As one year begins its inevitable slide into another, I start thinking about another year with the ED, another year still not better.  Yes, I have made a lot of progress this year, but there is still far to travel.

I remember thinking after I had been ill for about a year that one whole year had passed without me eating or drinking anything without fear.  Actually, at the time, I thought of it as one whole year obsessing about eating.  I didn't see the fear/anxiety connection at that point.  I remember thinking that one year was quite a long time, but I also didn't see any way out.  It was tremendously disheartening and depressing (I was in the hospital at the time), but I thought that's just the way things were going to be.

It's been a decade since that moment.  It's been 11 years since I've eaten something without calculating calories or second-guessing whether I "should" or "shouldn't" eat it (yes, I do realize that I need to update my profile- I must have last updated it around two years ago).  My meal plan helps--the rules provide a necessary structure.  But I still frequently ask myself "Do I really need this slice of cheese, this pat of butter, this extra gob of peanut butter?"  I have to remind myself that yes, I do need this, even if I don't want it.

One of my old therapists told me that I should get mad at how much time the eating disorder has stolen from me.  I looked at her and I said: but I let it take this much time from me.  I can speak at length about the fact that eating disorders are illnesses, not choices, and I still can't shake the feeling that my suffering is my own fault.  That if I were smarter or less stubborn, I wouldn't have become anorexic in the first place or had as much trouble pulling myself out.  It's an odd disconnect.  I don't blame myself for my anxiety or depression, although I can't remember not being anxious and depressed.  I do remember there was a time before anorexia, although I have no idea what that was like.

I usually get all horribly introspective twice a year: on my birthday in July and around New Year's.  It's sort of the major landmarks of the passage of time in my life.  Winter, summer; age, year.  I'm not despairing about my recovery, but I do start to hyper-analyze things.  No, it doesn't usually help, but then, I don't do it to feel better.  I just feel compelled somehow to take stock of my life over the past year.

And 2010 has, on the whole, been pretty good to me.  I fought for that good.  I fought hard.  I quit my first job for reasons totally unrelated to the eating disorder--never done that before.  I either got sick or sacked first.  I bought a townhouse, I started a new career, and succeeded fairly well at that career.

Still, in the dark hours of the night, I feel irreparably broken.  That my life may never be normal.  That I may forget that it's possible to eat a meal without scrutinizing every crumb.  That, ultimately, I'm damaged goods.

But we're all damaged.  That's part of being human.  We all have our baggage and our semi-healed wounds.  Those wounds become scars that fade but never completely, and still we put one foot in front of the other and get on with things.

That's what I wish for you in 2011: the fading of hurts, the learning from pain, and the getting on with life.

Model and actress Isabelle Caro, most famous for posing her emaciated body in a 2008 anti-anorexia billboard, died at age 28.

Her goal, says the Los Angeles Times obituary, was to show others the dangers and horrors of anorexia in order to prevent the illness.  A noble and honorable goal, to be sure--but Caro knew and lived these dangers and horrors of anorexia, day in and day out.  Still she could not shake her illness and instead died at age 28.

The billboard that flung Caro into the limelight was produced by fashion company Nolita, in an effort to raise awareness about anorexia in the fashion industry.  Aside from the fact that I'm not convinced of the relationship between anorexia and fashion, Nolita was happy to use Caro's wasted body in their ads.  They were happy to use the shock value and run with it.  Yes, the company likely meant well by it, but what was that phrase about the road to hell being paved with good intentions?

After the April 2008 billboard, Caro went on to be a guest judge on "Top Model France," to write a book and song lyrics, to appear in television and film.  All while deathly ill with anorexia.

When I heard of Caro's untimely death, all I could think was: these people were using this poor girl.  They knew she was sick.  It was obvious just by looking at her.  They knew she was dying from a lethal illness and yet the chose to look the other way.  Maybe they figured that as long as Caro thought she was fine, then she had to be fine.  She was "trying" to get better, but your heart, your liver, your immune system don't much give a damn about trying.

It was like what I used to tell people: I'm working on it.  Which is all well and good, but Caro's and my lack of progress should have made it damn clear to anyone not blind that no progress was actually being made.

Yeah, I'm angry.  Media outlets and corporations were all too happy to let Caro continue on her merry way and not actually address her illness.  I'm guessing some of them told her she should gain weight and eat some more.  Gee, you don't say.  Caro had probably never heard that advice before, right?  If they cared, they should have refused to cast her until she was healthy.  It's hard enough to give up an eating disorder even when it's robbing you of everything in your life.  But when you can have the life you want and the eating disorder? 

The immediate cause of her death wasn't disclosed.  But the media industry--the very ones Caro turned to in her efforts to warn others of the dangers of anorexia--did quite a bit to contribute to her death.  She very well might have died if she didn't become famous.  Yet the people who knew and worked with her had an opportunity to close down any path but wellness and recovery.  And they didn't.

That's what makes me the most angry and the most sad.  That so many people are willing to ignore such a blatant disorder and look the other way.

Yes, I know, it's Monday.  But I fell asleep last night before I could post the smorgasbord, so without any further adieu...

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

A Losing Personality: Being neurotic boosts your chances of losing weight—lusting for adventure does not. A fascinating look at personality traits and weight loss- the links to eating disorders are really obvious.

The rise of the lifestyle nutritionist.

It's Beginning to Look A Lot Like Diet Season...

Smorgasbord of genomes for food lovers.

Think you can take a holiday from your eating disorder recovery? Alas, no. You can't.

Free online workbook, Overcoming Disordered Eating.

Need support for loneliness? Find out about website webofloneliness.com here.

Trouble with your health insurance coverage for ED treatment? Report insurance non-compliance with the Mental Health Parity Act.

What is "eating competence" and does it work?

"Real doctors, real people" series profiles Dr. Cynthia Bulik, her life as an ice skater, scientist.

Geneen Roth on how stopping the calorie counting changed her life.

Hungry for Meaning: Why Tofu Burgers Taste Better than You'd Expect.

I never used to be much of a TV fan.  As a kid, I was always far more interested in books.  Once I moved out of the house, I never had the money for cable.  Since moving back in with my parents a year and a half ago (has it really been that long?!?), I've gotten hooked on the show House.  I bought Seasons 1-5 on DVD--half price in the bargain bin at Barnes and Noble--and will pick up Season 6 for $15 at Target as soon as I'm no longer snowed in.

It's been nice, too, as I've gotten my dad hooked on the show.  Which has been a nice bonding experience for us.  We're too damn similar and have historically butted heads.  But a TV show is a nice opportunity for us to spend time together.

So.  To the actual point of this post.

My dad and I were finishing up Season Two of my House DVDs, and Wilson said this (I totally forget the context--I've seen too many episodes lately):

HIV testing is ninety-nine percent accurate, which means there are some people who test positive, who live with their own impending doom for months or years before finding out everything's okay. Weirdly, most of them don't react with happiness, or even anger. They get depressed, not because they wanted to die, but because they've defined themselves by their disease. Suddenly, what made them 'them' isn't real.

And so it goes with recovery.  Not because the ED wasn't real, but because it's hard to go from defining yourself (or being defined) by an illness or set of behaviors to being out there in the wide, wide world with nothing to anchor you.

The AN gave me a sort-of script to get through life.  My fear of food and eating ruled everything, so I always knew how to respond.  If the situation might involve eating, say no.  If the situation involves exercise, say yes, and then skedaddle before people suggest food.  And so on.  My life was carefully calibrated by these rules.  It was miserable and lonely, but it did provide me with some manner of direction.

I never really thought of myself as "an anorexic," but everything I said or did was filtered through anorexia.  My friends didn't necessarily know about my ED, but they were aware on some level that I didn't eat in public, or I was always at the gym.  Things like that.  My illness was my identity--it was how I defined myself and organized my life.

I wasn't proud of that label.  I never joined websites proclaiming their "Ana Pride!" because I was very ambivalent about the whole thing.  I did view some of the behaviors--how long I could go without eating, how long I could workout--as successes, but they were very much internal things.  It never occurred to me to share them with others.  I also didn't want to see myself as being ill, because that would take the air out of some of the seeming "benefits" of AN.  If I was starving myself because I was sick, then I couldn't use that to feel good about myself.  If I was starving because I had lots of willpower, then, well, that was something.

Recovery means letting that go.  Recovery means cutting the anchor and redefining yourself.  An ED consumes everything in your life--friends, family, free time, hopes, dreams, you name it.  Without ED, it seems, you have nothing.  Where was my script?  Where was my ability to self-soothe?  I'm supposed to leave behind the one thing that made it easier to be me?

Faced with that, it's not surprising that I initially said "Well, hell no!"

As time passed, I began to realize that my fixation with this label, this definition, was killing me.  I felt that the AN did make me me, and yet I didn't like that me anymore.  The one who lied and cheated.  The one who didn't call friends back because it might interfere with my workout schedule.  The one who was snappy and waspish and depressed and never wanted to get out of bed except to make the pilgrimage to either the treadmill or the scale.

I'm still working on redefining myself.  The ED identity isn't totally gone--it was a part of me for such a long time that I can't just forget about it.  I'm trying to make peace with the stage of "figuring it all out."  I would like an answer, but searching and seeking is nonetheless a valid place to be.

I got some wonderful replies to yesterday post In Defense of Biology.  I was responding to one of these comments, when I realized that what I was saying was a post in and of itself.  So I moved it to an actual post.

First of all, here's the comment:

We're on a slippery slope, as patients, when considering the role of biology and the disease process. On the one hand, acknowledging a biological root to a disorder allows us to let go of some guilty, feeling (appropriately) that something else contributed to this condition or caused it.


On the other hand, it seems we often view biology as simply medical, that someone medical will need to fix for us, taking away our responsibility to also help ourselves.

The more the medical community seems to learn about most diseases, the more it appears they are more complex than we originally believed, combining genetic predisposition, an environmental trigger and then support of the disease process.

It's the middle paragraph that intrigued me the most.  I'm not entirely sure I see how viewing eating disorders as biological and/or medical takes away our responsibility to help ourselves.  Yes, newer treatments like Family-Based Treatment do take away the sufferer's responsibility to feed themselves.  But the goal of FBT is ultimately to give these responsibilities back.

Part of treating a broken ankle is resting the injury and putting any weight on the ankle.  It's temporarily relieving the ankle of its responsibility to help you walk, yes.  It's also a medical treatment.  But the point of using crutches for months is to let your ankle heal so that you can walk properly again.

One of the most frequent reasons I've heard against understanding the neurobiology of eating disorders (besides the fact that our culture equates biological with "I'm screwed, so why bother.") is that it makes people into passive, helpless victims.  But is that really true, or is that just a faulty assumption on our part?  I bet if you asked, say, a breast cancer survivor, you would hear that a cell in her breast couldn't stop dividing, but then she got treatment.  That treatment isn't entirely passive.  She had to show up.  She had to get her mammogram or do her self-exam.  She had to have the scans and the biopsies and the surgery and the chemo.  All very medical things.  None of which relieved her of responsibility for managing her illness.

It did say that she couldn't stop that cell from dividing.  She couldn't ask the cell if it had issues with its mother, and hope that if she gave the cell some control, it would stop dividing.  No, the cell was going to keep dividing and keep making that tumor bigger because that's just what cancer cells do.  With an eating disorder, the life-threatening behaviors aren't going to go away on their own.  After a while, biology takes over, and ain't nobody messes with Mother Nature.  The sufferer needs help and support to be able to stop.  Viewing this as a medical issue doesn't mean the patient is helpless. Nor does the medical view discount the fact that things that happened during this woman's life may have increased the chance she ultimately got cancer.

Doctors never viewed my broken ankle as anything more than a broken ankle.  They did realize that osteoporosis had ravaged my bones.  They did ask questions like "You broke your ankle doing what?" (I slipped on a patch of black ice in front of my apartment.  I still get panic attacks when I have to walk on ice).  But the surgery to repair the break and the rehab and all were essentially medical.

Other than occasional soreness and swelling and two nasty scars, my ankle is fine.

People use the word medicalization like it's some sort of cuss word.  And yes, medicalizing things (such as grief) can be unnecessary and rather harmful and counterproductive.  A grieving person doesn't need a pill.  They need neighbors to bring them casseroles, friends to listen to them cry, and time to heal.  There are lots of examples of making normal things medical conditions--I won't deny it.

But we medicalize cancer.  We medicalize tuberculosis and diabetes and Alzheimer's disease.  I'm not entirely sure I understand how mental illness in general and eating disorders in particular are different.  I, for one, am glad the medicalized broken ankles so I didn't have some BO-laden guy laying his hands all over me and telling me the Lord Commanded It!  I'm glad they no longer think of epilepsy and seizures as being the mark of the devil and instead give you EEGs, medication, and one of those little alert bracelets. 

If someone offered me a pill that would make my eating disorder go away, you better fucking believe I would take it.  I don't need to spill my guts to a therapist for $100 each week to create meaning to an illness.  I go to therapy because it's the only thing I've got.  Creating something metaphysical out of an illness doesn't create a cure.  Honestly, giving meaning to my suffering and illness is nice, but really?  Cancer patients don't need to do it in order to get better. Nor do diabetics.  Nor do people with schizophrenia.

I don't know--maybe I'm just bitter.  I would love to be able to take a pill for my eating disorder.  That might make me lazy or unwilling to do the hard work of recovery.  Maybe that is true.  But it would be nice nonetheless.

Many of you have asked, so here is a link to some pictures I took of my new condo yesterday.  All of the Polident chic decor has been moved out (excepting the rosette shades and pink drapes), and you can get an idea of my new place.

Carrie's New Condo!

And since we're on the subject of pictures, here's the latest one of Aria, basking in the sun on the shores of the Kitty Riviera:

The influence and importance of biology is an interesting and controversial topic in the field of eating disorders.  When I was first diagnosed with anorexia ten years ago, the debate centered more on if biology was involved.  Now, it's pretty widely accepted that biology is a factor in eating disorders. The question that remains is how important is biology.

We don't have percentages.  No one can say that biology is 75% important, and environment is 25%.  Every person I have met with an eating disorder has at least one (and often several) tick marks in each category.  For me, in the biology category, I have

• impaired set-shifting
• anxiety
• perfectionism
• depression
• loss of appetite under stress
• temperament traits of harm avoidance, low novelty-seeking, high persistence

In the environment category, I have

• thin-is-in culture
• tried to lose weight
• teased (weight was among those topics, but not always the focus)
• achievement-oriented culture
• fat phobic environment

So, yeah.  It's not an either/or question, and it frustrates me to no end that so many people think that it is.  This isn't a game of Red Rover, Red Rover.  You don't need to pick sides.  In fact, you can't pick sides because you can't separate genes and environment.  It doesn't work that way.  Environment affects what your genes do, and your genes affect what environments you seek out.

Even the researchers who specifically study the neurobiology of anorexia don't say that culture is irrelevant.  They say (and I would agree) that culture doesn't cause eating disorders.  But that's far from some sort of robotic, reductionist view that life is just some biochemical soup.  The study of biology in relation to eating disorders has added volumes to our knowledge about the subject.  Biology is a powerful thing.  We shouldn't take it for granted, nor should we scoff at it as an easy way out.  If it's biology, you're either stuck with it, or you just take a pill and All Better!

Which is really funny because none of the researchers I know think anything even close to that.

This is why I was really chagrined to read this article on addiction and eating disorders.  It starts as follows:

These days researchers and writers like to boil all maladies down to the biochemical level. The medicalization of all things sure makes life simple: if it’s just faulty brain chemistry, then there’s eventually going to be a pill for it.


But there is no pill to erase the feelings that grip Katherine’s gut when she walks into her childhood home for Thanksgiving. The Marlboro stench of the old curtains, the worn areas on the carpet, the heaviness on her mother’s hips and in her voice, the back bedroom filled with unopened boxes from QVC shopping binges, her father’s palpable misery about his job, the bathroom where she first learned to throw up…

I will say that when neurobiological studies were first published maybe 20 or 30 years ago, people probably did hope that we could take a pill and cure all of our mental ills.  We've gotten a lot older and a lot wiser since then.  No one remotely believes that you take a pill and bye-bye eating disorder (or depression or anxiety or whatever).  Medications can help, but they're not a cure-all.

Secondly, there's a growing body of research related to PTSD of what happens to the brain during stress and during traumatic events.  Psychologists have long known that environmental cues are a huge factor in relapse in drug addiction.  It's environmental (you see or hear something that reminds you have your drug use) AND it's also biological (this triggers memories and cravings and dopamine and what have you).

Memories are powerful.  One of the times I was most powerfully triggered was when I spoke with the boss I had from when I was most acutely ill.  I was shaking when I hung up the phone.  I wanted to throw up.  I never wanted to eat again.  Her voice immediately took me back to that place.  It's another reason I avoid the gym.  Memories of my exercise addiction trigger cravings for more exercise.

Researchers are looking for ways to help the brain unlearn the traumatic response to an event, and some of these methods may involve pills.  But a pill isn't going to cure PTSD, it's not going to cure anxiety and depression, and it's not going to cure eating disorders.

Walter Kaye is probably the top neurobiologist in the eating disorder field.  And he doesn't give out pills at this San Diego clinic.  He delivers therapy.  Therapy changes the brain.

Biology isn't a dirty word.  It's not the lazy way out, and it's not ignoring or neglecting environmental influences.  And it is important.

Now that I've closed on my house and am waiting to hear about several writing gigs in the near future, I'm sitting with a lot of anxiety.  Like many people, especially those with eating disorders, I find change difficult.  The thought of change makes me nervous and apprehensive--what if things don't go right?  What if they do?

Then there's the simple fact that I don't like change.  It's a fact.

Let's face it: I'm moving from an environment with a built-in support system to living on my own (albeit only fifteen minutes away).  I have some career uncertainty, and with that comes financial uncertainty.

In the past, I have tried to cope with change in some, shall we say, less-than-productive manners.  I have too much on the line now.  I don't want to go back to the eating disorder.  Which means I am going to have to figure out some way to cope with the change.

Basically everything in my new place will be familiar, as I already have most of what I need.  I'm having a new sofa delivered tomorrow, but that's pretty much it.  I will also have mostly the same food around, and use tried-and-true recipes.

Oh yeah--I'll also have the same cat. :)

In the past few months of freelancing full-time, I've come up with a solid daily routine. It can be a little unusual (I hate mornings and don't expect that to change), but it works for me.  So I have that to rely on, too.

What has helped me the most is reminding myself that I have the skills and strength to cope with these changes, even if they do go pear-shaped. That I've coped with it in the past and I can do so again.

Change does stir up a lot of ED crap.  The body dysmorphia has never really gone away, and the chattering has gotten a little louder recently.  I've started to fantasize about having my own exercise equipment--what fun I could have!  I know that's a Very Bad Idea, and even if I didn't, I don't have the spare change to buy it anyway.

I have to keep telling myself that these thoughts are just a sign that I am stressed, not a sign that I am a fat, lazy cow.  Having a thought doesn't make it true. {{See, TNT, I really was listening!}}

I also have to keep telling myself that it's normal to feel apprehensive at times like these.  When I was first diagnosed with anorexia, I was told that I was having trouble "individuating" from my parents.  Aside from the fact that, outside of my mental health issues, I was handling my own life just fine, thank you very much, didn't seem to matter.  I've been itching to start my own life for months now.  But with the privileges of adult life (you mean I don't have to go to bed on time?) come the responsibilities.  Paying the bills is a pain in the ass.  So is emptying the dishwasher and taking out the trash.  As much as I hate the fact that I'm currently living with my parents, I also know that I've had things pretty plush.

My goal for the transition is to establish healthy new routines so that I can stay sane and stay on track with my recovery.

Orthorexia: An Unhealthy Obsession With Healthy Eating.

Cracking the moody brain: The rewards of self starvation.

Kids Who Won't Eat: How to Help Children with Eating Disorders.

Adventures of a manic-depressive web server.

Social Anxiety Sufferers May Have Inaccurate Self Identity.

The woman who can't feel fear may give scientists new insights into PTSD and other anxiety disorders.

Link found between shoplifting and eating disorders in women.  The similarities are especially profound when reading about how the women described the dissociation around shoplifting and their ED--it's a feeling I know well.

Hope When Recovery Seems Impossible.

Seeing My Past Eating Disorder through the Eyes of My Daughter.

The Truth About Holiday Weight Gain: the average woman gains around half a pound.  This only makes those shrill articles about "How to avoid getting the gift of TEH FATZ this season!" more annoying, if that were possible.

Holiday Eating: Getting Rid Of The Guilt & Restriction.

4 Things We Learned About Fat This Year.

What It Means To Fear Food: Q&A With Expert Marcia Herrin.

Fast Food and Sweets Advertised When Children Watch Television.

Scientist Shows Link Between Diet and Onset of Mental Illness.
Eating disorders are an equal opportunity offender: Rates of eating disorders in kids keeps rising.

If two's company and three's a crowd, and if the third wheel is usually something that feels unnecessary, then I usually feel like the third wheel when I go out with people.  It's not that I feel less welcome than, say, the second wheel, but I do feel like an add-on.

It's not what others are doing, it's what I associate it with. When I was younger and in elementary and middle school, I was usually the last person picked for group activities, for teams in gym class, for pretty much anything besides academic projects, in which everyone could mooch off of me.  You know how there would be an odd number of people, and you'd have 10 groups of two and one group of three?

I was almost always in that damn group of three.  Not because two people wanted to be with me, but because the teacher or whoever stuck me with someone.

So yeah, I really dislike that feeling of being a third wheel.

And because I haven't really established my own group of people where I live now, and because this stupid dating thing is slow as hell, I usually end up tagging along with my parents.  Like I said, I don't feel unwelcome, but I do feel unwieldy.  It reminds me of being back in the third grade and waiting for someone to take pity on me.

It's that feeling that if I left, everyone would still have somebody else.  Feeling extraneous.  Not unwanted or unwelcome, but unnecessary.

I hate this feeling.

I know I'm not in third grade anymore, that no one's making my friends and family include me in their activities.  I know they genuinely want me there with them.  That's what makes this different from third grade. 

The other thing that grates is that I'm how old and the only people I have to hang out with are my parents?  It's...disheartening? Embarrassing?  Pathetic?

Despite knowing that my friends and family really do want me to spend time with them, I still often feel that I need to fend for myself.  That if I'm not careful, I will once again be left alone.  That no one will pick me out and say "I want to be her partner!"  I've never really experienced that.

I try not to let these feelings get me mopey, but, the fact is, they often do.  And these feelings stir up that nasty pot of loneliness, which sucks.  I feel like I am working hard, I am doing all the right things to meet people, and I still spend my Saturday nights with my parents.

The only question I can ask myself is: what the hell is wrong with me?

My mom was telling me about a clip she saw of Sarah Palin's new reality TV show (please don't judge me based on my relative's appalling TV-viewing habits) wherein she's trying to teach her daughter how to shoot some sort of large animal.  A bear, maybe?  Anyway, her daughter (don't know which one, but I'm hoping its her oldest) took a shot and the animal either didn't die or she missed.  The daughter put the gun down and my mom said that Sarah Palin said, "Don't retreat; just reload!"

{{She probably didn't use a semi-colon, but I'm a professional writer; semi-colons and I are Very Good Friends.}}

I've been to Alaska.  It's a lovely place, but that's not what this post is about.  Nor is this post about shooting animals, which I don't condone unless Mr. Grizzly is going to eat you.  This post is about the quote: don't retreat; just reload.

I don't give up easily, but my basic MO towards life is to retreat.  To pull back, pull my head inside my shell like a turtle.  It's not a bad strategy--after all, turtles have been around for hundreds of millions of years.  Natural selection wouldn't stick with a crappy strategy for that long.  And yet turtles aren't major predators.  When someone is a go-getter, when someone overcomes something in their life, it usually isn't because they've hid inside their shell the whole time.

During recovery (see, I told you this was relevant), I might try something new, but the eating disorder didn't just give up and die.  It takes an awfully well-placed bullet to kill a grizzly in one shot.  It takes an even better one to fell an eating disorder.  So I acted my usual turtle-y self and retreated.  I left the ED around because if I couldn't kill it even with a shotgun, then I may as well hide.

When you're in the moment and scared out of your wits, it's hard to understand that maybe you just need to reload.  Okay, it's hard for me to grasp that I might need to reload.  I'm looking for the nearest tree or highest cliff.  I want to know where I can hide, not where my spare bullets are.

My insinct wasn't to keep fighting the eating disorder. It was to run away and hide.

I needed someone to keep yelling in my ear that I should reload, not retreat.  It went against every instinct I had.  But when I couldn't run--when I couldn't stop eating again--I would reload.  And fight.  Again and again and again.

By almost overwhelming request in last week's scientific random poll, you all wanted to know how to deal with dumb, annoying, and triggering comments about food and weight.  And because I love you all to bits, here are my thoughts.

1. It's unavoidable. People are going to say something stupid.  It's inevitable. You can't prevent it.  There's nothing you can do to stop it, so don't waste time trying.  Save your energy for figuring out how to cope.

2. Take a deep breath. Before you do anything--before you freak out, before you call someone a douchebag, before you start crying--breathe.  Anything you say or do will still be a good idea after you take a few good, deep breaths.  It gives you a few seconds, a little time to calm down and let your wise mind get stronger.

3. It's not about you, it's about them. When someone says something about how you look or what you're eating, it says that that's what they're noticing. It doesn't say anything about you.  People are going to notice things, they are probably going to look, but bringing it up (unless it's a matter of acute concern) is kind of rude.  So don't take it personally.

4. Know your limits. Before you go into a situation, try and get a grip on what you're willing to let slide, what you're going to comment on, and from whom.  There are people in my life who have never understood, will never understand, and there's no point in getting them to understand.  My response is generally grunting or something similar.  I've had other people who have a chance at understanding what's appropriate and helpful and what's not.  So I will speak up with them.  Knowing the difference can save you a lot of hassle.

5. Don't explain.  You don't owe people an explanation for how much you're eating or how much you weigh. You can answer questions and still provide minimal information. If someone comments that you're too thin, you can just say you have trouble keeping weight on.  If they comment on your food, you can say that you're working with a doctor and nutritionist to meet your nutritional needs.  It's your health and your life, and you don't need to explain it to anyone if you don't want to.

6. There's a time and a place for snark. Despite my having plenty of appetite for snark here on my blog, I generally steer away from it in my real life.  I've had complete strangers and random medical professionals tell me idiotic things.  Generally, I let it rip to complete strangers and others I won't have to deal with.  When it's a person I have to deal with a lot, I keep my answers much more aboveboard.

7. You can choose not to answer.  It's not the same as letting people walk all over you.  It's not the same as being evasive.  It's you being in charge of your life.  It might piss some people off.  That's okay.  Your goal isn't to make everyone happy.  And with that, see the next tip.

8. Keep your goals in mind. When dealing with difficult situations, I try to ask myself the goal of this interaction.  Sometimes, it may be to educate the person about stupid things they shouldn't say.  Sometimes, the goal is to get them to shut the hell up.  Others, it might be getting through the interaction without strangling the other person.  That goal will help guide how you choose to respond.

9. You always have a choice.  Your choices can suck.  You might not like any of them.  You might wish you had different ones.  But you can always choose how you respond.  Are you going to choose health, life, and recovery after someone comments on weight gain, or are you going to go back to the eating disorder?  The first one may feel more uncomfortable now, but it's more rewarding in the long run. You can choose to walk away from rude, insensitive conversations. You can avoid people.  You can surround yourself with supportive people. You can choose to attend a holiday dinner to keep the peace and put up with dumb diet talk.

I hope these ideas help.

Share your suggestions in the comments section!

About two months ago, I mentioned that the condo I was looking at didn't work out.  The mortgage fell through because there was Chinese drywall in the complex, and no one would close on a loan if there was even the remotest possibility of having Chinese drywall.  So I had to walk away.

The news of the drywall in this condo complex actually made the news, which was really funny.  My name was never mentioned in this context, but I never expected that it would have made the news on TV.

I was really upset by this, not only because I had to leave a condo I really, really liked, but also because I had to go out looking again.  The fact that the one major condo complex in the area was now off-limits left me with much fewer options.

The good news is that I found a place.  And it looks like I'm closing on Friday.  I didn't want to mention anything until everything was certain because I didn't want to have to make another update announcing I had to walk if the mortgage fell through.  It was dicey because I am self-employed, and I practically had to sign over my firstborn child, but the right people have checked off the right boxes, and--fingers crossed--everything will be mine on Friday.

The place I found is a townhouse with two bedrooms and two baths.  One bedroom is on the first floor, and I'm turning that into my office, piano, and guest room.  There's a full bath, a living/dining area and fairly small kitchen on the first floor as well.  Then there's a loft area with a wall full of built-in storage cabinets (perfect for yarn!) and a master bedroom upstairs.

I won't move in until the beginning of January. The carpets need to be cleaned, and I need to get new light fixtures for the bathrooms and then have everything painted, which will be much easier when all of my crap isn't in the way.  The exception is the sleeper sofa I got for the guest room which will be delivered next week.  I will probably need to replace the kitchen counters soon--there are a number of stains but they're definitely still usable.  And it needs new blinds as the current ones are old and dirty and don't work all that well.

I don't have pictures as the place was decorated in what can only be described as Polident Chic, and it's hard to actually see the place beyond the lady's angel figurines and rosettes.  Not my taste.  So once I actually get the keys to the place, I will take pictures and share them here.

Phew.

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

The imagination diet: People who imagined indulging in sweet/salty foods ended up eating less of the actual food. It's interesting to think that one of the symptoms of starvation (obsession with food) might actually make it easier to go without food. It makes evolutionary sense--there's no point in wanting to eat if there's nothing to eat.

Gene-environment interaction in anorexia nervosa: relevance of non-shared environment and the serotonin transporter gene.

Eating Disorders in Pregnancy - Risk of Miscarriage.

New Study Questions Parents' Influence on Their Children's Eating Habits--suggests it's limited.

Body image and eating disorder symptoms in sexual minority men: A test and extension of objectification theory.

New study of 4 holiday gifter profiles + what constitutes a "great" gift. Also, my gift picks for the scientists and geeks in your life.

Ballet's big fat body issues.

Body dissatisfaction, ethnic identity, and disordered eating among African American women.

Intuitive Eaters' Holiday Bill of Rights.

A systematic review and meta-analysis of cognitive bias to food stimuli in people with disordered eating behaviour.

Eating disorders a problem among Orthodox Jews.

Battling Anorexia: When Parents Take Control.

I don't usually read news about celebrities, even when it does pertain to eating disorders. But by mistake, I clicked on a link about actress Portia De Generes, who has been in the news about her own eating disorder and subsequent memoir.  It was a very brief article--it covered a book signing--but there was one quote from Portia that really struck me:

I didn’t decide to become anorexic. It snuck up on me disguised as a healthy diet, a professional attitude. Being as thin as possible was a way to make the job of being an actress easier…

It's something I really understood.  I'm no actress, but being anorexic made it easier to be me.

Anorexia distilled all of those nagging doubt, those annoying existential worries, into just a few questions: How many calories did I eat? How many did I get rid of (exercise/purging)? What do I weigh?

That's it.  That's all that mattered.

I went through phases where other questions would branch off from those (How many fat grams? How many pills? How many hours without eating?) but those were The Big Three.

Worrying about my career choice seemed like small peanuts compared to thinking about how to construct a low calorie dinner followed by a brutal cardio routine.  It made life feel manageable.  Those three things were something I could control.*

Like Portia, I didn't decide to become anorexic.  I thought I was exercising more and cutting out extras to feel better and yes, have the five or so pounds I'd recently gained go away.  And I often hid my eating disorder behind the guise of a strange diet, a love of the gym, a need to be "healthy."  It took me a long time to understand that I wasn't someone who loved to exercise, I was someone who was addicted to exercise.  And that "healthy eating" was a big joke--I didn't give a damn about health and I knew it.  But it was something that would make other people get off my back, and for a long time, I honestly thought there was nothing wrong and I had the situation under control.

The rigidity of anorexia fit my persona: the driven go-getter, the ambitious student.  No one questioned that things might be going to far until they were so far gone that I was well and truly f*cked.  My attitude towards life was reflected in my attitude towards food.  Nothing less than the best. Don't play if there's still work to be done. You're too lazy, you need to work harder, you're going to fail.

And that has been the hardest part of letting go, having to give up the one thing that seemed to make life easier.  What has helped was realizing that it didn't actually make life easier, it just made life seem easier.

*I still get skeevy when people say an eating disorder is "all about control."  It's not all about control, but control is a major theme for many people with eating disorders.

Today's Tip Day can be summarized thusly:

Don't forget it's tip day.

I totally lost track of the fact that yesterday was, in fact, Wednesday, and that Wednesday means Tip Day.  I never forget the smorgasbord, but remembering Tip Day is far harder than it should be.

Compounding this is the fact that I rarely have good ideas floating around to really choose from.

With that in mind, please use the comments section to share topics you would like me to cover for future Tip Days!

A week or two ago, I mentioned that TNT is leaving clinical practice at the end of the year.  She gave me three therapists in my small town who had at least some familiarity with eating disorders.  One of the therapists wasn't taking new clients at this time, although she said if the other two didn't work out, she would see me.  I called the other two; I left a message with the receptionist of the first therapist and didn't hear back.

I had a "getting to know you" appointment with the third therapist (I'll call her Dr. H) this afternoon, and I really liked her.  Her primary focus is eating disorders, and she's loosely affiliated with the local college.  Ironically, we both graduated from the same college in Michigan, although she's a number of years older than me.

She described herself as mostly therapist, but also part coach and cheerleader.  As needed.  I liked that.  I like the hands-on approach.  Talking about feelings isn't something I find universally helpful.  I like CBT stuff, and that's her major orientation.

{{Dr. H also had a Keurig coffeemaker in the waiting room, which was a very nice bonus. If I ever come into a boatload of cash, I will make large charitable donations but I will also buy a Keurig.}}

So I think I'm going to start seeing her in January, after I wrap things up with TNT and we get through the holiday festivities/insanity.

As much as I love keeping up to date on ED news and research, I sometimes cringe when I click on a link.  Is the author of this news story going to screw it up?  Will they have done their homework?  Much of the time, the stories are a mixed bag--some bits are okay, some could use a bit of tweaking.

Every once in a while, though, someone knocks it out of the park.  With these two stories, though, the authors didn't do so in a good way.  It was awful.  I don't know whether I blame the journalist more, or I blame the people they interviewed.  Or both.

So for the first one:

Is Victoria's Secret Peddling Eating Disorder Porn?

No, Victoria's Secret is peddling overpriced unmentionables.  They're also peddling sex and clothes that make your partner want to do you.  They're peddling an image.  They're peddling an image of a sexualized, idealized women with huge boobs and a tiny waist.

It's very common for people with eating disorders to compare themselves to these idealized images and find themselves wanting.  It's also very common to try and lose a few pounds or get breast implants.  All of which are a waste of time and money and form a tremendous drain on society.  But really?

Eating disorders existed long before women with gigantic breasts and push-up bras paraded around on national television. In the Middle Ages, women with eating disorders compared themselves to holy women and other saints.  Those were the idealized images of what a woman could be, if she tried hard enough.  Part of that trying involved fasting for religious purposes. 

Today, some people with eating disorders fast for cosmetic purposes, or to be better at a sport or it just sort of happens.  It could very well be that women in the Middle Ages had a variety of reasons that motivated their behaviors.  They probably did.  The world may very well be a better place if Victoria's Secret disappeared. It would definitely be a better place if we stopped promoting only one body type as beautiful or sexy.  But whether there would be fewer eating disorders?  I'm not entirely convinced. 

These images, and our society's obsession with food and fat, are the cultural backdrop against which eating disorders occur.  We use and co-opt this language to help explain what we're going through.  Although exactly what motivates an eating disorder is far from irrelevant, motivation doesn't always explain causation.

Which brings me to the second article.

Butler Hospital Physician Too Familiar With Eating Disorders

Based on this doctor's quotes, however, I might advise a little more familiarity before saying such things as this:

Qualls said the disease usually arises from a person’s unhappiness with their appearance.

The media play a role in the equation, he said, providing a model of the body that may not be realistic or healthful for people to strive to imitate.

...Diseases such as compulsive purging or not eating tend to occur during transitions in life, he said. Among them: girls going from eighth grade to high school, “which is a triggering event because all of the sudden boys become more important,” he said. “The next change is when they go into college. Once they experience [a disorder], they are at risk of this recurring at any point for the rest of their lives.”

*headdesk*

In case this isn't obvious by now: my eating disorder had nothing--nothing--to do with wanting to look good or attract men.  Nothing.  I thought that eating better, exercising more, and yes, maybe losing 5 pounds would help me feel less depressed.  After a while, I knew I looked atrocious.  I thought nothing about sex and dating.  I knew that the ED was destroying my health and appearance, and yet I couldn't stop.

The concept of "re-education" sounds very Soviet, and maybe it is, but I kind of want to have an intensive training program for these journalists and especially these doctors before they are allowed to even see another ED patient.

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

NPR weighs in on food addiction and brain chemistry.

Inside one boy's anorexia: "How can I burn the most calories?"

Subconscious saves the day when the hungry brain fails.

Dealing with the Guilt of Overeating.

Women's diets not a man's domain.

Male students eschew balanced diet in favour of supplements.

Psychiatric Comorbidities of Female Inpatients With Eating Disorders. It's a few years old, but it's really interesting.

Social Anxiety Sufferers May Regard People Too Highly. In a word: yep.

How neuroscience can help you design your kitchen.

Aberrant Brain Activation During a Response Inhibition Task in Adolescent Eating Disorder Subtypes.

Becky Henry's new book, Just Tell Her to Stop, is now available for pre-order.

Identification and Management of Eating Disorders in Children and Adolescents. This research sparked numerous news stories like:
Rates of Eating Disorders on the Rise in Kids.
Rate of Eating Disorders in Kids Keeps Rising.

Does Extremely Picky Eating in Adulthood Signal a Mental Disorder?

Treating eating disorders and paying for it.

Linear growth in anorexia nervosa.

Inside the online sisterhood of eating disorders.

Last night, I had a fat attack.  My old therapist back in Michigan would have preferred that I reframe it as a "bad body image attack."  Well, maybe.  But this feeling was very different than looking in the mirror and saying "Ewwww..."  Which I've also been known to do, but not last night.

For starters, I was laying in bed and not looking in the mirror.

For seconds, it wasn't a visual issue.  It was a more physical, visceral issue. 

I wanted to claw my way out of my own skin.  I felt huge, uncomfortable.  I couldn't stop thinking about my body.  I wanted to do something, anything to get rid of this feeling.

Somewhere through the anxiety, I started thinking, "You know what this reminds me of?"

OCD.

I had the stereotypical germ OCD when I was in high school.  Mostly, I obsessed and worried over every little thing.  Either I was harboring some nasty germ that was going to kill everyone I knew or saw or had contact with, or everyone I knew, saw, or had contact with had a germ that was going to kill me.  I would wash my hands or reply scenes in my mind to make sure I hadn't touched something "bad" or coughed wrong or whatever.  I would inspect every inch of my skin to make sure I didn't have any cuts that could get or receive germs.

Therapists call these contamination fears.

I felt like my skin was crawling with germs.  I washed my cracked, pathetic hands in bleach to try and make this feeling go away.  No, I couldn't see the germs. I wasn't always 100% positive they were there, but I was sure that I could feel them.  All I wanted to do was make that feeling go away.  If it meant screaming in pain from bleach, so be it.  I was so distressed and terrified that nothing else mattered but making this feeling go away.

Which brings me back to the fat attack.

I didn't feel that my skin was crawling with germs, but it did feel like it was crawling with fat cells.  And in moments like that, it suddenly doesn't seem so foreign/stupid/pointless to do something like purge or overexercise.  I didn't, but nonetheless.  Thinking of these fat attacks as another manifestation of my OCD has made a lot of sense to me.  Yes, I have significant body dysmorphia above and beyond the fat attacks. 

Yet any time off exercise or eating something "unsafe" or "forbidden" would bring about a fat attack--just as touching something dirty would set off a contamination attack.

I don't think this totally explains my eating disorder.  Not at all.  But it does explain parts of it.  It helps explain why I would do such crazy things.  To escape the distress.  To keep the calm.  Vanity and sticking to my "diet" wouldn't--couldn't--explain this.  If you're scared enough, you will do some crazy things.

I never was able to recover on my own as an outpatient because the fears and the feelings were just too strong.  It meant living in a non-stop fat attack for months with no sense of relief.  Considering the crazy stunts I pulled to avoid the feeling just for a few hours or days, is it really any wonder that I tried to avoid refeeding and recovery?

Seeing fat attacks as OCD helps me calm down in the moment.  It's just the OCD talking.  The OCD was wrong about me spreading or receiving the plague, so it's certainly wrong about this.  What's more, I know the awful feelings do pass.  Eventually.

I have seen this ad a number of times on my Facebook page, and it took me a while to figure out exactly why it bugged me.

In some sense, it was true.  I had been damaged by anorexia, yet I really get squeamish about thinking of myself that way.  I don't like thinking of myself as "damaged."  My illness has changed many aspects of myself--some for the better, some not so much.  But as much as anorexia may have altered me, it hasn't damaged who I am.

Yes, anorexia has caused a whole host of damages in my life.  The physical ones are a good place to start; my bone density has improved, but it's still sub-par.  I tend to be a lot more hesitant, wary, and cynical than I was before.  I'm more easily hurt.  These are some of the damages that have been done.

But I don't think of myself as "damaged goods."  I'm battered, bruised, and scarred, but hell--who isn't?  It's called parts of life.  I have way more scars than I'd like to have, and some very interesting stories that probably shouldn't be shared with polite company.  What that means is that I've survived some pretty heady stuff, had some very close calls, and (hopefully) learned my lesson.

It doesn't mean I am damaged.

I damage my car in a fender-bender.  I damage my iPod when I drop it.  I can hurt, harm, wound, and maim other people.  But that doesn't make them damaged.  It makes them victims of my temper and pettiness.  My bones are a victim of my anorexia. 

I suppose that seeing myself as "damaged" would mean incorporating that damage into who I am as a person.  My eating disorder has fundamentally changed me.  It's altered many aspects of myself.  And yet, I'm still Carrie.  Maybe a different Carrie, and older, wiser, and more battered Carrie, but I'm still me.  If anorexia damaged me, then it seems like I'm permanently messed up.  It's one thing to try and fix a damaged car--or even, say, damaged skin and nails.  It's quite another to try and fix a damaged person.

I am smack-dab in the middle of trying to find a new therapist.  As I mentioned last week, TNT is leaving clinical practice, and I am left trying to find someone new. 

I hate finding therapists.  It's painful, time-consuming, and really, really tough.  So with me once again playing therapist picker-outer, I thought this week's Tip Day would be a great time to discuss what I've learned about picking out a therapist (this is the 13th time I've done this--I think I qualify as an expert!).

{{I realize some people don't have the fortune of being able to pick out a therapist.  The system where you are is that you get what you get.  If that's the case, I apologize.  However, I hope that what you read is useful for helping you figure out if you can apply for a new treatment provider or help them help you better.  I have choice, but with choice comes really steep medical bills for insurance and co-pays.  Win some, lose some, I guess.}}

1. Get referrals from people you know and trust. It might be a medical doctor.  It might be a friend or someone from the community who has also had an eating disorder or other mental health issue.  Or a guidance counselor at school.  Also check with your insurance company to see who might be covered and in-network. This way, you already know some things about the therapist--the basics of how they practice, that they're reputable, how much you might have to pay, and so on.

2. Don't rely too much on referrals.  Opinions are opinions, and not everyone sees the same thing in every therapist.  What I might find reassuring may drive you bonkers.  It's important when gathering data to separate fact from opinion.  That a particular therapist practices CBT is a fact.  That your friend finds them a total flake-azoid is an opinion.

3. Nice isn't the most important factor.  Of course we want our therapists to be nice.  Most of them are--misanthropes typically don't go into clinical psychology.  There are times when nice and kind and gentle is probably the right response.  But there are lots of times, especially when dealing with eating disorders, that firm and direct needs to take precedence over hand-holding.  The work of recovery is hard and miserable, and I've had therapists that were too nice and didn't push me into recovery.

4. Find out what treatment modalities they use.  I'm not especially keen on overly emotion-focused, insight-oriented psychotherapy.  I know many people find it helpful and useful, which is great.  For me, I like the acronym therapies: CBT, DBT, and ACT.  I like that they have evidence to show they are effective, and I like that they are much more concrete and practical.  So do your homework.  Find out which types of therapies you think would be most effective to help you move into recovery.

5. Ask them what causes eating disorders.  For me, this is the #1 screening question I use.  Because if I hear things like "unresolved childhood issues" or "boundary violations" as what causes eating disorders, I will run for the hills.  It means that, fundamentally, this therapist and I will not get along, will not see eye to eye on what I need to work on, and also that I know more about EDs than my therapist.  It's an easy way to gather information, and I often ask it right off the bat so that they don't have a chance to try and tell me the answer they think I would like to hear (this isn't that I think a therapist would really be blatantly dishonest, but it is human nature--heck, I've done similar things).

6. Find out their professional affiliations.  If you are trying to find a therapist for your eating disorder, then ask them if they're members of NEDA, of AED, of IAEDP.  Not all areas have an ED specialist, so you can also ask things like how many eating disorder patients do they treat, have they had any special training in eating disorders, do they know of a colleague who knows more about eating disorders, that sort of thing.  Good therapists will be impressed that you're asking this, so don't hesitate.

7. Ask hypothetical questions.  No, not the "if a tree fell in the middle of the forest..." types of questions.  But things like "If my parents called with questions, how would you respond?" Or "If I needed a higher level of care, what would you do?"  Or "If my symptoms increased, how would you handle it?"  It's good to know these things before a crisis hits, and it can also give you an idea of how the therapist generally handles issues, and how knowledgeable they are about EDs.

8. Don't let one bad apple ruin everything.  Bad therapists exist.  They might be a bad fit for you, or irresponsible, or whatever.  That's one therapist out of many.  Just because you found one bad apple doesn't mean that therapy doesn't work or that you're never going to get better.  It means you just found a bad therapist.  That's all.

What have you found helpful when searching for a therapist?  Share in the comments!