decide between Renfrew and Remuda when all of this happened. Since I could easily drive to Philly, I wound up checking myself into the Renfrew Center.

For the first few years after 9/11, the anniversary brought a sense of despair because I had gained so much weight since then. I was no longer skeletal, no longer special, and my pain was no longer visible. I had failed at anorexia, but I hadn't succeeded at anything else, either.

The last few years have been more of a sense of horror, that so many years had passed, and I was still sick. That I couldn't figure out how to get better.

This morning, I looked at condos. And then went to therapy.

I still judge myself for gaining so much weight. I still feel I've failed at anorexia and haven't yet succeeded at anything else.

But mostly, I feel a sense of lingering sadness for all the time that has slipped through my fingers. Time I can't get back.

I wrote this poem three years ago, and I still think it's decent, so I'm pasting it here.

I remember

the jingle of the phone
my mom shaking me awake
"turn on the TV, you
won't believe what's happening."
buildings falling- a bad movie.
no. this is real.

I remember

the people running and the
sick knowledge that I was to weak
to run for my life.
the anorexia had taken over and was
killing me as much as a plane
slamming into a building.

I remember

the hollow falling falling
rush and buzz in my ears
from CNN and starvation.
lost in a cloud of smoke
created by my brain
staggering and brushing away ash.

I remember

the frantic trip to the doctor
where I lacked pulse and blood
pressure. stand up sit down.
wanting to give blood
like everybody else
but I had no blood to give.

I remember

wondering why I cared about
calories in celery when
people were dying alone apart.
wishing I could trade places
with those who had perished
because they deserved life
and I didn't.

I remember

nothing.
everything.

I remember

and I am alive. still.

In my Twitter timeline this afternoon (you do follow ED Bites on Twitter, don't you?), I read the following tweet from the magazine Psychiatric Times, by way of The Canyon treatment center.

Trauma, rage, depression, codependency other issues may be at the root of most eating disorders.

The tweet linked to this article here: Eating Disorders' Underlying Issues.

I'll admit that any PR article has my journalist's bullshit radar on high alert. Remember, a press release is trying to sell you something--in this case, a treatment center, but they can also be selling a viewpoint, product, or idea. But press releases aren't going anywhere, and if you take them with a grain of salt, you'll usually do okay.

What made me twitchy was the use of the words "underlying issues" and about stuff being at the "root" of eating disorders. It's not that I don't think pre-existing and co-morbid conditions are irrelevant to eating disorders--far from it. They absolutely play into how and why someone might stumble into an eating disorder and then stay there.

But that doesn't mean that these issues are an "underlying cause." At the root of an eating disorder is an eating disorder. For whatever reason, a person with an eating disorder processes information about food, eating, exercise, and often weight in a very different way. To them, starvation may anesthetize anxiety or depression. Or maybe binge eating and purging helps alleviate social discomfort. If this didn't happen, you wouldn't have an eating disorder.

I'm not against addressing underlying disorders--much of the work I'm doing now is to address my anxiety issues. This untamed anxiety really drove my eating disorder. Starving and overexercising gave me relief. But addressing these "underlying issues" without first addressing the eating disorder is like trying to fill a bucket with a large hole in the side. It's kind of futile.

Refeeding alone isn't enough. Sitting someone with an eating disorder in front of a plate of food and just saying eat isn't enough. ED'd people need lots of support. Remember, the eating disorder does have some perceived benefits. Saying "Go home and eat a sandwich" isn't going to cut it. But a crucial part of treatment involves getting over your fears of eating that sandwich.

I always resented people digging through the midden heap of my life, looking for the "root cause" of my anorexia. The rage I had was primarily starvation-induced (even the men in Key's Starvation Study had anger outbursts). I didn't have any traumas, and therefore I figured I couldn't really be sick because I didn't have a reason to be. And so I spent years trying to find a cause to my eating disorder to the almost complete exclusion of addressing my actual illness.

If you have a tumor, you don't want to begin treatment until you figured out the underlying cause for your cancer. This isn't to say that it's not important to take a good look at your environment and remove any carcinogens, but that's not a reason to delay treatment.

I'm not saying that issues of trauma, bullying, depression, etc, shouldn't be addressed in treatment. In fact, I think they must be addressed to ensure full recovery. But that's not the same as saying that these things are an "underlying cause" of an eating disorder.

I joined an outdoor club in my area and went to my first gathering, which was a mountain biking excursion, followed by dinner and beers. I've gotten pretty good at road cycling, and so I thought I would try it out both for the physical challenge and for the opportunity to meet people.

Let's just say that although I anticipated that this bike ride would be physically challenging, I in no way anticipated just how physically challenging it would be. My shoulders and biceps are sore because I was holding onto the handlebars for dear life. Several times, my legs just about gave out from exhaustion. I ate a slightly bigger afternoon snack than usual, but it wasn't quite enough.

But during the entire ride, I wasn't thinking about my fat ass or my jiggling thighs. All I was thinking was "Don't fall. Don'tfalldon'tfalldon'tfall." Or "Please, lungs, give me one more liter of air. Fine, a milliliter. Or even just a couple molecules of oxygen." I was stark bloody petrified and had to concentrate intensely on the path in front of me. It was sandy and there were tree roots everywhere- any lapsed attention would have meant that I ate a faceful of dirt.

It was, in short, an exercise in the function of my body over its "form." I'm not much for the adrenaline rush, but I did enjoy the challenge. And I met a very nice group of people who do this every other week.

Will I do it again? Probably. I know I prefer biking on a road (or at least packed dirt) compared to off-roading, but it's fun enough. And it was nice to totally not think of the ED for a while.

What I started to get at near the end of my Compulsivity never cured anything post was the idea of perspective. I have a million worries and all one million of them are jostling for my attention. It doesn't matter that a few worries are big, legitimate worries (and I'm going to pay all my bills how?) and the rest are just small nagging worries (did I lock my car door/set my alarm clock/empty the litter box?). They all seem equally important and equally dramatic in my mind.

Because they all seem important and dramatic, being compulsive starts to seem like a rational idea. I'm addressing X worries out of Y, so hooray for me!

I've always had problems with perspective. One of my roommates in college looked over at me highlighting my biochemistry textbook at the beginning of the semester, and she said, "You highlight everything. Wouldn't it be easier to just not bother?"

I told her that I was only highlighting everything I thought might be important and that there was some stuff not highlighted--words like "and" and "the" and the obvious transition sentences.

She raised and eyebrow and said, "Girl, you have issues."

The poor girl had no idea...

So yes, perspective. It wasn't that I didn't understand the big picture (I usually did), it was that all of the other information seemed equally important. I couldn't figure out what was important and what wasn't. When I first started writing, I often included either totally irrelevant details or none at all because I just couldn't figure out what the important bits were.

With term papers in undergrad and grad school, I would spend so much time nailing down the world's most inane facts, terrified that Herr Professor would find out I said April 1786 when (silly girl!) I meant May 1786, that my paper's thesis suffered. I understood my subject- that wasn't the problem. But all of the details overwhelmed me because deciding what was important was extremely anxiety provoking.

I've coped with this anxiety in two ways: the above (by going overboard on the details) or by essentially covering my ears with my hands and yelling "LALALALALALALA!" Neither is really all that effective. Both these strategies make for crap writing and a somewhat less-than-effective approach to life.

Intellectually, I can tell the difference. I have a clue that eating 50 extra calories isn't on the same plane as a nuclear apocalypse, but it still feels the same in my brain. I get rather frustrated when by brain won't calm the hell down over such trivialities, just as I got frustrated when working on said term paper. I was pretty sure I was wasting my time on little more than a fool's errand--but I wasn't positive, and so I fretted and worried and wasted my time.

It's interesting to note that I have a problem with actual depth perception. When I'm driving, cars usually look closer than the actually are. It's better than the opposite problem, but still. For that matter, I can't see those stupid Magic Eye thingies no matter how hard I try, how many hints I get, or how long I stare. Something with my vision is just messed up (no, I don't wear or need glasses). I'm not saying this has anything to do with my psychological inability to put things into perspective, but it's an interesting parallel.

Do you have problems putting things into perspective? Share your thoughts in the comments.

Actually, maybe the "again" bit is a mistake because I don't actually remember ever liking my life before. Not that I was a ball of misery who hated everything (well, not all the time anyway), but I wasn't content, not even marginally so.

Truth be told, I still have massive anxiety issues. I didn't get nearly as much done last week as I needed to because I was freaking out about a gazillion things. I still worry a lot about my writing career, but I'm not really that worried about being able to do that. These first few weeks have shown me that this is a very viable career path for me. Whether I'll be able to get a mortgage is a different story--and one of the reasons I was freaking out--but if writing means moving into an apartment instead of a townhouse, so be it.

But right now, I'm actually feeling okay. Not great, but good. I'm sitting outside, in the sunshine, working on my writing, drinking coffee, listening to Dar Williams, and I'm realizing: I'm gonna be okay. Things are going to be just fine. Maybe not right away, and they probably aren't always going to be okay, but for now, they're okay.

It's quiet moments like this when I think that there is a life after an eating disorder. It doesn't come quick or even all that surely, but it does come. I'm not fully recovered, no. I still struggle greatly with eating "off plan" and with wanting to overexercise and all that other stuff. I'm not fixed or cured or "all better."

For now, though, I'm just going to sit back and enjoy the moment (and hope my editors get back to me!)

Another Sunday, another smorgasbord. I trawl the web for ED-related news, research, and other happenings so you don't have to.

Have something you'd like to see in a smorgasbord? Email me at carrie [at] edbites [dot] com

On the other side of anorexia

Coping with denial in eating disorders

Adolescent inpatient psychiatric admission rates and subsequent one-year mortality in England: 1998-2004.

Three Ways to Snap Out of The Comparison Trap

It's National Body Image & Eating Disorders Awareness Week in Australia- help create awareness

The "Just do it!" Trap: why telling people to change is missing the point

America's $88 billion anti-ageing industry: dangerous and with no scientific backing

Personality disorders in adolescent patients with anorexia and bulimia nervosa

City’s Efforts Fail to Dent Child Obesity

The Professor is the Guinea Pig. He aims to dispel diet myths with calorie-controlled junk food diet.

Five-year outcome of cognitive behavioral therapy and exposure with response prevention for bulimia nervosa

Brain Imaging Shows Brain Changes in Depression

The BEDA 2011 conference speakers were finalized, and you can read more here.

Depression: Is Critical Thinking Part of the Cure?

Measuring perceived mutuality in women with eating disorders: the development of the connection-disconnection scale.

At least, this is what I'm telling myself right now.

It seems to be the cure, because I'm always anxious about something. So if I do XYZ, then I won't have to worry about this one thing.

The problem is that the thing my brain is currently freaking out about (did I exercise enough? Did I ask the right question during the interview? Did the person I was interviewing think I'm a dumbass?) really isn't relevant to what I'm actually anxious about, which is the boatload of uncertainty in my life right now. Being compulsive fixes these little worries (do more exercise, double-check the interviews, nitpick over their transcriptions, analyze the questions you asked) but it really does nothing to address that big, looming question.

But at least that one worry is fixed, right? At least then that's one thing I don't have to worry about.

Except that outside of my OCD-wired brain, I'm not actually worried about these things. They're a smokescreen. Or a record that gets stuck. You know, the old black vinyl circles that our parents (and occasionally some of us aged bloggers) used to listen to. If the record got a scratch, the needle couldn't translate the sound right because it got stuck on the scratch. It couldn't play any further. OCD is like that stuck needle, playing the same annoying two-second stretch of song over and over and over again. It can't get off of it unless you get up and physically move the arm. The entirety of the album is like my overarching worry. Focusing on every little scratch doesn't help you listen to the album.

(Am I totally dating myself here? I owned several records when I was younger, one of which was a Sesame Street album, and also a Debbie Gibson record. There were others that I'm blanking on. Good times.)

So metaphors and reminiscences of the 80s aside, it's easy to over inflate the importance of these nagging worries. Sometimes yes, they do need to be addressed, but sometimes it's just your brain getting stuck. It's easier to focus on silly things you can do something about that a ginormous, looming fear that you can't quite articulate.

Of course, when these nebulous worries plague me, my brain gets stuck more easily. It's almost primed to get stuck on every stupid little thing that comes my way. I don't deliberately try to focus on the minutiae, but that's just where my brain goes. Then I forget all about the big picture because I'm caught up in ridiculous details like "is the fact that I exercised for 27 minutes instead of 30 going to make me gain 10 pounds?"

One not-so-irrelevant detail is that it's bedtime, and sleep deprivation doesn't help one bit.

There was an interesting thread I found on a discussion board that was discussing why medical professionals were so obviously not clued in about eating disorders. There are issues of insurance companies (in the US) and national healthcare rules (in Canada, the UK, etc), but that's not exactly what I'm getting at. It's that most medical professionals just don't get it--even, occasionally, those that say they "specialize" in eating disorders.

I can think of several reasons this might be:

1. Ignorance. Some doctors really truly don't have a clue. The more dangerous (and common) situation is where the doctors think they have a clue, but they really don't. We can break this down even further: there are those medical professionals who have no idea that they're out of their league and there are those won't admit that they're out of their league.

It's interesting, because I really respect a doctor who can say "You know, this really isn't my area of expertise, but let me find someone who can help you better." I'm guessing it's hard for someone (a doctor in particular) to admit they don't know everything, but I can tell you that I respect you more because of it.

2. Powerlessness. Many things that GPs and PCPs are trained to treat basically involve telling a patient what to do or giving them some medicine, and then the problem is solved. Even when other chronic conditions aren't quite this straightforward, there's an obvious path to take. First you do A, then you try B, then C. So some doctors will do the old "have a sandwich" routine because it's the kind of thing that works with other illnesses.

But the problem with an eating disorder isn't actually eating the sandwich. It's getting yourself to eat (and digest) the sandwich. Not that EDs aren't frequently accompanied by GI issues, but I can guarantee you that most ED patients have thought about eating a sandwich. It's the fears of what might happen if I eat that sandwich that get most patients, and I don't think that's really understood.

The other thing that I don't think many doctors realize is that EDs really aren't like other illnesses. The reason why?

3. Wrong assumptions. When someone gets sick, they usually want to get better. The problem with eating disorders is two-fold: many patients don't recognize there is a problem. And when they do, there are often serious issues with the follow-through. Sometimes motivation fades. Sometimes you're just lying to get the hell out of the office. Sometimes the patient underestimates just how hard it's going to be. Or they don't grasp the depth of the problem ("My eating disorder really isn't that big of a deal.") Most medical professionals don't get this. They don't understand why someone would engage in ED symptoms. So they assume that you're ready and willing to stop--which isn't always the case.

4. They take the patient's lead. This isn't always a bad thing. I think it's good for doctors to take a patient's lead on interaction style, what types of treatments work best, that sort of thing. But when a patient really isn't all that distressed by something that is killing them, the doctors often figure that it must not be that serious.

(I've had this problem with depression simply because I'm not overly demonstrative of my emotions, and I have a very dark sense of humor anyway. So I can be severely depressed and making smart ass remarks...only I really do mean them.)

5. The media. Mostly when you see EDs in the media, you see the most extreme cases. So when someone comes into your office whose weight isn't as low as that chick on TV last night, or who doesn't binge and purge as frequently, it's much easier (though no less irresponsible and stupid) to write that patient off.

6. Over- and under-reliance on labs. Many people with eating disorders can be severely ill and still have normal labs. On the other hand, people can look rather healthy and have totally whacked out labs. But since their weight isn't really low, it can't be that bad. If their weight is low, but their labs are normal, then they're not that sick.

7. Over-reliance on weight. This one pretty much explains itself.

8. Obesity hysteria. When all the messages you hear are to make sure that your patients aren't too fat, you're probably not looking to see if some of them are too thin. A doctor frequently encourages someone's weight loss efforts because they're thinking "At last! Someone I don't have to lecture about Cheetohs!" Or they overlook weight loss in a growing child because they're not yet "underweight" even though the weight loss is dramatic, marked, and takes the person off their growth curve.

9. They just don't want to deal with it. I'll be the first to admit that I'm probably not the easiest patient to have, especially when I was ill. I'd skip appointments or show up and deliberately blow off your advice. I wasn't aware that I had a problem, and then a crisis would arise and all hell would break loose. I don't envy my doctors and therapists, which is one of the most obvious reason why I don't want to be a doctor/therapist myself. But tough patients come with the territory. It's part of the game, and it's someone's life that you're gambling with.

Why do you think so many medical professionals just don't get it? Share in the comments, but I ask that this not become a comparison to see who was the sickest. You don't need to say how many times a day your purged, or what your weight/BMI was. That's not the point. What I'm curious to see is what have your experiences taught you about why so many doctors are so clueless about eating disorders.

I logged into my Pandora account today, and while I was waiting for my songs to load, I happened to remember that today was September 1. Yesterday (being August 31), I checked my account and had something like 27 of my 40 free monthly hours remaining. I listened to a few songs as I sent some emails, but I was attacked by this momentous sense of guilt. I immediately logged off so that I wouldn't "use up" all of my free hours at the beginning of the month.

I had to laugh at the irony. I am so worried that I'll run out of something that I never use it at all.

I realized I do this with lots of things other than my Pandora account. I have a Coldstone Creamery gift card from several years ago still in my wallet. I didn't not use it just because of the ED. No, I held onto it because I never felt it was the "right time" to use it. Maybe in a week or two I would have a craving for ice cream but wouldn't have the extra cast. So I better pay for my ice cream this time, just in case.

I bought chocolates on my way home from my Europe trip to use up my few remaining Euros. I've eaten a little bit, but they're still sitting in my cupboard. Yes, some of that is ED-related, but I also haven't found the "perfect time" to eat it. This happened when I was much younger, too. I ended up throwing out a lot of my Halloween candy at Easter because I hadn't found the right moment to eat it.

When I had a lot of homework to do, I generally did the icky stuff first (assuming I could prioritize in that manner) so that I would have the easier assignments to look forward to. At dinner, I eat what's on my plate in a particular order: salad first (it's always been a "thing" of mine, eating the salad first), and then in order of least-liked to most-liked foods.

It's all the same mentality: forgo pleasure now so that you can have it later. If later always came, then perhaps that would be okay. But I always keep pushing "later" further and further back. It seems the anticipation of pleasure is actually more pleasurable than the pleasure itself. Since I've delayed for this long, I think, then I need the experience to be perfect.

(I think I would make a great Puritan.)

It's not hard to see how this would play into the AN mentality. Fantasizing about what you'll let yourself eat when you finally don't feel like a barge is more rewarding than actually eating it. And since you can always lose more weight, you can also always look forward to that meal. I'm killing myself on the treadmill now so that I won't feel so anxious later. It makes you essentially live in the future, where everything is going to be okay, perhaps even perfect. Then when the future does arrive, you find it sucks as much as the present did back then. So you redouble your efforts for that perfect future, and the cycle repeats itself, over and over and over.

I'm not going to blow through all my free hours on Pandora in the next few days just because, but it's interesting to see the patterns. To see how a way of thinking infiltrates so many different areas of my life.