I loves me some irony, and I have two updates that prove it.

Update #1: I was at Target yesterday, buying some lamps for my new place (the office doesn't have any overhead lighting, and so I need to seriously bulk up in the lighting department).  I painted my office a light plum, and I found a lamp to match the decor that I could sit on the piano. I also bought a cute purse on clearance for $6.  So I went through the checkout line, signed my receipt, and gathered my bags.  As the cashier handed me my copy of the receipt, she said, "Oh, you got an extra coupon!  For $2 off!  A...scale!"

I took it mostly because I found it funny, although I didn't explain to the poor lady exactly why I found this so hysterical.

Update #2: Another moving-esque update.  I'm packing up my books tonight, and I'm trying to figure out where to have the movers put them in my new place.  I'm still not entirely sure exactly where I want to put every last bookshelf (I have 4 folding ones and one really big one that my dad built me), so I was thinking and thinking about where to put the books.  I didn't want to drag them up or down the stairs too much, but space upstairs is going to be at a premium since there's already plenty of crap going up there.

I called my mom in and we discussed it.  Eventually, we both realized the best solution was to put the books in the dining room.  I have my table, but there's space against one or both of the walls to stash some boxes.  The books are definitely a Carrie Priority, but I also realize that there are lots of other practical things that need to be sorted first.

So my books will be temporarily housed in the dining room.

That's my update for now.  I'm exhausted!

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

Do We Really Want To Change? Change means having to hate your symptoms. The blog is about relationships, but it's very appropriate to those of us with EDs and/or addiction.

FEAST announces its Volunteers of the Year!

Guardian Science weekly podcast: the science of Ikea, and more. Nope, not related to EDs, but nonetheless fun.

Enough is Enough: When you need to tell the tyrant and other self doubts to shut up.

Low calorie sweetener may not increase satiety, suggests study.

Weight loss's link to better health questioned.

FROZEN BUBBLES!!!

Conquering food addiction.

Do Eating and Money Disorders Share Commonalties?

EDs often exist in combination with other harmful pursuits and unhealthy mentality in patients.

Screening for anorexia nervosa via measurement of serum leptin levels.

Quality of Eating Disorders Websites: What Adolescents and Their Families Need to Know.

Gender differences in perceptions of the severity and prevalence of eating disorders.

Affect consciousness and eating disorders: Short term stability and subgroup characteristics. Wikipedia article on affect consciousness.

Eating in eating disorders. Yes, there's a link.

The emotional regulatory features of bulimic episodes and compulsive exercise in muscle dysmorphia.

Improvement and Emergence of Insulin Restriction in Women With Type 1 Diabetes.

After a few weeks of getting my new place move-in ready (painting, fixing the bathroom lights, getting the carpets cleaned, etc), it's finally ready for me to move in.  The big day is next Thursday!

I'm very excited to be taking this next step.  I have worked very hard, not just on the recovery aspects, but also on the career/financial aspects.  It's been a long, long slog.  And it's nice to see that all my hard work is paying off.

Not that I'm not nervous.  Transitions are always hard for me, and I know that this is a slightly higher risk for relapse.  I've been working with my former therapist and parents to set up a good plan.

In the meantime, though, there are boxes to pack and bills to pay and stories to write.

I'll plead guilty--I've thrown around the phrase "brain disorder" in my time, even here on this blog.

But what the hell does this term even MEAN?!?

Here's the problem: there's no consensus.  Not in the field of eating disorders, not in the field of psychiatry, not in mental health.  Obviously, the idea of "brain disorder" means that biology is involved, which, for this trained biochemist anyways, is pretty darn obvious.

In a recent email, my friend Sarah Ravin said this:

I conceptualize a brain disorder as a disease or disorder that originates in the brain and influences mood, thinking, learning, and/or behavior. So EDs, autism, bipolar disorder, OCD, Alzheimers, and most of the DSM would fall under this category.

To me, “brain disorder” does NOT mean:

• Environment does not play a role in its development
• Environment does not play a role in recovery
• It is 100% biologically based
• It can only be treated by physician or with a pill
• Psychological interventions won’t help
• The patient can’t do anything to influence the outcome

In fact, I don’t know of any physical disease or medical condition in which any of the above is true.

I think this is, bar none, the best explaination of what a "brain disorder" is that I have ever read.  I think that if professionals can be more clear about what they mean when they say "brain disorder" then people can start understanding and integrating biology into their picture of what eating disorders actually are.  Understanding the biology of EDs has actually left me far more hopeful than any other explanation.  No, biology doesn't mean that I'm hopelessly f*cked, but it does help me approach recovery from a more realistic standpoint.  Even if/when I resolve all of my ED issues, I will remain vulnerable to relapse.  That doesn't mean I will be tortured by AN thoughts, or even have them at all, but that it's also smart to be cautious.

On this past week's Sunday Smorgasbord, one of my readers asked me for hints on breaking free from that maelstrom of worries that so often overwhelms people with eating and/or anxiety disorders.  I'm not saying that I'm an expert on this, because I frequently find myself sucked in to my worries, which never results in anything productive.  Nonetheless, I'm getting better at surviving the worry storms, and here are some of the tricks that I use.

1. Breathe.  It's a classic.  Take a deep breath.  Or several.  Deep breathing is very calming in and of itself.  Besides just breathing, pay attention to your breath as it enters and leaves your body.  Feel your lungs expand.  Feel the tiny hairs on your upper lip ruffle as you exhale.  It's called mindfulness, and it helps bring me back to the present moment and the present problem.

2. Take a break.  It was one of my homework secrets in high school and college: I always started the frustrating work first.  Not just to get it out of the way, but also so that I could take a break and work on something else if and when I got too anxious and frustrated.  Often, walking away from my physics or linear algebra homework, doing something else, and coming back to it after I had calmed down and regrouped made things go so much smoother.  So if balancing your checkbook is causing you to freak out, put the calculator down, do something else, and come back to it.  You will think more clearly and find the task much easier to accomplish.

3. Prepare for the worst.  Yeah, I know, much of The Advice out there is to tell ourselves that our worries are exaggerated and look at them rationally.  Which is a good thing, but often I find it more helpful to just bite the bullet and prepare for the worst.  If the ultimate worry is that I'm going to go broke and end up on the streets, figure out a plan.  What savings do I have?  What resources can I call upon?  What are my other options job-wise?  I don't spend a lot of time on this, but just knowing that even if the worst does happen, I can handle it calms me right down.

4. Animal therapy.  My cat or another furry friend always makes me feel better immediately.  It's like I can exhale just a bit.  Besides, how can a soft, purring kitty not make someone feel better?

5. Distract yourself.  This is a little different from #2, although it can be used as part of the "do something else."  Sometimes what I need isn't another task because I'm too frantic to concentrate.  I need something more distracting and mindless.  For me, watching re-runs of TV shows (I love House) or movies is calming.  They're familiar, as I've probably seen them before, which is soothing in and of itself.  And they get my mind off of whatever I'm worrying about.

6. Talk about it.  This is not something I'm good at.  I hate talking about my worries because what's the point?  Often, no one can help me, and I feel like a burden--or at least a neurotic basketcase.  But even if someone can't do anything about what's got my panties in a knot, just saying it out loud helps.  And many times, my friends and family will have a different way of viewing what's going on that can help, too.

7. Better living through chemistry.  I have a prescription for lorazepam (Ativan) for when I'm freaking out, panicky, and nothing else has worked.  Or I'm so wound up that using a coping skill is just ludicrous.  I resisted for a long time because I was afraid that benzodiazepenes were addictive, and I didn't want to just pop a pill.  But even just knowing that I have the pills in reserve helps me get through bad situations because I know I have something to make it better.

I had another session with Dr. H this afternoon (and another chance to play with her Keurig!) and we were discussing any number of things.  She asked me how my week went in the most wonderful way.

Think of your week like a rose, she said. There are thorns, there are buds, and there are blossoms.

Roses have thorns.  So does recovery. There's no way around it.  Thorns are the difficulties, the things that don't go as planned, the slips and the slides.  The horrible, awful, no good, very bad days.  You don't have to like the thorns, but you do have to learn how to avoid them--or at least live with them. 

Like I'm guessing some of my readers do, I have conflicts about struggles.  I don't like struggling.  But I also don't like admitting when I'm struggling.  I also also know that talking about my struggles is the path to getting them to stop.

File under: hard place and rock, between a.

I told Dr. H that I feel either I "have to" be a perfect anorexic or a perfect recovering person.  I can get the awful, unproductive mentality of "I already screwed up, so why bother?"  {{Why, hello, black and white thinking.  Nice to see you.}} Or I'm so embarrassed and ashamed of what happened that I cover it up.  Screwing up somehow means that I'm a disappointment. Neither of which is conducive towards recovery.

Which is when Dr. H told me about the rose metaphor.  If roses have thorns, so does recovery.  You're the only one who expects you to be perfect, she told me.  Which is true.  But then, I've always been the main force pressuring myself, so that's not news.  Nor does it tell me how to stop pressuring myself. 

Nonetheless, thinking of recovery as a complete package--screw ups, missteps, and all--helps relieve some of that pressure.  Part of learning how to do anything involves making mistakes and then learning from them.  Recovery is no different.

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.

11 Tips to Help Manage Anxiety.

Do recreational drugs and exercise share a neurological high?

Brief on weight bias in the US from the Rudd Center at Yale University.

Stress, Anxiety Both Boon And Bane To Brain.

Accounting for Taste.

Getting Someone to Psychiatric Treatment Can Be Difficult and Inconclusive.

The latest issue of Current Topics in Behavioral Neuroscience is all about eating disorders! And you can read them all for free!

Personality and temperament.
Cognitions and emotions in eating disorders.
Serotonin: Imaging Findings in Eating Disorders.
Dopamine-Based Reward Circuitry Responsivity, Genetics, and Overeating.
Reward and Neurocomputational Processes.
Cognitive-Behavioral Flexibility in Anorexia Nervosa.
Neural Circuits, Neurotransmitters, and Behavior: Serotonin and Temperament in Bulimic Syndromes.
The Heritability of Eating Disorders: Methods and Current Findings.
The Genetics of Eating Disorders.
The Influence of Gender and Puberty on the Heritability of Disordered Eating Symptoms.
New Frontiers in Endocrinology of Eating Disorders.
Animal Models of Eating Disorder Traits.
Neurobiology Driving Hyperactivity in Activity-Based Anorexia.
Translating Experimental Neuroscience into Treatment of Eating Disorders: Two Examples.
Cognitive Remediation Therapy for Eating Disorders: Development, Refinement and Future Directions.
Incorporating Dispositional Traits into the Treatment of Anorexia Nervosa.

I don't know whether this means I'm definitely in the right career, or just a glutton for punishment.

I started another blog.  A science writing blog.

"Somewhere, something incredible is waiting to be known." --Carl Sagan

I know that the only way to get better at writing is to actually do it.  And there are so many cool things to write about, things that I won't get the chance to cover for, you know, money.  That's where this blog comes in.  It's my chance to write about all of the cool things that I normally wouldn't write about.

I probably won't be blogging all that much at first.  I'm trying to pack and move, and deadlines for paying work will always take prescedence.  So, too, will ED Bites.  It's my baby.  It's not going anywhere.  I've put way too much effort into this blog to let it wither away.

But I also need to start putting more effort and time and energy into non-ED things.  I don't think this blog is holding me back--far from it.  Yet I also don't want to be known just for my ED work.  It doesn't bother me that most of the world knows me for ED-related and recovery things.  At the same time, that's not all I want the world to know me for.  It's been a big part of my life, but I hope to make it a much smaller part of my life.

Hence this blog. 

It's a recovery step, in a way, even though it really has nothing much to do with the eating disorder at all.

Last month, I wrote about the death of anti-anorexia activist Isabelle Caro. This morning, I learned that her mother Marie had committed suicide over the death of her child. Grief, guilt, and despair are painful, if normal, responses to loss.  I'm not faulting her mother for these seemingly intolerable feelings.  What I am wondering is how our habit of subtly blaming the parents for their child's eating disorder contributed to Marie's death.

In basically all of the news stories on Isabelle's death, there were comments about her mother, who was portrayed as a sort of Cruella de Ville of anorexigenic mothers.  An AOL story today said that:

Isabelle often spoke about her mother's phobia about Isabelle growing up and gaining weight, as well as her mother's depression. She had a lonely, difficult childhood as a result and had been anorexic since the age of 13. She wrote a 2008 memoir titled "The Little Girl Who Didn't Want to Get Fat."

This story also noted that Marie was especially devastated after a particularly critical article was posted about her in the wake of Isabelle's death.

Was Marie a perfect mother? Nope.
Did she cause her daughter's eating disorder? Nope.

A susceptibility to anorexia was part of Marie's genetic legacy that she bequeathed to Isabelle. Did she comment on her daughter's weight and size? I don't know. Even if she did, that couldn't cause Isabelle's anorexia.

Writes Dr. Julie O'Toole of the Kartini Clinic in a comment on her blog:

Even the most neurotic, dysfunctional, abusive parenting will not cause AN, much less what you have described above. AN is a brain disorder. Such parenting might, however, cause severe disordered eating, a neurotic obsession with appearance, or misplaced values.

In my years of practice I have had two mothers who actively tried to give their daughters anorexia nervosa. Why? Because they were mentally ill themselves. It is called Munchausen-by-proxy, and of course it didn't work. You can't give someone anorexia nervosa, even if you want to, and certainly not inadvertently.

It is likely that Marie was never told she could help her daughter recover, imperfections and all.  She clearly loved her daughter.  And if Marie herself had a subclinical eating disorder (I have no evidence that she did), it could have contributed to her alleged fears of Isabelle's gaining weight.

I remember discussing contributing factors with my mom in therapy.  At first, I believed that all of the unhelpful things she did were a direct cause of my eating disorder.  Anorexia was a rebellion!  A way of getting back!  A way of control!  Now I realize that these unhelpful things were a) inadvertent (how was she to know that getting good grades could be a bad omen?) and b) totally unrelated to my eating disorder.

Marie's death shows that the blame game is deadly--not just for sufferers, but also for loved ones.

Many of my recovery milestones thus far have been directly related to food/weight.  Things like eliminating my list of fear foods, not purging for a year and a half (and counting!), reaching my target weight and staying there.  Not that these aren't huge milestones, but they were also very concrete things.  I can do concrete goals very well, but more nebulous goals (increase flexibility! meet new friends!) are much more difficult.  I can't break them down into little steps.

One of the things I worked on a lot with TNT and have started to do with Dr. H is making friends.  I have been living here for a bit over a year, and I really didn't have any friends.  If I wanted to do something on a Friday night, I asked my parents.  There wasn't someone for me to call.

A few months ago, I joined a book club on meetup.com because I love reading, and it seemed like the perfect fit.  I lucked out, as the people there are really cool, really nice, and really smart.  My kind of people.  I could discuss politics without feeling the need to censor myself.  They were very accepting.  January's meeting was last weekend, and I went and had a very nice time.  I brought some killer scones (Banana Peanut Butter Chocolate Chip). The hostess made decaf coffee for me, since last time I turned the regular coffee down lest I be up all night, which I thought was the sweetest thing ever.

I stayed around a bit after to help clean up and to spend more quality time with their pup.  As I did, the host, hostess, and one other person began talking about their weekly jam sessions.  Apparently, every week, a bunch of them get together with their stringed instruments and just play music. It had come up during the group that I play piano and sing, and so they invited me to come.

As I was driving home, I realized: I finally have friends now.  I haven't had that in ages.  It occurred to me that they might be inviting me out of pity or guilt (they were talking about this music thing and I was right there next to them), an idea I can't totally shake.  But I also know that they genuinely seem to like me, and they aren't the type to throw out a pity invite.

It feels...really good.  I have a friend in real life, and I have online friends, but I honestly don't remember what it's like to have a group of people to actually do things with.  It's all very new to me.

Sunday was my last group therapy session with TNT.  As much as I disliked the idea at first--I would be the fattest one there, I was either not sick enough or too sick to be helped--I really came to enjoy the group.  One of the requirements was that you had to be in active recovery.  That meant you couldn't be actively involved in ED symptoms.  A slip up didn't mean you would be asked to leave, but you had to have significant abstinence from the eating disorder.

That last little bit was some of what made the group really helpful.  I'd done support groups before that ended in what can only be described as a hot mess.  I quit going because it was so hard to continue my recovery in that environment.  All people would talk about is how much weight they had lost, how many times they threw up, and so on.  File under: Pointless, Definition of.

I had groups when I was in treatment, and many of those were, in fact, helpful.  Learning DBT skills in a group setting, doing relapse prevention with others, learning from each other was remarkably helpful.  I was lucky, too, in that most of these groups were led by good clinicians who could keep things on track.  Other groups I went to outside of treatment were at best a waste of time and at worst directly harmful.

So yes, I was wary, both from ED-related reasons and from experience.  I tried to remember that the ED blog community is kind of like group therapy (well, there is a group of us and blogging is therapeutic), and I've never regretted getting involved in that.  TNT asked me to commit to one month, which I did.  I figured if things really went to hell in a handbasket, I could discuss it with her and leave sooner if I really had to.

The women in the group ranged in age from mid-twenties to mid-fifties.  And the wonderful thing was that we all related to each other so well.  I didn't know anyone's diagnosis, although after the first few weeks I had a guess.  In the end, though, it didn't really matter.  Not age, not diagnosis.  Many of us had similar problems in figuring out life after the eating disorder.  How do you manage urges?  How do you decide who to tell?  How do you handle the holidays? 

I'm going to miss my group.  I actually began looking forward to Monday nights.  TNT tried to find someone else to take over the group after she left, but she couldn't find anyone.  There's no group closer to home--at least, no other similar group.

I'm really grateful I got this chance, though, and maybe one day I'll get another chance.

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

Anorexia nervosa complicated by OCD. Another wonderful video from C and M Productions.

Is the campaign against childhood obesity responsible for the increase in eating disorders? Likely, says this psychologist.

10 Eating Disorder Resources for Families from Jenni Schaefer.

The relationship between compulsive buying, eating disorder symptoms, and temperament in a sample of female students.

Is there an upside to anxiety? One psychologist says anxiety provides us with drive, focus, and directed attention.

Non-suicidal self-injury in eating disordered patients: A test of a conceptual model.

Why I don't diet: Anatomy of a 5-day binge. (trigger warning for bingeing, weight loss stuff)

Stanford Researchers Develop Video Games That Let You Interact With Bacteria (This has nothing to do with EDs, but I just think it is so freaking cool. My undergrad research was in microbiology, my mom was a microbiologist of sorts, it's in the blood.)

Interesting theory of pleasure/addiction: multiple selves vying for control

Factors affecting crossover from anorexia (both subtypes) to bulimia.

Association between neuroendocrinological parameters and learning and memory functions in adolescent anorexia nervosa before and after weight recovery.

Exercise a Treatment for Eating Disorders?

Think you're not intelligent? Take the Rogers Indicator of Multiple Intelligences.

I've read a number of studies that show people with eating disorders have difficulty reading emotions in other people.  A new one came out this week. The general theme for people with anorexia is that they tend to be hypersensitive to anger--that is, they see people as angry, even when they're not.  No one really seems to know why this is, but it seems to be one of those general traits of people with EDs.

It's something I know a lot about.

I don't like social situations for any number of reasons (anxiety, etc), but I also tend to dislike them because I always feel that everyone hates me.  Saying that they hate me is probably an overstatement, but I am usually very uncertain about how people feel about me.  My brain tends to hone in on even the slightest hint of anger or ambivalence.  I can never quite seem to tell what people think of me.  On the one hand, my brain sees lots of anger.  On the other hand, I often don't see much angry behavior directed towards me.  Or at least not a huge amount of it.

So yeah, social situations are very confusing and difficult for me. 

It's not just random social situations, either.  I've often thought my mom was angry at me or yelling at me when she wasn't.  She might be stressed, even if it's unrelated to me or the ED, but I interpret it as anger.  And when someone is mad at me, I feel that they must hate me. 

What this really means is that I feel I live in a hostile world.  It's scary, and it doesn't help with my stress level.  It helps to explain some of the reason I have lots of anxiety, and why I tend to isolate myself.  Meeting new people means wading through even more uncertainty and feelings that someone is angry with me.  Anorexia played into this by almost buffering me from these feelings.

I find reading these studies helpful because it helps me reframe social situations.  Instead of leaping to conclusions that, in fact, people really do hate me, I can remind myself to wait for something more concrete than random worries.  I can try to assess the situation before letting my emotions take over.  I still don't like social situations, but I'm getting better at dealing with them.

In yesterday's tips, I mentioned how acknowledging my jealousy of others was ultimately empowering.  One of my readers asked how this was possible.  How did I move from wanting to stab out my own eyeball to a calmer understanding of what was going on?

At first, when people would talk about food, weight, and dieting, I got seriously pissed.  I was so tremendously angry that they "got to" restrict their food, get smaller sizes, etc, while I "had to" gain weight and buy larger clothes.  I was furious at their seeming smugness.  I stewed in anger for a while, a sort of quiet rage that poisoned everything.  I was angry at the world for any number of things, not just our dieting culture, but that was part of it.

Then I read something online where a women mentioned that she used to get angry at impulsive people who would flake out on her.  She was legitimately angry, yes, but she was also jealous of their ability to blow off mundane tasks in favor of the more exciting.  The mundane tasks got left to her, but she was really insanely jealous of their ability to take the world less seriously.

That's what I understood why I was so angry and frustrated: I was jealous.  I wanted to be able to restrict my food.  I wanted to blab non-stop about the gym.  Essentially, I wanted the social sanctioning for what I did during my eating disorder.  ED symptoms were a "get to," but recovery was a "had to."

I suppose I could have tried to see recovery as a "get to," but frankly, the thought never occurred to me.  Most people don't initially see recovery as the gift it is.  Recovery was a burden, a literal pain in the ass that I resented.  Being able to reconcile both my anger at being jolted into recovery and my jealousy of others' disordered eating habits was tremendously empowering.

So how in the hell did that happen?

I utlimately had to come to terms with the fact that I could go back to my eating disorder if I really wanted to.  I wouldn't have any money or a place to live, and I'd have to give up the cat, but yeah, I could go back to starving myself.  But I didn't want to lose all those things.  I didn't want to disappoint my parents or cause them the anguish that kicking me out would cause.  I didn't want to drop out of school.  I didn't want to quit my job.  So I began, over time, to reframe recovery as a choice*.

I didn't always like my options--my old therapist called this "choice amongst lack of alternatives."  I stayed with recovery because the alternatives were worse.  Slowly, I was able to reframe the situation not as "I can't restrict my food," but as "nothing good will come out of restricting my food, and so I won't do it."  It made me a powerful adult instead of a petulant child.  I didn't always feel the choice, and my treatment team would have stepped in if I made it, but nonetheless, I gave myself that power to decide.

That was the empowering bit.  The realization that I could want to restrict, acknowledge that wanting, and still stick with recovery.

I still hate diet talk with a vengance, but I don't usually find it triggering.  I still want to stab out my own eyeball, sometimes, but mostly out of boredom and annoyance.  I, myself, am choosing not to engage in self-destructive behaviors.  I can miss it all I want, but I can also reclaim my power over my behaviors.

*I didn't really choose recovery, because I was dragged there kicking and screaming, against every fiber of my being.  I think people should be given the option to choose their recovery, but it isn't always possible, and recovery shouldn't hinge on a sufferer "choosing" it.

No, a diet isn't the same as an eating disorder, but there are quite a few overlaps.  The obsession with food, the good food/bad food dichotomy, the talk of weight and the losing of it.  When I was still new in recovery, I found this talk tremendously triggering.  Now, I find it insanely annoying but it doesn't trigger ED thoughts and behaviors.  Here are a few tips I learned for how to cope:

1. Avoid the worst offenders.  I've had great conversations with co-workers, but I've also learned to avoid them in food situations.  Honestly?  I don't care how "bad" you were the other day.  In the name of expediency, I just avoid those people when we had our company lunchtime gatherings.  It might be that you can tolerate diet/body talk most of the time, except when you're feeling vulnerable.  So that might be the time to avoid such offenders.

2. Start a new conversation.  "So how 'bout them Yankees?" might be a bit of a cliche--not to mention super-obvious--but try talking about something besides food and weight if the conversation steers that way.  I like what I call micro-conversations in big groups, that conversation within a conversation.  Ask the person sitting next to you what they thought about something, if they caught the homework assignment, if they know of a good place to get their oil changed.  It's much more subtle than a big shift in the discussion, but it still serves the same purpose.

3. Try to educate.  I confess I don't use this tactic very much.  As open as I am on my blog, virtually none of my former classmates and co-workers knew of my eating disorder.  So getting on a big spiel about the diet/binge connection came too close to "outing" myself.  Not that I didn't disagree or raise a new piece of evidence, but I don't like being preachy.  That being said, every now and again someone says something that basically begs me to interject, and I sometimes do. 

4. Create a Diet-Free Zone.  At my old job, the space was pretty informal.  I had already called attention to myself by protesting the Big Fat Loser contest--the last thing I wanted was a confrontation.  That being said, I refused to engage in conversation about the virtues of diet foods and dieting people.  It was astounding how quickly the talk ceased around me.  I didn't engage, they didn't get their "props," and so they looked elsewhere.

5. Determine who's a lost cause.  Some people can't or won't be educated or shut up.  There's not much you can do about this fact.  They are what they are, and your job isn't to convert the world.  It's to preserve your sanity as much as possible during your recovery.  It's not your fault, and it says nothing about who you are.  Once you realize someone is a lost cause, don't waste any more time and energy on them.  If they ask your opinion, you should still feel free to give it, but otherwise, just let them talk.

6. Acknowledge the green-eyed monster.  Oh, jealousy.  It took me many years to realize that one of the things that most annoyed me when people talked about their diets was the fact that I was insanely jealous.  They got to lose weight.  They got the pats on the back, the feeling of accomplishment.  They got to obsess about food and exercise all the time.  And for them, it was all okay.  Totally sanctioned and encouraged.  Whereas any idle talk of wanting to lose weight that happened to come out of my mouth could practically have convened an emergency meeting of the UN.  It wasn't fair, and it drove me bonkers.  Totally crazy.  Realizing that I was jealous allowed me to put those feelings into context.  Of course I was jealous, just as I would imagine an alcoholic would be driven nuts by the advice to drink a glass of red wine every night, or conversations about getting totally wasted.  Letting myself be jealous and miss the eating disorder--while simultaneously commiting to recovery--was remendously empowering.

As always, if you have any tips to add to the list (or any suggestions for future tip days), please share them in the comments!

I had my second appointment with Dr. H this afternoon.  Don't get me wrong--I like Dr. H.  She has a Keurig coffeemaker in her waiting room, so there's no way I couldn't like her. And I like how she approaches therapy and she seems to "get" me.  That's no small order.

But she's not TNT.

I don't miss the hour-long drive each way to go see TNT, but I really did like the work we did together.  She's helped me feel a lot more secure about my recovery.  TNT talked me down from a number of psychological ledges.  We did some work on body dysmorphia, although it's still majorly present.  Nonetheless, although the dysmorphia itself isn't any better, I'm able to overlook it a bit more.

I do like Dr. H, though.  When I asked her what her philosophy was, she said that she mainly did CBT.  She followed this up with the comment that she doesn't see herself as just a therapist, but she also sees herself as part coach and part cheerleader.  Thankfully, she doesn't wear short, polyester skirts or insist that I wear them, either.  Keurig be damned, that would be a deal breaker.

It's hard to adjust to the change.  It's hard for me to adjust to any change, let alone something major like this.  I think I've been lucky overall with finding good therapists, especially recently.  I had a few doozies in my time (like the one therapist who told me, in all seriousness, that "I just needed to get laid." Well all righty, then), but I've mostly found good clinical support.

I think Dr. H will work out just fine, but making the transition is tough.  I see TNT next weekend for one last group therapy session, and then we're done.  I'm trying to remind myself that this is a chance to learn from someone new, to get a new perspective on my recovery.

Also, the Keurig.  Let's not forget the Keurig.

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

Journalist Feels Daughter's Eating Disorder Caused by Effexor Side Effects.

An open letter, not in character, to Mr Kenneth Tong, by SIRJoshuaToThee.

Anorexia in adolescents, by C and M Productions.

The Religion of Dieting—How to Tolerate Friends & Evangelists of the Latest, Greatest Diet.

Mindfulness Training and Meditation to Combat Obesity? Research indicates it's helpful.

Do fonts affect our learning? The Revenge of Comic Sans.

Perfectionism is a lie.

Favourite music evokes same feelings as good food or drugs.

Duping the brain with cues about taste. What happens when the brain is told it'll be bitter, but it's sweet?

When energy levels drop, it triggers more calorie absorption. Real-world translation? The body is much smarter than Weight Watchers and Jenny Craig.

How social networks spread disordered eating. From the looks of it, the study measured disordered eating attitudes, not diagnosable eating disorders.

Transcript of a webchat on eating disorders in children.

New study reveals impact of eating disorders on Native-Americans.

Insight in eating disorders: clinical and cognitive correlates.

Association between neuroendocrinological parameters and learning and memory functions in adolescent anorexia nervosa before and after weight recovery.

Changes in neuronal correlates of body image processing by means of cognitive-behavioural body image therapy for eating disorders: a randomized controlled fMRI study.

Stability of long-term outcome in bulimia nervosa: a 3-year follow-up.

The significance of repetitive hair-pulling behaviors in eating disorders.

First do no harm: Iatrogenic maintaining factors in anorexia nervosa. Co-authored by the always fabulous Finding Melissa.

Anxiety in anorexia nervosa and its management using family-based treatment.

Reduced capacity in automatic processing of facial expression in restrictive anorexia nervosa and obesity.

I read many news stories about eating disorders every week--most of them are okay.  I don't feel that they've turned the world upside down with great knowledge, but they also aren't heinous.

Then there are the heinous stories, about which I need to splutter in verbose dismay because I can't think of anything else to do.

Let's start with the title, shall we?

Addictions & Answers: Behind the insideous 'art' of anorexia

Okay, just to clear up any misconceptions here: ANOREXIA ISN'T ART.  It's not pretty.  It's not insightful.  It doesn't bring value to the world.  Watching your hair fall out in chunks, watching your skin turn yellow and gray, watching your kidneys stop working--this has nothing to do with art.

Being so afraid of eating, or the consequences of eating, isn't art.  It's an illness.  We don't call cancer or diabetes or mesothelioma an "art."  We seem to reserve that concept for eating disorders.  Stop making eating disorders into something they're not.  This so-called "art" kills thousands of people, and precious few people take it seriously.  We need a lot less art concepts and a lot more illness concepts.

I love metaphors, and I have used metaphors a lot to try and explain my own experience of having anorexia.  But there's a difference between using a metaphor to describe something ("It was like being trapped in a burning building") and actually using that something as a metaphor ("The burning building is like our society").  Frankly, I find it insulting and demeaning.  Anorexia-as-art smacks of vanity, of something less than serious, that maybe I huffed a few too many turpentine fumes on my way out the door.  Nuh-uh.

Onto the actual article...An excerpt is below:

BILL: Can't these people just look in the mirror and see something is radically wrong?


DR. DAVE: That's like saying to a meth addict, 'Can't you see you're killing yourself, why don't just stop?'


BILL: Dave, not the same. The meth addict is out-of-his-mind high. The alcoholic who dies in a one car crash or even the gambler who suicides in a deep depression rather than face his creditors—these are things our readers can understand. The closest I can come to understanding anorexia was when someone called it "the art of starvation."


DR. DAVE: Exactly: People like Isabelle Caro and Jeremy Gillitzer are addicted to view starvation as a kind of body image art.


BILL: An art they can totally control.


DR. DAVE: When the 87-pound anorexic loved one is genuinely horrified about how a stick-thin arm is "too fat," and pushes away the plate, barely touched, their families are baffled.


BILL: I can see how easy it is for parents to miss anorexic behavior. Aren't they in the midst of their own post-Christmas diet rituals --Jenny Craig "personal counselors," the new Weight Watchers "Points Plus" programs, and the rest? OK, Doc -- how does a parent or lover intervene to end this addiction?

"Body image art?"  So having anorexia is like getting a tattoo?  My only response to that is WTF, buddy?

The drunk, the meth addict, the gambler are all out of their minds, but someone with anorexia--a diagnosable mental illness--is somehow perfectly sane?  It's not just a bad choice.  The chaotic eating patterns in any eating disorder mean that the brain is painfully, thoroughly affected.  Someone with an eating disorder is exactly like a meth addict or someone as drunk as a skunk.  Their brain isn't working properly.  They need to detox before they can start behaving rationally.  Most starving people aren't completely rational--the men in Keys' Minnesota Starvation Study showed that rather well.

The last thing that really irked me is the comparison of anorexia and dieting.  An eating disorder is not an "extreme" diet or a diet gone overboard.  It's not uncommon for an eating disorder to start as a diet, but that doesn't mean that an eating disorder is a diet.  A suicidal person is often depressed and in a bad mood (trust me on this one).  Suicide isn't just a really rotten mood.  It isn't something you deal with by watching a funny movie and hoping it will go away.

One of the best things about the Internet is that everyone has a voice.  One of the most frustrating things about the Internet is that everyone has a voice.  Some people--especially these two--shouldn't have microphones.  It's one thing to peddle your whackjob theories on your own personal blog, but to have an official "stamp of approval" from a news organization is ridiculous.

I was rather sick yesterday (one of those 24-hour virus thingies), so the tip day post got shifted to today.  In last month's scientific random poll, one of the requested topics was how to pick yourself back up after a slip.  Ask and ye shall receive, my dearest readers.

{{Share any other ideas you might have in the comments section or drop me an email at carrie@edbites.com Because I suck at coming up with these, so help me out!}}

1. Do the next right thing.  I'm taking this line straight out of Jenni Schaefer's book Life Without Ed.  But it's what I tell myself when I slip.  Do the next right thing.  If I exercise too much, I take an extra rest day.  If I were to purge, I would drink an Ensure to make up for the calories.  If I were to binge, I would eat the next meal or snack.  Once becomes twice becomes...disaster. 

2. Respect yourself.  Yeah, yeah--the ED behaviors feel good in the short-term.  But in the long run?  They totally eat away at my self-respect.  I'm lying.  I'm bitchy.  I'm miserable.  I suck up vast sums of money first for ED behaviors and then for treatment.  My body dysmorphia may make me twitchy now--it does!--but it's nothing compared to the self-hatred of relapse.  So sing it with me: R-E-S-P-E-C-T.

3. Don't beat yourself up.  Relapse is exceedingly common.  I don't know anyone who has recovered without a relapse.  This isn't a blank check to give into urges because you're f*cked anyway (been there, done that, got the ill-fitting t-shirt), but it is to treat yourself with grace and compassion.  You screwed up.  No amount of self-flagellation is going to change that so stop wasting your time and effort.  Put your effort into tip #1.

4. Take it seriously.  It's one slip, right?  Just once.  There's no need to mention it to my therapist or doctor or support people.  They don't need to know.  Not that you have to wear a sandwich board advertising that you slipped, but you do need to be honest.  That means: telling your therapist. It also means telling your support people when they ask "How have you been?"  We all need our little secrets, but this ain't one of them.

5. Think of your therapist.  Yes, I'm Facebook friends with a former therapist, which is an odd but rather 21st-century situation.  But when I'm making a status update, I ask myself what she might think if I updated my true status rather than my most recent decline into the state of crazy cat lady (my purchases at the grocery store were cottage cheese, kitty litter, and Prozac).  There are things I'd rather not reveal--how awful my cramps are or the nasty thing that Aria coughed up the other morning--but I wouldn't go out of my way to conceal them, either.  So if I don't want my ex-therapist to know what I'm up to, then there's probably something wrong.

6. Reach out.  When I struggle, I tend to isolate.  So one of the most powerful things for me to do after a slip is to go be around people again.  It might mean seeing if a friend wants to catch a movie or grab some dinner.  As much as I preached honesty, you don't need to let the random chick from your psychology class in on all the nasty details.  You can say you're having a bad day, or you're bored, or you need to get out of the house before you lose your freaking mind.

7. De-brief yourself.  After you have gotten back on track, it can help to look at what started to go wrong and when.  Were there triggers you hadn't anticipated?  Did you have coping skills you didn't/couldn't/wouldn't use?  One of the most useful things for me is learning where I could have intervened.  At what point should I have reached out?  If I really didn't realize anything was wrong until behaviors had already unfolded, what are the signs that I missed?  Sometimes the slips seem to come out of the blue, but generally, they don't.

My latest story for Scientific American, More Than Meets the Mirror, is actually relevant to this blog (it doesn't happen very much!).  It's about the relationship between body image and what's known as interoceptive awareness.

Are you cold?  Thirsty?  Hungry?  Short of breath?  Whatever your answer, you used interoceptive awareness to answer the question.  Previous research has linked interoceptive awareness to the insula, and people with eating disorders have been shown to have deficits in both of these areas.  But that didn't mean the two were necessarily related.  After all, I have red hair and green eyes, but my green eyes didn't cause my red hair (for that, I thank Garnier Nutrisse Honeydip).

So a neuroscientist at the University of London devised an experiment where he tested students' interoceptive awareness by having them measure their heartbeat without taking their pulse.  Then he used a trick known as the rubber hand illusion to trick the students into thinking that a rubber hand was actually a part of their body.  Those students with low interoceptive awareness were more susceptible to the rubber hand illusion.

From the story (I do feel a little weird quoting myself, but whatever):

"People with low interoceptive awareness might have a less strict distinction between what is 'my body' and what is the external world," Tsakiris says. "They might be ruled more by vision, rather than by internal sensation." Previous studies have also found that people with anorexia have an impaired ability to sense internal cues, making the results of this new work useful for understanding and potentially treating severe body-image disturbance.

To be sure, the study used a small sample size and has not yet proved causation, but "if we can train people to sense their interoceptive states," Tsakiris says, "it might make a change in their body image. An interesting avenue for future research would be to see if improving interoceptive awareness impacts different areas of these disorders."

I'm a few days late in posting this (then again, I posted the Sunday Smorgasbord on Saturday night, so let's just say that my timekeeping this week totally sucks), but I figured better late than never.

It was New Year's Eve, and I was thinking about resolutions.  I don't really like them--I've never really made one--in part because they're all about stuff you don't want to do rather than stuff you DO want to do.  The joke among parents is that the easiest way to get a kid to do something is to tell them not to do it.  And adults are just old children. 

Yet I like the spirit of self-improvement, of making a goal and working towards it (this got very hijacked in the AN, but I do my best).  And goal setting has been a really useful recovery skill for me.

The problem with goal setting is that we often settle for really vague goals and don't map out a plan to get there.  Either one of these can set you up for failure.  Lots of people use weight loss goals, but if I see another ad or story about dieting, I think I'm going to stab myself in the eye.  How many Weight Watchers points are in an eye, anyway?  I digress.

So let's use smoking.  Quitting smoking isn't a vague goal, but unless you know how you're going to quit and how you're going to cope when you want to start lighting up again, it's going to be really hard to stay quit.  Recovery is something similar.  "I want to recover!" is awfully vague--what does that mean to you--and it also doesn't help you plan how you're going to get there.

It's where I ran into problems.  Occasionally, I told myself that I was going to quit all behaviors and embrace my thighs and blah blah blah.  If it lasted a day, I was doing well.  Vague and directionless is pretty much the way to get nowhere.

On Twitter (do you follow me on Twitter? You should. I keep you posted on my near nightly consumption of nature documentaries and other nerdy fun, as well as ED research), I started a hashtag called #recovery2011, where I encouraged people to tweet their recovery goals for 2011.  They didn't have to be specifically food related--an ED takes over your entire life, and recovery is about more than just food.  I told everyone that I would share the responses on my blog, which I am doing here.

• Try learning hunger cues again and accepting them as they are not as something to fight with!
• I'm changing my relationship w my body. I'll try not seeing it as something that could be smaller & just as something that is
• Food is great & all, yet not worth all the power we give it. Hoping 2011 brings food enjoyment & fuel yet time spent on more.
• Hope 2011 allows u 2 b open & trust your body's wisdom: hunger/fullness/cravings communicate your food & movement needs.
• I'm going to practice being relaxed and joyful around food, with the idea of "fake it till ya make it."
• I intend to be fully present in my life rather than obsessing over what has been or will be.
• Learn to love myself, even if it means by Dec 2011 I have learnt to love only my little toe, accept that, love that, be that!
• Try something new and scary. Take things in stride. Embrace the present while looking forward to the future.

I would love it if you, my readers, would share your own recovery-related goals in the comments section.  Be specific.  Not just "Be mindful about eating." but "I am going to concentrate fully on at least one meal every day."

So go for it! What's your goal?

--Muriel Barbery
"Elegance of the Hedgehog"

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

Save Adelaide's Only Eating Disorder Clinic: Stop the closure of Flinders Medical Centre's eating disorder ward

Top 8 reasons why you relapse during eating disorder treatment.

Why Is It So Damn Hard to Change?

Year In Dieting: Distraction, Noise Cause Overeating.

Join the New Year's Revolution, HAES-style.

Recovery from Eating Disorders: A New Year of Hope.

Anxiety in anorexia nervosa and its management using family-based treatment.

Mental Health Vocab Glossary. It's your one-way ticket out of acronym hell.

Measuring self-report obsessionality in anorexia nervosa.

Google Body. No, really. Raise your hand if you hear the sound of your free time being sucked into the vortex of the Internet.

Electrophysiology of appetitive taste and appetitive taste conditioning in humans.

Effects of distraction and focused attention on actual and perceived food intake in females with non-clinical eating psychopathology.

Avoidance of affect in the eating disorders.

Eating disorders in adolescents: Correlations between symptoms and central control of eating behavior.

Biases in emotional processing are associated with vulnerability to eating disorders over time.

The impact of perceived social support and negative life events on bulimic symptoms.

Coping and social support as potential moderators of the relation between anxiety and eating disorder symptomatology.