E-Mail Reveals Dispute Over City’s Antisoda Ad.

Studying Candy as Guilty Indulgence-Is Candy Evil or Misunderstood? 

Outcomes of Empirical Eating Disorder Phenotypes in a Clinical Female Sample: Results from a Latent Class Analysis.

On my "to read" list: Against Health: How Health Became the New Morality.

Impact of broadening definitions of anorexia nervosa on sample characteristics.

Anti-obesity drug dulls brain response to food porn.

Top 20 Fitness Trends for 2011, according to American College of Sports Medicine.

The Relationship Between Executive Function, AD/HD, Overeating, and Obesity.

The use of birth control pills for women with eating disorders remains common to prevent bone loss despite studies showing it's not very effective.  Nonetheless, here's an interesting interview with Charles Djerassi, the inventor of the Pill, who helped change women's lives.

One of my readers, Renee, asked me this question:

I am just wondering what keeps you from trying to negotiate about your weight. I don't want to go back to where I used to be, scrawny and starving and cold, but there is about a 10 pound difference between where "they" want me to be and where I'd like to be. And I am finding it harder to keep on those last 10. I keep telling myself that this time will be different, I won't lose any more than 10. I am not stupid, I know this is all ED talking. But still, lately it's all I can hear. How do you stay so resolute, even though you feel "fat"?


It's a really good question, so i thought I would answer the question here.

And my honest answer is this: I still haven't stopped negotiating.  Seriously.  At my last session with TNT, I raged for more than a little while about how I wanted to lose weight, that I didn't need these extra pounds, blah blah blah.  And TNT said, basically, that losing weight was not an option, that maybe my weight would go down, maybe it wouldn't, but I wasn't to influence the process.

Here's the thing: It's not your job to stop negotiating.  Of course, yes, acceptance of a healthy weight comes with recovery.  Yes, one of the goals of recovery is to learn to fight these thoughts internally and squash or ignore them.  All of that is true.

It is your treatment team's job to stand firm in the face of your anxiety.  Your ultimate goal is to manage your anxiety about weight and weight gain.  But don't confuse your ultimate goal with staying healthy in the meantime.

A brief metaphor, perhaps.  The ultimate goal for a young kid would be to learn how to cross the street by herself.  But when they're two years old, it's the job of the adult to hold their hand and take them across the street.  As they get older, you teach her (slowly) how to get back and forth across the street as you walk next to them, as you watch, across a slow street, and finally across a busy street (I think it's fairly safe to assume she'll pick up jaywalking on her own).

You're the little girl, your treatment team is the grown-up.  A two-year-old will almost certainly insist that she can cross the street by herself, that she knows best.  There's no point in arguing with her, because she really truly believes she's fine.  That's just what two-year-olds do.

Your eating disorder is making you anxious about your weight.  Of course you're going to try and decrease your anxiety--it's normal.  It makes sense.  Yes, the anxiety does get better, but it can last for a really long time, just like it takes a long time to learn how to dash across a busy intersection.

I'm sure my therapist-readers will be thrilled to hear that I'm advocating being a little argumentative and pugnacious about this.  But by talking about it and being forthcoming and honest, it can help you learn how to better cope with your feelings and anxiety.

Hi everyone!

Tomorrow, I'm going to be doing a fundraising walk for the National Eating Disorders Association in Williamsburg, Virginia.

I've pledged my support, and now I'm asking you to help pledge yours.  All donations to NEDA are tax-deductible, and you can make a donation at my fundraising page.  No amount is too little.  Anyone who donates in any amount will be entered in a raffle (okay, let's be honest- it will be me and a random number generator, but still) to win an autographed copy of my book Next to Nothing.

That's right.  Donate a nickel or some belly button lint and you have a chance at winning a book.  Seriously.  It's that easy.  I know times are tough financially right now, so don't feel bad if you aren't able to spare the money.  I feel guilty asking my wonderful readers for donations, but it's a cause I believe in, so I'm swallowing my guilt.

I will post pictures of the walk tomorrow afterwards.  I thought about seeing if Aria would behave on a leash, but I'm thinking that taking my cat would be a losing battle.

Thank you all for your support!

by Guest Blogger Jen P.

Anorexia nervosa is a disease, not an excuse for cruelty to an entire group of people. For five years, I suffered from an eating disorder, bouncing in and out of hospitals and residential treatment centers, counting every calorie that entered my mouth, furiously sweating out the pounds that I imagined were glomming onto my frame, agonizing over my size, the numbers on my clothing, and the number on the scale that taunted me every morning. Do you see the key word here? My. My mouth, my frame, my size. Anorexia nervosa is marked by a fierce, irrational obsession with one’s own appearance, a fear of gaining weight, and a distorted self-image. Nowhere in the clinical diagnosis of anorexia does it state that the disease makes an individual hate fat people. Nowhere in the definition does it state that anorexia makes it “aesthetically displeasing to watch a very, very fat person simply walk across a room,” as Maura Kelly states in her Marie Claire article. This cruel, mean-spirited, and judgmental point of view can not be blamed on a disease, a disease that has afflicted some of the kindest, gentlest, most supportive women (and men) that I have ever encountered. Maura Kelly’s words come from within herself, from her individual issues, not from this often misunderstood disease.


In fact, most individuals suffering from eating disorders are so stuck in their own minds , so judgmental of themselves alone, that they don’t have the time or the mental energy to judge others. When I was in the depths of my eating disorder, I thought that the normal rules that govern reality didn’t apply to me. In my mind, a teaspoon of peanut butter could instantaneously make me gain ten pounds—yet in the mouths of other people, it was just fine. In my mind, I had to work out X hours every day—yet others didn’t. I existed in my own universe, my own fantasy land, with regulations and punishments that applied to only my body, my shape. I yearned for the normality of others’ lives, ached to be free of the torturous vice that gripped my mind. In the depths of my illness, I was jealous of everyone who wasn’t me—jealous of women with curves, jealous of women with flesh, jealous of women who were just plain happy with themselves, who lived their lives in the bodies they were born with. The paradox was that while I didn’t want fat on myself, I loved to see others who embraced it upon them. It gave me hope.

And that’s Mike and Molly. While I haven’t seen this show for myself, I love that television is starting (very slowly) to show a range of bodies on television. Because for both women suffering from eating disorders and for women of every shape and size, it is essential to see these images of happiness in the media. Of plus-size women living their lives, falling in love, feeling empowered and strong. That’s what our young girls need in order to escape the tyranny of eating disorders. That’s what all women need in order to love themselves.

Because it’s hard to be a woman today. No matter what size you are, no matter how much you weigh.

Throughout my recovery process, as I struggled with the weight that I so desperately need to gain, as I came to terms with the self-esteem issues that led me to restrict and over-exercise, as I watched my body finally become what it truly wanted to be, rather than the form that I forced it into, it was hard. I won’t say that it was harder than the struggles that many women go through everyday, facing the kind of prejudice and hatred that was evidenced in the Marie Claire article. But it was hard, nonetheless, as I watched myself change, as I challenged the internal standards that I had always held myself to, that society holds all women to today.

And today I am bigger, yes, but I am also myself. I am a recovered anorexic. The disease is part of my past, will always be a part of me. But I will never use it as an excuse for hatred. Instead, I use it as an excuse for love—toward myself, however I end up looking, and for others. Because happiness and self-acceptance is worth more than anything.

One of my favorite non-ED blogs is The Happiness Project, and the author has designated every Wednesday as "Tip Day."  So taking a nod from her, I'm going to do recovery-related tips every Wednesday.  Keep in mind that I'm basing a lot of these tips off of what has worked for me.  They're not universals.  So take what works and leave the rest.  If I find research to back up what I'm saying, I'll cite it.  Otherwise, consider it the devious work of Yours Truly.

Remember the old song that goes something like:

Nobody likes me,
Everybody hates me,
Guess I'll go eat worms.

(You don't want me to sing it. Trust me.)

That's self-pity.  The world sucks, you have no friends, you are a terrible person.  These feelings are both normal and common.  We're all entitled to a bit of self-pity; the idea is not to treat it like an all-you-can-eat salad bar.  Self-pity is a process that feeds itself.  The more you think about it, the deeper in you sink.  And when you're in deep, it's hard to see the possibility of climbing back out.  But the possibility is there.

1. Get real.  Folks with eating disorders often tend to compare themselves to unrealistic ideals.  Yes, models get thrown around a lot as a culprit, but the truth is I compare myself all the time.  Of course, I don't compare myself to, say, my "average" classmates.  I compare myself to my classmate who is the current Assistant VP of the New York Stock Exchange.  Cue the self-pity.  Many of my classmates have done outwardly amazing things.  Many of my classmates have also lived average lives of more quite amazing-ness.  My VP classmate may be miserable.  So get real.  Are you doing (mostly) the best you can with what you've got?  Okay, then.

2. Accept it. Life isn't fair.  In fact, life downright sucks sometimes.  Once I can stop dwelling on the Unfairness Of It All, I can stop feeling sorry for myself and start trying to find the solution.  Don't get down on yourself for thinking that life sucks here and there.  It does.  That's okay.  Life is gonna suck and you're allowed to hate it.

3. Do something.  Read a book.  Crochet a scarf.  Clean your apartment.  Rake your neighbor's lawn.  Whatever.  But do something positive to get you out of your head and into your life.  Especially when you have a bad case of I-suck-itis, doing something nice for others can really help provide tangible evidence that you are not a crappy person.  Because crappy people don't do nice things for others. 

4. Distract yourself.  Some people watch crappy made-for-TV movies because the silly plots make them feel better about their own life (I am, occasionally, Some People).  Indulging in schadenfreude isn't always the most endearing of human traits, but it's useful in a pinch.

5. Write a statement to yourself.  I'm taking a line from the wonderful folks over at F*ck Feelings, in which they advise the people who write in to compose a statement.  It lays out their goals for the situation, and the values that they're sticking to.  I use this when I get comparing myself to others and feeling that I'm not nearly as successful as they are.  So I tell myself, "I am doing my best to fight a dangerous disease, and I need to give myself credit for the hard work I've done, even though others may not recognize it."

6. When all else fails, wallow in it.  I know- it sounds contradictory to everything I've said above, but if you really can't shake feeling sorry for yourself, then you may as well indulge it.  When I was living in Scotland in college, I had a huge crush on a boy who I later learned had a long-term girlfriend.  I was devastated.  So I locked myself in my dorm room with two little sample bottles of fancy liqueurs I had swiped from the airplane.  (Take it easy- each bottle was maybe one shot. I don't advocate alcohol as a coping mechanism).  I drank the booze, wrote bad love poetry, and cried for a few hours.  And then?  I was so done with it.

I hope you liked this week's tips.  Share your other suggestions in the comments section.

I got home from group therapy tonight (which was really great- I will fill you in tomorrow) only to find that it looks like I won't be able to close on my condo.

Why?

The building (not necessarily my unit, but the building itself) had some Chinese drywall in it.  My unit didn't appear to have any of this, but without ripping everything out, there's no way to prove that it didn't.  And Freddie and Fannie won't give mortgages to places that might have Chinese drywall.  Since there's no way to prove that my place doesn't have the drywall, the assumption is that it does.

Which leaves me without a place--assuming my real estate agent says what I think she's going to say, which is walk away now. 

I had hoped that, for once in my life, something could go according to plan.  That it would go like: girl finds house, girls gets mortgage to buy house, girl buys house.  Finances aren't my problem.  Finding a place isn't a problem.  Stupid, cheap-ass builders who imported toxic drywall is my problem.  I had hoped that this was a sign that my life was starting to come together.  My career is actually doing well.  I am starting to make real progress in recovery.  I was hoping to have my own place to go along with all of this.

It's one of those moments when I just want to write a note that says "Dear Universe, F*ck you, too.  Love, Carrie."

I realize the situation could be a lot worse.  I could be like the current owners who can't sell their place because it might have Chinese drywall.  I could have bought the place only to find out later that it had this problem.  I'm trying to remind myself of this.

And it still sucks.  I'm feeling more than a little sour.  I don't want to go through all of this again.  It sucks.  It's a pain.  But no amount of whinging is going to change that.

Sorry- it feels better to get this off my chest.

It's once again time for your Sunday Smorgasbord, where I trawl the web in search of the latest ED-related research, news, and more so you don't have to!

Top Ten Worst Things to Say to Someone With an Eating Disorder.

Happiness is Within: A personal eating disorder recovery journey to positive body activism.

Laugh & Learn About Eating Disorders at November 4 Presentation in PA.

The outer limits of psychiatric genetics.

Funniest restaurant menu of all freaking time.

National Survey Shows Dramatic Increase in Awareness of Eating Disorders.

'I didn't notice how thin she was': Help for parents of eating disorder sufferers.

No F.D.A. Approval for New Diet Pill.

World of Psychology: Men Get Eating Disorders Too.

For the more cerebrally inclined, this: Neuron has a free special issue on neurogenetics, free to access until Nov 17.

Asylum Notes: history of psychology postgrad is blogging her tour of US asylums.

Commercial weight-loss programs: The evidence.

The popular concept of the 'nervous breakdown': a history.

TNT is starting a therapy group, and she wants me to go.  The group is CBT-based, and it's sort of an "Advanced Recovery Skills" group.  In order to attend, you need to be asymptomatic in your ED and at least decently into recovery.  I fit the bill, and TNT wants me to come.  She says "it will be good for you."

I think all therapists say this when they know you're going to object to their advice.  It's in the Therapist's Handbook that provides scripts like "Tell me about your mother," and "How does that make you feel?"  Okay, I'm being somewhat sarcastic, but still.  I definitely have mixed feelings about group therapy.

I agreed to go, and I had to commit for the first month.  So four Mondays, 1.5 hours each week, 6 hours total.

But still I worry.

I worry I will have nothing to say or contribute.  I worry I will be either too utterly mental or too normal.  I worry the group will turn into a competition-fest.  I worry that no one else will think I should be there.  I worry I will waste everyone's time.

And yes, sad to say, I worry a lot that I will be the fattest one there.  I've already gained over my target weight--significantly over my target weight.  Whether that means the initial target was wrong or that my body wants to hang onto some extra weight because of the years of starvation, I'm not sure.  So yes, I am very uncomfortable with my weight right now.  It's worse because I have no idea of my actual size (I know, I can look at the tags on my jeans, but unless I know everyone else's pant size, I have no real way to compare), and so all I can do is obsess about how large I really am.

I know EDs can come in any shape and size.  I know that.  This comparison is much more of an internal thing.  It's competition combined with body dysmorphia combined with the fact that I have no real idea how big my ass is.  When I see pictures of myself from New York two weeks ago, all I can see is how huge I am.  It blots everything else out.  I get panicky and start to feel ill. I'm HUGE compared to everyone else.  And I'm so disgusted I kind of want to throw up.

This is the part that TNT thinks would be really good for me to deal with in group.  That would be a fantastic group icebreaker: "I feel like the fattest one here. Let's discuss." 

So, yeah, group therapy.  This should be really interesting...

Laura's post yesterday on eye damage and eating disorders got me thinking.  When I read articles about the health dangers of eating disorders, I almost have to laugh.  Not because it's funny, but because of the tone of many of these articles, as if these straight-laced doctors can knock some sense into us silly ED patients, then the problem would be over.

Here's the thing: we are often well aware of the dangers.  This isn't that we don't think it won't happen to us, or we've got it under control or we're not that bad, because we do.  At least, I know I did.  I was in the ER numerous times for low potassium from purging and dehydration.  What did I do when I left the ER?  Purge.

Yes, there's a bit of a disconnect.  But in the moment, the dangers are irrelevant.  What I always sensed as far more dangerous than heart failure was what would happen if I didn't purge, if I did drink that glass of water, if I ate that plate of food.  Death was far-off.  The food was right there in front of me.

My ability to ignore the medical issues wasn't a sign of how much I valued thinness--I knew water didn't have calories, but I was tremendously afraid of consuming anything.  It added "weight" to my body, and that totally would freak me out.  I took pathology, physiology, biochemistry classes as an undergrad and grad student.  I knew exactly what was going on.  And yet my eating disorder raged, raged against the dying of the light.

Sometimes, over the very short term, minor health scares would shake me up enough to get me to rein in at least the more flagrant of my behaviors.  But these changes rarely lasted.  They did nothing to arrest my illness.

I do think psychoeducation on the dangers of EDs are important, as is learning to deal with a wrecked body.  I still blame myself for my crumbling bones, my uncertain digestive tract, my history of seizures.  I know that I had an illness.  I wasn't being stubborn or stupid or vain.  Yet the pervading medical culture holds that if only I wasn't so freaking dense, I wouldn't have damaged my body.

I need to take charge of my health from here on out.  I eat plenty of dairy and take a multi-vitamin.  I take calcium chews when I remember.  I keep my weight healthy and I take my Prozac every morning.  I am well, now.  Or at least more well than I was.  Rather than wasting time scolding people, help them stop their symptoms so they don't have to face the health risks.

Remember this: we're not stupid. We're scared.  There's a difference.

While I was posting from NYC earlier this month, someone mentioned that staying in recovery while traveling is really hard.  I totally agree- traveling (as much as I love it) is also a really big trigger.  For me, it's the breaking of my routines.  Then I start missing meals and snacks, or the food fears kick in and I start ridiculously overestimating what I ate.  Or I'll end up in a situation where nothing really "fits" my meal plan, and then I get the all-or-nothing thinking that since it's not perfect, I may as well just skip dinner.

I do much better on the road now, in part because I've learned lessons the hard way.  Been there, done that, got the t-shirt.  So here are a few of my hints for hitting the road and keeping your recovery in one piece.

1. Plan ahead.  Pack extras with you.  I always take protein bars, packets of Carnation Instant Breakfast, some instant oatmeal, and little packets of almond butter.  If I'm going by car, I might throw in an Ensure.  They've helped not only when snack time comes mid-flight, but also when I'm feeling anxious and unsafe eating food I'm not familiar with.  I've smiled and faked my way through events, with a decoy plate of food, and then had my snack back at my hotel room.  Perfect?  Nope.  But it worked.

2. Let go of perfection.  Recovery is learning about how to live with stuff that is less than perfect.  Life is flawed.  There will inevitably be times when you eat too little or too much, through no fault of your own.  Do what you can to avoid those situations, and then roll with it.  Traveling is supposed to be fun.

3. Tell your travel companions about your nutritional needs. No, I'm not talking about sharing your meal plan or having your boss remind you about afternoon snack.  Ideally, you'll be with someone who you feel comfortable mentioning that you need to eat regularly.  They don't need to know why.  I realize that when I traveled for work, I was often on my own, which made it much tougher.  It might help to check in with someone back home or even a member of your treatment team while you are gone.

4. Keep extra food with you.  Lots of people do it, so carrying a protein bar won't make you look like a freak.  Carrying your own food is often cheaper than eating on the run, so it's good in two senses.  That being said...

5. Try to sample the local cuisine.  I realize that traveling to Podunk, West Virginia may not open up any opportunities for new cuisine (possum-fried pizza, anyone? Honestly saw that at a restaurant in West Virginia, though sadly I didn't have my camera with me to document it.) but if your trip does and you're not going to use the experience to indulge the ED, then try some of the new foods.  I really enjoyed being able to try new things when I was in Europe- as much as my poor beleaguered stomach would allow.  It's one of my favorite parts of traveling.

6. Have a contingency plans.  Know ahead of time what you're going to do if things start to get pear-shaped (even outside the ED).  How are you going to contact friends and family if traveling internationally?  What's the information for your embassy?  What prescriptions are you taking and what is your doctor's phone?  If you need to get home early, what are your options?

7. Do some research before you go.  Look for restaurants, eateries, and grocery stores that are near your hotel.  The hotel staff can also be really helpful, but knowing ahead of time what's nearby can help you pack better.  Not sure if you'll need all 10 protein bars and space is tight in your suitcase but there's a CVS down the block?  Bring 5 bars.  You can always buy something when you get there.

8. Individual serving packets help.  Generally, I buy in larger packages because it's cheaper, and then I just divvy it up when I get home.  But those individual milk or soy milk boxes, the packets of peanut butter, the individually wrapped Oreo cookies--all of these are great for travel.  Keep in mind that nut butters are considered gels by the TSA, so pack it in your checked luggage or take the individual packets in your carry-on.

9. Don't be afraid to stay home. Traveling is super stressful.  When I'm in the throes of the ED, every trip has been a total disaster.  If you're uncertain about travel, don't go if you can avoid it.  Your recovery comes first.  You will have lots of time for trips when you are well.

10. Practice.  Traveling requires a lot of eating out, and the best way to know if you're ready is to practice before you go.  Take one day and "pretend" that you're on the road and eat the food you would likely have to eat while traveling.  That way, you will know ahead of time if one restaurant chain doesn't work for you, what issues will arise, and how to cope.

I hope you liked the tips.  Let me know if you would like to see more tips like this in the comments section.

Recovery needs to continue whether we want it to or not.  And I'm not just talking about those moments when it seems like losing a few pounds is, quite possibly, the best idea you've had all year.  The moments I'm talking about are when it all seems to suck, when you wonder why in the hell you even bother, when you know that giving into the ED will make you feel at least a little bit better.

Those moments.

Sometimes, when I have these days or weeks, I get at least a small amount of pride when I can look back on the day and realize I did not indulge my ED obsessions and compulsions.  At least, I think, at least that went well. Everything else might be in the toilet, but I held strong to my recovery.

Yesterday was not one of those moments.  I was compliant with my treatment plan.  I ate every last exchange I had to (though not a crumb more).  It wasn't going to go down as a Hall of Fame Good Day, and I was okay with that.  Yet despite doing everything I could in recovery, I didn't get that small surge of pride when I realized I had held tight to recovery and life and HOPE.

Nope.  I realized:

This
F*cking
Sucks

I knew a run or a marathon exercise session would take the edge off the stress.  Or that going to the drugstore to buy some pills might alleviate some of the negativity and anxiety.  I knew that, and I also knew that what little relief they brought would be temporary at best.  That all too soon, I would be back to the stress and funky moods, only now I would have to contemplate telling TNT when I saw her next Monday.  There was nothing more to do than stay with those crappy feelings and hope that they would pass.

It took most of today for them to pass, but they did.  I'm still not gung-ho about life and ready to skip off into the sunset with my unicorns and glitter.  But for almost 48 hours, my recovery simply boiled down to going through the motions.  There was no joy at overcoming my illness or enjoying a nice meal out.  There was no pride in knowing that at least I clung to health.  There was just the daily slog of three meals, two snacks.  Almost as soon as I had finished one meal, it seemed like it was time to start thinking about the next.  Food was the last thing on my mind.

I realized: it doesn't seem fair for recovery to suck this much.


Much of my bad mood was steadied by the realization that it really isn't fair.  That good recovery means you feel like shit and you go through the motions and you don't give a crap about health or any of that.  But it means you don't stop trying, and you don't let the negativity win.

(Thanks to Z for the post that helped inspire this.)

This is your weekly smorgasbord, where I trawl the web for the latest ED-related news, research, and more so you don't have to.

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

A new blog on eating disorders called Keep Smilin.

How Cognitive Dissonance reduces thin ideal & prevents eating disorders.

Fat Talk Free Week: Body-Image Campaign Goes to College.

The disappearing family dinner phenomenon – how it impacts someone with an eating disorder.

Dr. Walt Kaye on convergence of biology in obesity, eating disorders.

Have eating disorder symptoms? Age 13 or older? Participate in an online study.

Podcast from the Anxiety Disorders Association of America on Eating Disorders and Anxiety.

Study Links Weight-Loss Surgery to Heightened Suicide Risk.

Nip it in the bud before the bloom. U of Chicago family web-based early bulimia study.

Information processing of food pictures in binge eating disorder.

Attention deficit hyperactivity disorder and eating disorders.

Association study in eating disorders: TPH2 associates with anorexia nervosa and self-induced vomiting.

Experience with activity based anorexia enhances conditioned taste aversion learning in rats.

Like many people, I have been following the story of the Chilean miners and the rescue. As a writer/storyteller, the saga has been enthralling.

But my friend Charlotte had this to say:

"I spent all day yesterday weeping, watching the Chilean miners coming up. All I could think of was that this was what it must have been like for my d, in the depths of ed, a dark and frightening place. H, other d and I strapped her into her tiny capsule and have heaved and heaved and she is now above ground, learning to take off her sunglasses.

IMHO, you need to strap your d in her capsule and start pulling. Think of bringing her out of the darkness and back into the light. It is a terrifying and claustrophobic journey, but well worth it in the end."

Except with an eating disorder, you're not entirely sure you want to come to the surface. You start to find the darkness comforting, and you find you forget what it's like to be on the surface. The darkness is simple, predictable. You know exactly what to expect. And the longer you are down in the hole, the more frightening it becomes to even think about coming to the surface.

I would climb into the rescue capsule on occasion, but as soon as I started leaving the darkness of my eating disorder, I panicked and climbed back down.

Even though I've been on the surface for some time, I often think about the safety of the darkness. That as much as I'm enjoying being back in the land of the living, I still think about my time down below. I'm not debating going back to the eating disorder--that's not it. It's that the ambivalence about recovery can persist. You ask yourself: Did I do the right thing by coming to the surface? Wouldn't it be easier to stay in a cold, dark hole?

The answer to that last question is definitely yes. But life isn't about easy. Easy is boring. It can be lonely. I'm still adjusting to the sunlight, but I am, in fact, adjusting.

An excerpt from this poem was shared on an ED listserv I'm on, and it was so beautiful and appropriate, I had to share it here:

For What Binds Us
Jane Hirshfield


"And see how the flesh grows back
across a wound, with a great vehemence,
more strong
than the simple, untested surface before.
There's a name for it on horses,
when it comes back darker and raised: proud flesh,


as all flesh,
is proud of its wounds, wears them
as honors given out after battle,
small triumphs pinned to the chest?"

I'm spluttering not so much at this article about insurance refusing to cover bulimia treatment (though the situation is very much splutter-worthy), but at the comments.

Generally, I don't read the comments on news articles mostly because they're either from extremist wingnuts, they're irrelevant, or people use the anonymity of the web to act like immature jackasses.  But I started reading the comments on this article, and my eyes just saw red.  I've gotten used to a lot of the misconceptions about eating disorders ("Just eat a sandwich!"  As if that hadn't occurred to me...) and although they're annoying, I understand that much of them stem from a lack of knowledge rather than sheer idiocy.  That is, I have hope that this person will one day understand EDs a little better once they have more knowledge.

These comments, however, are the epitome of sheer idiocy.  Some examples:

Blue Cross/Blue Shield is my insurance carrier as well. I will call and support them in this decision and I hope many more call and support this decision. I don't want to pay for her care. She is an adult, she needs to take care of herself. I'm glad this has been on the news. It brings awareness to many of us, of the crazy things people try to get insurance companies to pay for. No wonder this country is in a health care crisis. If we all get a disease then we can all be on easy street. WHATEVER

They don't help many child genetic issues either. The disabled children in this country and the Veterans in this country can't even get the medical help they need. So, why does this family feel that their daughter's condition is worthy of help? As far as I am concerned they can pay for it out of there pocket. I have to pay for "most" of my disabled child's medical bills, because insurance won't pay them. Do you see me ranting on tv and picketing the insurance company? No!!!

Or

Let her parents support her! Why should the insurance company pay. In the end all of us that have insurance with BCBS will be contributing to paying for her care. I too am going to call them tomorrow and agree with their decision to not pay for her care. My grandparents need medical help,they have cancer, the insurance company don't pay all of their bills. They act responsible and pay their bills, they don't go picket the BCBS office. They pay for their own home care.

The logic is so bad it's astounding.  Yes, getting sick drives up health care costs.  We will all get sick and it will cost money to get it treated.  Unless you have a way to prevent all illness (and something tells me if you're this blatantly stupid, you don't have the extra neocortex to come up with something so groundbreaking), then we're going to get sick and need insurance.  Any questions?

Also, I think some of these people have picket envy.  If you're pissed off, go picket.  It's your right.  You're allowed.  But don't get pissed because you can't/don't/won't take such a stand.

I just end up incensed when people (some of whom are in my family) see an eating disorder as the self-indulgence of a pampered kid.  I was exercising for hours a day on a broken foot--that's not being pampered.  Something primal in my brain was driving that, something that can't be explained by wanting to stay on my parent's health insurance policy (which wouldn't have happened because I was 28).  If that was the case, the curing an eating disorder would be as easy as refusing people with EDs health insurance.  It has happened to me (I am, literally, uninsurable), and I didn't spontaneously recover once that occurred to me.

I know I shouldn't let the little bastards get to me.  There were supportive comments on there, too.  I know most people try to understand.  But every now and again, the ignorance just astounds me.  I don't wish an eating disorder on anyone, but sometimes, I do wish these people would be able to experience an eating disorder from the inside before they open their gaping, ignorant maws and spew forth utter crap.

A few weeks ago, I heard of a girl named Sofia Benbahmed who was trying to raise money so that she could get the treatment she needs and deserves to fight her eating disorder. Her insurance company won't pay for the long-term treatment Sofia needs to get well, and so bloggers are taking turns sharing Sofia's story to help raise money for her treatment.  You can donate (tax deductible) to Sofia's care here.

As I sat down to write something for Sofia's fund, I realized I had already written what I wanted to say.  So here's my metaphor for eating disorders and the need for long-term care: The Half-Baked Cake.

When I was at the Congressional Briefing following the EDC Lobby Day last April, I heard the clinical director of the Renfrew Center in Bethesda, MD speak. Mainly she spoke about how managed care has dramatically changed the treatment of eating disorders--and not for the better. One of her comments really hit home with me, when she said (approximately) the following:

Normally, you look in a cookbook for how long to bake a cake, and the recipe says to bake at 350 degrees for an hour. Managed care operates under the premises that you can make the cake at 500 degrees for 20 minutes and still have a finished cake. The irony is that often the cake looks done on the outside, but the inside is still completely raw. And if you let the cake sit for any length of time, the uncooked interior causes the whole cake to collapse.

The parallels to eating disorders are obvious: as soon as you start to "look" or outwardly seem better (i.e., the outside of the cake looks baked), the heat is turned off, the support is removed, and the whole thing collapses because it can't yet support itself. The analogy transcends issues related to managed care and really has to do with how we view eating disorders.

We need to start seeing the initial phase of weight restoration and normalization of eating behaviors similar to detox from addictions--it's a necessary first step but far far from the last. Furthermore, intensive, ongoing support is still needed after detox and weight restoration so that brain healing can take place and the person can learn how to overcome their tendency towards substance abuse or eating disorders.

Although the Renfrew director and I differ on why care needs to be continued after initial weight restoration (for her, it's the need to address the root cause of the eating disorder; for me, it's the need to allow ongoing brain healing and begin to learn and use better skills to deal with life), I do agree with her on the priority of weight restoration and the need for intensive support long after you start to look "better."

Maintaining a healthy weight is still hard for me. I have made huge strides, yes, and the higher weight has (I think) really helped to start to cement some of my recovery in my brain. (I kind of wish it didn't, but there you have it.) But I still need a LOT of therapy to help me learn to turn off that knee-jerk response of lose weight-restrict-control-control-control that my brain seems to have when faced with basically any kind of stress. My perfectionism is alive and well--perhaps because I can't bury it exactly six feet under. And the body dysmorphia? Well, let's just say that my mom's suggestion of a soak in our jetted tub to recover from Lobby Day was nice but almost laughable because I close my eyes when I shower so I can avoid seeing myself. A bath is totally out of the question.

My cake isn't fully baked yet, no matter how good the outside looks. I don't blame people for getting impatient- heck, I'm getting impatient. But the cake needs to stay in the oven and my therapy and support need to remain in place until the cake is baked.

And then I'll probably have to frost the damn thing.

Many of you have been asking for a shakedown of my NEDA talk on relapse prevention.  So, without further ado, here are my thoughts.

I presented on relapse prevention (with the help of some LOLcats), basically using the information from my relapse prevention series from earlier this summer.  Yes, this was deliberate--I knew I would be presenting on the topic and thought I would double dip a bit to get some of my work out of the way and have a good blog series.  The presentation itself was a total rush of adrenaline, and I remember only two things:

1) One of my slides had a typo (it read "you" instead of "your")

and

2) One of the animal pics I used didn't elicit the same laughter as the others.

So yes, I remember the details and negative ones at that.  I do think the talk as a whole went exceedingly well, but much of it was a blur.  I spent the morning guzzling coffee to combat sleep deprivation, and then I had to take some lorazepam before the talk started because I was shaking and nauseous from nerves (and potential caffeine overdose).

My co-presenter and former therapist Stephanie rocked it out--it was so wonderful to work with her as a colleague rather than as just a client.  We made a fantastic team fighting ED, and we made a kick-ass team doing our presentation.

After we got done, my mom came up to the both of us and asked, "So did the two of you have fun?"  I raised and eyebrow and said that "fun" definitely wasn't the word I would have used to describe presenting.  It was, however, very rewarding and enjoyable in its own way.  It's not going to be my career, if for no other reason than public speaking would involve way more traveling than I would like!  I'm hoping to present at other eating disorder conferences, and I hope to meet some of you there!

It's true that I go to the NEDA conferences every year to stay on top of the latest research and findings, but after so many years of going, the main draw for me is to see all of my friends.  Many of them, I've met before, but this year was especially nice because I got to meet so many new people.

It's odd, meeting people you've only known over the internet, people who know more about you than 90% of your "real life" friends.  Yet I couldn't pick some of these people out of a police lineup.  It was just lovely to be able to put names and faces together after (sometimes) years of online correspondence.  I'm sitting in the lobby of my hotel next to the lovely Melissa of Finding Melissa.  I spent a lot of time with Laura and the other moms of Around the Dinner Table--you know who you are!  My mom and I got to meet Marcella, who first met my mom back in 2001, shortly after I was first diagnosed.  They had been friends for years but never got to meet.

I also got to be with the ED recovery Twitteratti, which included Kendra, Rachel, Jenn, Claire, and Julie (among others).  I had more than a few laughs with Susan Ringwood of B-EAT and her charming husband and Becky Henry of the Hope Network.  I also saw David again, and finally met Sarah Ravin in person.

It was a lovely time, being with everyone.  I truly felt at ease and comfortable in my own skin, even in some overwhelming and demanding social situations which doesn't happen very often!  It was nice to have my blog and all of the work I've done here over the years to really get some good recognition.  I didn't need it, and I would have been fine without it, but it's always gratifying to know that my work has impacted others.

I fly back to Virginia tomorrow, and this will be the last time I see a lot of these people until the AED conference in Miami next April (if my proposal is accepted) or next year's NEDA conference in Los Angeles.

(Sorry if I forgot to mention anyone- my brain is pretty much frazzled right now!)

Writer Naomi Wolf was the keynote speaker at NEDA this year, and I honestly wasn't sure I was going to hear her speak.  Not because I'm anti-feminist (I'm not) but because I've read her book "The Beauty Myth" and I didn't find it that relevant to my own experience of an eating disorder.  I'm glad I went as a) it wasn't as bad as I feared and b) I found that many people had a similar response to what Wolf had to say.

I've heard Wolf speak before, and she is a phenomenal, engaging speaker.  She's super-articulate, very intelligent, and she knows her stuff.  I very much respect her and what she has to say.

However...

Although I think our cultural ideas and beauty obsessions and diet mentality are absolutely toxic, I don't think that if you eliminated them, you would eliminate eating disorders.  Most women feel bad when they're looking at Photoshopped models.  Most women diet at some point.  Most women don't have eating disorders.

(Not to mention, what about men?  What about people who live in cultures when thin isn't overvalued?  What about people with non fat-phobic anorexia?)

It's not uncommon for an eating disorder to start with an effort to "tone up" or "lose a few."    Yet once the disease process starts--once it kicks in--appearance is the last stinking thing most people with EDs are really thinking about.  People told me that my ED was making me look atrocious.  I was aware, on some level, that they were right.  By that point, the ED had a life of its own.  I was terrified of eating.  Even if it didn't have calories and exercising didn't burn any of them off, I would have still felt compelled to starve and exercise.  I couldn't stop.  That's why it's an illness.

I'm aware that the only evidence based prevention programs for eating disorders have focused on improving body image, and I'm not saying they don't work.  The research literature shows they do work.  But in a survey of 6000 eating disorder sufferers, no one said that their eating disorder had anything to do with vanity or cultural ideas (I heard this in a presentation by Susan Ringwood, the CEO of the UK charity B-EAT).  They did say that cultural ideals made it harder to recover, something I definitely endorse.

Eating disorders existed before thin was in, and they will probably exist after Size Zero seems as antiquated and misguided as chastity belts and foot binding.  The cultural language of fat and thin and dieting are what we have to put our experience into words.  They are how we frame what is happening to us.  People in the Middle Ages framed anorexia has an effort to be more spiritual.  Now, we look at it as an effort to be thinner or look like some supermodel.  But the way we make sense of an illness is different than the illness itself.

It just fundamentally bothers me that fighting eating disorders is seem as (in large part) fighting the fashion and cosmetics industry.  They use our obsession with being thin and such to sell products, it's true.  They make lots of women feel insecure about their looks, and then go on whackjob diets.  The body dysmorphia that accompanies an eating disorder isn't just a really bad version of wondering if these pants make your thighs look fat.  Being beheaded isn't just like a really bad paper cut, either.  An eating disorder isn't a really extreme diet.  It might look like that, but it's fundamentally different.

Wolf mentioned nothing about underlying vulnerabilities like anxiety and depression to eating disorders.  She did say that restricting in and of itself is crazy making, which is good.  Although she said that "parents don't cause eating disorders," she also said that her own mother's bitching about her thighs primed her for anorexia.  None of her other siblings developed an eating disorder, yet I'm sure they all heard the kvetching and comparing.  Why Naomi?  Why only her?  It's fundamentally not okay if your mother is diet-obsessed and tells you you're too fat.  Not okay.  And that sort of environment is certainly conducive to the development of an ED, but it's impossible to say that had this person grown up in a different environment, they never would have developed an eating disorder.

It was...frustrating at times to hear no mention of science and biology.  My friend Sarah Ravin asked Wolf afterwards why there was no mention, and Wolf said "I don't really do that science stuff."  I understand that science might not be everyone's little pet, but seriously?

The emphasis on beauty images only reinforces the idea that EDs are an expression of vanity, or just a bunch of beauty-obsessed kids who need to stop reading magazines.  And they're not.  Our focus on this does everyone a disservice.

I leave for the NEDA conference in about 8 hours.  I've rehearsed my talk numerous times, made sure there are no typos in my slides, and I've broken in my new shoes.  My suitcase is mostly packed, and I am just about ready to go.

My presentation is at 4:15pm on Saturday afternoon, which leaves me about 42 hours until I have to speak (not that I'm counting).  I am more than a little nervous.

Of course, because of my ED history, the nerves don't stop at my talk itself.  As I step out into the public as an advocate and person in recovery (which doesn't happen as often as some of you might think), I have all sorts of worries.  For one, I worry that people will look at me and think, "You? You had an eating disorder?!? You're way too fat to have been anorexic!"  And the issue of trying on clothes I haven't worn for a while doesn't make the body image issues any easier.

But I'm not going to NEDA to "look like" an ex-anorexic (if, indeed, an "ex-anorexic" can be said to look like anything...), I'm going to share my wisdom and re-connect with friends.  I'm going to make new friends and meet people I've only known through the internet.  These are not people who are going to be judging me.

It's nerves about travel and being in public and putting myself out there.  I'm packing lots of snacks and I have books and my phone, so it will all be fine.  Just fine.

Breathe.

The "It Gets Better" campaign is geared at gay, lesbian, bisexual, transgendered, and questioning young people who might be struggling with the issues surrounding coming out to friends and family.  It was started in the wake of horrifically common bullying and rejection that these teens face, to let them know that life does eventually get better.  It's a wonderful campaign and a wonderful message.

If there was only one thing I could tell my readers who are struggling with ED and recovery, it would be that it gets better.  It really does.

I didn't know that I would ever be able to look forward to a meal with friends, or buy a pair of pants without a major meltdown in the dressing room.  I didn't know that I would ever be able to exercise without being obsessive and compulsive, or put butter on my bread.  I didn't believe that I could get through a meal without wanting to jump off the roof because the anxiety and guilt were so horrific.

It took far longer for the pain to ease than I thought it would.  I had stopped believing that things would get better.  But eventually, with more work than I thought possible and the healing hand of time, things did start to get better.

The waiting was the worst part.  The waiting and the not knowing if it would get better.  It was something I had to tell myself, over and over and over again.  Recovery is terrifying, and I had been so battered by the eating disorder that I didn't think I would make it through recovery. 

But then I got to the day where I realized recovery was almost a default.  Eating wasn't scary, it wasn't an effort to haul myself off the treadmill.  My life was my life, and I had an existence that honestly had nothing at all to do with my eating disorder.  It took me a long time to realize that this "getting better" wasn't going away.  The hard work had finally, finally paid off.

So a little article in Marie Claire magazine called The Hunger Diaries about online food and health bloggers has raised quite a stir.  The premise of the article is whether these health bloggers might be promoting an unhealthy and obsessive lifestyle.  The health bloggers say that their quotes were taken out of context and the dangers of such health blogs were horrifically overblown.

Generally, I don't read these blogs and really am not interested in these types of blogs, where food and exercise routines are documented in almost pornographic detail.  I think about food and weight quite enough, thank you.  Unless it's specifically helping me with my recovery, I'll pass, thank you very much.  Also, these blogs tend to make my competitive and judgemental side get twitchy.  She exercised more than me, I will think, which then takes me down the path of "She's stronger/better than me" => "I must exercise more and eat less." => RELAPSE.  So yeah--for any number of reasons, these blogs aren't for me.

So I can't really say anything about the accuracy of the article and whether some health bloggers might have disordered eating or an actual eating disorder.  That's not my place, I don't know, so I'm not going there.  But I do have several points to make that have gotten lost in the dust of the kerfuffle.

1) Don't believe everything you read on the internet.  Maybe I've watched a few too many House reruns, but the fact is: everybody lies.  And it's very easy to do so online.  Just because someone says they ran X miles doesn't mean they actually did.  Maybe they ran less.  Or more.  Who knows.  I'm not anti-blogger; after all, I am a blogger.  Yet the fact remains, people are complicated.  Things might get left out inadvertently.  You might have misinterpreted.  And just because someone calls themselves a "health blogger" doesn't mean that they are healthy or that doing what they are doing will automatically make YOU healthy.

2) "Health" is not an extreme.  In a lot of the comments on the Marie Claire website, people talked about these bloggers as being something the rest of us Big Mac chowing Americans would do well to emulate.  Um, hello.  Did you not realize there is a ginormous freaking gap between a steady diet of french fries and marathons fueled by kale brownies?  To me, health is not health without joy, and joy comes from real brownies, not kale ones.  I exercise regularly, eat a very healthful diet most of the time, and I humor my sweet tooth when I can.  You can take steps to improve your life without following the dictates of a health blogger.  Are they healthy?  I don't know- that's between the bloggers and their doctors.  Which leads me to my next point:

3) "Health" is an individual definition.  People have tried to define health for centuries and have really come up with vague descriptions.  What someone else defines as health (such as kale brownies and marathons) might not be healthy for someone like me in recovery from an eating disorder.  I have to take steps to moderate my impulses to exercise.  Ultimately, you have to define health in your life.  That definition needn't be static--it can change with age, circumstance, you name it.

4) Bloggers have an obligation to their readers.  These obligations will be different based on different types of blogs, but, like it or not, bloggers have an obligation to their readers.  I see my obligations as being honest about my own recovery (the struggles and the victories), and not passing along information I believe to be unhealthy or uninformed.  I can't vouch that everything I write about is 100% accurate--no one can.  But I can (and do) refuse to write on subjects that will be obviously misconstrued, not in line with my own authenticity, and not anything I wouldn't tell someone to do.  I try to be careful and say how something (such as a meal plan) has been helpful to me, but a meal plan isn't universally helpful.

5) Your readers are listening.  This goes along with the point above.  If people are reading your blog, then they are listening to what you have to say.  They are absorbing this information.  Remember this.  Unless your blog is completely private, you are writing to an audience.  When you talk about how great your workout routine is (and then describe it in detail), people are going to copy you.  No, you aren't responsible for the fact that they do copy you and that people can be idiots (sorry, too many House reruns again), but you are responsible for being cognizant of what you say.

6) Obsession can masquerade as health.  I'm not saying anything about these bloggers in particular.  Like I said, I don't really read them and so I'm making no judgements.  But I do have to applaud the writer for bringing up the thorny cultural issue of health being used as a smokescreen for any number of obsessive behaviors.  Part of the problem is that most of the obsessed really think they're just being healthy.  They see nothing wrong, and the unending kudos from adoring blog readers probably doesn't make it any more likely that people will see the light.  Many eating disorders have started by a simple effort to be more healthy.  Soon, it becomes a life-threatening obsession, but how can you be sick if you're just trying really hard to be healthy?  It's a fine line and it's hard to find out where to draw it.

So those are my thoughts.  What do you think of health blogs?  Do you read them?  Why or why not?  Share in the comments.

I trawl the web for all the latest ED-related news, research links and more so you don't have to.

Hunger affects our financial risk taking: eating neutralizes risk aversion immediately after

Toddler's sponge-eating pica eliminated by correcting her iron deficiency

Eating disorders in patients with traumatic brain injury: A report of four cases.

If low serotonin levels aren't responsible for depression, what is?

Support for parents of eating disorder patients in Ireland

Nigella Lawson: please don't celebrate excessive thinness.

Experimental measurement of the regulation of anger and aggression in women with anorexia nervosa. There have been several studies looking at emotional dysregulation in eating disorders, and this is the latest.

Better screening for self-injury needed for teens with eating disorders.

CYP2D6 polymorphism in patients with eating disorders.

Alexithymia and emotional awareness in anorexia nervosa: time for a shift in the measurement of the concept?

The efficacy of a brief motivational intervention for individuals with eating disorders: A randomized control trial.

Motivation to change in adolescents with bulimia nervosa mediates clinical change after treatment.

Men Battling The Skinny Jean, And Eating Disorders.

One of my best friends from college wrote this amazing poem about her own anorexia.  It's just achingly beautiful and I had to share it here:

June 1st, 1942: 927 calories, 63° Fahrenheit

The first verse:

what is it like, to measure time
in calories, each moment a caloric collection
of seconds, each month a record
of how many grapefruit eaten, how many
pieces of cake or slices of cheese denied,
days upon days stretching into the absence
of every fat gram you did not eat,
every desire you did not pursue,
every dream you did not have.

I am not, by nature, a very confident person.  I doubt myself.  For that matter, I doubt everything.  And so, like many people with eating disorders, I doubted my ability to get better.  For years, I thought I was too messed up to ever return to anything called normal.

I was lucky.  I had family and friends and a treatment team who believed in my ability to get better.  As much as I hated being strong-armed into treatment, I realize now that it was a sign of how much they believed in my ability to overcome anorexia.  They (rather smartly) didn't try to make me become a prima ballerina because the odds that the class klutz could manage a pirouette were pretty slim.  I think they knew, deep down, that I could get better if I had the chance.

There were many things that made a different in my recovery, but I think that was one of the big ones.  I needed someone else to believe in me until I could believe in myself. I tried to get better numerous times, but I could never shake that monkey on my back.  And so each effort, I had less and less belief that it would actually work.  Not surprisingly, each effort had less and less effect on the ED behaviors.

Some of the clinicians I saw doubted my ability to get well.  I was "chronic" and "long-term" and "unlikely to recover."  I had no reason to disagree with them.  But those treatment providers who did continue to believe in me provided me with a ray of hope.  That ray of hope wasn't enough for me to kick anorexia on my own.  I had to be strong-armed into treatment one last time, but nonetheless.

It's hard for people to balance their confidence in your ability to get well and the extreme difficulties that getting better actually takes.  The Pollyanna-ish "Oh, you'll be fine, dear" struck me as rather fake.  An eating disorder isn't a cold.  It's not a take two and call me in the morning illness.  Yet in order to do the hard work, to go to therapy week after week and take your pills and eat the damn food (all that damn food!), you need to know that, somehow, you will get well.

I think people underestimate the effects of confidence.  I finally have confidence in my own recovery, after years of doubt and disbelief.  By giving me no other choice that complete wellness, I could finally get healthy enough to see that recovery was possible.  It sounds almost paradoxical, but it's true.