On my way to see TNT and go to group, I was listening to a podcast from last year's DarwinFest at Arizona State University (2009 was the 200th anniversary of Darwin's birth and the 150th anniversary of the publication of "On the Origin of Species").  The next talk on my playlist was by Nina Jablonski on the evolution of skin pigmentation.

Dr. Jablonski spent a portion of the talk discussing how UV radiation damages the skin, and the different responses animals have evolved.  She said that certain types of UV radiation were pretty much universally bad; they had no real positive effects on life.

And yet, Dr. Jablonski said, UV radiation was an "enormously creative force" in the evolution of life on Earth.  UV radiation created DNA mutations, which are the raw material of natural selection and evolution.  Without mutations, we'd all still be pond scum.

And all I could think was: this is such a great description and metaphor for eating disorders.  EDs are tremendously destructive.  I know some people say that they are grateful to their eating disorder, that it helped them cope with life when nothing else did. Although I understand and sympathize with the sentiment, it's not something in my own personal experience. 

That being said, here I am.  The destructiveness of my eating disorder has been a creative force.  It's resulted in two books and this blog.  More indirectly, it's led to my career as a writer.  It's brought me to where I am today.  As much as I whine about my life, as much as I hate it at times, I am where I am, and it's really not all that bad.  Okay, true, my current life is nowhere near the one that I thought I would be living.  At the same time, I'm working to accept that where I am is just freaking fine.

UV radiation is tremendously destructive, and yet from this destruction has sprung an amazing array of plants, animals, fungi, protists, and microbes. And so it goes with the eating disorder and my life.  Enormous destruction has led to enormous creativity.

I was stressed and in a funk this weekend for a variety of reasons (which shall remain unnamed for privacy purposes), and I was thinking about how much different the experience was compared to when I was sick with AN.  The AN acted as kind of a dimmer switch for such banal stresses as "Will my mortgage go through?" and "Am I going to find a new therapist?"  All that mattered was not eating and overexercising.  It made my world cohere.

It's one of the things I miss about the eating disorder.  I don't miss being sick, don't miss feeling like rancid raw chicken all the time.  I don't want to be sick again.  But what I still get the occasional, achy twinges for (or sappy longing--whatever) is that coherence factor.  The feeling that I could make my life seem "okay" via the anorexia and its routines.  Now, I have to sit with my stress and problem-solve and communicate and it's so much easier to just head to the gym.  So not only do I get the anxiety relief, both biochemical and otherwise, but I also get to wallow in the fact that I'm being healthy! and fit! and good!

I addressed many of these feelings in my Roadblocks to Recovery series, and they're just a relevant as ever.  Although the exact situations that trip me up vary, they tend to be of the same theme.  Dealing with change.  Stress/Anxiety.  Perfectionism.

I guess I shouldn't be down on myself that I miss some of the aspects of anorexia, but more astonished that I don't miss it more.

I know that I can't go back to being that gym bunny and lettuce lover without feeling like crap, even if there are some short-term benefits.  It makes me feel a bit like a petulant child, stamping her feet and shrieking "But it's not FAIR!"

No.  No, Carrie, it isn't fair.  None of this is.

But by working through my problems--asking for advice, communicating, buying every House MD season on DVD for 50% off*--I'm realizing that I don't need a Xanax salt lick or marathon exercise session to get through life without flipping out.  I still want to fall back on my defaults from the years of my eating disorder (which is why I call them defaults, no?) but I'm working on it.

*There's no insurance cutoff on retail therapy! ;)

Appetite regulating hormones cortisol and peptide YY are associated with disordered eating psychopathology independent of body mass index.

Personality development characteristics of women with anorexia nervosa, their healthy siblings and healthy controls: What prevents and what relates to psychopathology? This has to be one of the more fascinating studies on EDs that I've read lately, and it looks at why some family members develop an eating disorder, and others don't.

Attentional Processing of Food Pictures in Individuals with Anorexia Nervosa-An Eye-Tracking Study.

*This is derived from an old joke when I used to play the viola.  "What do violists use for birth control?" "Their personalities."

I'm like Laura- I've always had 13 as my lucky number after I won a cakewalk with that number.  (Ironically, my OCD "safe" number is 5.  Thirteen has no OCD attachments, though.)

What does 13 have to do with anything?

TNT announced on Monday that she was leaving clinical practice in January due to difficulties in finding childcare (she has several young children).  Which means I have to find another new therapist.  The end of TNT means I will be on lucky number therapist 13.

Yes, I counted. I'm a dork like that.

I love TNT and I don't want to find a new therapist.  On top of that, finding a new therapist is really hard for me.  For one, I'm not the world's easiest client, and not every therapist can put up with my issues.  For another, I know a lot about eating disorders.  More than most therapists, even some of those who specialize in eating disorders.  I don't mind doing some education, but I'm not forking over my hard-earned cash to teach someone about eating disorders.

I also really hate interviewing therapists.  Asking probing questions with my journalist's hat on is different from asking a therapist "So what do you think causes eating disorders?"  It's a hassle.  I don't mind it professionally because it's part of the job, but for finding a therapist, I kind of resent it.

The other really hard part is the fact that I'm not exactly around a large, urban area, which means I probably won't find an ED specialist.  I'm driving an hour each way to see TNT, and I'd ideally like to find someone closer.

I hate change to begin with, and this is not exactly something I want to deal with right now.

Much of the "fun" of holidays for people with eating disorders isn't just the food, it's the less-than-helpful comments from everyone around us.  In an ideal world, people would know to zip their lip about diet talk, Aunt Zelda's habit of wearing purple sequined pants, and what you are choosing to eat.  But this isn't an ideal world.  In order to walk through the landmine of interpersonal and familial relationships, you need to do something that therapists like to call "setting boundaries."

It's not something that most people with eating disorders are good at.  Some people wind up as human doormats.  Others (like me) just avoid people altogether.  Or they vacillate between the two.  Boundary setting is a skill--it's not innate like breathing.  You have to learn how to do it, and practice this skill over and over and over.

With the holidays in mind, here are some hints on how to start doing this:

1. Identify your non-negotiables.  Before you go into a challenging situation like a family get together, know ahead of time where you will want to draw the line.  When you're angry or anxious, it's easy to draw battle lines where they shouldn't be drawn.  This probably isn't the first time you've been with these people, so you can at least begin to anticipate what might go wrong.  Know what you are absolutely not willing to tolerate and will speak up about, and also keep in mind what you might prefer to let blow over.

2. Change the subject.  If diet and weight talk make you uncomfortable or drive you crazy, change the subject.  If you are at the gathering, you are part of the conversation.  This means you get to have input on what is discussed.  Of course, topics of conversation are never put up for a vote (at least they aren't in my family), but you can influence what is being said.  Have some topics in mind for these occasions.  It might be a great time to ask how grandma's surgery is healing from last summer.

3. Use "I" statements.  Yes, it's cheesy therapist talk, but it's also remarkably effective.  "I'd rather not discuss that" can frequently end a conversation.  Remember, setting boundaries is about YOU, not them.  It's about treating yourself with respect.  So own it.  Say "I feel uncomfortable when..."  and things like that.  The point isn't to accuse someone of being petty and ridiculous--even if they are.  It's about keeping your recovery strong.

4. Let go of the outcome.  Some people are going to walk all over every boundary you set up.  And there's not a thing you can do about it.  You can, however, make it very clear how you are willing to let yourself be treated and what behavior you expect of others.  You can't control how others are going to react to what you say, but that doesn't mean you shouldn't say it.

5. Know your goals.  When I'm in a difficult situation with another person, I usually ask myself "What's the goal of this interaction?"  Is it a meeting with my boss in which I'm trying to keep my job?  Is it catching up with Uncle Bob?  Is it to do my filial duty by chatting with annoying relatives?  The boundaries you set may be different based on whether you are asking for something or receiving something, how often you have to see this person, and how much you value the relationship.  Some boundaries might be a universal (ie, "Please don't comment on what I'm eating.") whereas others are going to be more specific.  It's tricky, but knowing what you value in the relationship often helps me guide my choices.

6. Know what to let slide.  Some people will tramp all over your boundaries because they're mean.  Others will do it simply because they don't know any better.  Often, that's just the way these people are.  Although I'm notorious at keeping people at a distance, I'm also hesitant to flat-out say "Please don't talk about this."  Sometimes, the best choice is to bite your tongue and soldier on through.  That doesn't mean you're letting yourself be a human doormat; it means you're making the conscious choice not to act at this very moment.

7. Do it ahead of time.  If you can, communicate beforehand if there are any glaring landmines, such as you just started treatment for your eating disorder, you recently got out of the hospital, etc.  Most people truly don't want to be jackasses.  Their ability to respond to your boundaries may vary widely.  Some people will forget, others are just clueless, and there are always those who are petty and mean.  But people often appreciate knowing what is helpful and not helpful.

8. Prepare for the worst.  Boundaries are great, but what are you going to do if people don't respect them?  There's a time to grin and bear it.  There's also a time to reiterate what you're saying, calmly but firmly.  Don't be dramatic and threaten and deliver ultimatums because people will often call your bluff.  You see it in movies all the time, where someone snaps and says "It's me or the dog!"  The dog usually wins because they dog doesn't make you choose.  Having been on the receiving end of these situations, it sucks.  Don't go there.  It just makes you look like an ass.  There's a difference between saying "If you don't shut the hell up, I am walking out that door!" and saying "I'm really uncomfortable, and I need to get going."

What has helped you set boundaries?  Share your tips in the comments!

I've never really gotten in touch with my inner child, but TNT is having me work on getting in touch with my inner parent.

The fact is, I'm not that good at parenting myself.  It's not that I didn't have good parents--I did.  My problem is that I never learned how to treat myself any way but harshly.  Call it the remnants of being a ruthless perfectionist, but much of my inner dialog is scolding and criticizing myself.  This frequently horrifies people, but it's rather true.

Along with the perfectionism comes black-and-white thinking.  I would seesaw between taking huge amounts of time to make the bed "perfectly" to not bothering to make it at all because it wouldn't look right anyway.  I've been known to procrastinate on doing anxiety-provoking things (like making phone calls) that nonetheless need to be done immediately.  It's all an opportunity for me to harp on myself and my carelessness, my procrastination, my anxiety, my willingness to pay a fine in lieu of making a simple phone call.

I babysat throughout 8th grade and then high school for the same family.  The two girls were more like my little sisters than the two kids I watched for a few hours every week (the oldest is now in college, which makes me feel practically ancient!).  I had to prod them into brushing their teeth at night, into washing their hands, and then read them to sleep.  They pulled some crazy stunts, as kids are wont to do.  I remember one incident where the youngest girl spent over 20 minutes "washing the soap" because it was dirty.  But I didn't yell at them or scold them.  I just kept encouraging and occasionally (metaphorically) strong-arming them into doing what needed to be done.

Although I have mixed feelings about whether I want my own children, I do know that I have parenting skills. I do okay with other people.

But with myself?  That's a different story.

For me, it helps to imagine what I would tell Aria to do.  If skipping a meal or snack would make her sick, then I would insist she eat.  It would be nice if she volunteered, or if she grew a pair of thumbs and opened the damn can herself, but if she doesn't, I would make sure she ate.  I need to learn how to do that with myself.  Be gentle but firm.

As for the criticizing bit, that's a whole 'nother story.  When I was talking to TNT yesterday, she said "Gosh, you are really hard on yourself."  And I was all "Ya think?"  People have always told me to be gentle with myself, but it's not something I've yet figured out how to do.  It's like all I can see is people who are doing more, who are more successful than me, and I feel that I "should" be doing all that and then some.  I've never learned how to give myself props, that reassuring pat on the back that I've done a really good job.  I can do that on occasion--I've finished a story recently and loved how it turned out--but not consistently enough to make any sort of difference in my day-to-day life.

That's one of the things I still need to work on, those "adult skills" that I never quite picked up.

What are some of the ways in which you have learned to be a good parent to yourself?

I think that self-care is a big part of recovery.  That being said, my history of adequately caring for myself is generally bad.

If you are friends with me on Facebook or follow me on Twitter, then you have probably heard me whinging about my awful cold.  The terrible I-think-I-just-swallowed-glass-shards stage has passed, and now I'm into trying to figure out how to get through life with five gallons of snot sloshing around in my skull.

Not fun.

So instead of blogging tonight, I'm going to take a bit of my own advice and practice good self-care.  I am logging off the computer and getting some extra rest. 

With that, I'll talk to everyone in the morning.

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

Scientists uncover genes linked to anorexia.

5 tips for mindful holiday dining.

An off-line pilot evaluation of a web-based systemic cognitive-behavioral intervention for carers of people with anorexia nervosa.

Therapeutic factors affecting the cognitive behavioral treatment of bulimia nervosa via telemedicine versus face-to-face delivery.

Critical appraisal of the provisional DSM-5 criteria for anorexia nervosa and an alternative proposal.

Why are Americans so obsessed with food?

The media, eating disorders, and you.

Fear- and disgust-related covariation bias and eating disorders symptoms in healthy young women.

Gray matter decrease distribution in the early stages of Anorexia Nervosa restrictive type in adolescents.

1 in 5 US adults suffer mental illness.

Binge Eating Disorder / Compulsive Overeating and Its Treatment.

College gives resources to treat eating disorders.

I left my laptop on my bed, only to come back and find my cat, Aria, trying to edit my blog.

An email from an ED colleague of mine (who shall remain anonymous) about the anti-obesity campaigns was just so spot-on and brilliant that I had to repost it here:

To me the most critical point is that weight is not a behavior. That's why anti-smoking campaigns are different from anti-obesity campaigns. Smoking is a very easily controlled behavior if you have not taken it up yet. You can most certainly decide not to start smoking but you can not simply decide not to be fat - you can do all the right things and still be fat. I have little nieces and nephews like that. They are active and energetic kids who eat healthy (more so than my kids!) so what else are they supposed to do? How does the message that they have the wrong kind of body that puts them at risk for health problems and earlier death serve them? To elaborate on Jon's point, should I raise my son to know that he is estimated to have a shorter lifespan than his sister? The only thing a kid needs to hear about his or her body is that it is precious and deserves good care.


Another thing that concerns me with our approach to obesity is that instead of normalizing behaviors, like we tend to do with other conditions, we push people into adopting abnormal lifestyles. When we see people with depression or anxiety or EDs, our goal is to normalize behaviors (e.g. that the person with depression be able to get out of bed and go to work, that a person with social phobia be able to go to social gatherings without distress, that a person with an ED be able to eat normally without compensatory behaviors). But in obesity treatment, our goal is to go beyond what we would consider normal. We want people to eat less than what a person who is not obese would eat, we want them to move more than we would expect of a person who is not obese, and we want them to be hypervigilant about their eating and weight - something that would concern us in a person who is not obese. Besides the obvious ethical questions involved in asking something of fat people that we would never ask of a thinner person, how many people are willing or able to go to such extremes?

From what we have seen, not many. The most optimistic reports of "long-term weight loss success" I have seen is around 20% ("long-term" defined as at least 1 y and "successful weight loss" defined as at least 10%). When we look at the behaviors of those successful at losing weight, described in the much-touted National Weight Control Registry, we see patterns resembling the habits of our patients: Low caloric intake, long hours of exercise, frequent weighings, and a constant vigilance - those who are most successful at maintaining their weight loss never stray from the dieting routine, no matter if it's Christmas, birthdays, vacations or what have you. I don't know about you but I wouldn't want my kid to live like that.

I wish more people wrote and thought like this!

I'm a writer, so it might seem kind of odd that I have trouble expressing my emotions verbally.  But there you have it.  It drives my mom bonkers that I don't like to talk when I'm upset.  She wants to help and I'm as closed as an emotional clam.  This isn't always good--I often hold things in until I snap--but I often find that I don't need to process emotional stuff out loud.

I've never been one to wear my heart on my sleeve.  I'm a terrible actress because I find the thought of being emotional in front of others terribly embarrassing.  So verbal displays of emotion with anyone besides my cat is pretty darn rare.  When I used to read those little magazine articles about "How to communicate with a human male" or how men respond to problems, I always laughed, because they seemed to be describing me.  I enjoy helping others with their problems, and listening and problem-solving, but when it comes to being the actual person with the problem?  I'm not a talker. 

For the therapeutically inclined, not liking to talk about your feelings is pretty much anathema.  Maybe it's why I like CBT, DBT, and ACT so much.  But this recent thread got me thinking about how I can express myself non-verbally.

For one, I've always been better at writing about my feelings than talking about them.  For another, there are so many ways you can deal with emotions, even strong intense emotions, without words.  Some people love art.  Others clean when they get stressed.  I like to crochet or blog.  I also love cleaning out my drawers, closet, etc--it's like emotionally purging.  Getting out on my bike really helps clear my mind and let's me be more rational about what's upsetting me.  Being outside period is therapeutic.  So are crafty things like making jewelry and sewing (I swear I'm not a reincarnated version of Donna Reed. I swear).

Some of my old therapists liked to link my seeming emotional constipation with my eating disorder.  If I could just talk about my feelings then I wouldn't need to use ED symptoms.  Except, of course, I did my best to hide the ED symptoms, which meant that I couldn't be using them to communicate.  Nor did anyone bother to ask whether I was this way about emotions long before the eating disorder surfaced.  But I digress.

Rather than expressing emotions, I think the important thing is to accept, understand, and process them.  Verbally is fine.  So are non-verbal methods.  What do you think?

How do you deal when words fail? Share your thoughts in the comments!

When I was actively ill with the eating disorder, Thanksgiving was effectively a Day of Torture.  A holiday all about food and eating?  Count me out.

I still don't exactly look forward to thanksgiving, but I don't dread it, either.  After many, many years, I've learned how to cope with the holidays and survive in one piece.  Some of it is the hard work of recovery, and some of it are simple tips that I've figured out over the years.

1. Lower your expectations.  Norman Rockwell may have painted portraits of a nice, happy family sitting around a table with a turkey.  I don't know about you, but my Thanksgiving dinners never looked like that.  People bickered or got drunk.  Dishes got burnt.  Or the slightly deranged second cousin shows up, all gung ho with her new religion/cult/whatever.  It's nice when families get along, but that can be the exception, not the rule.  It gets easier to deal with all those familial imperfections once you stop expecting families to be happy and nice.

2. Ask what you can bring.  Lots of food I'm not preparing was always stressful.  If I brought at least one dish, however, at least I had something I knew was safe.  It helped me make it through the meal.

3. Eat before or after. It would be nice if recovery was nice and easy and you could push through and eat normal-sized portions at dinner.  But recovery isn't nice and easy.  Sometimes, you do the best you can do.  Maybe you're too anxious to eat, or you don't feel comfortable, or you have to eat a lot and you don't want to look odd.  Whatever.  In that case, eat a little before you go and /or eat after you get home.  That way, you can participate in the whole Thanksgiving festivities (keeping in mind point #1) and still meet your nutritional requirements.

4. Find out what's being served.  This is pretty related to points number 2 and 3, but it's still something I have found to be helpful. It helps me decrease anxiety because I know what to expect.  As well, I can figure out what will fit into my meal plan, I can decide what I need to bring (or what several things I want to bring), and what to have before or after.

5. Talk to your treatment team first.  Your therapist, dietician, or whoever can help you troubleshoot any emotional or family issues that may arise, as well as help you deal with the practical aspects around the food part.  It can help to roleplay some of the comments that may arise around weight and food, or other kooky comments.

6. Create an emergency plan.  When I've been in stressful situations, I like to have a sort of safety valve.  Sometimes I've asked a friend to call at a prearranged time so I can go and get some air.  Or I'll find an empty room and do some deep breathing.  I've brought books to read, games to play with the kids, that sort of thing.  It helps to make everything less about the food and more about the crazy people you're related to.

7. 'Fess up. If you feel comfortable with the host/hostess, or at least someone else at the gathering, talk to them about your eating disorder.  They can provide support and help run interference if people make inappropriate comments, you start to get triggered, or you start to use symptoms.

What helps you make it through the holidays? Share your tips in the comments section.

The last week or so has been one massive slog through writing, editing, revising, interviewing, and writing some more.  It is, in a sense, a very good sign that I'm rather swamped with stuff.  It tends to make paying the bills easier (although some of that writing is for a freelance gig that I'm "auditioning" for at this stage, and therefore no payment is guaranteed. But it's a great career opportunity, and I'm excited about it).  I have a headache, I can barely keep my eyes open, I want to beat my head against my desk in frustration half the time as I'm trying to write about science I can't quite wrap my mind around.

I'm simply exhausted.  I just want to nap.  I took an hour or two this afternoon to read, as I had a brief reprieve in the never ending gauntlet of deadlines.  But tonight it's back to the computer and work, followed by more of the same for tomorrow.

This kind of grim exhaustion, followed by the deep inner sense that I have a job to finish, reminds me of eating in the early days of recovery.  I would have gladly eaten all of my exchanges at an all-you-can-eat buffet first thing in the morning so I didn't have to worry about eating the rest of the day.  I was just so sick of the endless slog through meals and snacks.  I wanted it to go away.  And that's what this is kind of like, although I do actually like writing, which I couldn't say about food back then.  It's this numb exhaustion, combined with the knowledge that the end result is rewarding.

Today's work really hurt my brain, as I'm trying to write smartly on science I'm not exactly sure I understand.  In fact, I'm pretty sure I don't understand it one bit, and I had to eventually phone the researcher and ask him to explain his work using words with no more than three syllables.  I still don't think it worked.

And this exhaustion has led a slight uptick in feelings of depression.  It's more of the anhedonia and apathy caused by being too tired to care much rather than an actual "I hate my life" feeling.  I used to deal with this in a very ED way.  First of all, I better not be tired because I still had to get through my exercise routine, and I was never too tired for that.  The exercise also served as a little pick-me-up, and as a vent for my stress.  It's hard not to turn to that when I know it's so effective--at least for the short term.

I suppose this is part of what recovery and life are all about. Surviving the crappier times without resorting to unhealthy behaviors.  Recognizing that said crappy time won't last forever.  Integrating self-care into your life (such as my reading and blogging this afternoon).  And the acceptance that the ED won't change your current situation for the better.

It's your weekly Sunday Smorgasbord, where I trawl the web for ED-related links, news, research, and more, so you don't have to.

Eating disorders in youth: Diagnostic variability and predictive validity.

Embracing the complexity of eating disorders.

Weight Bullying in Childhood Could Trigger Eating Disorders Later in Life. The issue is a lot more complex than the press release says, but I think it's important to remember that bullying in general and about weight in particular is a common ED trigger.

Why making dinner is a good idea. Whether it's a solution to obesity, I'm not sure, but I do know its tremendously satisfying to cook and prepare your own food.
 
The socio-emotional processing stream in Anorexia Nervosa.

Vulnerability & The Mask of Thinness.
 
An investigation of the joint longitudinal trajectories of low body weight, binge eating, and purging in women with anorexia nervosa and bulimia nervosa.

News flash: Healthy living is more than nutrition and exercise.
 
Clinical correlates of eating disorder comorbidity in women with bipolar disorder type I.

Sleep has many benefits for your life and health. It's tangentially ED-related because many people with EDs tend to burn the candle at both ends, and learning to take a break is something I'm working on in recovery.
 
New book says: Give food a chance.
 
An investigation into the relationship between eating disorder psychopathology and autistic symptomatology in a non-clinical sample.

High-speed video shows how the cat gets the cream.

And so things come full circle.

I am currently in Washington DC celebrating the birthday of my current best friend.  I drove up earlier today and we spent the afternoon together.  Then, a group of us headed out for dinner (sadly, Yu was not in the cards) and then to a concert.  It was a really nice evening.

Considering how yesterday I was going on and on about how this wonderful birthday party was ten years ago, I've been sick the entire time, yadda ya, it seems interesting that today I went to another birthday party.

No, it didn't involve vast quantities of booze and Peking Duck, but it did involve vegan chocolate cake, which was pretty darn good.

I'm not grateful I had an eating disorder.  I don't think anything will ever make all of that crap "worth it."  I believe in trying to use the crap to fertilize something useful, but let's not forget that crap is still crap no matter how useful it might be.  So yes, there's the crap, but there's also the stuff it's fertilizing.

Without the eating disorder basically interrupting everything in my life, I'm not entirely sure it would have occurred to me to start writing.  I may very well have been happy as a research scientist--I'm guessing I would have--but I also don't know that I would have dropped everything to start writing.  Recovery has given me a certain amount of guts, the ability to put it all on the line and learn to deal with the consequences. (I suppose you could say I did this a bit with the eating disorder, but that was also less than rational and driven by fear rather than ambition.)

No, I'm not grateful.  Yes, I still get sappy and sad and such when I think about how much time was wasted.  But at the same time, I have to remember to pick myself up and practice radical acceptance.  I am where I am.  The past sucked.  There's no getting around it.  Prolonged moping, however, really isn't in my personality.  I have many less-than-admirable traits--ridiculous stubbornness, low frustration tolerance, anxiety--but moping isn't one of them, even when I am severely depressed.

In a sense, my life has come full circle since that birthday party ten years ago.  I am older and wiser and weigh a few pounds more.  I have more compassion but less bone density.  And I once again have friends with whom I can celebrate birthdays, even without vodka and chopsticks.

It was one of the last memories I had before the ED arrived--at least, one of the last happy memories.  I was spending the fall semester of my junior year in Aberdeen, Scotland, and I had made friends with a number of other students in my exchange program.  One of the girls was turning 21, the first in our group to do so.  Considering we were in the UK, where the legal drinking age was 18, we decided to have a big party for A. 

First, we went out to a nice Chinese restaurant called Yu.  I forget exactly what we ordered, but there was Peking duck involved.  It was crispy and moist and juicy and so freaking good.  Sake was also involved.  It wasn't exactly authentic Chinese, but we were giddy and happy so we ordered it.  ((As a hint, save your money.  I've never drank rubbing alcohol, but that's what it reminded me of.))  After dinner, we went to the Wodka Bar and each did a shot of flavored vodka--mine was lemon.  We stole the shot glasses as souveneirs, though for the price of the vodka, you could reasonably assume that the shot glass was included.  We made one last stop at yet another bar--I sound like a total lush!--where I was talked into having a drink out of a test tube.  "You're the chemistry major, Carrie! You have to drink it!"  So I did. 

Then we all went back to A's apartment and played Go Fish, and I'm fairly certain there was more booze involved.  But we were up until about four in the morning, laughing and playing cards.  It was incredible. 

I was already starting to get paranoid about food around then.  About two months later, the eating disorder really picked up steam as I fell into a deep depression.  And then my life disappeared into a gigantic black hole known as anorexia.

That was 10 years ago.  I'm now Facebook friends with A, and she celebrated her 31st birthday today.  I hadn't thought about her 21st party literally in years.  I couldn't believe that for the entire decade afterward, my life would be essentially obliterated by an eating disorder.

It seems like so long ago now.  I seem so young and innocent and maybe even stupid.  I never thought I would become anorexic because I knew better.  I had seen friends and roommates struggle with eating disorders.  I wasn't obsessed with supermodels.  I was, frankly, smarter than to get myself stuck in an ED hell.

I didn't know that intelligence has nothing to do with it.  I didn't know that almost 10 years would pass before I felt even a glimmer of that happiness again.

Tonight, it hit me just how long I've been sick, and I'm once again struck by the full horror of what my illness took from me all these years.  It's like my twenties just disappeared.  They were sucked into a black hole where all I can tell you about it beeping heart monitors and glasses of Ensure, of being too weak to get out of bed but running 5 miles anyway.

And it sucks.  The time lost, the money spent.  It all sucks. I want to tell that 20-year-old she should never lose weight.  That if she does, she may as well kiss her health and her life goodbye.  Not that this would have stopped me.

I just...I can't believe it's been ten years.

So I totally lost track of the fact that yesterday was Wednesday, and that Wednesday is Tip Day.  Also, my Netflix DVD of House Season One came in the mail, which may or may not have had something to do with yesterday's lack of posts.

Many people with eating disorders tend to eat a very regimented diet.  For me, I typically ate the same few things that caused the least amount of anxiety.  Outside of entering a structured treatment program, I had major difficulties learning to eat a wider variety of foods.  More often than not, I would sort of slide back into a pattern of eating the few same things.

Of course, some people like more food variety than others, but it's also important to eat sufficient variety of foods to get vitamin and mineral intake.  As well, the extreme lack of variety (I'm a creature of habit, and my diet isn't super-varied, but I do think pushing variety was a key part of my recovery) can keep you stuck in ED thoughts and habits.  Today's tips will deal with ways of increasing variety in your diet.

1. Think of it as a game.  One person I knew would only eat veggies of a certain color.  So her therapist had her make a color wheel, and she got a sticker every time she had a different colored fruit or vegetable.  After filling in all the different parts of the chart, she could treat herself to a prize. Yes, it's cheesy and can seem a little infantile, but it's important to remember that fun can be a part of this process.

2. Be a kid.  Look at foods not as "good" or "bad" or by evaluating their nutritional minutiae.  Instead ask yourself what looks interesting or tasty or fun to cook.

3. Try something new.  There are no expectations here.  You don't have to like what you've tried, you don't have to eat it all the time.  But it can be fun to experiment, and you might just find yourself enjoying something you didn't even know you liked.

4. Try something old.  For a while, I was hooked on treats from my childhood: Little Debbie stuff, that kind of thing.  After I tried some, they did lose a bit of their appeal as they were never quite as wonderful as I remembered.  Except the Nutty Bars.  Those things are awesome.  But trying these opened my eyes to many other new foods, and they made me more flexible and willing to try new/old things.

5. Be social.  Social situations can be very threatening for me, but at the same time, it can also be a good push to broaden my horizons.  If your friends order pizza and you normally get something different, that might be a good opportunity to try a slice of pizza.  It makes the experience much more normalized rather than dwelling on being that freaky person who doesn't eat pizza.

6. Stay accountable.  It's easy to say you're going to try something different, but it's not so easy to carry out.  Often, I would enter a situation intended to break the mold a little bit, but as it came time to actually decide, I would back down.  To get around that, I've occasionally had friends or family order for me, or remind me of my goal to order something on the menu besides the salad with grilled chicken.

Next week, I'm going to do tips on surviving Thanksgiving.  I hope you all enjoy!

I have a slight problem: I'm running out of decent lunch ideas.

Part of the problem is that I'm not much of a sandwich person, and I don't really like lunchmeat unless it's from the deli counter (it's a texture thing). 

I forgot to plan my lunch last night, and so today is a sandwich day by default, but I'm less than thrilled with this turn of events.

I'm reasonably creative at breakfast--at least as creative as I can be when half-asleep.  For some reason, breakfast ruts don't bother me as much as lunch.  Dinnertime is also rather varied.  Snacks are what they are- I often prefer a set of two or three different items, so that doesn't require much creativity.

But lunches--lunches are the bane of my existance.

So I'm turning to some of the best blog readers for some good (recovery-oriented) lunch ideas.  Also keep in mind that the nearest Whole Foods is 1.5 hours away, so please nothing too exotic.  I do follow a meal plan, so I will almost certainly end up tweaking whatever you suggest, but please: suggest away!

"Do something every day that scares you."
--Eleanor Roosevelt

If recovery had a quote, this would definitely be it.  Recovery is about pushing yourself and challenging yourself every single day.  An eating disorder traps you in a world of fear and anxiety.  Yet to break free, you need to experience even more fear and anxiety, and learn how to live in tandem with that fear and anxiety.  I've been an anxious person all my life--I was before AN, and I am after.  I worry and get fearful rather frequently, usually about pretty minor things.  Much of the AN helped me avoid these fears and anxieties.  I didn't have to worry about social rejection because I never went to parties because there would be food.  I didn't have to worry about not doing well in school because all that mattered was sticking to my eating/exercise routine.

Recovering meant not just embracing food anxieties (it wasn't easy, but it was relatively straightforward) and learning how to live with the more existential anxieties.  Things like: who am I? What do I want to do with my life? What do I want to do with my free time? What do I want to wear?

Recovery means that I am risking being wrong.

That scares the snot out of me.

The safe protected life that my anxieties would like me to live (the one where I eat the same thing, wash my hands in Clorox, and check and re-check everything) isn't always the life that I want to live.  It's not the life that I know would be fulfilling and make me truly happy.  That means I have to push myself.  Every day, I have to do something that scares me.

Sometimes those scary things can seem silly.  Things like just relaxing.  Or saying hi to someone.  It can mean leaving the house when I feel disgusting.   Answering the phone when I want to isolate.  Or not answering the phone when I don't feel like talking right then.

Life is fraught with uncertainties.  I can say that and say that, and it still doesn't get any easier.  Nor do I like it any more.  But there's also that radical acceptance that uncertainties are the price I have to pay for a life well-lived.

So I keep pushing.  And being scared.  And pushing again and again.  These things don't get less scary, but the thought of pushing myself does.  Part of the mental "game" of the eating disorder was seeing how long I could go without eating, how much I could exercise, how little I could weigh.  So I try to remind myself that meeting challenges is something I thrive on, and it's something I do well.

Lest I drift into the category of unbelievably sappy, I'm going to stop here. :)

Being fat is not a crime. Although really? We don't need to ask why some people are skinny, so why are we asking why others are fat?  Some people have more adipose tissue and that's all there is to it.  It's not a flaw or defect, it's just a fact.

How to Winterize Your Body to Stay Fit and Healthy in the Cold Months Ahead.

Hard work improves the taste of food.

Mirror, Mirror - A summary of research findings on body image.
 
From Farm to Fridge to Garbage Can--How Much Food is Wasted.
 
Positive Body Image is Always In Season: 7 Tips for Better Body Image Boosting.
 
Gastric bypass alters sweet taste function.
 
The real reason we're lazy.
The Taste Of Coke Is All In Your Head.
Exercise interventions for women with AN: A review of the literature.

My friend Charlotte had posted about how far her daughter had come in her fight against anorexia over the past year.  In an email to me, she asked me to post this on my blog:

This time last year (3rd November, 2009), my daughter's anorexia had changed my warm, funny bright loving daughter into a cobra with PMS, my other daughter was crying hysterically, my husband was as angry as a hungry grizzly and I have never felt so hopeless and helpless in the whole of my life. So, taking courage in both hands and laying aside my uptight English reserve, I posted on the ATDT forum asking for help.


And through them, I found Carrie.

A year on, a lot has changed. My warm, funny, bright, loving daughter is back. My other daughter only cries when she gets moisturiser in her eyes. My husband is back to his habitual horizontal position and I feel empowered and useful.

And, I still have Carrie.

We talked about how far we have come in a year and for both us, looking back, has been cathartic and hopeful.
 
I feel like I've known Charlotte for so much longer than a year.  She has truly become a dear friend.
 
And yet, looking back over this past year, I realize how far I've come.  I've actually embraced the concept of recovery, not just to get my parents off my back or to make my therapist happy.  There are still parts of recovery I hate, but I'm starting to really accept them.  I do still miss the eating disorder at times, but I also have other times when it's not at the forefront of my mind.
 
If you would have asked me last year what I would be doing in November 2010, I wouldn't have told you that I would be trying to buy a condo and working full-time as a freelance writer.  That I would actually be showing signs of success in my career.  To be honest, back then I wasn't really thinking of the future.  The future consisted of trying to weasel out of the next meal or next snack.  It consisted of dreaming and hoping and wishing.  Yeah, it would be nice to kick this ED to the curb, but it would also be nice if pigs would fly and my coffee cup magically refilled itself.  That didn't mean it was going to happen anytime soon.
 
My life isn't what I anticipated it would be before I got ill.  I didn't expect to be still living with my parents at age 30.  I didn't expect to have more health problems than I care to count and know that padded rooms on psych wards actually exist.
 
Yet time passes and things get better.  Until I got into this conversation with Charlotte, I didn't realize just how much progress I have made.  I am, by no means, totally recovered.  I still struggle with ED thoughts, but I find it getting so much easier to keep the behaviors in check.  Thinking of a life beyond the ED isn't just a pipe dream anymore.

I have the Arnold Family Thighs^TM. It makes jeans shopping an absolute nightmare, and let's not even start in on my body image issues.

But I'm not going to bore you all with an entire post about how much I hate my thighs.  I think about it enough.  Instead, I'm going to write about a time this past weekend when I didn't totally hate my thighs.

I've written about my love for my bike and how cycling has really helped in my recovery.  This past weekend, I did a longer ride as part of a group outing to a local national park.  The trip was really, really fun.  I was rather proud of myself that I kept up with the fastest in the group with no problem (except for the one self-proclaimed Speed Demon).  It was a mixture of road and paved and unpaved bike trail.  The weather was perfect, and I had a great time.

While I was riding, though, I wasn't cursing those Arnold Family Thighs^TM.  I was thinking that those thighs--my own damn thighs!--might be one of the reasons I was so good at biking.  Instead of being a liability in jeans and a bathing suit, my thighs were an asset.

I still hate how they look.  I still think they quiver so much when I walk that you could reasonably measure the vibrations on the Richter scale.  Cycling hasn't made me love my thighs, but it has made me appreciate their function.  I'm not going to get all sappy on you and write a long thank you note to my thighs.  That's not the point of this post, nor could I handle that much cheesiness all at once.  The point of this post is learning to appreciate something you don't like, of turning your liabilities into assets.

I've probably mentioned this before, but my OCD habits and behaviors have gotten me a writing job (that I ultimately turned down for other reasons).  My proposal was the only one without any typos, so the person picked me--I don't think I was supposed to see that email, but there you have it.  Most of the time, my OCD is a huge drain on me and the stuff I want to do.  I can't do things because I'm too busy checking and counting and double-checking.  I don't like my OCD stuff.  It annoys the crap out of me.  But as much as it has been a tremendous liability, it has also been an asset.

The liability of my thighs is probably mostly in my head--and in a few screaming hot pairs of jeans I had to leave behind.  But my thighs aren't universally bad or useless.  They help me ride my bike.

Wednesday is Tip Day, which means I'll be sharing with you some of my tried and true well-researched often improvised ideas for surviving recovery.

Dealing with Dubious Advice.

In a post a few weeks ago, one of my newest regular readers asked how I handled the ubiquitous health advice that seems to be everywhere.  Places like the American Heart Association recommend about 30 minutes of exercise per day.  Other places talk about limiting fat or carbs, or cutting back on calories and portions.

It's all well and good, but for many people with an eating disorder, it sounds so contradictory to what our treatment teams are telling us.  Eat more fat.  Take some days off exercise.  Pay attention to your hunger signals.  It's pretty crazy-making, trying to recover from an eating disorder and living in a world that is seriously messed up about food and weight.

So here are some ways in which I try to deal with the disconnect:

1. They're not talking about you.  These recommendations are for otherwise healthy adults with no big hangups on eating properly and exercising.  If you have an eating disorder, you're not generally healthy and this good-meaning advice can often backfire.  I often like to think of the recommendations that people drink a glass of red wine everyday.  If you're an alcoholic, drinking red wine is like playing with fire.  Any benefits of red wine will be dramatically overshadowed by the potential for relapse into alcohol abuse.  I'm not sure that cutting back on my fat intake will make me any healthier, but it will probably make me much more crazy.

2. They don't know you.  I hate sweeping generalizations (which may very well be a sweeping generalization in and of itself, but whatever).  They are often mostly true, but they also fail to consider the nuances of individual situations.  Think of something like wearing sunscreen.  It's a great thing to do, but someone with a significant Vitamin D deficiency might want to walk around for a bit without sunscreen to boost their Vitamin D production.

3. These are meant to be guidelines, not rules.  When I was in the midst of the eating disorder, if I read something like "Women should try to eat no more than X-Y grams of fat each day," I made absolutely sure that I only ate X grams of fat.  Not a milligram more.  The thing is, these aren't meant as die-hard rules.  It's hard for me to take guidelines as anything but literal rules akin to the Ten Commandments.  What the person writing this article is probably saying is try to eat around X-Y grams of fat each day, knowing that some days you're going to eat more and some days, less.

4. You're not the only one with eating issues.  Anyone can publish stuff on the web--it's one of the best parts of the Internet, in my opinion.  The problem is that you have have precisely zero in the way of credentials and still be thought of as very credible, even as you give out awful advice.  Sometimes, even the people with credentials are a little off their rockers.  What helps me is to remember the source.  The American Heart Association is really into heart disease and obesity prevention; their advice is going to be skewed in that direction.  Not that it's necessarily bad or wrong, but that's where it's coming from.

5. Talk to your treatment team.  If the advice you want to follow really is good advice, then your treatment team shouldn't have a problem with you following it.  So talk to them about it.  It can help clarify your motivations and help you make sure that your ED isn't trying to sneak back in.  If you're hesitating to tell your team about what changes you want to make to your food and/or exercise, that might be a sign that your motivations are more disordered than you are willing to admit.

6. Avoid it.  It's impossible to avoid all advice that might be bad for you--this kind of thing is everywhere.  But there are certain places (food and diet websites) where it's especially prevalent.  If it bugs you and throws you for a loop, don't go there.  Don't visit those sites.  I don't visit- they don't tell me anything I don't already know about how I can be healthier.

7. You are the exception.  All throughout the eating disorder, I thought I was the exception to the rules of biology.  I wouldn't have health problems.  I could start eating whenever I wanted to.  I couldn't eat that food without instantly getting fat, even though everyone else could.  It was almost laughable and pathetic.  Remember, though, that in terms of much of the "health" advice out there right now,  you are, in fact, the exception.  For you, stopping all physical activity may be the best thing for your health.  Or maybe adding more fat to your diet.  So enjoy the fact that you are special in this respect.

Last week, I was freaking out about the start of group therapy led by TNT.  Tonight was the second episode of Group Therapy, TNT-style, and it was much less intimidating than last week.  I wasn't quite looking forward to going--therapy is a positive experience, but it's not fun--but I wasn't freaking out, either.

Facing your fears sucks, and usually facing them results in this gradual ebbing of fear.  It usually happens so slowly, or over such long periods of time that you don't get to notice.

I noticed this week.

I still struggle with getting out of my head each week and really participating in the group.  I usually have comparison-itis, much of which is related to my own body image issues, and the rest of which has to do with how others are dressed, how they talk (ie, thinking I sound dumb when I open my mouth), if they work harder than me or have a cleaner house.  Things like that.  And it's all an excuse for me to find a big metaphorical stick with which to hit myself.

I'm guessing this isn't the point of the group.  Especially because I can compare and despair without driving for an hour and paying for group and individual therapy.  I know this has nothing to do with what everyone else has done, and much more to do with my own deep-seated feelings of inadequacy.  I'm starting to realize that I'm wasting much of my life beating myself up for things I have no control over, when there are really much more productive ways to use my time.  Like for the pointless navel-gazing I like to call blogging.

I think group will be good for me.  It's good to spend time with people who relate to what you're going through and can provide instant feedback.  I guess TNT knew what she was doing when she said that group would be good for me.