When I was in college, I remember sitting in church and listening to a sermon where we were exhorted to take Sunday (or any other day of the week) and not do any schoolwork, nothing, and instead devode the day to prayer and worship.  I almost burst out laughing--not so much because I couldn't imagine spending an entire day focused on religious activities (and I was much more religious then than I am now), but because I couldn't imagine a 24-hour period in which I didn't do any studying or homework.

I've always sucked at taking time off.  When I was in 8th grade, I skipped most of my brother's high school graduation party to study.  In fact, I brought books to the graduation itself.  In high school, I studied for exams on Christmas (the exams were about a month later).  I rarely went out on the weekends in college because, again, studies came first.  Clearly, I have issues.

But the past few weeks, I've been basically banging my head against the wall at work. I've been sending out story ideas, only to be rejected over and over and over.  I know it's not personal, but it is rather discouraging and frustrating as hell. Since I was sleeping more, it seemed that all I did was eat, work, and sleep.  I think much of my fatigue was old-fashioned burnout.  Don't get me wrong- I still love what I do.  On Friday, though, I had simply had it. {{I did get two smaller stories on Friday afternoon, so all is well on that front.}}

No, my weekend wasn't quite that serene.

So I took the weekend off.  Okay, I did a little work.  But just a few hours, probably half on my Psychology Today blog (a new post will appear tomorrow morning or whenever I hear back from the author of a study) and half on the FEAST Conference Planning.  Other than that, I hung out with J, watched TV, crocheted, and read (At Home by Bill Bryson, if you're curious).  It was unusual.  It was also nice.  I was far more apprehensive of how my little prefrontal cortex would handle the change than I was about actually taking time off.

Yeah, I paid for it a bit today.  But I also had a vacation, and I really needed that.  I'm trying to remind myself that the break has made me much more productive than I might otherwise have been today, and that extra boost of productivity will extend through the week.  It's a total shift from my usual MO.  Before, when I've taken time off, it's been because I was either too sick or too depressed to give a crap about not getting anything else done.  Although I've had at least one "vacation" this year, it was to AED last month, and there wasn't much down time.

I know I need to be more vigilant about separating my work life from everything else.  It's too easy to let work bleed into other times.  Sometimes it's simply necessary (when I have a deadline or need to do an evening interview because of time zone differences), but it's still an area where I need to get better at.

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

Nick from Men Get Eating Disorders, Too writes on body dysmorphia.

Fluctuations of Body Images in Anorexia Nervosa: Patients' Perception of Contextual Triggers.

Do You Fall Into the Trap of Overthinking? I know I do!

The common co-occurrance of generalized anxiety disorder and anorexia nervosa may be explained by shared genetic risks.

Weighted Words: What A Perfect Food World Looks Like.

A study from the journal Molecular Psychiatry raises the hypothesis that anorexia is a metabolic disorder rather than a psychological one.
See the stories by:
Live Science and
Jezebel.

Healthy balance of bacteria in the flora could prevent obesity, suggests study.

Fantasizing about food seems to help dieters eat less. Puts a new spin on the food obsessions common in eating disorders.

Reduced automatic motivational orientation towards food in restricting anorexia nervosa.

Eating Disorder Recovery: Inner Critics & Relapse.

Advice on recovery for mothers with eating disorders by my dear friend June Alexander.

The role of negative urgency and expectancies in problem drinking and disordered eating: Testing a model of comorbidity in pathological and at-risk samples.

I went to a local farmer's market this morning, since the weather was nice.  I was visiting the various booths, sampling things and just seeing what was available.  The farmer's market had more than just produce--there was quite a few stands with gourmet prepared food.  One was sampling roasted coffee, along with applesauces and such. 

As I was standing there, sampling the coffees, she kept saying how her foods were low in sugar and easy on the waistline.  And so on.

My first thought: is it that obvious that I've gained weight?

My second thought: why are you assuming that I'm worried about stuff like that?

I don't blame her, exactly.  She's just trying to sell her stuff.  I know from when I worked craft fairs that a lot of making a sale is trying to figure out what the customer is thinking.  I guess I fit the bill of the food obsessed: young, female, decently dressed.  And part of it was probably a reflection of what the woman herself was thinking, what she thinks when she decides whether to buy food.

But it irritates me that being diet-obsessed is considered the default mindset.  It's sad, really.  That it's safe to assume that the majority of people look for what's not in a food than how it tastes or what is in it (flavor, texture, etc).  I know plenty of people have to read labels, and that reading labels isn't necessarily disordered.  It can be a very normalized thing.  But still...  It's become so not only are people expected to be obsessed with food labels, but it's expected that they should be obsessed.

I know the lady was just trying to make a sale.  She did annoy me, but it was more the assumption that I found irritating rather than the lady herself.  It would be really nice if I could find somewhere where people didn't obsess.

A girl can dream, right?

I was chatting with one of my friends on Facebook last night, and we were discussing some of the issues we were both facing in recovery.  One of the things we ended up discussing was how embarking on recovery brings about the possibility of failure.

One of the things that so enthralled me with the eating disorder was that I felt it was something that I was good at.  Not that I ever felt it was quite good enough, but I knew I was good at it.  I didn't need anyone to tell me this.  I knew I could succeed at losing weight even when everything else seemed to be falling down around me. 

Recovery, on the other hand, was very different.  I knew how to lose weight.  The methods were very straightforward.  Eat less, exercise more. I knew, ultimately, I couldn't fail.  But recovery wasn't so straightforward.  I could stop eating much more easily than I could start.  It's like--anorexia was like falling off a cliff.  I had the help of gravity.  Recovery was like trying to climb up.  You have to fight gravity.

Here's the thing: I am really afraid of failure.  Like really really afraid.  And recovery meant the possibility of failure.  I don't like to do things if I'm not sure of success.  It's why I didn't bother applying to any top-tier schools--I was too afraid of being rejected.  It's also why I never really played sports.  I've come to enjoy being active later in life, but I never played sports when younger because I wasn't that good.  I also didn't like the idea of dating unless I knew the person I was going to go out with was going to be "The One."  Needless to say, I didn't do much dating until very recently.

Because of all this, I built my life so that I basically always succeeded.  I'm not familiar with failure, so it stings especially badly when things go wrong. I don't like uncertainty, and so I either worked my butt off or simply avoided situations where I might not succeed. I was lucky to thrive in academic settings, which meant I didn't get much practice--if any--at learning how to deal with failure.

It's easy to see how I might be a little wary of recovery.  Where the outcome was unclear.  Where I wasn't sure if I could do it.  Where, to boot, I wasn't even sure I wanted the outcome.

It's something I need to get over in order to keep making progress.  Fear of failure keeps me from trying new things, from branching out.  It keeps me trapped.  Logically, I know that each thing I try in recovery won't always be successful.  I know that not everything I try will be useful.  But I hesitate to try or do things that won't be perfect, useful, or (for that matter) perfectly useful.  Except there's no way to find the things that will work without trying a bunch of things that might not work.

It's pretty ironic that I need to get better at failure in order to succeed at recovery.  But then nothing about eating disorders makes much sense.

I got weighed yesterday, which is never a fun prospect.  And since I'm supposed to be gaining a few pounds, I have very conflicting feelings about what might happen.  Basically, there are three options: I gained, I lost, or I maintained. 

No, I don't want to have gained weight.  I do have an eating disorder, after all.  And yet a part of me does want to have gained because that means I won't have to shove even more food down my gullet.  The prospect does not entertain.  Of course, I would love to have lost weight (remember that bit where I mentioned having an eating disorder?), and I'd settle for maintaining.  But that would also mean that I'd have to eat even more.

See conundrums, definition of.

There's never a way to win when you have an eating disorder.  Never.  If you eat more to appease others, you'll feel guilty for eating something you "shouldn't."  If you stick to your guns, you'll feel guilty for making people worry.  What's a girl to do?  My MO was generally to avoid eating situations altogether and distance myself from friends and family.  Easy peasy lemon squeezy.

Except now I've had an eating disorder for more than a decade and avoiding people and food is getting old.  Really old.  Now I have to deal with these very conflicting thoughts.

I guess the irony is that, with recovery, although it seems somehow that there's no way to win, there's also no real way to lose.  (Did I mean that pun?  I don't know if I did or not...)

Although I don't know my weight, no one has been harping on me to eat more, so I'm guessing my weight is going in the right direction.  I don't like it.  I feel like a barge.  And I just want all of this to be over and go back to normal. I'm exhausted and stressed and...I don't even know.

Sigh.

Check out my new Body of Evidence post:

What We're (Not) Eating.

In reality, the health kick fits the eating disorder mentality perfectly. For some reason, it seems to be important to some people with eating disorders that the food restriction is socially sanctioned. After all, we are people who generally place a premium on the opinions of others. So we use or concoct schemes by which others will give us a good, solid pat on the back while we starve, binge, and purge.

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

Ways the Reward and Planning System Can Go Wrong - Part 1.

Eating Disorders: A Fish Story.

Finding Your Destination on the Road to Recovery.

Small Steps You Can Take To Feel Better Now.

Dopamine Release Fuels Anxiety in Brains of Anorexics.

New Antidepressant Targets Body Clock. It's an interesting approach to fighting the symptoms of depression. This chronic insomniac is certainly interested!

Weight-Loss Blog Title Generator.

Many teens with eating disorders lack access to care.

New genetics findings challenge ideas about mental illness.

Looking to find good, recovery-oriented and non-triggering ED websites? PJ tells you how to do this.

7 Signs Your Gremlin is in the Driver’s Seat of Your Life.

Depression, Mood Disorders May Be Due To Gut Problems Early In Life.

Group cognitive remediation therapy for adolescents with anorexia nervosa.

The importance of eating behavior in eating disorders.

People with bulimia have highest rates of novelty-seeking of major psychiatric disorders; people with anorexia have highest rates of persistence.

Measuring state trait properties of detail processing and global integration ability in eating disorders.

How to deal with sociocultural pressures in daily life: reflections of adolescent girls suffering from eating disorders.

The May/June 2011 issue of European Eating Disorders Review is a special issue on compulsive exercise.

FBT in the Real World.

Leptin as a Neuroactive Agent.

Binge eating proneness emerges during puberty in female rats: A longitudinal study.

Body size estimation in early adolescence: Factors associated with perceptual accuracy in a nonclinical sample.

Thank you all for your kind and wonderful comments on yesterday's post.  They were really helpful for me.

What I've come to realize over thinking about this awful fatigue and hypermetabolism mess is that I need to practice some serious radical acceptance.  Not that I expect that this will eliminate my fatigue, but hopefully, I can scrape up a few scraps of energy that I was wasting on resisting and fighting the current state of events.

So what do I need to accept?  Several things:

1. My need to eat a lot. My mom tells me most people would kill for my metabolism.  I tell her they don't need to bother, as I'm perfectly happy to give it away upon request.  But there's not much I can do about how much food I'm burning off right now.  It's just reality.  It's what I need to do to get better, it sucks, but there's also no real alternative.
2. I'm not going to be as productive as I usually am. This one is really hard for me. I generally hate on myself if I'm not constantly busy. It's fine when I have the energy, am engaged in life, and can plan in some breaks.  That's not my current life.  Again, it's unavoidable.  I'm lucky in that my work schedule is pretty flexible, and a couple of short months financially aren't going to be the end of the world.

I still don't feel good about these things, but I feel a smidge better. 

It's hard for me to just "accept" something.  I generally try to fight it, or change it, or subvert the system if there's something I don't like.  I'm not naturally very zen.  I'm anxious and high-strung, I don't like to just "be," and I don't generally take things in stride.  So radical acceptance is a very new concept for me.  New, but helpful.

What's something you're looking to radically accept? Share in the comments section!

I try to keep this blog positive, even though I don't consider it "inspirational" per se.  There's not enough unicorns pooping rainbows for that.

Well, okay, maybe that does make my blog a little more cheery and happy.

I hate using the blog as sort of a whinge to the world.  For one, I feel I'm wasting everyone's time.  For another, I'm guessing that most of you know all to well the hell of having an eating disorder (or living with someone who does).  You don't need me to sit around and remind you of it.  I like my posts to have some sort of takeaway message--one that goes beyond "Carrie sure is a cranky thing, eh?"

I am, but that's not the point.

Most of the time, I do some serious cognitive reframing and focus on the positive stuff.  If not always happy, at least the how-can-I-grow-flowers-in-the-manure-of-my-life vein.

I'm trying really hard to summon positivity right now, and I just can't do it.

I'm not depressed, just insanely tired.  My body is as hypermetabolic as it's ever been, and it's taking a lot out of me.  Because I'm sleeping more, more of my awake hours are occupied by work. Although I do try to pencil in relaxation time, it feels less restoring than I need it to be.  Which means that, basically, I eat, sleep, and work, in roughly that proportion.

This is the first time I've really done serious refeeding while trying to work full-time, and I'm realizing why it didn't work out so hot previous times.  In a way, catching the uptick in ED behaviors sooner has made it harder because my metabolism at least at a hint of life to it, I have more muscle mass, and more body weight--all of which are driving my metabolism upwards. I'm a walking hot water bottle.

Not fun.

I want a break from the constant onslaught of food.  I want a break from worrying how the hell I'm going to pay the bills.  I want to move into the freezer.

What I really want, though, is a several days long nap.

Adjusting to my new metabolic needs is hard, and I think things will ease up once I get more used to things.  At least, that's what I keep telling myself.

In Jenni Schaefer's book Life Without Ed, she writes about the two main tactics for combatting ED thoughts:

• Disagree: counter the ED thought that a slice of cake will make you fat with thoughts like Eating cake is normal, one slice of cake won't change my weight, I trust my treatment team and the food plan they gave me.
• Disobey: the ED thought tells you not to eat that cake and you eat that cake, dammit.

All of which are well and good.  My dad always told me I should have been a lawyer since I can argue anyone into the ground.  Arguing against myself is harder because both sides of my brain are equally skilled in coming up with convoluted statements, odd facts, and seemingly incontrovertible bits of logic.

Even when I do win against the ED thoughts, the previous hours-long pissing match between Healthy Carrie and ED Carrie has left me exhausted and more than a little demoralized. It shouldn't be this hard!

Indeed it shouldn't. File under: Pyrrhic victory, definition of.

So I came up with another "D" strategy to deal with the ED thoughts: Disengage.

So when I start bickering with the voice in my head that tells me I shouldn't eat, that I'm going to get fat, that eating means I'm a pathetic failure, I don't argue back.  I just say "Mmmmm..."  When you're trying to make a decision, it's not like your brain instantly comes up with a unanimous agreement.  Different parts of your brain provide different input, and that input isn't all equally important or relevant.  It's sort of like the vaguely rabid people preaching the End Times on the street corner: I know these people are irrational, so I just kind of ignore it.

ED thoughts are similar; it's not worth my time to argue.  Arguments seem to give the thoughts credibility, that they're work an argument.  The problem is that they're not.  So I've been trying to mentally walk away from the ED craziness in my head.  We'll see whether it works, but hopefully it will leave mw with more energy and sanity.

The past few weeks have been really chaotic, work-wise.  I actually haven't had that much work (I'm mostly finishing up old stuff), and so I'm scrambling to get stories placed so I can hopefully pay the bills.  Tonight, I got slammed both with a need to send out new ideas and finishing up a story from before.  When I figured out what my workload was going to be, I pretty much panicked.

How was I going to get all of this done?

I realized I was going to have to move some of my trawling for story ideas to tomorrow--deadlines always win out over no deadlines.  But I was behind anyway and frustrated, and then I had to contend with trying to schedule and then transcribe several last-minute interviews.  I was simply overwhelmed.

Photo by Summations

So I watched TV for an hour and did some crochet.  Then I went back to work.

I still have more to finish tomorrow morning, but that was part of my plan.  I feel okay now.  Still frustrated and disappointed at how hard it is writing-wise right now, but I put on my Big Girl Panties and did what needed to be done.  That "me" time was essential.  I wouldn't have made it through the rest of the evening without that little break.  But I did it.

I guess the moral of the story is that I can balance work and play, and that I can calm down and assess the situation like a professional.

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

{{Sorry this is a little late--I had a lot of work to do yesterday and didn't have time to finish everything.}}

Could “fat stigma” increase the prevalence of eating disorders?

Taking Measure of Weight-Loss Plans, and the Studies of Them.

Shop For A Psychotherapist To Avoid The Lemons.

It’s Not Just Teen Girls: What to Know About Your Adult Partner with an Eating Disorder.

ADHD in adults may become easier to diagnose.

Parents Outraged Over Shape-Ups for Kids: Shoes designed to tone your legs and backside are now made for young girls.

Smart NYTimes story about how deceptive food-label health claims can be.

Electronic Patient Records used to help Identify Biological Causality in Psychiatric Illnesses.

(Not) Eating at Harvard.

Participate in an online research study: Eating Behavior, Perceptions & Attitudes In Adult Women.

Measuring state trait properties of detail processing and global integration ability in eating disorders.

Global and specific brain changes in anorexia that affect disease onset and course.

An experimental exploration of behavioral and cognitive-emotional aspects of intolerance of uncertainty in eating disorder patients.

People with bulimia have highest rates of novelty-seeking in psychiatric disorders; anorexia has highest rates of persistence.

Muscularity versus leanness: An examination of body ideals and predictors of disordered eating in heterosexual and gay college students.

Marital functioning and binge eating disorder in married women.

One of my readers recommended this iPhone app that she said was very helpful in meal planning in recovery: MiMeals Meal Planning App. I don't have an iPhone and thus haven't checked it out, but I'm sharing in case it might be useful. I do my meal planning on scrap paper and old receipts, for the record. :)
Neural response to angry and disgusted facial expressions in bulimia nervosa.

Are you the parent of an adult child with an eating disorder? Run, don't walk to this blog post by one of my favorite blogs, F*ck Feelings.

Actually, I'll save you the bother of clicking and just post the whole thing in its entirety below (the question from the parent is in italics. Everything else is from the blogger/psychiatrist):

People like to turn to an authority when they’re helpless, and if that helplessness only applied to 911-like situations, there would be no problem. For problems that don’t involve theft or fire but sadness and family, however, authority is useless; sure, doctors like me can give advice, but until medical schools start borrowing from Hogwarts’ curriculum, the best resources you have are your own. The sooner you realize that, the sooner you’ll learn to draw on your own authority to come up with the best possible management plan and execute it with confidence. You are your own best first responder.


I need to find a doctor who will tell my daughter she needs to take her medication. She’s always had a problem with depression, and she did well in high school when she took antidepressants. Now, however, she’s 24 and very reactive to however she’s feeling, whether it’s not getting out of bed, or not working, or feeling dizzy and deciding it’s the medication and stopping it. My husband and I can’t get her to stick with anything, and she won’t listen to us in any case, so our goal is to get you, or some professional, to tell her what she needs to do.



Whenever parents want a doctor to tell their kid what to do, you can be pretty sure they’ve lost faith in themselves and overestimated the power of communication/a medical degree.

And no, it doesn’t matter how old the kid is or how many Harvard degrees the doctor has; the doctor doesn’t have more power than the parents, no matter how powerless the parents feel.

In your case, I don’t know whether your daughter can be induced to take her medication, but I do know that she’s not going to be persuaded by the authority of a doctor at the age of 24 if her own experience and your words haven’t done it by now.

The probable reason for her unresponsiveness, by the way, isn’t stubbornness or a lack of respect, but a lack of control over her own impulsivity (probably enhanced by depression). In other words, it’s not clear she can make herself take medication regularly, even if she sincerely believes she needs it. At some point, other impulses take over, like the impulse to stay in bed indefinitely.

Fortunately, even though persuasion is probably useless, you have other tools that a mere doctor can’t touch. You can access them if you believe you know what your daughter needs, regardless of what she has to say about it.

For instance, if you believe that she needs to get up early and follow a daily activity regimen, then let her know that’s what you’ll pay for. If she says she’s too blah, tell her you know it’s hard, but she needs to try, and that she might be able to do it if she puts together a schedule and asks friends to help her keep it.

If she argues that she can’t do it until she feels better, tell her that you don’t know when she’ll feel better, so she’d better start trying to keep busy now, and maybe that will help her feel better later. Your tone should say that you believe what you believe, and there’s no point in arguing.

If she tells you that you don’t know what she needs, tell her that you’re the mother and you have a good idea what she needs. Don’t ask a doctor to be the authority– get whatever information you need from the doctor, and then assume you’re the authority. At 4 or 24, your kid needs to hear the same thing; you’re the mommy, that’s why. End of discussion.

If your incentives don’t work, don’t blame her or yourself, because, again, you don’t know whether she’s too sick to have the control she needs. By putting a priority on self-control, however, you provide her with a blueprint for moving forward that is not reactive to negative feelings or thoughts or painful side-effects.

You’re urging her to embrace goals that arise from her values and that she can stick with, regardless of how she feels or how much she accomplishes. Knowing medicine isn’t as important as knowing your daughter and what’s best for her. If she won’t listen to me, you can, and I’m telling you you’re the most qualified professional for the task.

STATEMENT:
“I’d like to think my daughter could respond to persuasion from someone she respects, but I suspect it’s not true. I’ll push her towards doing as much as she can, regardless of how she feels, and hope that incentives for good habits will take over where persuasion has failed.”

Excuse me while I go clone this guy millions of times over so that a) he can be all of our doctor and b) so that we can have him as our very own Psychiatrist Pocket Pal^TM.

One of my readers shared this quote from Grey's Anatomy in the comments section the other day, and it just rang so true for me that I had to share it here:

After a trauma your body is at its most vulnerable.
Response time is critical so you’re suddenly surrounded by people; doctors, nurses, specialists, technicians.
Surgery is a team sport; everyone pushing for the finish line, putting you back together again.
But surgery is a trauma in and of itself.
And once it’s over the real healing begins.
We call it recovery.


Recovery is NOT a team sport.
It’s a solitary distance run.
It’s long, and it’s exhausting, and it’s lonely as hell.


The length of your recovery is determined by the extent of your injuries.
And it’s not always successful.
No matter how hard we work at it, some wounds might never fully heal.
You might have to adjust to a whole new way of living.
Things may have changed too radically to ever go back to what they were.
You might not even recognize yourself.
It’s like you haven’t recovered anything at all.
You’re a whole new person…
With a whole new life.

Yes, this.
Many people speak of the link between trauma and eating disorders, but it's much less often that people speak of an eating disorder as a trauma in and of itself.  Sure, it might not be traumatic in the same way as being raped is, but it's still traumatic.  An eating disorder destroys your life, it destroys your sense of self.  Recovery forces you to face your wounds.  To stare down that is which the most painful.  This isn't something you survive unchanged.

There's not a lot I can recover from my pre-ED life because I don't have much left.  I'm not so much recovering as recreating a life.  You can't unchange things, no matter how hard you try.  But a new life is waiting out there, too.  It's hard to find the balance between allowing myself to mourn what is lost but also save my energy for finding out what else is out there.  I do worry that it will be more of the same and my life will wind up as some sort of collossal disaster.  In the meantime, though, there's trauma and recovery.

Every night, the same thing happens. I mean to blog, I really do, but then I sit down at my computer and I'm just too stinking tired to write very much.  All I want to do is go to bed, preferably for a very long time. Plan B is to see if I can chug some Animagus juice and become my cat.  It's pretty much the same, I'd say.

Having such a mismatch between my drive to get things done and the energy needed to carry them out is really frustrating.  Usually when I'm extremely fatigued, I'm either so driven by anxiety and OCD that I don't even ask if I have the energy, or I'm so depressed that I don't care if I get anything done.  I'm fundamentally a very driven person, and I usually can summon the energy to do what I need to do on a pretty consistent basis.

But over the past few weeks, I've just been utterly drained.  I rarely make it through the day without a nap.  I feel like all I do is eat, sleep, and work.  I've done some crochet, yes, and I do try to watch at least one TV show a day, even if I am catching up on email while watching.  And it figures my book club picked A Tale of Two Cities for this Saturday's meeting. This isn't a piece of literature that can be described as a "page turner." 

I easily slip into mopey, woe-is-me moods.  I feel like I have no confidence, not because I'm actually lacking in confidence or drive, but because I don't have the energy to summon confidence.  Screw life goals, I just want a nap.  I want my email to stop pinging me with new messages, I want my editors to stop requesting another set of changes.  I want to wander around Target and not worry about how much work I need to be doing.

I wish I could just accept the fact that doing the extra eating and recovery work means that I might not be able to function as well at work and that's okay.  But that doesn't come easily to me.  In fact, it doesn't really come at all.  I don't look at my grades in grad school in the depths of my ED and think "Imagine how well I could have done if I wasn't sick!"  No, I think that I should have done better and worked harder and maybe tried to get more studying done while spending hours on the elliptical machine.

I can tell myself that I'm doing the best I can, and even though I get that it's true, I also feel that this still isn't good enough.  And then I realize that I don't have the energy to try harder even if I could, so it doesn't really matter.  The spoon analogy does help here. I'm using extra spoons at mealtimes and on recovery stuff, so it makes sense that I have fewer to "use" with work and other things.

I guess the moral of the story is that I'm tired of always equating fatigue and proper rest with laziness.  And when you're constantly fatigued, it's a pretty crappy situation to find yourself in.

Another AED conference update, this time on my Body of Evidence blog at Psychology Today:

The common thread in successful eating disorder treatment.

Read, share, comment, and enjoy!

Recovery, it is said, is more like a marathon than a sprint.  It's long.  It's grueling.  And you have to pace yourself. 

I got thinking about this metaphor today, and I remembered something my old boss (who had run several marathons in the past) used to say.  He said the "obvious" halfway point of a marathon, which is just over 26 miles, is at mile marker 13.  After that, technically, you're on the down slide. 

My old boss said that any marathon runner will tell you that the race isn't half over at mile 13.  No, at mile 13.2, you're still at the beginning.  Many runners don't consider themselves beyond the halfway point until they hit mile 20.  My boss? His "halfway point" was mile 25.

Mathematically, passing mile 25 of a 26.2 mile race is far beyond halfway.  It's not that my boss had math difficulties.  Rather, those last 1.2 miles seemed just as long as the first 25.

Which reminds me a lot of recovery.  It's sort of like you're trudging along, and you look at the mile markers, and you feel like you should be further along.  You think "I'm nearing the end. I must be nearing the end."  But there's always three, seven, ten more miles.  How in the heck are you going to endure for that much longer?

The last bits of recovery seem to take the longest, and sometimes you just have to buckle down and endure.  Those last 1.2 miles--the seeming endgame of recovery--feel as long and as intense as the first 25.  And it's hard for people from the outside to understand this.  Outsiders are measuring distance through math: half of a marathon is 13.1 miles.  Period.  But when you're actually in it, those kinds of calculations don't really capture the emotional experience.

I don't think I'm exactly at mile 25 yet.  But it does help me better understand why recovery can seem to take so damn long, when you feel it should be over by now.

To all of my moms, real and virtual.  And to my readers, whether or not they have actual children, for all of you are helping me learn how to parent myself (which is a lot of the point of being a mother, no?):

I posted a few weeks ago that my weight had dropped a bit since my move, and although I've managed to stop the slide, I haven't been able to put any of the weight back on.  I got the smack down from my treatment team this week, and so I've been pushing the food over the past few days.  I can feel my body kicking into hypermetabolism (hot flashes, etc), but I also feel like Twitter's infamous "fail whale":

Yeah, that big.

I know the chances I've gained more than a pound or two in the past few days is probably miniscule.  So I can't really been significantly larger than I was a few days ago and feeling (relatively) normal.  But there you have it.

EDs aren't rational, and I suppose there's no point in trying to rationalize any of it.  I know the feeling will eventually pass, and I also know why I hate the weight gain process so damn much.  It's mentally and physically uncomfortable.  I'm functional, unlike other times I've had to gain weight, although I have significantly less weight to gain than before, which helps.

I know I shouldn't waste time kicking myself and thusly bruising my ass.  I had been doing a good job juggling many aspects of recovery, but keeping all of the recovery "balls" in the air was beyond my capability at the time.  Dr. H suggested that I come up with not only a food and exercise plan to keep me in recovery, but also to come up with a social plan.  When I'm more stable, I want to volunteer at a cat rescue or something.  I have a weekly crochet group and a monthly book club, which is good.  I also need lots of "me" time, so it's hard to balance both needs.

I know the fail whale feeling will pass, and that I will get back on my feet.  But in the meantime, it seriously sucks.

As I have promised, I'm going to do a few posts on some of the things I learned while at the AED conference last weekend.

The best session I went to was called "Who's Who in the Brain?" and it looked at what neural systems malfunction in anorexia.  To try and summarize the talk would be ludicrous, especially since the best part was interactive.  Basically, session leaders Bryan Lask and Ken Nunn had us get into groups of 8 (since most of the participants were MDs or PhDs, there was a little bit of eye rolling at this suggestion) and we each took on a role of one of the neural systems profiled, from the nucleus accumbens (the pleasure center) to the prefrontal cortex (PFC, the "executive" or decision-making part of the brain).

We were given the task of trying to decide where to meet for dinner.  We each had to play the part of the brain part we were assigned (I was the basal ganglia, which is involved in movement/exercise, precision, and also malfunctions during OCD. I'm pretty tight with my basal ganglia...) in deciding where to meet for dinner.  As the basal ganglia, I needed to know exactly where and when to meet, like give me some GPS coordinates, people, and exactly how much money did we have to spend?  So perhaps a little neurotic, but I was bound and determined to get us there on time.

The other five group members also provided their feedback, and the insula carried all of our messages to the prefrontal cortex, who made the final decision.  We were going to meet at the hip Asian joint down the street at 6:45 pm for drinks and sushi. Ta-da! Decision made.

Then, we had to make the same decision in a malfunctioning anorexic brain.  As the basal ganglia, I couldn't find the "perfect" restaurant or the "perfect" entree or be sure that everyone else in the group would agree.  The prefontal cortex was also malfunctioning, and pretty much left the five brain parts to rule in anarchy.  The insula was simply missing in action and none of the brain parts could talk to anyone else.

Our decision?

Skip dinner.  All around the room, the groups returned with the same verdict: no dinner.  With a malfunctioning brain, the decision was just too complicated, and so the "brains" defaulted on not eating.

Our group decided we'd get tattoos instead (there was some sort of inside joke there--it was tremendously funny at the time, but I can't exactly remember why). Another group went to the gym.  Mostly, people retreated to their rooms and spent a socially isolated evening on their own.

Sound familiar?

Lask and Nunn referred to this conundrum--an endless shouting by the various parts of the brain while the prefrontal cortex merely shrugged its shoulders and the insula had long since left the building--as analysis paralysis.  Wikipedia defines it as:

over-analyzing (or over-thinking) a situation, so that a decision or action is never taken, in effect paralyzing the outcome. A decision can be treated as over-complicated, with too many detailed options, so that a choice is never made, rather than try something and change if a major problem arises. A person might be seeking the optimal or "perfect" solution upfront, and fear making any decision which could lead to erroneous results, when on the way to a better solution.

Figuring out where to go for dinner seems like a pretty simple decision.  It's not like figuring out where to move or whether to take that job or how much to invest in your 401(k).  It's just dinner.  Yet the decision making process, though it can happen lightning fast, is also very complicated.  If the brain can't share and process information--if the insula isn't working properly--the brain gets stuck on the simplest of decisions, like a scratched record or CD.

The insula is known to malfunction in anorexia.  Starvation reduces blood flow to the brain, which makes other areas of the brain malfunction as well.  Soon, the simplest questions cause paralysis and the brain defaults to a simple answer: no.  I already ate. I'm not hungry. I'm busy. No thanks. I'd rather not. No. No. No.

It's our way of avoiding analysis paralysis.  Our brains, Nunn said, are rather like Congress.  Lots of bickering, lots of going back and forth, and without strong leadership, nothing gets done. Actually, even with strong leadership, things don't always get done in Congress, but I digress.  Even if the insula alone isn't working properly, the entire brain is affected, and it gets stuck in analysis paralysis.

The solution is for other people to step in and act as the insula and prefrontal cortex of the person suffering from anorexia, whether it's parents, caregivers, friends, or therapists.  It's often too complicated to decide what to eat, and so it helps for someone else to do a bit of the decision making, sometimes in the form of making all food choices, or giving guidelines in others.  Eventually, the brain regains enough function to begin to take over those decisions, and being able to easily make decisions is a sign of recovery.

I was discussing life and recovery with Dr. H today, and somehow the idea came up that recovery was a lot like the childhood game Chutes and Ladders.  It seems that it's much easier to slide back down than it is to climb your way up.  What's more, it seems that there are far more chutes than ladders, and the chutes seem to take you bad much further than the ladders propel you forward.

"I remember getting so close to the final square as a kid," I told Dr. H, "and then I hit that stupid slide that took me back to the very beginning."

So it seems with recovery.  My recent struggles have made me feel (however incorrectly) that I'm back at the beginning again.

Then Dr. H said, "That horrible slide takes you back, but never to Square One. You're never back at the very beginning. At the worst, I think you end up on the second square. But never the very first one."

Translation: you have always learned something along the journey, however much you may feel you have failed completely.  Realizing you're at the end of a slide and have lost ground is disheartening, but you've never lost every last inch.

And ED slips can be often like a trip down a playground slide. Exilharating at times, but then the ride comes to an end, and you hit the ground with a thud.

Of course, the entire point of a slide is to climb up and go down.  The point of recovery is to not slide back down.  That being said, I think we all do at some point or another.  We slide a bit--maybe not all the way back down to the asphalt, but standing at the top of the slide can seem rather alluring.  We think we can catch ourselves before we hit the ground.  Sometimes we can, and sometimes we can't.

Not to mention that climbing back up a slide isn't the easiest of tasks. Just ask these kittens.



Remember: no matter how much you slide, you're never back to Square One, not really.

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

When you demand that you attain perfection, you are in for a life of frustration.

New trends in eating disorders.

With anorexia, total recovery can be elusive. My response over at Body of Evidence is here.

Bringing Partner Into Anorexia Treatment May Aid Recovery.

How to Combat Your Company’s Weight Loss Challenge. I also recommend a different tack: start a blog. Hey--it worked for me!

Latest research suggests that those born in Spring are more likely to develop anorexia.

More children being admitted to hospital for EDs in Australia.

With Liposuction, the Belly Finds What the Thighs Lose.

What I've Learned from Fight Club. Trust me, you will never think of chicken feathers in quite the same way again.

Seeing through anorexia’s academic charade.

What Should I Say?

"I Focused on Who I Wasn't By My Mid-Thirties...Instead of Focusing On Who I Am."

Treating 'Diabulimics.' Young women with type 1 diabetes are twice as likely to develop ED as their non-diabetic peers.

The Importance Of Control In People's Lives.

Am I a Size 4? 8? 10? Tackling a Crazy Quilt of Sizing.

What Neuroscience Cannot Tell Us About Ourselves.

Tonight finished up the 2011 International Conference on Eating Disorders. It was a fantastic conference--so good, in fact, that I didn't have hardly any time to blog or Tweet. {{It doesn't help that internet access is $12/day, and I don't want to have to pay for today. I'm blogging on my phone instead.}} I will definitely remedy that when I get home tomorrow.

Tonight was the closing social event, with dinner and a cash bar. I had salad, salmon, mashed potatoes, veggies, and chardonnay. Then, the DJs fired up. It is an odd thing to see some of your idols trying to do the funky chicken. I got jiggy with Cindy Bulik and Susan Ringwood (head of B-EAT in the UK).

And then?

Then I saw a sight that will leave me smiling until the day I die.

I saw Walt Kaye.
On the dance floor.
Trying to bust a move.

It will really be hard to beat that moment. The sight of him dancing with about my level of skill and grace (my mother can confirm it's pretty minimal), was too classic.

I will be sad to leave Miami tomorrow. I really did have a wonderful time.
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