ED Bites

Bad decisions?

2012-01-31T23:18:00.002-05:00

This week is, apparently, a good week for infuriating emails and blog posts. I've written about the email that had me scratching my head (or, more accurately, banging it against my desk). Now it's time to write about the blog post that has me doing the same.

Today, I read the latest blog post from fellow Psychology Today blogger Emily Troscianko, aka The Hunger Artist, who is herself in recovery from anorexia. In the title of her post, she posed the following question: Is Anorexia a Disease, a Series of Bad Decisions, or Both?

Writes Toscianko:

A reader recently made a comment which prompted me to write this post. She said that 'anorexia, despite being a "disease", also involves a series of very bad decisions, for which we as the sufferers must bear some responsibility'. This made me reflect on my own experience, and the various 'points of no return' at which the development of full-blown anorexia became significantly more likely...At any of these moments - before leaving the house for school before the non-breakfast, when at the Swiss supermarket or in the kitchen on my boat in Oxford - I could have identified the danger in what I was contemplating doing, and decided otherwise. In the first of these three examples, I had the 'excuse' of really not knowing where this could lead, although I knew that lying to my family about how I was living couldn't be a good thing; but in the second two examples I knew perfectly well what the consequences would be, and went ahead regardless. Yes, numerous physiological, situational, and emotional factors were contributing in each instance to that decision - a decision is not a freely willed thought act detached from its embodied context - but I did nonetheless have the capacity to do otherwise. Whether that doing-otherwise would on its own have significantly slowed or even halted the progression of the anorexia is impossible now to say, but it's clear that all three decisions did have the opposite effect.

...Expressing personal responsibility through action against anorexia is an act of freedom and of self-understanding. The striking simplicity of what is at the heart of any such step towards rejecting anorexia - the simple act of eating - was what made slipping into illness so easy, and is now what makes climbing out of it a process that is constituted primarily of those trivial-seeming daily decisions. Sitting down now with the meal which you have planned to eat, and deciding to take the first bite, may not be an easy decision to make, but the effects both of doing so and of not doing so are very clear, and the moment at which the decision needs to be made - does this fork go into my mouth now, will I swallow now? - equally evident. All the things that have led you to be sitting here at this table contemplating this plate of food are complex and often opaque, but now that you are here, right now, you can make a good decision or a bad one, and however much an inner voice may whisper afterwards to confuse you, you know which is which.

Here's the thing: anorexia isn't a choice. It's not a decision. It's an illness. Which Troscianko admits. The problem is that these types of beliefs about anorexia and recovery--that the sufferer must actively choose and want recovery--don't always lead to the best outcomes.

For years, I felt like a treatment failure because I couldn't simply make the choice to get better. At the beginning, I couldn't see that there was anything to recover from. As the years passed, I started to see that the eating disorder was becoming very problematic, but I couldn't understand why I was still stuck. After all, I didn't want to live this way, I just couldn't figure out how to untangle myself. I couldn't figure out how to choose to get well.

I might not have been able to choose recovery, but I do have to continually choose to stay in recovery. It's a recovery that, now healthy, I am capable of making. It's a choice I have to make many times each day, and will everyday for the rest of my life. I have to take responsibility for my ongoing recovery, and I have.

An eating disorder isn't an illness of bad decisions. Bad decisions are things like buying a pair of Crocs and thinking you'll look stylish. Or buying a house in 2008 thinking it will make a good investment. We all make bad decisions in lif, and most of the time they come to bite us in the ass. This isn't to say that the innocent-seeming decisions we make in the course of everyday life have nothing to do with whether or not we will develop anorexia. The question to ask about some of my seemingly insane ideas and decisions during anorexia is this: was I actually capable of behaving differently? Not in the metaphorical or existential sense; if you look on paper, of course, I could have put food on my plate. But in the thick of the terror and the throes of anorexia, could I have actually done so? Most of the time, I would say no.

Researchers have found that, in the brains of people with active anorexia, reasoning abilities are significantly impaired (McCormick et al., 2008). Which means that the ability of someone with an eating disorder to be able to make rational decisions like eating more, not throwing up, or going into a hospital program pretty limited. It's not impossible--I've known many people who have done the hard and heroic work of having to choose recovery.

Still, current treatment systems for eating disorders (where they exist) are predicated on the patient's ability to choose recovery. "If you don't want to get better," patients are told, "then we can't help you." Of course, everyone's job would be lots easier if eating disorder patients wanted to get better, just as everyone's life would be easier if cancer cells stopped multiplying, psychotic patients stopped hearing voices, and a diabetic's pancreas started producing insulin again. The difference is that we don't view these failures as willful behaviors. We don't sit around and wonder whether it was a bad decision on the part of your lung cell to start dividing and not stop. Or whether someone who is acutely psychotic should try and stop paying attention to those imaginary idiots giving them directions. We understand (okay, at least some of us do) that this is just the limitations of the illness.

If people with anorexia could simply stop making the bad decision of not eating, then it wouldn't be an illness and there wouldn't be a million-dollar treatment industry.

The problem with believing that anorexia is a choice is that we leave sufferers to die alone in their apartments after years of illness. We discharge long-term sufferers to either figure out how to live with their illness or die. We tell them it's their choice whether or not to use behaviors. These are the bad decisions, not the eating disorder itself.

I'm not saying that people have no responsibility for their health, nor that people can't choose to recover. The thing is this: we shouldn't rely on it, nor should we expect it. Someone who is drunk can't drive properly, and we know this. We don't expect someone who is slurring their words after 10 beers to be able to drive a car. They might be able to get home safely. But we still tell them to call a cab. It's like that for eating disorders.

The real bad decisions, in my mind, are in the hands of treatment providers who expect that their eating disorder patients are fully competent and capable of making good decisions. Maybe they are, maybe they're not. But the desire to recover shouldn't be necessary for treatment.

The Renfrew Response

2012-01-27T22:24:00.002-05:00

As I mentioned in the Lipstick post, I received an email about a study conducted about women and makeup use by the Renfrew Center Foundation.

I emailed the PR rep, Jennifer, with the following:

I have a question for you, Renfrew, and Dr. Ressler: I'm curious why an eating disorder organization is studying makeup use in women. I don't see the connection, nor do I see what going without makeup has to do with eating disorders awareness week.

I have a blog post here: http://ed-bites.blogspot.com/2012/01/lipstick-connection.html

I really am interested in hearing a response from you guys. Thanks so much.

Jennifer's response:

Thank you for your response, Carrie. Attached please find a copy of the full press release which further explains the survey that we conducted as well as our campaign, Barefaced & Beautiful, Without & Within.

Barefaced & Beautiful, Without & Within is a call to action - an opportunity for women to join together and go without makeup in order to celebrate their natural beauty and start a healthy dialogue about body image, self-confidence and self-esteem.

It is our goal that through this campaign, we will get people talking in broader terms. For many, negative feelings about one's self-image can set the stage for destructive behaviors, such as addictions or disordered eating. It is our hope that Barefaced & Beautiful - a community of supporters sharing natural photos of themselves - will promote a greater understanding of how beauty and confidence come from within.

Upon your review, please do not hesitate to contact me if you have any further questions or if you would like to schedule a time to speak with our expert.

The press release was a Word document, which I've copied here:

NEWSURVEY RESULTS INDICATE THERE'S MORE TO MAKEUP

USE THANMEETS THE EYE

Inresponse to study, The Renfrew Center Foundation launches nationalcampaign, “Barefaced & Beautiful, Without & Within,” during NationalEating Disorders Awareness Week

PHILADELPHIA,PA (January 23, 2012) — The Renfrew Center Foundation, anon-profit charitable organization dedicated to advancing the education,prevention, research and treatment of eating disorders, today announced surveyresults which revealed that nearly half of all women have negative feelingsabout their image when not wearing makeup and associate a “bare face” withfeeling unattractive and insecure. Additionally, one quarter of the womensurveyed began wearing makeup at age 13 or earlier.

This survey was conducted online withinthe United States by Harris Interactive on behalf of The RenfrewCenter Foundation, from December 20-22, 2011—among1,292 women 18 years of age and older. Highlights from the survey include:

· AlmostHalf of Women Have Negative Feelings When They Don’t Wear Makeup

Forty-fourpercent of women have negative feelings when they are not wearing makeup,reporting feeling unattractive (16%), self-conscious (14%) and naked/as thoughsomething is missing (14%). Only three percent of women said going withoutmakeup made them feel more attractive.

· WomenWear Makeup for Both Physical and Psychological Reasons

Almosthalf (44%) of women wear makeup to hide flaws in their skin. They also cited emotionalresponses, with 48 percent noting that they wear makeup because they like theway they look with it and 32 percent agreeing that it makes them feel good.Eleven percent said they wear makeup because it is a societal norm.

· WearingMakeup is Not Just for Adults

Ofwomen who wear makeup, almost half started wearing it between the ages of 14and 16 (51%), yet more than a quarter of women began using it between the agesof 11 and 13 (27%).

“Wearing makeup to enhance one’sappearance is normal in our society and often a right of passage for youngwomen,” said Adrienne Ressler, National Training Director for the RenfrewCenter Foundation and a renowned body image expert. “There is concern, however,when makeup no longer becomes a tool for enhancement but, rather, a securityblanket that conceals negative feelings about one’s self-image and self-esteem.For many individuals, these feelings may set the stage for addictions orpatterns of disordered eating to develop.”

During National Eating Disorders Awareness Week(February 26 – March 3), The Renfrew Center Foundation is sponsoring a nationalcampaign, titled Barefaced & Beautiful, Without & Within (www.renfrew.org). Through the campaign, Renfrew will encourage women nationwide to gowithout makeup for a day in order to start a dialogue about healthy body imageand inner beauty.

“In this age of toddler beauty pageants,digital retouching, celebrity worship, and other unrealistic cultural messagesabout beauty, there are definite challenges to developing a positive bodyimage; challenges that put women at risk for eating disorders and other selfdestructive behaviors,” said Ressler. “Our hope is that through Barefaced & Beautiful, Without & Within, we will promote greater understanding that real beauty andself-esteem truly begins from within.”

To show yoursupport for Barefaced & Beautiful,Without & Within, The Renfrew Center Foundation is asking for women togo without makeup on Monday, February 27th and promote their participationthrough their social media networks by tweeting a photo or changing theirFacebook profile picture to one of their natural self. Tolearn about participating in Barefaced & Beautiful, Without & Within, please go to www.renfrew.org.

TheRenfrew Center Foundation

The RenfrewCenter Foundation, founded in 1990, is a non-profit, charitable organization dedicated to advancing the education,prevention, research and treatment of eating disorders. The Renfrew Center Foundation is supportedfinancially by private donations and funding from The Renfrew Center,the nation’s first and largest network of eating disordertreatment facilities. TheRenfrew Center now operates eleven facilities in nine states. Through its programs, the Foundation aims toincrease awareness of eating disorders as a public health issue and researchthe pathology and recovery patterns of people with eating disorders. TheFoundation also seeks to educate professionals in the assessment, treatment andprevention of behavioral and emotional disorders by sponsoring an annualconference, as well as numerous seminars throughout the country. To date, theFoundation has trained nearly 25,000 professionals. For information about The Renfrew Center Foundation, please calltoll-free 1-877-367-3383 or visit www.renfrew.org.

Survey Methodology

This surveywas conducted online within the U.S. by Harris Interactive on behalf of TheRenfrew Center Foundation from December 20-22, 2011 among 1,292 women ages 18and older. This online survey is not based on a probability sample and,therefore, no estimate of theoretical sampling error can be calculated. Forcomplete survey methodology, including weighting variables, please contactHolly Dean at 215.875.4365.

About HarrisInteractive

Harris Interactive is one of the world’sleading custom market research firms, leveraging research, technology, andbusiness acumen to transform relevant insight into actionable foresight. Knownwidely for the Harris Poll and for pioneering innovative researchmethodologies, Harris offers expertise in a wide range of industries includinghealthcare, technology, public affairs, energy, telecommunications, financialservices, insurance, media, retail, restaurant, and consumer package goods.Serving clients in over 215 countries and territories through our North American,European, and Asian offices and a network of independent market research firms,Harris specializes in delivering research solutions that help us – and ourclients – stay ahead of what’s next. Formore information, please visit www.harrisinteractive.com.

So, to some extent, Renfrew isn't trying to deliberately link lipstick and eating disorders. They mentioned disordered eating, not eating disorders, which is very good.But it still rubs me the wrong way for some reason. I guess what I really want to know is why the Renfrew Center is studying makeup use. It just doesn't compute.

Jennifer's email ended with an invitation to speak with Dr. Ressler. I would like to ask her directly the question in the above paragraph. And since I'm going to be sending her the question via email, there's plenty of room to add other questions.

What other questions would you like to ask Dr. Ressler? Feel free to suggest away! I may edit your question slightly for clarity, brevity, or to combine several questions into one. I can't promise that I will submit every question asked, either, but I will do my best to make something comprehensive but not overwhelming.

The Fatigue Saga, or where I've been

2012-01-27T00:26:00.000-05:00

As I'm sure some of you have guessed, my blogging has tapered off a bit in the last few months. I'm trying to correct that now, but I figured I owed you an explanation.

At the end of September and beginning of October, I got two viral infections pretty much back-to-back. I bounced back...somewhat...but not completely. Then the fatigue set in, big time.

After a few weeks, I went to the doctor and asked her to run some tests to rule out anything obvious (anemia, Vitamin D deficiency, etc). I also asked her to run an Epstein-Barr virus titer to check for mono/glandular fever. The symptoms were eerily similar to what I had about six years ago when I had mono. I'm not sure if the doctor checked for Epstein-Barr specifically, nor did I ask (I call her Dr. Bitchyface, and I try to have as little to do with her as possible). All the other tests, however, came back normal.

Although I have no definitive diagnosis, I'm still leaning towards mono simply because the symptoms have persisted for so long and seem to have limited connection to mood and anxiety.

The fatigue is starting to lift. I'm mostly back to normal. I still have a day or two a week when all I want to do is sleep, and no amount of coffee can convince me otherwise. It's taken a massive toll on my productivity, which is hard for me to deal with. I'm on the home stretch for my book, which means I need every last ounce of energy I can get.

So that's where I've been and where I am. I'm on the upswing now, and I hope to keep it that way.

The Lipstick Connection

2012-01-24T10:49:00.000-05:00

As I've mentioned before, I get lots of email from PR people. Mostly, they neither bother me nor really attract much of my attention. One from this morning, however, did.

First, the pitch:

Dear Carrie,

It’s no surprise that most women wear makeup, but what drives the desire to wear bright red lips on a trip to the grocery store or a face full of foundation to the gym, beach or pool? And how does wearing makeup influence a woman’s self image? I thought you might be interested in covering this on your blog.

The Renfrew Center Foundation, a non-profit charitable organization dedicated to advancing the education, prevention, research and treatment of eating disorders, recently conducted a survey which revealed that nearly half of all women have negative feelings about their image when not wearing makeup and equate a “bare face” with feeling unattractive and insecure. Additionally, more than a quarter of the women surveyed began wearing makeup before age 13.

We’d love to work with you on a story revealing the results of this survey and are happy to provide nationally renowned body image expert, Adrienne Ressler of The Renfrew Center Foundation, to discuss the findings.

If interested, I’d be happy to send a full press release on The Renfrew Center Foundation’s survey on women’s attitudes towards makeup. The release also provides information regarding The Renfrew Center Foundation’s Barefaced & Beautiful, Without & Within campaign, a national call to action for women to go without makeup on February 27th in conjunction with National Eating Disorders Awareness Week (February 26- March 3).

Let me know if this is of interest.

The only thing I can think is: what the HELL does makeup have to do with eating disorders?!?

I know that body image obsessions are common in EDs, and I know that makeup can be part of that. But I almost never wear makeup, and I still got an eating disorder. So I'm just wondering how going without makeup is related to Eating Disorders Awareness Week. It's kinda maybe tangentially related, maybe, if you lump body image distress in with eating disorders.

But really? Makeup doesn't cause eating disorders.

Redoing the mental accounting

2012-01-23T14:56:00.000-05:00

So I'm trying to finish up my book. The manuscript is due in a little less than a month, and I'm trying to get the last little bits filled in, the references checked, and so on. It's tedious, hard work. I also don't really have much in the way of an advance (basically, the publisher pays the author $X amount in future royalties up front; the first $X of royalties goes to the publisher instead of the author. After that, the royalties goes to the author. It's basically a gamble on the part of the publisher as to how much money they think the book will earn. I'm working with an academic publisher who operates under a royalties only system. No advance, but once the royalties start rolling in, they're all mine.), which means I have to keep up my regular writing stuff, too.

So I devise daily tasks for myself, like finish Chapter 10, email so-and-so, etc. The most common task, however, is "Write XX words." I like numbers. I like tasks that are easily definable and clear-cut. Things like "work on references" are awfully vague, and I never know how much work is required to be able to check that SOB off my list. On the one hand, discrete goals like writing, say, 1500 words are easier to accomplish because they are so concrete.

On the other hand, 1500 words don't always come magically flowing off my fingers. Sometimes I get stuck, sometimes I spend several hours chasing down a single study that I need to make my point (PubMed is a contact sport...really...), sometimes I have other paying writing jobs that act as a giant time suck. My carefully scripted goal of 1500 (or 1000 or 2000 or 500) goes caput.

That happened on Saturday. I did several lengthy interviews during the day, which were all duly checked off. But I still primarily measure my progress in words per day, which was definitely lacking. I really meant to get more done in the evening, but I got in a groove cleaning my place and then some trashy TV came on, which made me keep cleaning so I could justify my occasionally questionable taste in television programs. As it happened, time passed and here I was at bedtime with hardly any progress made on my book.

I was beating myself up in my head for being lazy and not making progress and I was a crap writer so what business did I have trying to finish a book--a book for crap's sake! But then I started thinking. My interviews gave me a LOT of good material, and I can't really write without doing interviews. I got some cleaning out of the way, which was a good thing.

The problem was that my accounting methods weren't actually factoring in the other important work I was doing. It had become just about the numbers, when in fact, the numbers only tell part of the story of book progress.

I suppose this story says a lot about my focus on numbers and on details at the expense of the big picture. No doubt it does. But this focus isn't necessarily written in stone, either. I might gravitate to it rather naturally, but I also need to work on recognizing the problems I encounter when I do this and work on bringing my vision back to be more holistic.

Sunday Smorgasbord

2012-01-23T00:17:00.001-05:00

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.

Lack Of Sleep Might Make You Feel Hungrier.

Warning: Dieting Increases Your Risk of Gaining MORE Weight, Independent of Genetics.

The first artificial sweetener poisoned lots of Romans. Mmmmm...lead (II) acetate...tasty and calorie free!

A Bridge to Recovery on Campus.

Exercise Can Reduce Anxiety in Women.

Psychological and behavioral traits associated with eating disorders and pregnancy: a pilot study.

Too many US adults with mental illness don't get treatment.

How Frequent Are Eating Disturbances in the Population? Norms of the Eating Disorder Examination-Questionnaire.

The Exhilarating Effects Of Exercise.

Online counselling for eating disorders: Reaching an underserved population.

What To Do the Morning After a Binge.

Made with love, cookies do taste better. The way we read another person's intentions changes our physical experiences.

Age at menarche and digit ratio (2D:4D): Relationships with body dissatisfaction, drive for thinness, and bulimia symptoms in women. Digit ratio is a way to study your androgen exposure in utero.

No Proof Paula Deen’s High-Fat Southern Cooking Caused Her Diabetes.

Adolescents' brains respond differently than adults' when anticipating rewards.

Is There a Perfect Human Diet?

Great article on 'The Age of Anxiety' in this weekend's New York Times.

Anorexia nervosa: patient and family-centered care.

Mindful Eating Restaurant Study-Folks trained in mindful eating ate fewer calories, regardless of portion-size served.

Poor Cognitive Flexibility in Eating Disorders: Examining the Evidence using the Wisconsin Card Sorting Task.

5 Intriguing Facts About Intuitive Eating.

The war on fat backfires. Understanding “Weight” as Social Identity.

Early response to treatment in adolescent bulimia predicts outcome.

The value of solitude and introversion in a world that praises collaborative creativity.

Binge eating, purging and non-purging compensatory behaviours decrease from adolescence to adulthood: A population-based, longitudinal study.

Ecological momentary assessment of bulimia nervosa: does dietary restriction predict binge eating?

The effect of gonadal and adrenal steroid therapy on skeletal health in adolescents and young women with anorexia nervosa.

Talking to reporters

2012-01-21T21:03:00.002-05:00

I got this question on my ED Bites Facebook page, and thought it was such a good one that I wanted to share it on my blog and get feedback from all of you. Ideally (when I get the time after my manuscript is due), I would like to compile this into a guide for how to talk with the media about eating disorders.

So here is Lindsee's question:

Ok I might need some help because I think when I polietly spoke up after I thought about this about a question on why our state makes this big deal each October and April with a month spread on Autism and Breast cancer awareness, but never really paid much attention towards eating disorder awareness month, I apparently got a response from one of the editors and reporters. They like to do a story or piece so I guess does any of the members have any suggestions they like me to maybe adress or say.

You can comment either on the blog or on the Facebook page.I think it's a really important topic and I'd love to hear what all of you have to say!

Sometimes...

2012-01-19T14:54:00.003-05:00

For everyone out there who is struggling and trying to hang on right now, remember this:

Sometimes things don't go, after all,

from bad to worse. Some years, muscadel

faces down frost; green thrives; the crops don't fail;

sometimes a man aims high, and all goes well.

A people sometimes will step back from war;

elect an honest man; decide they care

enough, that they can't leave some stranger poor.

Some men become what they were born for.

Sometimes our best efforts do not go

amiss; sometimes we do as we meant to.

The sun will sometimes melt a field of sorrow

that seemed hard frozen: may it happen for you.

--"Sometimes" by Sheenagh Pugh

Male eating disorders

2012-01-17T22:54:00.000-05:00

Men get eating disorders, too. A British organization by the same name has a website and Twitter account by the same name. Eating disorders information can be found at the website for the National Institute of Mental Health, and also on the website for information on women's health. It implies that eating disorders are just a women's issue.

As the Kartini Clinic blog pointed out last week, one of the very first medical descriptions of anorexia was of an adolescent male. In 1689, believe it or not. So the idea that eating disorders are "just" women's issues is actually quite wrong.

The problem is that after Richard Morton first described anorexia in 1688, later medical doctors lumped anorexia in with "hysteria." Hysteria is derived from the Greek word for the uterus (which is why you get a hysterectomy), which means that men automatically can't be "hysterical" in the nineteenth century, technical usage of the word. Which is where we started to go wrong.

Later conceptualizations of eating disorders continued to exclude men, because eating disorders were seen as a female over-concern with one's looks, or a diet gone wrong. Men, it seemed, didn't face these pressures and/or were too smart to fetishize the size of their asses. Since men didn't face the body image pressures that women did, men couldn't get eating disorders.

It's bollocks, by the way. If you're human, you can get an eating disorder.

I'm blogging about this not just because I've been reading stuff about eating disorders in males, but also because I got a press release emailed to me this morning about a symposium on male eating disorders at the 2012 IAEDP conference this spring. The tag line was:

Our latest news shares the sad and startling fact that one in three men are willing to shorten their lifespan just for the sake of better meeting society's image of the "ideal" man.

Huh?

I mean, there are just so many things wrong with this. First of all, eating disorders have existed long before current body ideals evolved, so that can't be the cause. Second, an eating disorder isn't being "willing to shorten your lifespan." That's like saying someone is willing to develop cancer so they can lose weight from chemo. Eating disorders aren't choices. They aren't about vanity or looks. They're a real biologically-based illness that kills, not because vain and vapid people of all sexes and genders are too self-absorbed to stop harming themselves, but because they have an illness that we generally suck at treating.

Also, I'm not sure of the scientific validity of a hypothetical "would you rather" question in assessing body image issues or eating disorders in any population. Nor are people with eating disorders actually making these decisions. Like I said, it's an illness, you idiots.

Of course, what I got was a press release and promo information. I don't know exactly what the presentation is going to contain. The email I got did say that they were also premiering a male-specific eating disorders assessment, which could be a very good thing. I haven't seen it, so I can't say for sure.

It's just that perpetuating these myths about what causes eating disorders doesn't do anyone any good in the long run. Yes, issues of eating disorders in males does need more attention, but could we at least get the facts right first?

(Belated) Sunday Smorgasbord

2012-01-16T23:59:00.002-05:00

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.

Study Finds Problem Drinkers Get Bigger Endorphin Kick.

Is mental illness culturally specific? Fascinating read on the different ways we go mad.

This week in "No shit, Sherlock" science: Watching 'The Biggest Loser' may increase anti-fat attitudes.

And more on Sherlock- how the detective used statistics and the science of personality.

Scales don’t carry that much weight in determining health.

A randomized controlled trial of adjunctive family therapy and treatment as usual following inpatient treatment for anorexia nervosa adolescents.

New guidelines on the care of young people with anorexia nervosa from the Royal College of Psychiatrists.

Clinicians May Have Negative Attitudes Toward Patients With Eating Disorders.

High prevalence of eating disorders not otherwise specified in northwestern Spain: population-based study.

Eating Disorders Recovery Q&A.

“Photo-Therapy:” A Promising Intervention in Anorexia Nervosa?

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

Making the Case for Size Acceptance.

Disordered eating and suicidal intent: The role of thin ideal internalisation, shame and family criticism.

NPR's Science Desk Experiments With Twinkies. It's a tough job, but somebody's got to do it...

Weight is the number one reason kids are bullied.

How pregnancy triggered one woman's long-dormant eating disorder.

How (CBT) Therapy Has Worked For Me.

Exercise Hormone Helps Keep Us Healthy.

Moving from an Eating Disorder's Half-life to Your Full Life.

New blog article about the treatment of orthorexia using CBT and Mindfulness Based CBT.

Emotional Processing Following Recovery from Anorexia Nervosa.

'Tis the Season

2012-01-13T23:28:00.000-05:00

...for dieting, that is.

Most of us learned about the four seasons when we were younger, about spring, summer, autumn, and winter. Considering I grew up in Michigan, there were really two seasons: winter and three months of bad sledding. Now that I'm an adult, and living south of the Mason-Dixon line, there are many more seasons than I experienced as a kid in Michigan. To everything, there is a season, and to every season, there is a reason to diet.

Winter: It's your New Year's Resolution to have a Totally New You by developing those Buns of Steel. (I'd settle for buns of cinnamon, but then, that's me.)

Spring: It's going to be Bathing Suit Season soon, and you had better fit in that Itsy Bitsy Teeny Weeny Yellow Polka Dot Bikini you wore when you were three. So it looks like a thong. So what. I hear they're popular these days!

Summer: It's Bathing Suit Season and EVERYONE IS GOING TO SEE YOUR FAT ASS IN THAT BATHING SUIT SO YOU BETTER STOP EATING, YOU FAT PIG.

Autumn: Do NOT gain weight over the holidays, and here's how (you can start by not celebrating the holidays at all).

Ta-da! The year in dieting. Winter season is the worst, and right now about all I seem to hear commercials for are end-of-the-year car sales, cigarette cessation aids, and diet products. It makes me almost pity the poor guy who's trying to hawk replacement windows so that people can get their tax credit.

Almost.

Jeopardy!, the game show for grandmas and geeks like me, Jeopardy! for crap's sake, is now sponsored in part by a colon cleanser (aka, an overpriced laxative that just really dehydrates you and then you take a drink of water and bloat from here to Timbuktu. Trust me, kids, don't try this at home).

The Diet Survivor's Group blog has a list of alternate dieting headlines for magazines to use. Start with these examples and then you might just have a fun game to play in the checkout aisle at the grocery store.

Self Magazine:
The Food Lover's Diet - 31 Tiny Tricks That Peel Off Major Pounds
My Edit:
The Food Lover's Diet - Eat What You Love and Savor Every Bite

Allure:
The Easiest Diet Ever: Drop 600 Calories A Day Without Feeling Hungry
My Edit:
The Easiest Diet Ever: Eat When You Are Hungry And You'll Never Feel Hungry (duh!)

Shape:
How We Lost 477 Pounds Together: 6 Women Share The Diet Secrets That Worked For Them
My Edit:
How We Raised Our Consciousness Together : 6 Women Share Their Wisdom And Empower Each Other

Fitness:
Your Best Body Ever
My Edit:
Your Body Is The Best Body Ever

O Magazine:
How To Get What You Really Want This Year: Weight Loss That Sticks - Dr. Oz's Simple Secrets For Keeping The Pounds Off
My Edit:
Keep Working Toward Getting What You Really Want This Year: Body Satisfaction That Sticks - Dr. Oz's Simple Secret Is That There Is No Secret For Keeping The Pounds Off.

Seventeen
Total Body Confidence - Great Abs, Butt & Legs By New Year's
My Edit: (I got kind of hopeful with the first part...)
Total Body Confidence - Enjoy Your Body In Its Fullness All Year Long

Us:
The Biggest Loser - How I Did It!
My Edit:
The Biggest Winner - How I Did It! Tips To Love, Respect, And Honor YourselfWoman's World:Break Through Ohio State University BELLY FAT CURE! Discovery - Two Spoonfuls Of This Oil Will Block Fat Storage! Melt 5" Of Belly Fat - No Diet Required!
My Edit:
Woman's World Announces Bankruptcy As Readers Boycott Magazine Due To Outrageous Claims!

I guess this game beats hibernating...

{{brought to you from the archives...}}

Return to the RD

2012-01-12T01:18:00.000-05:00

Have any of you guys ever sat down to blog, knowing you had a great idea, but then after staring at the screen for 15 minutes, realized you couldn't remember what the hell it was?

No?

Oh, well then. Me, neither.

Anyway, I finally remembered what I wanted to say at about 2am, which was really too late to be helpful yesterday, but I am finally sitting down to blog this afternoon.

So I've started seeing a dietitian again. I had a few appointments last year, and it's been about two or three years since I really saw an RD with any sort of regularity. In the past, when I'd started back up with a dietitian after a hiatus, it was usually because I was in some sort of crisis mode and was futilely trying to put a Band-Aid on the bullet hole. Occasionally it worked, mostly it didn't.

My therapist has been talking me for a while about returning to a dietitian for a while. Not because I'm doing poorly or having troubles but so I don't in the future. I've been enjoying cycling and such, and I've started doing the occasional longer weekend ride with a group I found. When I've tried to increase my mileage in the past, it's either been an ED-related motivation and/or the exercise has gotten ahead of me and I've ended up in relapse mode.

The general idea, I've been told, is to avoid this in the future. Enter the dietitian.

We had our first session a few days ago, and mostly we discussed how I need to add more protein to fuel my workouts. She also mentioned that I might want to try eating more earlier in the day so I don't get so hungry at night. I, of course, instantly interpreted this as "YOU EAT TOO MUCH YOU FAT, DISGUSTING PIG!" Which isn't at all what she meant, and once I calmed down enough, I was able to make sense of it. My weight is stable, clearly I'm not eating too much.

Clearly, there's plenty of stuff to work on, not to mention things like flexibility, etc.

We meet again in two weeks.

It should be interesting, as I've never really worked with a dietitian while in serious recovery mode. She has been very helpful to getting me to where I am today, but we've never really had a "Carrie is doing well" kind of relationship. So we shall see.

Sunday Smorgasbord

2012-01-09T01:05:00.000-05:00

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.

Binge-eating and depression go together in teens.

Who pays for treatment of eating disorders?

Theory of mind in bulimia nervosa.

New specialist eating disorders unit in Scotland months behind schedule.

Experts urge BMI method for calculating weight in kids with eating disorders. It's better than throwing darts, but I think clinicians should use information from growth charts whenever available.

Racial/ethnic differences in adults in randomized clinical trials of binge eating disorder.

Great piece on Hope and Full Recovery.

The Starving Brain--FINALLY a magazine article about EDs that actually *gets it*!!!

Everyone has reasons for NOT getting treatment...but that doesn't mean we can't shake it off and move forward.

The usual results: dieting leads to putting on weight later.

Royal Society Christmas brain lectures available worldwide.

Totally unrelated to anything ED, but...what happened to "British accents" in 1776 America.

Tired of all the weight loss ads and diet products being thrown in your face? So is she...

More Examples of Women as Food as Women.

A call for better guidelines in diagnosing and treating childhood eating disorders.

On why guilt and shame don't work in anti-obesity ads.

Article highlights the troubles of EDNOS-- great to see this getting press coverage!

Living a healthy life may or MAY NOT include weight loss, study finds.

The American Dietetic Association gets a new name.

Drawing mental illness – just amazing.

Internet cognitive behavioral therapy for binge eating.

Diagnosis of Borderline Personality Disorder is Often Flawed.

Sad lonely lady rats may really eat their feelings.

Bracing for the Fake Sugar Rush.

Discourage teens to engage in frequent self weighing as per this research.

Why change is so hard and what you can do to make it easier.

Selective Attention of Patients With Anorexia Nervosa While Looking at Pictures of Their Own Body and the Bodies of Others: An Exploratory Study.

Lessons from oversleeping

2012-01-08T20:14:00.000-05:00

I overslept today. My sleep schedule hasn't approached anything that could reasonably called a "schedule" for several weeks (night owl + insomnia = chaos!), so it's probably not all that surprising. The problem was that it was late enough to throw off my food schedule for the day. I'm not on some sort of tight schedule where I need to have breakfast at X o'clock and lunch at Y o'clock, and so on. But I do like to have at least some break between meals so I don't get too full.

So I made up my breakfast at some embarrassingly late hour and then sat down to eat. While I was munching on my peanut butter toast, I started to think: okay, so how am I going to get all my food in today?

I was thinking and making adjustments--I have a crochet group in the afternoon that meets at a coffee shop, so adding a latte would be easy to get in some extra energy without feeling overly full, and then get something to eat along with it. Or I could bring some trail mix. And then add something extra in the evening, and all should be good.

Which is when it hit me: instead of planning how to "get away with" eating less, I was planning how to keep in recovery.

I don't think I've ever done that before. I've gotten past the point where I look for opportunities to restrict, but it's been much harder to *not take them* when they arise. And this was a great excuse. After all, I was sleeping, which isn't really known for its calorie-burning potential. Since I didn't wake up until almost essentially lunchtime (I'm, like, seriously moritified over how late I slept, yo), just crossing breakfast off the list would have been super-duper easy.

Except I didn't. I shifted a few things, and added them in here and there and tried to be flexible. It wasn't always ideal, but I was committed to making it work. And that's a really cool place to be.

When bad body image isn't about the body

2012-01-05T00:25:00.001-05:00

I remember going to a therapy appointment quite a few years ago, flinging myself into the chair and promptly launching into a ten-minute-long tirade about how fat this complete idiot was making me. Didn't she see how huge I was? And she still wanted me to gain weight?!?

After I came up for air, my therapist looked at me and said with a voice that can only be described as overly saccharine, "Now, Carrie, we know that bad body image really isn't about how we look. Why don't you tell me what's really going on."

The reframe sent me further into a rage. Don't patronize me, I said. I'm feeling fat because I am fat and that's it. There's nothing more to it. Period. End of story. So why don't we talk about what we're going to do about my need to lose weight now that you've porked me up.

And so on. The session would not be classified as "productive."

With time, maturity, and proper nutrition, I've come to realize that my therapist had a point. I remembered her point today, when my work schedule can only be described as a game of Whack-a-Mole on meth. I'd send one email, and other editor would ask for art. I'd send some potential images, do the changes on the previous email. While making those changes, editor #2 would write back and say those images don't work, do you have any more? So I'd search for some, and then editor #1 would write back and...well, you get the idea.

I was stressed and on edge, almost ridiculously so. Perhaps not surprisingly (to my ex-therapist, at least) the feelings of body dysmorphia, body hate, and generally feeling "fat" came back. It got me thinking to something my friend Charlotte said about her daughter. Maybe the "fat" feelings weren't really about fat at all. Maybe it was anxiety that she was trying to translate the best way she knew how. Given our culture's general angst around food and weight, maybe this is how we make sense of anxiety. It's got to be about food and weight, right? What other explanation can there be?

Obviously, this isn't the only explanation, but the more I think, the more I'm beginning to understand the validity of this. My stress today had zero to do with food or weight. Zilch. And yet I immediately started fretting about what I was eating and what I must weigh. Logically, I know my weight is probably the same as it was yesterday, and the day before that, and... I know that emails from editors don't magically make my thighs expand (seeing how many emails I get each day, that's probably a good thing). But that didn't stop my brain from diving into those old, familiar depths.

I don't think that this is the sole explanation for body dysmorphia in eating disorders--one of the emails today was from a piece about body dysmorphia that's will publish shortly--but I do think it explains why stress is such a trigger for so many of us. Our brains are just trying to make sense of something we can't explain, so we do the best we can with the vocabulary we have. My own vocabulary happens to be marinated in the larger culture of diet obsessions. Maybe Catherine of Siena would have worried about her abilities to be holy if she were in my shoes (and they had email and Whack-a-Mole in the Middle Ages). That might have been how she made sense of her compulsion to starve herself. I have the same compulsion, but a very different culture that provides a very different vocabulary.

It would have been nice--and much less patronizing--if instead of just saying "We know bad body image isn't about our bodies..." with an unavoidable patronizing undertone, my ex-therapist had said that sometimes our brains don't translate anxiety properly. That sometimes we get confused and attribute worries about something else to worries about food and weight.

Monday Smorgasbord

2012-01-02T23:21:00.003-05:00

It's time for part two of 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.

CBS News on children's eating disorders.

Fearless Youth: Prozac Extinguishes Anxiety by Rejuvenating the Brain.

The Joy of Feeding Babies, Without All the Parental Angst.

Altered implicit category learning in anorexia nervosa.

The myths of motivation: Time for a fresh look at some received wisdom in the eating disorders?

Self-forgiveness in anorexia nervosa and bulimia nervosa. This is something I really need to work on- it's an interesting, important, but overlooked aspect of recovery.

A retrospective look at the internal help-seeking process in young women with eating disorders.

Diminished size-weight illusion in anorexia nervosa: evidence for visuo-proprioceptive integration deficit.

Olfaction in child and adolescent anorexia nervosa.

Racial/ethnic differences in adults in randomized clinical trials of binge eating disorder.

Latent class analysis of eating and impulsive behavioral symptoms in Taiwanese women with bulimia nervosa.

Depressive mood, eating disorder symptoms, and perfectionism in female college students: a mediation analysis.

Social information-processing and coping in adolescent females diagnosed with an eating disorder: toward a greater understanding of control.

Direct and indirect effects of stress on bulimic symptoms and BMI: The mediating role of irrational food beliefs.

Social anxiety and eating disorder comorbidity: The role of negative social evaluation fears.

Nibbling: Frequency and relationship to BMI, pattern of eating, and shape, weight, and eating concerns among university women.

'Project HEAL': Teen Activists Honored For Fighting Eating Disorders

How I did it: Teen conquers eating disorder with help of her family.

Sunday Smorgasbord

2012-01-01T21:31:00.002-05:00

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.

{{Since I didn't do a smorgasbord last week, I have heaps of links, so I'm going to break this up into two days. The second half will be posted tomorrow.}}

Females who report alcohol probs and/or binge drinking are more likely to report recent eating disorder symptoms.

Eating Disorders Can Last Well Beyond Teen Years.

10 Things You Shouldn't Say To An Eating Disorder Sufferer.

Fighting Anorexia - Eating IS medicine.

Disordered eating is equally prevalent in whites, blacks, and Latinos.

Women with celiac disease are more likely to report symptoms of depression and disordered eating, says study.

Childhood hypersensitivity linked to OCD.

Olfaction in child and adolescent anorexia nervosa.

The futility of diets, whether or not you call them New Year's Resolutions.

The best TED talks of 2011.

The sociocommunicative deficit subgroup in anorexia nervosa: autism spectrum disorders and neurocognition in a community-based, longitudinal study.

On the "Demon" Fat, and Why We All Need to Make Peace with It.

Association between co-twin sex and eating disorders in opposite sex twin pairs: Evaluations in North American, Norwegian, and Swedish samples.

Link Between Opioid Abuse and Mood and Anxiety Disorders.

Self-imposed standards are central to perfectionism in eating disorders.

Depressive mood, eating disorder symptoms, and perfectionism in female college students: a mediation analysis.

Habit Formation Is Enabled By Gateway To Brain Cells.

Ideal Body Weight: What Does it Mean?

When Body Betrays: Infertility & Body Image.

Tip Day Tuesday: Handling Holiday Food Freakouts

2011-12-21T15:41:00.002-05:00

I got this email in my inbox last night from the always fabulous Michelle (aka The Fat Nutritionist), and, with her permission, I am sharing it with you. At the end of the list is a little promo for Michelle's Eat Without Drama groups, which I've heard are utterly fabulous. It's not a substitute for professional treatment, but I think they could be useful to some of my readers.

Hey you,

I hope you're doing okay and the term "freakout" doesn't apply to you.

But, after many conversations with students in my Eat Without Drama groups about the upcoming holidays, family food drama, and the Annual Campaign of Self-Hatred in January^TM, it has come to my attention that these issues are urgent and deserve airing.

Here are some pointers to remedy holiday freakouts:

1. Provide yourself with food - if you're away from home, bring food with you if mealtimes are irregular and the groceries aren't yours. Make a special trip to the store if you can, and get some snacks you can keep in your room or hotel, if necessary.

2. Continue eating regular meals, even on holidays! Just because there's going to be a big, fancy dinner later, that's no excuse to go without. You don't magically stop needing to eat regularly because it's a holiday - have breakfast, lunch, and snacks if you need them.

3. Make weight talk a non-issue. Don't compliment others on their weight - just tell them you love them. If people want to talk about your weight, tell them you manage it privately and prefer not to discuss it. And if people want to complain about their own weight - especially while eating! - insert a "Let's just enjoy this" or "I think you look great," period. Case closed. Change the subject.

4. Don't make comments on anyone else's eating, no matter how innocent or well-intended. Don't mention their picking up the salt shaker, or their love of stuffing, or ask why they're not eating something. Don't ask how their blood sugar or cholesterol is doing. Leave it be - in tense eating situations, it's best to zip the lip. Confine your comments to how wonderful the food tastes.

5. Give yourself permission to eat the food you really like, and remind yourself that it is okay to get as full as you want. It really is - if you get super-full now, you will probably just be less hungry later on. No biggie.

6. Don't threaten yourself by swearing to diet come Monday, or January 1st. This will only set up what I call The Last Supper Phenomenon, where you eat the entire house in preparation for self-imposed scarcity. Permission means you can eat as much as you want, from now on - not just until your next diet.

7. Make a new kind of New Year's resolution - like resolving to not weigh yourself anymore, or to eat three meals a day, or to actually take your lunch break at work every day. Commit the same zeal to self-care that you used to give to dieting.

I know a list of tips can only get you so far, so if you need more help, I've got some.

Normally, I do things in a series: a 12-week group, a 12-session program, and so forth. Well, not today.

Today, stuff is urgent, and the issues are of the acute variety - handling the imminent and impending holidays.

So I'm doing something I've never done before, and letting you pick just one or two sessions. No series required.

Between now and Jan. 30th, I'm opening up my calendar for some good old-fashioned quality time, one-on-one, with you.

http://www.eatwithoutdrama.com/holiday-freakouts/

We can meet right now if you need it, to gird up for what's coming, or we can debrief in January - your choice.

If you're just kicking back, eating some cookies, and feeling fine, I salute you. Go on with your bad self, and spread the love to anyone who might be having a rough time.

The rest of you? Come with me. We've got some stuff to handle.

http://www.eatwithoutdrama.com/holiday-freakouts/

Courage!

Michelle

The "I Don't Wannas"

2011-12-20T16:09:00.000-05:00

Sometimes recovery means accepting that you do, indeed, have an inner toddler. A whiny, cranky inner toddler who never wants to listen. They are loud and a pain in the ass. They generally have a point. The key is to listen without letting them run the show.

What I've been struggling with the last few days is a nasty case of the "I don't wannas." Mostly, this has to do with food. I don't want to fix a proper breakfast, not because I want to restrict or lose weight or anything ED related. It's just that some days, I feel I can't be arsed. So it's real tempted to just grab a protein bar or whatever and call it "breakfast" because it's a hella lot easier than hauling out bowls and cereal and granola and milk and measuring cups.

I know by now that not feeling like getting breakfast (or lunch or snack) is no excuse not to have lunch or snack. But things like long term planning and sensible behaviors don't pacify my inner toddler. She doesn't want to deal with dishes. Or waking up earlier. Or doing any of those things that grownups generally do.

It's helped me to stop always wanting to behave like I feel a grownup should. A significant proportion of my friends on Facebook are mothers (some of them even have toddlers!), and I can guarantee that their general maturity level isn't always higher than mine. We all have inner toddlers, and we all need to tame them.

Sometimes we feel like being obstinate, just because. Sometimes we lose our marbles for no particular reason--or reasons that are no doubt legit but seem like small potatoes in the grand scheme of things. With time and lots of practice, I've come to realize that this is no big deal. It happens to all of us. I've also learned (mostly) how to let these little fits pass, or simply indulge them in my head. After all, snark doesn't have to be vocalized to make me feel better. ;)

The problem is when these pitched fits start making our decisions and running the show. I can resent having to fix breakfast or, like today, burning the damn toast for lunch.* I can hate having to do dishes and clean the house. I can piss and moan to my heart's content. I also need to suck it up and take care of myself properly no matter how much of a pain it is.

It's something I learned in DBT while in treatment, that two opposite things can be simultaneously true. So I let myself get cranky and hate having to do food prep and so on. AND I can still recognize that it's important and do it.

And on that note, thankfully, I have leftovers for dinner!

*Same setting as I used yesterday, same bread and everything turned out fine. Today? Blackened to a crisp, smoke detectors going bonkers, big scene. Sigh.

Sunday Smorgasbord

2011-12-19T00:10:00.000-05:00

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 the post is late--I had trouble with the internet last night!}}

Your Family Tree Can Reveal Your Risk for Eating Disorders.

Body Image, Bullying & Eating Disorders In The Gay Community.

Moderators and mediators of remission in family-based treatment and adolescent focused therapy for anorexia nervosa.

Starving orangutans might help to better understand obesity and eating disorders in humans.

Wanting To Be Thin Doesn't Cause Anorexia But It's Still Damaging.

Recovery- What happens after Treatment.

Let this make your day– David Attenborough (of Planet Earth fame) reads "What a Wonderful World" to breathtaking scenes.

How A Blood Test Could Improve Your Chances Of Successfully Using Antidepressants.

Genetics of taste and smell: poisons and pleasures.

R.I. Hospital to study body image disorders.

The "War on Obesity" has some serious side effects.

More than 500,000 teenagers in the US suffer from severe eating disorders.

When alcohol and anxiety are a dangerous mix.

By how much will the proposed new DSM-5 criteria increase the prevalence of binge eating disorder?

Norway running out of butter as Scandinavian butter crisis spreads.

Molecular gastronomy- Western dishes combine foods with similar flavor compounds. Eastern dishes do not.

Depression and Binge Eating Linked in Teen Girls.

How the perception of your whole body is affected by the size of your body image.

So you know, how to navigate the online maze of health information.

New Study Finds Self-Criticism to be a Risk Factor for Bulimia in Adolescents.

Sunday Smorgasbord

2011-12-12T00:06:00.001-05:00

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.

Study Challenges Decades-Old Treatment Guidelines for Anorexia.

Alliance-focused therapy for anorexia nervosa: Integrative relational and behavioral change treatments in a single-case experimental design.

Study shows that prevalence of ED's among American teen is higher than what was previously thought.

Dysregulation of brain reward systems in eating disorders: Neurochemical information from animal models of binge eating, bulimia nervosa, and anorexia nervosa.

In outpatient family-based treatment does rate of weight gain matter to anorexia outcome? Yes.

Empirical Classification of Eating Disorders.

Evidence-based treatment and therapist drift in eating disorder treatment.

Anorexia nervosa: a unified neurological perspective.

How Food Likes and Dislikes Affect Our Eating Behaviors.

Effects of an Internet-based intervention for subthreshold eating disorders: A randomized controlled trial.

iRat: Robotic Rat Offers New Tool for Neuroscience Research.

New Model for Childhood Eating Disorders.

CBT can increase cortical inhibition, which can be beneficial for pathological perfectionists.

Coping with the holidays when you have a mental illness.

A really good list of cognitive distortions.

Kathryn Schulz on how regret makes us better.

Eating disorder app 'Recovery Record' developed by Australian student and Stanford University.

New therapy for hard to cure eating disorders.

Adventures in spontaneity

2011-12-09T16:17:00.001-05:00

This Wednesday, I had a chance to practice being spontaneous. A friend from my now twice-weekly knit/crochet group texted me saying "Feeling knitty? Wanna meet at XX Deli for dinner and yarn?"

Wednesday is, of course, my Zumba class. I had been planning to go and shake my thang. But this girl had come to our newest group up near my place the night before, so I thought I should probably return the favor and drive down to hear get-together. So I rode my bike instead of shaking my bootie, and went to the deli.

It was really fun, but let me tell you, it stressed me out to no end. I had to navigate changes to my eating and my exercise routines (oh, the horrors!) on the same day with basically no warning.

I got to the deli--I had never heard of the place before, but apparently it's some sort of a chain--and had another freakout. The menu was huge. I had no idea what to pick. To make things even more interesting, they had a "Light 'N Healthy!" menu. Not ordering the so-called "healthy" or low-cal, low-fat items still stirs tremendous guilt and anxiety. I mean, what are the people behind the counter going to think of me when I order something from a different section?!? If one section of the menu is "healthy," then the other is (presumably) not healthy. Or less healthful. Or whatever.

I was anxious to begin with, and then I had to figure out what to order and all of a sudden, I found myself at the front of the line. So I ordered off the "Light 'N Healthy!" menu. I was literally like a deer in the headlights. I froze. The one little section of the menu at least narrowed down my choices to something manageable. By the time I got the sandwich, the side, and the free frozen yogurt (free froyo? Why yes, I think I will), it was probably equivalent to a "normal" dinner. The sandwich was pretty good, all things considered.

I have mixed feelings about how the evening went. On the whole, it was probably positive. I did something spontaneous. And social. I switched things up. The anxiety, however, was a pretty big sticking point. I know I shouldn't have ordered off the diet menu. That the decision (to go to the event, or what to order off the menu) shouldn't have sent me into panic mode.

I hate that things like this are still so stinking hard. I'm doing better, so much better, in a lot of ways. But having to make snap decisions and do things outside the norm still cause ridiculous amounts of anxiety.

Background noise

2011-12-06T00:02:00.001-05:00

This past September, I upgraded my Blackberry to an Android. I love my new phone. The one problem I have is that the battery loses juice really quickly. I Googled the problem, and I found some apps that can shut down the other apps not in use that are slowing down the processor and sucking the battery dry.

{{In fact, my phone just eeped at me that it needs to be plugged in.}}

I was aware, of course, that apps run even when you're not actually using them, but I didn't know how much power they sucked up. On days when I'm not using my phone a lot--it's rare, but it happens!--the apps running in the background don't really pose much of a problem. I just plug in my phone before I go to bed like usual and all is well. Most days, however, I use my phone for pretty much everything, especially since I found a free Sudoku app, which keeps me entertained on my nightly Adventures in Insomnia.

I've been pretty busy with things lately, mostly work and writing stuff. I'm chugging along on my book, I've been freelancing, I've been crocheting, doing the recovery stuff. If I were my phone, I would be in a period of almost constant usage. It makes the ED stuff painfully obvious because there's not much energy leftover.

The danger zone for me is when I'm bored or work is slower. It's when the ED stuff isn't as obvious. The background apps suck the same amount of energy regardless, but it's harder to recognize all the time and energy it's using. The same for the eating disorder. Thoughts and behaviors suck up the same amount of effort whether I'm busy or not. I'm better able to recognize and fight them when I know there's lots of stuff on the line because I know I don't have that extra energy to spare.

Too much spare time isn't my friend. My brain is always working, always thinking. If I'm not thinking about nerdy stuff or yarn stuff or other stuff, then my brain will find other things to think about. Things like food, weight, calories, and exercise. It's hard to balance, since being too busy ratchets up the stress level to the point where I find myself reaching for the volume knob that is the eating disorder to turn down some of the stress.

Like so many things in recovery, it's a balancing act. But this knowledge is helpful--I know that letting myself get too bored is just as bad as getting too busy. For now, being busy is good for my recovery. Not to distract me from anxiety, depression, and all of that other crap, but to make it painfully obvious just how much the ED takes out of me.

Interview request: interoception

2011-12-05T16:25:00.001-05:00

This is a bit of a science writer Hail Mary, but I figured I have nothing to lose!

Have any of you out there been tested for interoception/interoceptive skills and have an ED or body image issue? Do you know anyone who has? The test could have been an informal thing in a psychology class or whatever--it doesn't necessarily have to be in a research setting. It's for an article I'm working on, and I've done one great interview on yoga and body image, but I'm looking specifically for something about interoception.

If you fit this criteria or think you can help, please email me ASAP at carrie@edbites.com

Thanks so much!

Sunday Smorgasbord

2011-12-04T23:28:00.001-05:00

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.

Fascinating connection between thyroid & anorexia nervosa?

New book breaks the code of silence about ballet and eating disorders.

How Trauma Affects the Brain.

Interpreting Holiday Eating Advice with an Intuitive Eye.

To make grocery shopping a little less stressful (or at least more interesting): The sociology of shopping cart and express check-out line etiquette.

British Columbia eating disorder patients denied treatment. {{Some triggering photos and information...read with caution. I included the article because I think the issue is really important.}}

DSM-5 and ICD-11 Watch. Geeky blog for diagnostic manual watchers.

Because you know you need to see video of an emu and a wallaby on a treadmill.

Follow Your Doctor's Orders...And Pet Your Pooch: Never underestimate the power of puppies, or other four-legged friends.

Inpatient Eating Disorder Treatment Checklist for Parents.

The gene "for" nothing, or, almost everything.

“Skinny girls are not glamor girls.” Vintage weight gain ads – changing standards, changing markets…

Tips for balancing the battle with eating disorders and the holidays.

Image Tool Catches Fashion Industry Photo Alterations.

Gray matter in brain's control center linked to ability to process reward.

Different Moderators of Cognitive-Behavioral Therapy on Subjective and Objective Binge Eating in Bulimia Nervosa and Binge Eating Disorder: A Three-Year Follow-Up Study.

Repeated gastric distension alters food intake and neuroendocrine profiles in rats.

Mealtime Support in Anorexia Nervosa: A Within-Subject Comparison Study of a Novel Vodcast Intervention.

How does the social environment 'get into the mind'? Epigenetics at the intersection of social and psychiatric epidemiology.

Automatic and Intentional Processing of Body Pictures in Binge Eating Disorder.

Efficacy trial of a selective prevention program targeting both eating disorder symptoms and unhealthy weight gain among female college students.

Eating Disorders Among a Community-based Sample of Chilean Female Adolescents.

The dual-pathway and cognitive-behavioural models of binge eating: prospective evaluation and comparison.

Sunday Smorgasbord

2011-11-27T23:30:00.001-05:00

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.

Treatment of binge eating disorder.

An eleven site national quality improvement evaluation of adolescent medicine-based eating disorder programs: predictors of weight outcomes at one year and risk adjustment analyses.

Eating disorders seem to be as prevalent in Asia as they are in the U.S.

Neuroscience and eating disorders: The allocentric lock hypothesis.

Young Children Not Immune From Eating Disorders.

Treatment of anorexia nervosa against the patient's will: ethical considerations.

"Dieters can be so preoccupied with rules that they lose touch with feelings of hunger and fullness."

Restraint of appetite and reduced regional brain volumes in anorexia nervosa: a voxel-based morphometric study.

“But you don’t LOOK anorexic...”

Food Addiction, Nutritionism, & Intuitive Eating in the Prevention & Treatment of BED: From Science to Application.

Recovering from an Eating "Oops".

Keeping One's Eyes On The Goal Despite Stress.

Watch Cindy Bulik's talk on YouTube: "Hip Hop or Viennese Waltz? The Complex Dance of Genes and Environment in Eating Disorders."

A mother’s food choice can shape baby’s palate, research shows.

Bacteria that live on the Atkins Diet.

Impulsivity, addiction, and your synapses.

Farm-Fresh Food May Have Shaped The Modern Mouth.

For Some, Psychiatric Troubles May Begin With the Thyroid.

In Anorexia Nervosa, Inner Conflicts Over The 'Real' Self Have Treatment Implications.

Building mastery

2011-11-22T18:17:00.001-05:00

It's something I've been noticing lately in my own life: a growing mastery of basic recovery skills. You know, the things other 31-year-olds take for granted, like the regular consumption of breakfast and not exercising myself half to death. In the beginning of recovery, I couldn't do any of these things unless someone was sitting right there and giving me death eyes to make sure I wasn't misbehaving. Preferably with an Ensure for any infractions.

There's nothing to deflate your ego quite like flipping through your friends' wedding and baby pictures on Facebook while realizing that you one even trusts you to, like, you know, eat.

When I first attempted to eat with no real supervision after attempting recovery, it was kind of laughable. I'd start off getting a small, nonfat cappuccino (more air, less milk!) and say I had some massive, calorie-laden drink. Then I'd switch to coffee or tea while simultaneously maintaining I had that beverage. After all, I wanted that drink. I even might have actually intended to order it, on some subconscious level. But faced with the gargantuan menu and the knowledge that there were calorie-free options just waiting for me, I caved to the anxiety. Then, ashamed that I couldn't do something as simple as order a simple snack, especially after promising on my kitty's tail that I would Behave Myself and Actively Choose Recovery, I lied about it. I justified this by telling myself that I wouldn't cheat again, that next time, I would have the massive calorie-laden drink.

Repeat ad nauseum.

All during this time, I would have sworn up and down that I could easily handle everything on my own. Easily. "I've got this," I said. After all, I could publish long feature stories in magazines. Surely I could eat adequately.

Except I couldn't. Each time I tried, I would bite off more than I could chew (is that pun intended? I'm not sure...). Sometimes, I would be forced to be ready because the insurance company said I was ready, dammit. Others, my treatment team thought I was ready. And still others, I convinced my treatment team I was ready to take on more responsibility for my own recovery. Each time, the result was the same: it was too much, too soon. The eating disorder triumphed again.

Ultimately, I began to lack confidence that I could ever feed myself properly again. Maybe I was just one of those few who would struggle forever. Maybe I would never get better.

The problem wasn't me or my (seeming) inability to recover. The problem was the complexity of the task and my available skills to master it. It's like asking a five-year-old to do calculus. I'm sure there are a few Einsteins out there who can, but most of us can't. Not that we won't ever be able to do calculus after we learn addition and subtraction and algebra and infinite sums, just that we can't yet do calculus. We don't consider a kindergartner a mathematical failure if they can't figure out a differential equation. Yet I would be discharged from treatment with a sheet of paper containing a list of foods I was supposed to eat and a pat on the back and have no freaking clue where to go from here.

What I really needed was fewer sheets and more time and practice. I needed to start way more slowly than most people thought. This grated both my ego and my patience (like I said, nothing like a good career to contrast your epic catastrophes around eating). So I started with tasks I felt confident about, things like putting milk in my coffee (yes, caffeine is a massive theme in my life) or spending short times unsupervised and not exercising. Then I began to build on that. I could figure out an entire snack or spend a whole afternoon by my lonesome and not lace up my gym shoes.

It took years for me to get where I am now, which is that I can eat independently and not overdo the exercise (though the latter is still the largest struggle for me) even if no one is the wiser. I'm not always perfect, but I can be honest about that, too. I have mastery over basic recovery skills, whether it's feeding myself or calling a support person. I'm doing calculus. It took me a little over 11 years to get there from my 2+2s(kindergarten until junior year of high school), but then I ended up a math minor in college. The successes, whether in recovery, math, or even figuring out how to program your DVR, snowball. They build upon themselves. That's what things tend to do, whether successes or failures.

It took me a long, long time to be able to slow down and take recovery one step at a time. To stop feeling that I "should" be able to do something because everyone else could and it sounded easy, ergo, I should be able to do it. It's still hard for me to admit that I couldn't do these things, and not always for lack of effort. I can't juggle or do those silly Magic Eye things, either, despite a plethora of people who do have those capabilities. I've accepted that, more or less. It is what it is.

I guess, in the end, recovery is a process. A long, hard, difficult, pain-in-the-ass process. But I tackled it one step at a time, and I did, eventually, get there.

Sunday Smorgasbord

2011-11-21T00:15:00.001-05:00

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.

Check out this great article for dealing with food gatherings during the holiday season while recovering from an eating disorder.

How food became food – a fascinating read from Adam Gopnik on roots of modern food culture.

Association Between Illegal Drug Use and Abnormal Weight in Teens.

BBC History of the Brain podcasts are now available for a short time. They're on my "to listen" list!

Patrick Kennedy Initiative Launched To Encourage Neuroscience Collaboration for Brain Disorders.

How Melanie Klein stopped waging a war against her body and made peace with her body.

Motor inhibition and cognitive flexibility in eating disorder subtypes.

Enough With the ‘Slut Gene’ Already: Behaviors Ain’t Traits.

Wisconsin parents accused of starving infant daughter because they feared she'd become obese.

Early onset eating disorders in male adolescents: a series of 10 inpatients.

What? Use science to combat fat phobia? Why did nobody think of that before?

An angel on my shoulder: a study of relationships between women with anorexia and healthcare professionals.

The Secret Life of Pronouns – computational linguistics and what our word choice reveals about us. (Nothing to do with eating disorders, but it's so stinking cool I just had to share it!)

Parental expressed emotion of adolescents with anorexia nervosa: Outcome in family-based treatment.
Eating disorders in youth: Diagnostic variability and predictive validity.

The importance of the family dinner.

Disordered eating behaviors in type 1 diabetic patients.

Restricting your meals sets you up for craving snack foods.

Abnormal Eating Behaviour in People with a Specific Phobia of Vomiting (Emetophobia).

Google Earth for the human body.

Clarifying Exercise Addiction: Differential Diagnosis, Co-occurring Disorders, and Phases of Addiction.

Self-harm, from adolescence to young adulthood.

Treating teen bulimia in the family context.

Synchronized Anxiety: how synchronized communication between brain areas affects (rodent) anxiety.

News piece on eating disorders in men.

Eating disorders more common than diabetes among young children.

Tips on How to Fight for Eating Disorders Health Insurance Coverage.

Uncertainty, fear, and eating disorders linked.

A request for my nerdy friends

2011-11-17T14:47:00.001-05:00

I know plenty of my blog readers are self-described nerds like myself. As such, if you have access to a university library system and can obtain any of the following journal articles, I would deeply appreciate it. It's for an article I'm working on for Scientific American Mind, and I need to submit the full-text journal articles with my draft.

So here's the list:

Reduced perception of bodily signals in anorexia nervosa

Brains of anorexia nervosa patients process self-images differently from non-self-images: an fMRI study

Self-Objectification, Disordered Eating, and Depression

Thank you ever so much! Please email any pdfs to carrie@edbites.com

Edited to add: Thanks everyone! I have all my files (not to mention the best readers on the face of the planet).

FEAST Symposium Summary

2011-11-16T00:32:00.001-05:00

Lots of people have posted fantastic, detailed, wonderful summaries of the FEAST symposium. When my internet is not being stupid, I'll even share some of those links!

My summary is going to be somewhat less detailed. The main reason? I got to be co-Master of Ceremonies, which meant that I was very, very busy during the whole conference. Everything was a blur, really. I was paying attentiona and absorbing the information, yes. The speakers were fantastic. But I also had to have part of my brain watching the clock, keeping an eye on the audience, making sure the speakers had their slides loaded and time cues, and so on. {{The upside was that I got to hand Dr. Insel some magnetic buckeyballs.}} It meant that I was constantly thinking of what might happen next rather than what is happening right now.

I loved doing the MC thing. It was a tremendous honor and kind of fun, considering I got to play Oprah for a while. But it also means my memory of both days is a little fuzzy.

It reminds me a lot of how I've been living my life: constantly worried about the future (and obsessing about the past) without actually paying attention to what was going on around me. So when people reminisce about high school or college, I just feel rather baffled. First of all, having several serious mental illnesses during this time does tend to make your experiences less than stellar. As well, I was so focused on achievement and getting the right grade/internship/whatever so that I could do XYZ that I didn't actually experience things. It was about what's next not what's now.

Which, the more that I think about it, is a pretty sad way of experiencing life--or rather, not experiencing life. Much of this is, for me, related to anxiety. I get so worked up about what might happen that I feel I need a contingency plan for anything that might happen. And so I'm constantly thinking about that rather than, say, taking a hike with my friends. Of course, if an emergency did happen, I would probably be the person you'd want to be stuck with (assuming you wouldn't stab me because of all my fretting).

The problem is that I've really missed out on a huge chunk of life because I'm not really there. It's hard to come to terms with, and it's something I know I need to work on, but sitting down and trying to summarize the FEAST symposium really got me thinking and let me actually put my finger on what was going on in my life.

I do have some further thoughts that I will share tomorrow as well.

Have any of you experienced this there-but-not-really syndrome? How did you get better at staying in the moment? Please share in the comments!

Sunday Smorgasbord

2011-11-13T23:26:00.001-05:00

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.

Study Finds Disordered Eating Combined With Heavy Drinking Is Common Among College Students.

Super memory, obsessive behavior: Do they share brain space?

Flexible Brains Are Habit-Forming.

Serotonin and food motivation.

Scientists genetically alter mice so they can run longer without requiring extra food.

Clarifying Exercise Addiction: Differential Diagnosis, Co-occurring Disorders, and Phases of Addiction.

Study in Psychology and Sexuality looks at how LGBT women experience eating disorders.

Body image dissatisfaction versus over-evaluation in a general population sample of women.

"It's easy to forget that eating is, by definition, a social activity."

Eating disorders in youth: Diagnostic variability and predictive validity.

Facebook-like portal helps teens with Crohn's Disease collaborate on medical research. I think there should be one for people with eating disorders!

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

The Process of Discovery for Women: Exercise vs Body Work.

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

The Antidote to Depression (or, changing our behaviors can change our thoughts).

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

Tips to Rest an Anxious Mind.

Change in binge eating and binge eating disorder associated with migration from Mexico to the US.

Calories Depend On Food Preparation.

A study of neurocognition in bulimia nervosa and eating disorder not otherwise specified-bulimia type.

Adolescents report weight as a primary reason for bullying at school.

Eating habits, physical activity, consumption of substances and eating disorders in adolescents.

Five Things Teachers Should Know About Eating Disorders, Resources and Prevention.

Assessing rumination in eating disorders: Principal component analysis of a minimally modified ruminative response scale.

Carl Warner's food landscapes – whimsical miniature vignettes made out of edible ingredients.

Consent to treatment in adolescents with anorexia nervosa.

Should scientists fight misleading anecdotes with data--or with anecdotes of their own? (as someone who runs into resistance in getting some clinicians to accept ED science, perhaps I'm taking the wrong approach...)

Therapist in your pocket--monitoring mental health with a smartphone.

Major Milestone

2011-11-08T10:51:00.002-05:00

Just six weeks before ED Bites turns five (Yes, I will be having a blog birthday party), I checked my stats and found that sometime in the last week, my blog hit a massive milestone.

Over 500,000 of you (half a stinking million!!) agree that ED does, in fact, bite.

I'm blown away. I never thought that anyone would really ever read my blog, let alone that I would still be blogging after five years. I thought I would get sick of blogging or you guys would get sick of ME long before I hit this mark. But that hasn't happened.

So hats off to all of my readers, for making these past five years possible.

Monday Smorgasbord

2011-11-07T23:01:00.000-05:00

It's once again time for your weekly Sunday Smorgasbord (this time appearing on a Monday since I fell asleep last night before I had a chance to finish the post!), where I trawl the web for the latest in ED-releated news, research, and more, so you don't have to.

The Truth About College Weight Gain. The Freshman 15 is a myth--the average person only gains 3 pounds.

Fear foods aren't exclusive to eating disorders. Duke University researchers help adult picky eaters introduce new foods.

Anorexia Is Not Only About What She Sees in the Mirror.

ACT and how we get stuck in the happiness trap.

Inequality, Health Disparities, & Obesity.

Recovery projects to help you tackle various stages of eating disorders.

Eating disorders in the twenty-first century.

An amazing pinboard of positive self esteem, body, recovery, confidence, and beautiful books.

Laboratory evaluation in patients with anorexia nervosa: usefulness and limits.

Treatment of Children with Mental Illness.

Prevalence of Personality Disorders and Their Clinical Correlates in Outpatient Adolescents With Anorexia Nervosa.

'Biggest Loser' Not Healthy. Stigmatizes overweight folks & offers redemption via drastic weight loss, says scientist. Blogger says "No shit, Sherlock."

An Update on Hospitalization for Eating Disorders 1999-2009. Free and full text.

Assessing rumination in eating disorders: Principal component analysis of a minimally modified ruminative response scale.

Defining What it Means to Be "Recovered."

Binge Eating Disorder and body image perception among university students.

Do Deficits in Brain Cannabinoids Contribute to Eating Disorders?

Starvation and emotion regulation in anorexia nervosa.

Objectified body consciousness in relation to recovery from an eating disorder.

Evaluating the quality of websites relating to diet and eating disorders.

Decoding eating disorder myths, risks.

Whoever said money can't buy happiness never went on a yarn crawl

2011-11-02T00:27:00.002-04:00

This past Saturday, I went with my knitting and crochet group on a yarn crawl to a nearby city. What's a yarn crawl, you ask? Well, it's like a pub crawl, where you visit a series of pubs (or yarn shops), one right after the other, sampling the wares (and fondling merino superwash at $35/hank) along the way. We had been looking forward to this for weeks, and the day did not disappoint.

I am not looking forward to getting the bills. But I did pick up some beautiful swag.

We hit three shops and lunch during the day, and made brief detours to two different cupcake places. Having to specify which cupcakes you're eating means it had to have been a good day.

The nice thing was that it made me feel so normal. I wasn't "Carrie the Girl with the ED." I was "Carrie the Crocheter" or "Carrie who has to fondle all the yarn." Or even just "Carrie." It was a nice change from my day to day life where the ED stuff is front and center. Yes, I have a fulfilling career and good hobbies and friends and family, but the ED, food, and recovery occupy a lot of my thoughts. Just for a few hours, I got to pretend I was normal like everyone else.

That was nice.

The irony is that I had to put so much work into recovery until I could actually get to this point. Not all that long ago, I wouldn't have gone because I would have had to navigate lunch and it would have interrupted my exercise routine. Then add the whole "spending money on myself" thing, and it would have been a disaster. So after placing all of my other obligations to the side (or at least demoting them on my to do list) and really doing all of the hard, seemingly unrewarding recovery work, I finally got to experience normalcy. Or the closest thing to it when your yarn bill for one day may very well have hit the triple digits.

I have to remind myself: I'm not destitute. I deserve good things. I can handle stressful situations. I will be okay.

It was a lovely day, and I know that all of the bills will have been worth it to feel like I'm part of the world again.

Sunday Smorgasbord

2011-10-31T01:11:00.002-04:00

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.

The Darkside of Skimping. In difficult economic times, indulging ourselves might be a Good Thing.

MentorCONNECT Announces Collaboration with UCSD Eating Disorder Research Program.

Comorbidity of partial and subthreshold PTSD among men and women with eating disorders in the national comorbidity survey-replication study.

Interaction between visceral states (hunger, desire) & cognitive states (impulse behavior, self-control).

An Examination of the Ravello Profile - A Neuropsychological Test Battery for Anorexia Nervosa.

Study explains why 90% of dieters regain the weight.

The impact of adverse life events and the serotonin transporter gene promoter polymorphism on the development of eating disorder symptoms.

Found in the developing brain: Mental health risk genes and gender differences.

Increased plasticity of the bodily self in eating disorders.

Eating Disorders & Autism.

Weight suppression predicts time to remission from bulimia nervosa.

Study says 1 in 10 men are binge eaters--a serious disorder not just among women.

Neuroimaging in eating disorders.

Navigating the Search for True Maudsley Treatment.

Social appearance anxiety and bulimia nervosa.

Carer's experience and perceived effects of a skills based training programme for families of people with eating disorders.

Illustrated Guide to Depression

2011-10-28T19:09:00.004-04:00

Yeah, I know. An illustrated guide to depression? Comic strips don't generally cover things like, you know, depression.

But Allie over at Hyperbole and a Half did. It's probably the most accurate representation of what it's actually like to be so depressed you can't quite get out of bed.

Apparently, you don't need an advanced psychology degree to help people understand mental illness. All you need is a computer doodle program.

{{If you don't read her blog, you should. It's pretty much epic.}}

Tip Day Tuesday: Later

2011-10-25T23:41:00.002-04:00

So it's time for another Tip Day Tuesday. I didn't get any emails or requests from you guys (please write! My brain is frazzled!), so I came up with one of my strategies for riding out ED urges.

It's so simple, in fact, I can summarize it in one word: later.

So what do I mean by later? I mean that ED urges usually come in the form of now. Purge now. Exercise now. Take the pills now. Skip the meal now. For me, the ED behaviors help me regulate my emotions, especially anxiety and depression. Over the years, I've gotten used to low levels of anxiety and depression, so by the time I start getting urgey, my emotions are pretty much skyrocketing. This means that I want relief NOW. Not later--now.

Of course, the ED works, but only for a short time and only with a very high price tag. Therapists and my parents would probably like me to say that "ED is not an option," but that feels a little bit fake. After all, the ED really is an option. A crappy option, but it's an option. Unless I'm being physically restrained, the ED is an option. So that line of thinking is a no go for me.

What does help me is to think "later." The ED can be an option in an hour or several hours or tomorrow or whenever. For some reason, knowing I have an "out" is calming in and of itself. It lets me know that if I really, truly, utterly can't hack it, then the ED is there. So the ED is an option...just not right now. I need to try other coping skills first.

So I crochet or snuggle the cat or blog or call a friend or text my therapist or (let's face it) swallow a lorazepam and try to ride out the urge. If the urge is still there at the end of the hour/afternoon/evening/whatever, then I delay again.

What I tell myself is this: if using behaviors is really a good idea, it will still be a good idea after my time is up. Also, I should feel comfortable discussing my decision with my family and treatment team. Feeling the strange urge not to tell someone about my new miracle plan? That's the ED and I should probably delay and talk.

It's not foolproof, and it's probably not workable for everyone, but it does help me. The ED helps me get through a difficult moment, and the idea is ultimately to find something else to work in the meantime. I also use a lot of self-talk to remind myself of the downsides of ED and the benefits of sticking with recovery. I won't lie--it's hard work. Much harder than just giving in to the ED and acting out. But I can also hold my head high and look at myself in the eye in the morning when I actively choose recovery.

Sunday Smorgasbord

2011-10-23T23:26:00.000-04:00

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.

The Dangers of "Drunkorexia" Among College Students.

Nice article on re-feeding and re-feeding syndrome in eating disorder recovery.

Have a child with an eating disorder? Maudsley Misconceptions: An Interview with Angela Celio Doyle, PhD.

PANDAS: Strep Throat Can Lead to OCD in Children.

An interesting roundtable discussion on insurance coverage for eating disorders.

When it comes to finding a good therapist, you may need to try, try again.

Check out the UCSD Eating Disorder Program's new research newsletter "Successful Recovery."

Two types of treatment are showing promise when it comes to helping those with eating disorders.

Eating disorders more common than diabetes in young children.

Creating an emotional safety plan.

Do we have a set point for exercise?

Study Offers Clues to Emotional Eating.

The Agreeable Power of Sugar. People who eat a lot of sweets are perceived as more agreeable. Are they?

OCD, bipolar, schizophrenia and the misuse of mental health terms.

Inner experience in bulimia nervosa.

Low GABA Levels Hinder Teens from Experiencing Pleasure.

Tips for Reading Scientific Research Reports.

Perspective

2011-10-22T23:35:00.000-04:00

My metabolism has once again gone completely bonkers. After I first increased my eating after being sick, my weight dropped again (less than a pound, but still...it really needed to start going in the other direction), which meant an even larger food increase. This sent everything into an upwards spiral. I'm eating insane amounts of food right now, and it's really frustrating because I'm not sleeping well, I'm having hot flashes left and right, and I'm just really sick of stuffing my face.

BUT...

My other freelance writing job is for an ALS clinic. ALS, for those of you who aren't familiar with it, is amyotrophic lateral sclerosis, also known as Lou Gehrig's disease in the US and Canada. ALS is uniformly fatal. No cures exist, and neither do any real treatments. It generally kills in 2-5 years after diagnosis. Your motor neurons die, which means your muscles are paralyzed. You can't swallow your food, hold a pen, or even talk as the disease progresses. You can't breathe properly, which is the frequent cause of death. You basically suffocate. It's one of the few diseases that can almost make an eating disorder seem cheery.

I have days when I get done with my work, and I want to order a vodka and Prozac, shaken not stirred.

My job provides some pretty good income, but it provides something just as important but much less tangible. It gives me a really good dose of perspective.

See, when I was younger, my mom used to try and make me feel better by reminding me of all the people who had it worse than I did. No doubt it's true, but I interpreted her statements as the equivalent of "Stop being such a big baby about this!" It's why I don't like to compare my situation with others, because it makes me feel that I'm just being a big baby and I need to buck up and deal with it.

I'm older now, and I'm better able to appreciate subtleties. I can see that an appreciation that other people have it worse than me doesn't have to mean that my situation is a piece of cake, either. I can have a good whinge on my blog about all that damn food and the stinking hot flashes while simultaneously realizing that it could be worse. I hate when people point this out to me, because it feels so tremendously invalidating--again, like I have no right to my pain or feelings. This doesn't mean that it's not important to get this perspective and to develop ways of viewing the world where I can acknowledge my own struggles and also keep them in perspective.

It's a hard balance to keep. I'm not always good at keeping that balance. Most of the time, I'm sick of my own whining. I find myself jealous of the strangest people, just because their life seems to suck less. I also feel that I have no right to complain since I feel I'm doing this to myself.

In the end, both me and the ALS patients I write about have shitty illnesses. We all struggle to make it through the day. I'm lucky. Recovery is a possibility for me. For lots of other people with lots of other illnesses, it's not. So yes: acknowledge the suckitude and then take a deep breath and do what you can with what you've got.

All will be well

2011-10-19T10:00:00.000-04:00

I found this song by the Gabe Dixon Band yesterday, and it really spoke to me.

Link to the lyrics is here.

Music really helps ground and soothe me. Do you have some favorite recovery songs? Please share in the comments!

Adventures of a Girl Scout Dropout

2011-10-19T00:04:00.002-04:00

{{or, how to start a fire with bacon grease and a brown bag from Whole Foods...}}

So I have returned safely from my weekend frolicking with darling woodland creatures. I've not done much camping in my life. It wasn't part of my family culture, and I'm generally walking bug bait (an overnight in college left me with 50 mosquito bites on my legs alone, and I was too depressed after that to keep going), which makes the situation less than pleasant.

Friday afternoon was rainy, but the weather cleared around dinner time, so my best friend L and I decided to venture out into the wilds of Maryland. We got a later start than we had hoped, and it was pretty dark by the time we arrived. We set up the tent by the headlights of my car, and then bought some crates of firewood from the camp host. He said it was "kinda damp," but we were pretty much out of options at that point, not to mention we were hungry and it was late. L had some firestarter thingies, and I was a chemistry major in college, which makes me an honorary pyromaniac, so we figured we would be okay.

Ha. Hahahaha.

No amount of firestarters or leaves and twigs or lit napkins from my glovebox or even L's notebook paper would make the fire catch. I don't think I had ever wished for an arsonist friend before, but I was definitely wishing for one that night! By this point it was around 10pm, so we eventually decided to get dinner that didn't need to be cooked. I had several doughnuts and a giant can of baked beans. I hereby apologize to the state of Maryland for the several metric tons of methane that resulted from my dinner. L can thank me for the impromptu bear repellant.

Saturday morning dawned bright and early, but the damn fire still wouldn't start. L brought super-duper gourmet bacon from Whole Foods for our breakfast, and there was no way we were going to let that go to waste. So we went to the grocery store for some fake firewood and accelerant, looking like pyros with a serious grudge. I seriously debated adding a box of tampons to our loot just to see the reaction on the clerk's face.

The faux wood lit just fine, and we placed some of our sopping logs on top to dry them out. Then we fried our bacon and it was so yummy. The logs weren't lighting all that well, even with a generous squirt of accelerant, so we doused a brown paper bag with the bacon grease and tossed it in the fire. The porky magic did the trick, and from then on out, we had fire.

Aside from the fire fiasco, the weekend was wonderful. My cell phone had basically died by the time we got there, so I switched it off to save any remaining juice for an emergency. Nearly 36 hours with no emails, no phone calls, no texts, nothing. Just me and L. We sat and talked. We did crosswords and crochet and Bananagrams. We sang songs by the campfire. We made smores and banana boats (banana split down the middle and filled with chocolate chips and marshmallows, wrapped in foil, and placed on the hot coals).

It was exactly the break I needed. Not just a break from the stress of my job and all that, but it also ended up being a break from the ED stuff. It was an adventure in intuitive eating. I had hot chocolate and doughnuts and lots of other things that are either rare or off limits for me. I spent much more time in the moment because I couldn't fix anything I was worrying about, so what's the point.

L and I have already made plans for another trip next spring. Only this time, we'll come armed with faux wood.

From the Archives: Waiting for the Lightbulb

2011-10-15T21:00:00.000-04:00

Seeing as I will be away this weekend, I've selected several of my favorite posts from the archives to tide you over until I return.

Many of the recovery stories I read when I was first diagnosed with anorexia usually featured an epiphany for the now-healthy person. Usually, it went something like: "I saw a photo of myself and saw how bad I looked. I realized I was killing myself. So I started eating again."

If only...

My problem wasn't that I didn't know the damage I was doing--I could recognize it on a cognitive level, even if it didn't always have the same emotional impact--it was that I didn't really care. So my treatment stays came and went, and I went through the motions, but I was waiting for that Come to Jesus moment when everything would click and I could move forward with recovery. I said many of the Right Things, those profound statements that therapists just totally eat up- "I'm recovering for myself now!" "I'm listening to my body!" "Anorexia really isn't about food!" And so on. Part of me wanted to believe them, and a part of me probably did, but I was completely and utterly full of crap. In reality, I was still waiting for the lightbulb moment, that hallowed clarity, to see the meaning behind my behaviors and start the meaningful work of recovery.

Needless to say, I've never had an epiphany. My thinking has evolved over the years, sure, and I've certainly have some realizations, but no holy-crap-anorexia--is-stupid moments. Those moments are nice, and I'm not saying they aren't important if they happen, but they're often not the basis of a lasting recovery. I realized that anorexia often created more problems that it solved quite a few years ago, but that never meant I couldn't still be scared to eat.

I've stopped waiting for these sudden jolts of clarity and understanding. Perhaps my most important revelation is that recovery is based in the dogged repetition of recovery behaviors and not any masterful realizations. For so long, these recovery behaviors felt awful. I wanted to crawl out of my skin- I would even rake my nails up and down my stomach and legs because the feeling was so intense. Talking about my feelings, asking for help, drinking the Ensure, none of this felt normal or natural, and it definitely didn't seem to help. I didn't understand what I was supposed to be working toward. What was recovery anyway? And if anorexia made me feel better, how freaking bad could it be?

But I am learning that recovery behaviors can become more natural, just like learning a foreign language. When I first started to speak Spanish, I no doubt sounded like a demented gringo. After several years, I couldn't exactly speak like a native, but I didn't sound like a little girl playing dress-up in someone else's language. I eat. Day in and day out. I try to relax. I try to get to sleep at a normal hour. I talk to friends. I blog. These have created my recovery much more so than any mind-blowing realization.

There are no recovery shortcuts, no miracle elixirs, just the healing tincture of time and practice.

From the Archives: The zone

2011-10-15T09:00:00.000-04:00

Seeing as I will be absent this weekend, I've selected two favorite posts from the archives to tide you over until I return. Enjoy!

Though people have claimed to be "addicted" to darn near anything (herbal tea, Sudoku puzzles, hitting the snooze button, and cats are several of my non-addictions), it's pretty widely accepted that gambling is a bona fide addiction. And with any neurological talk of addiction, you pretty much have to talk about dopamine (a good if slightly technical explanation is here). Performing your addictive behaviors, or even just anticipating getting a "hit" later on, releases dopamine in your brain, which makes you feel good. So you do the behavior more, although less dopamine is released as your brain and body begin to tolerate what you're addicted to. So you increase the amount you use, and the cycle is off and running.

I have no doubt that addiction and dopamine are closely linked, and that there are also links between eating disorders and dopamine*. But new research from Natasha Schull at MIT found that people addicted to gambling aren't motivated by the "hook" of a possible big win. That may have drawn them into the habit to begin with, Schull said, but it's not what keeps them going. What keeps them going is their entrance into what Schull calls "The Zone." The zone is

a dissociative state or trance in which players lose a sense of time, space and physical embodiment, consumed totally by the spinning numbers, symbols or electronic card hands before their eyes. Because gambling machines don't require social interaction (as is the case in table games such as poker), they let people get into and stay in a state that is not dissimilar to, but far more intense than, watching TV; players describe the zone as a compelling, mesmerizing condition of intense concentration -- an almost out-of-body experience. Heavy machine gamblers come to crave this state, says Schull.

"It's about wanting to keep playing," she says. "People will actually get disappointed or irritated if they win a jackpot because it may freeze up the machine and interrupt their flow. Then they have to sit there until they lose it. Walking away with the jackpot is not an option" in their state of mind.

I've played one slot machine in my life- a nickel machine, and I put one nickel in, got nine back, and quit while I was ahead- but I am very familiar with the zone. That, to me, was one of the biggest draws of the eating disorder. I've been around the block enough times to know that losing weight won't make me happy and make me into a different person. I know that not eating will make me feel physically terrible in the long run. I know there will never be a magic weight that will finally make me feel "thin" and okay and good enough and relieved.

But damn don't I miss that zone. The blinding haze of starvation. The single-minded focus of exercising until I wanted to drop. The obsession with food. It distanced me from the world. I was interviewing for jobs several years ago and wound up the last of my friends without a permanent position. After getting turned down for a position yet again, I just thought "I've lost X lbs in the week since I last spoke with you- oh well about the job." It's partly a self-esteem thing (at least I'm good at losing weight), but the other part is the zone.

I almost feel half-dissociated when I'm in the throes of the eating disorder because my connection with reality is blunted at best and gone at worst. All that matters is eating less and exercising more. All that matters is making that number on the scale go down. So the normal, day-to-day stresses kind of fade into background noise.

Eating would wrench me out of the zone, back into the dark, noisy, smoke-filled casino that is my life. This was why I couldn't stop starving even after I reached my initial "goal weight." The zone was what mattered. If I couldn't be in the zone, then my brain tried to find any way in the book to get back there, even just a little bit. No slot machine in a casino? Well, maybe there's one in Safeway, or at the gas station, or on the internet. Maybe I can shove my snack into my pocket or lie about that bowl of cereal I ate for breakfast.

Maybe the zone is nice, even nicer than reality at times. But if all you see of life is the inside of a casino, you're missing out on a lot.

*Yes, I do have to bring everything back to eating disorders if for no other reason than I'm assuming that's why you're reading.

Weekend preview

2011-10-14T18:49:00.001-04:00

So I've completed my work requirements for the day, and now my friend and I are going camping for a few nights. There will be lots of smores and yarn and all that but I will also be completely without Internet for several days.

I know. I must be nuts.

Nonetheless, I think it will be fun and good for me to get away from things.

I dug up a few posts from my archives to keep you entertained while I am away. You should have your smorgasbord as usual on Sunday, assuming all goes according to plan.

Have a wonderful weekend!

"The Usual"

2011-10-14T18:28:00.000-04:00

I am once again on the road for my freelance job (meeting to go to this morning- I left my place last night, spent the night in a nice hotel with crap Internet access), which means facing the task of eating on the road. I knew that I would need to eat dinner at about the halfway point of my 4.5 hour drive, seeing as I left at 5pm. I had found a craft store to pick up some yarn at the halfway point (I feel ridiculously oblique writing this, but I'm really paranoid about privacy since I use my real name), seeing as the store by me was all out of the one color that I needed, so I figured I would eat after I got my yarn.

Which I did.

I was going to go to Panera, since it's a pretty "safe" choice AND one where I know I could meet my meal plan requirements without flipping out. But en route from the craft store to Panera, I saw the sign that Moe's Southwestern Grille had recently opened. We have a Moe's by me, and it's a favorite of mine and my parents.

I have my "usual" that I get when I go. It started as a way to use a coupon or some other deal, and I really liked it, so I kept ordering it. It's pretty much my default when I go. I don't go to Panera that much, so I didn't have a default decision.

The more I thought about it, the more I realized that one of the reasons I really wanted to go to Moe's was because there was a default. I didn't have to decide and calculate calories and things like that. I could just order and pretend I was sort of human instead of agonizing over the menu for half an hour and then spend the next little bit filled with gut-gnawing doubt that I had ordered the "right" thing.

It's hard to explain to someone who doesn't have an eating disorder, exactly how hard restaurants and ordering can be. I don't really have food fears anymore. I'm a little wary at the idea that I don't always know exactly what's in my food, but generally I'm over that. I can deal with it just fine, even if it isn't my favorite idea. For me, the anxiety is over having to decide what to eat from a vast array of options. I find it totally overwhelming.

So that's why I wanted to head to Moe's with my "usual."

Don't get me wrong- I loved my dinner and am glad I ate there over Panera, all other things being equal. But it made my life so much easier to just order without looking at the menu and second-guessing myself. I am that much of a creature of habit. I didn't even think to order anything else. And it was nice to be on my own and eat a complete restaurant meal by myself and not have a total breakdown.

Maybe that's part of the function of "safe foods." It's not just that they're generally lower calorie or whatever, it's also that they help limit our choices when things get overwhelming. Options are a good thing--really, they are--and I'm definitely glad that I've tackled my fear foods. But it also helps for me to have something to order when I can't make up my mind, too. That I can default to XYZ and meet my nutritional needs and also find a pressure release valve for my anxiety.

Does that make any sense? Do any of you do this, too? Please share in the comments, but also try to be mindful not to be too specific about foods and calories lest things get competitive or triggering. I want my blog to be a safe place!

Aria and the Skinny Box

2011-10-13T01:13:00.002-04:00

One of the joys of being mom to a cat are the laughs that she brings into my everyday life. It's also caused me to reevaluate objects and their purpose. Now, the universe contains two different types of things: Cat Toys and Not Cat Toys.

I ordered a copy of the book Eating Disorders and the Brain, which came in a lovely cardboard box that was perfect for a kitty. {{Aria will be sending Bryan Lask a thank you card shortly.}}

Or so it seemed.

I had tossed some papers and such into the box to bring upstairs, which made the box a bit too small for Aria. No matter how hard she tried, or which way she attempted to wedge herself in the box, she just couldn't fit. And she gave me this exasperated look...

So of course my response was to grab my phone and get some documentaion. My mom also found the photos hysterical, and so I began to invent a dialogue of what was obviously going on in the poor dear's head:

I totally fit in this size box last year. I know I did. Damn vanity sizing. A size four box isn't a size four anymore. Maybe if I just suck in my gut...a little more...and inhale...and...wait, don't I have some Spanx? I don't look like I did before I had kittens. Maybe I need a tummy tuck.

But then, didn't I see in Good Mousekeeping a way to lose 10 pounds in 10 days? You know, so you could fit in your skinny box by Christmas? Simple swaps, the article said. Like put your tuna in a smaller bowl so it looks like you have more. Switch to low fat cheddar, and always always order your gravy on the side. The stuff is loaded with calories, I hear. And the size of the mice they serve these days...they're like twice the size of the ones I caught when I was a little girl. Factory farming and hormones...

Maybe if I get the box in another style or another brand. Okay...one last inhale...and...I...think...I...can...zip...these...up...

Does this box make my butt look fat?

Sunday Smorgasbord

2011-10-09T21:10:00.000-04:00

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.

Apparently, not all artificial sweeteners are created equal.

Free exercises that use expressive writing, mindfulness, and the arts to assist in recovery process.

Cognitive Distortions That Contribute To Negative Body Image & Eating Disorders.

8 Keys To Recovering From An Eating Disorder.

Eating disorders and major depression: role of anger and personality.

Reward and penalty processing is widespread in the human brain.

Childhood eating disorders: British national surveillance study.

10 ways to boost endorphin levels naturally and healthily during ED recovery.

Selflessness Gone Awry, and the Damage It Can Cause.

Self-loathing explained: depressed brains may be wired to re-route feelings of hatred inward.

Male Eating Disorder Patients With and Without Non-suicidal Self-injury: A Comparison of Psychopathological and Personality Features.

Listen to an interview with Harriet Brown about her book Brave Girl Eating.

Understanding the neural circuitry of appetitive regulation in eating disorders.

Asylum – a haunting photographic tour of abandoned 19th-century mental hospitals.

Chicago author examines history, psychology behind shoplifting.

Brain type 1 cannabinoid receptor availability in patients with anorexia and bulimia nervosa.

Disordered eating behaviour is associated with blunted cortisol and cardiovascular reactions to acute psychological stress.

Grey matter abnormalities within cortico-limbic-striatal circuits in acute and weight-restored anorexia nervosa patients.

Therapeutic alliance and family-based treatment for adolescents with anorexia nervosa.

Increased neural processing of rewarding and aversive food stimuli in recovered anorexia nervosa.

Altered temporal difference learning in bulimia nervosa.

Jinxing myself?

2011-10-06T23:57:00.002-04:00

You'd think I would know better than to write manifestos like that. Because just a few hours after I clicked "publish," I got sick. Again. Worse than before.

If I moved at all, I would get so horribly dizzy that I would throw up. Which I did, several times. All over my bed. Because I couldn't figure out which way was up nor could I move without making things worse.

So yeah. Vomit + bedspread = klassy with a "k". If there had been cigarette butts and empty liquor bottles and mega-eyeliner, I might have been able to pretend being some sort of has-been rock star who just trashed a hotel room, but alas. Just a laptop and a cat (both thankfully spared the trauma of a bath).

After 12 hours of this never-ending fun, I finally managed to sleep off the worst of it. My stomach was still dodgy, but I could get some food down (toast, Gatorade, chicken soup, bagel). This morning I felt like I had been chewed up and spit out, but I was back to normal except for a headache and a bad attitude. Come to think of it...that's pretty much normal for me. ;)

Food-wise I'm mostly back to normal. I'm still sticking to very bland foods, but I'm adjusting to actually having food in my system again. And I enjoyed several cups of coffee today, trying to make up for the lack of caffeine yesterday.

This is just getting old. Being sick, the stomach stuff, the ED stuff, all of it. I don't think I'm out of line to be feeling seriously frustrated...am I?

Practicing radical acceptance

2011-10-04T23:53:00.001-04:00

Between my stressful week at work and then food poisoning, my weight has dropped some. I suppose I wasn't that shocked to hear it- even with just the illness, my eating hadn't been optimal for several days. I was, however, a little startled at how much (my therapist was rather cryptic, saying "more than a few." I have my guess at what that means, but still).

I suppose I could launch into a rehash of the potential reasons why. I could have pushed myself to try and eat more while sick. I could have been more careful while at my work conference. Coulda, woulda, shoulda. I'm not trying to wash my hands of my responsibility in what happened, nor am I trying to take on responsibility where none existed (though I am kicking myself for eating that damn hot dog that most likely got me sick).

I tried adding a little bit more to my normal meal plan, but that didn't do much. In fact, my weight dropped slightly more because my metabolism kicked in again. This led to a very frank discussion about What I Was Going To Do About This.

The difference--the massive, can't-be-overstated difference--was that I was able to fully participate in this discussion and follow through with what I promised. I don't like much of what I'm doing- Ensure Plus can go suck it, thank you very much. Ditto for the extra snack. Again, that's not the point.

I don't need to want to do this. I do, however, need to be willing.

Frankly, I do think my therapist is being just a tad alarmist about a single-digit weight loss. I didn't feel that I had lost weight. I'm not keen on going back to the chugging of the Ensure and the metabolic shift that once again leaves me burning through massive calories just watching TV.

But I could see it as necessary. I know enough that every relapse starts with "just a little" weight loss, however inadvertent (or, well, not) it might be. I know that good intentions don't save you. I know that promising to eat more is a long way from actually eating more. I know that recovery can be really f*cking inconvenient and you still have to do it anyway because an eating disorder is even more f*cking inconvenient.

So in the past few days, I have been eating foods I haven't touched for years: hot chocolate, Pop Tarts (not exactly a nutritional powerhouse, but sometimes it really is just about the calories), chips. It wasn't as bad as I thought. It helps that I know my metabolism is fierce at the moment and can "handle" the extra/sloppy intake. We'll see whether my weight changes this week. If it doesn't, well, we'll deal with that, too.

Sunday Smorgasbord

2011-10-02T23:51:00.001-04:00

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.

Breaking the silence: Eating disorders in black women.

Eating Disorders Coalition News and Information: What is the FREED Act?

Emotional inhibition helps to maintain AN.

Compulsivity predicts fronto-striatal activation in severely anorectic individuals.

Eating disorder symptoms among college students: prevalence, persistence, correlates, and treatment-seeking.

Enjoy your food and feel fuller, satisfied: An Upside to Indulgence.

Teaching recovery, rather than treating addiction.

Similar Behaviors Found in Women with Food and Substance Issues.

Calorie Counts in the Dining Hall: Harmful or Helpful?

Weight Stigma Awareness Week: What You Need To Know.

A fine-grained analysis of eating behavior in women with bulimia nervosa..

Bringing order to chaos: Professor Chris Fairburn.

Eating Disorders And The Executive Woman.

Brain-derived Neurotrophic Factor, Food Intake Regulation, and Obesity.

Women's Clothing Sizes: Is a 4 Really a 4?

The clinical utility of personality subtypes in patients with anorexia nervosa.
Pressure to lose weight in the form of weight stigma creates more problems--it's not a motivating impact, says study.

Everybody Thinks They're Typical – how our self-perception skews our perception of our peers.

Moral disgust carries foul flavour, researchers say.

First time evidence links over interpretation of social situations to borderline personality disorder.

Brain Bugs – a fascinating look at the glorious imperfections of your brain.

Lessons from Zumba

2011-09-29T23:16:00.000-04:00

Over the last few weeks, I've started taking a Zumba class at my local community center. Several of my friends had said that they enjoyed Zumba, and I thought it would be fun to try. So I went. It's really fun, actually, despite the fact that I look like I'm re-enacting that scene in Date Night when Tina Fey and Steve Carrell do the robot dance when in fact I'm really doing the cha-cha.

Gracefulness has never been my strong point. I can follow along. I can keep up. But I'm not very skilled at the intricacies of the movies. I'm just...not.

So I'm following the instructor* and trying to figure out exactly what she's doing with her fancy footwork, and I kept getting frustrated for my first two classes. I couldn't get my feet and legs to move that fast. So I just hopped and trotted and jumped in combinations that I hoped resembled what the teacher was doing, and then soon enough we would be back to a section that involved walking or the grapevine, and I was all good.

When I went the other day, I finally figured out what my problem was. I was making the moves way more complicated than they really were. The instructor wasn't actually stepping, just sort of shifting her weight from foot to foot. And there weren't three little jumps, just two, and so on. I was getting angry and frustrated at my inability to keep up with all of the steps, when in actuality, I was keeping up. I was just overcomplicating things rather dramatically.

It's pretty much a metaphor for my life. I make things way more complicated in my head than they actually are in reality. I'll grant that some of this is what I call the ignorance of the newbie: all the moves look really complicated because I haven't mastered them yet. But often, whether it was when I was still in school or working at the bakery, I had an alarming talent for taking a simple task and making it really difficult. Then I would get stuck in that horrible cycle of berating and blaming myself for an inability to do a simple task, which slowed me down further, which made me hate myself even more.

I need to remind myself that most things aren't all that complicated. They might seem that way at first, but once I get going, I need to remember that things also get easier. That if I can quell my initial panic that I suck and I'm in over my head and I'm never going to be any good and holy crap, do I suck!, then I can see more clearly exactly what I need to do.

Of course, it's much easier to identify these things in a relatively meaningless dance class than in more important things like career and recovery, but I guess it's a start.

*The instructor this week was a sub--it was the male yoga teacher. His style was totally different, although the class was still good. It was, however, a total blow to my minimal self-esteem to see a large, hairy male be far more light and graceful on his feet than me. Sigh.

Tip Day Tuesday: Getting people to STFU about food and calories

2011-09-28T00:02:00.001-04:00

A few months ago, I started "tip days," in which I tackled some of my readers' biggest recovery quandaries. It fell by the wayside due to time crunches and that annoying little thing people like to call life.

But a question from a reader resurrected the idea of tip day, and I like the idea of moving it to Tuesday, since Tip Day Tuesday has a much nicer ring to it. Yes, I am that shallow.

The question: My roommates talk about calories and exercise constantly - they even ask me questions like "do you know how many calories are in that?"; this is obviously triggering and generally uncomfortable. How do I live with all this diet talk without taking a dive off the end?

Ah, yes. The small, curious pleasures of recovering from an eating disorder in a culture that quite possibly has more food issues than we ever did. Some people might cultivate their inner advocate and tell people that diets don't work, etc. If that's you, congratulations. You have more chutzpah than me. Especially in these situations, I want to distance myself as quickly and easily as possibly.

There are ways to survive intact--or at least minimize the damage. Here are a few things that I do in these situations.

This ain't your drama. It's a simple reframe, and it doesn't always make the situation any easier. At the same time, letting them own their piece (the obsession with calories) and you yours (how the talk makes you feel), can give a better perspective on what's really going on. Looking at it this way, there are really two issues: the outer talk and your inner talk. Just because they're getting sucked into the gigantic cultural drama of don't you know how many calories are in that? doesn't mean that you have to.
Change the topic. You don't have to be that subtle about it, either. Ask about homework, if someone noticed the leaky faucet, who forgot to clean the dishes, etc. If they're too self-involved or clueless not to notice that you're not digging the calorie talk, then they probably won't figure out the rapid change of subjects. It does mean you need to be prepared with at least one workable idea, but there's generally something.
Cultivate your inner smartass. I realize that you can't always say what's on your mind, but that doesn't mean you can't say it in your head. What I mean is you can answer the question of "Don't you know how many calories are in that?" with "Just a fraction of the calories that I'll burn when I pop you in the jaw." Just, you know, do it quietly. Really quietly. Like, silently. And then enjoy...
Answer the question. They're probably not expecting an actual answer, so maybe give them one. You know how many calories you're eating (or at least you have a good guess), and they did ask, after all. I would typically follow that up with "So?" Lastly, you can always say, "My food is my business, okay? I don't comment on what you eat, please return the favor." It probably won't give you major friendship points, but you probably don't want them with these people, anyway.
Tell them to STFU. With that last comment, it gives them an idea that this is NOT a cool subject, but it doesn't reveal anything you might want to remain private. I have generally kept this as a last ditch effort, for when everything else has failed.
Accept that you might not be able to do much. In fact, accepting you can't control the situation should probably go at the TOP of the list, rather than the end. But I'm lazy and don't want to reformat the list, so here it stays. There's a chance that no amount of "I" statements and feeling talk will get your roommates (or anyone else) to take a hint. In that case, I recommend distance. Distance and headphones.

Do you have a pressing recovery question you'd like me to take a stab at? Email me at carrie@edbites.com, and it just might appear on an upcoming Tip Day.*

*Legal crap: Any questions you send to me will become my property, and I reserve the right to reuse them on my blog and edit for clarity, brevity, and any triggering information. Sending in a question doesn't mean I will be able to answer it on the blog, so don't be worried or offended if it doesn't appear. I won't answer medical questions, and this isn't a substitute for actual, on the ground support. Parents and family members are welcome to submit questions, too.

Sunday Smorgasbord

2011-09-25T23:47:00.000-04:00

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.

Do we need to talk about weight to bond with other women?

A New Law on School Fitness Data Faces Obstacles.

Looking into Ramachandran's broken mirror.

There Is No Biological Reason to Eat Three Meals a Day -- So Why Do We Do It?

Repetitive behaviors reduce stress in elite athletes and mere mortals. In other words, OCD-like behaviors reduce anxiety, at least temporarily.

Mouse Model May Help Reveal New OCD Treatments.

Girls, ADD, and Anorexia Nervosa.

The secret world of mid-life bulimics.

Use of treatment manuals in bulimia nervosa treatment.

Alexithymia and its relationships with eating behavior, self esteem, and body esteem in college women.

Which criteria for recovery are relevant according to eating disorder patients and therapists?

Psychosocial barriers to engagement with an eating disorder service: a qualitative analysis of failure to attend.

The Use of a Nonimmersive Virtual Reality Programme in Anorexia Nervosa: A Single Case-Report.

Impulsive behaviors in female patients with eating disorders in a university hospital in northern Taiwan.

Sick :(

2011-09-25T00:00:00.000-04:00

Sorry for the lack of posting these past few days, but I came down with a stomach bug and have been pretty much out of commission the last little bit. I think I've turned the corner, as I actually got to make the bed today. I basically didn't get out yesterday, so this was big news indeed. I'm also glad that I won't have to reschedule my haircut tomorrow morning because I'm rather shaggy and it's driving me nuts. Tomorrow will resume your regularly scheduled programming.

My first drive thru

2011-09-22T00:11:00.000-04:00

When I was driving home yesterday after one of the most non-ED-related mentally grueling days I've had in a long time, I had to stop for dinner. I was tired. And cranky. And had spent Lord only knows how many hours sitting in traffic the last few days, and I was cruising along well down a major interstate. I was petrified that I was going to hit (yet another) traffic snarl.

Yet the fact remained: it was dinnertime.

So I did something unusual. I pulled over at the next exit to the Chick-fil-A* and went through the drive thru. I realized, as I placed my order, that I was 31 and had just ordered my first drive thru meal. I've ordered beverages at a drive thru plenty of times, but never an actual meal. I've ordered fast food in the actual restaurant as well, also on my own, but again, not the drive thru.

Let me give this a bit of context. Drive thrus were illegal in my hometown because they were deemed a safety issue (eating and driving). They have a point there- I feel horribly guilty for eating and driving yesterday, but it really couldn't be avoided. I really don't like ordering stuff out (it has nothing to do with food and everything to do with my fears of talking to strangers. Apparently, you can be 31, have never eaten from a drive thru and also have an overblown case of stranger danger. Sigh), and since I've been on my own, I've pretty much had an eating disorder. Diet Coke, fine. Actual food, not so much.

But I guess all of that changed yesterday. I got crumbs on my lap and grease on my fingers and I survived. I didn't like it, and I survived. I much prefer eating dinner when I'm not behind the wheel, but I also think the dangers of not eating outweighed the dangers of eating and driving.

So that concludes the tale of Carrie and her First Drive Thru.

Random story postscript: Doing this blog post reminded me of my undergraduate advisor and a story she told me when we were at a conference. She was originally from Taiwan, and when she first moved to the US to start her PhD, her English was pretty limited. She said that for the first week or two she lived in America, she ate dinner at McDonald's every night because you can order by number and she knew she could count to ten. Now, whenever I have to order a menu item by number, I think of her. She was a really neat person.

*As a family, we rarely ate fast food and still really don't. I generally don't like a lot of fast food places, but I do enjoy me some Chick-fil-A. My RD made me to food exposures at all the major fast food chains so I know I can eat there, but still.

General update

2011-09-21T13:17:00.000-04:00

The last few days have been really hectic. Yesterday was simply brutal--I spent from 8am to 5:30 pm listening to very dense, technical scientific talks with only two ten minute breaks, and a brief lunch. I had to pay attention the entire freaking time, and my brain was just fried by the end. After I got done, I had a 4 hour drive back home, and then I basically collapsed into bed shortly after. I didn't wake up until shortly before 10 this morning.

I will return to my regular blogging later this evening.

Sunday Smorgasbord

2011-09-18T23:07:00.001-04:00

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.

The Psychology Of Yogurt, or what probiotics can teach us about the mind-body problem.

Help improve the Maudsley approach for teen anorexia in Uuniversity of Chicago study.

An n-gram of the phrase "fat free." More on n-grams here. {For fun, I made an n-gram of anorexia.}

Beautiful Brains- National Geographic piece on the teenage brain.

Families and Mental Illness: What Do They Know?

The Same but Different? Treatment of Anorexia Nervosa in Adolescents and Adults.

Intuitive Eating Pro Newsletter, September 2011.

The End of Dieting? ADA Debate Throws Obesity Science Into Doubt.

Eating disorders plague teen boys, too--it's not just a girl thing.

Changes in salivary cortisol levels as a prognostic predictor in children with anorexia nervosa.

Women with history of EDs more vulnerable to postpartum depression.

Brain as art: Waves of Mu.

Social cognition in bulimia nervosa: A systematic review.

Wonderful Robert Krulwich post about "extreme tidying up."

Yale psychologist calls for end of individual therapy-based mental health.

Eating Patterns in a Population-Based Sample of Children Aged 5 to 7 Years: Association With Psychopathology and Parentally Perceived Impairment.

Amazing new eating disorder magazine out of Scotland, "The Voice."

Imagine running one marathon & then another, no preparation - for parents and child, this is what beating AN is like.

Getting my mojo back

2011-09-18T18:44:00.000-04:00

A little over a week ago, I was writing about my unruly puppy dog brain. A puppy chews on anything--it needs to chew. Just like my brain with thinking. It's why I don't do well with down time and being bored. This was the case a week ago, and things have become rather different in the past few days. I was traveling Thursday and doing the lengthy meeting thing on Friday. I'm staying with my friend this weekend and trying to get some work done in the off hours. Then tomorrow and Tuesday, it's back to the lengthy meeting thing, plus writing some press releases for them and trying to work on my book.

Phew.

It's good to have work to do. It makes me feel like I have a purpose. It pays the bills. And it also gives my brain something more productive to chew on.

I know I need to do a better job at making time to work on my book. I was working on the bit about "analysis paralysis," which got me laughing because it's exactly why I'm ~~a little~~ ~~a bit~~ ~~just a touch~~ more than a little behind where I need to be on the writing. Starting the writing process is terrifying because I don't know if I can do it. I've never had to juggle this many interviews and references and all this other stuff before. I don't know if I can churn out that much writing, let along quality writing.

I also have to censor myself, as saying something is "bullshit" isn't likely to get high marks from my editor. It is still, of course, bullshit, but that's besides the point.

The solution, I've found, is simply to dive in. Start writing. Accept that there will be shitty first drafts and that this doesn't imply a shitty final draft. And so now, I'm neck deep in PubMed references, pdfs of journal articles, interview tapes, and snippets of blog posts. But I banged out over 1000 words this afternoon, which is a pretty good clip.

So.

Being in the thick of a project makes it much easier to work because I've gotten over the most massive hump that's known as "Getting Started." I'm still petrified that there will be some scrap of research I've failed to factor in to all of my writing, and that it will essentially blow my book to bits. I know--how ironic that with all of the reading and researching I've done, I still have this fear. But there you have it: analysis paralysis in action.

Worth it

2011-09-15T21:33:00.000-04:00

I'm currently on the road for one of my recurring freelance gigs. It's pretty new--I just started last month. I found out about the job from my science writing teacher, who passed along the job opening. I'm really liking it, and it pays really well.

Which brings about the point of the post.

I asked my teacher how much I should charge on my job proposal, since I really didn't know what the going rate for a freelancer was (generally, I'm paid by the job, not by the hour or month). She told me what she knew, and my jaw dropped. It was a serious amount of money, and I hesitated for a long time about quoting that much.

I thought about it and figured it couldn't hurt, and I didn't even know that I was competing against anyone. And if it was the going rate... I did put on the proposal that the rate was negotiable because I didn't want them to reject me outright because of my fees. I'm not so comfortable financially that I'm unwilling to take a little less money with the knowledge that it was going to be a regular, recurring job (it's a MAJOR luxury when you freelance).

I fretted for days about the amount of money I was charging. I thought they would laugh me out of the interview room.

In the end, my fee wasn't mentioned. They hired me right after the interview, no questions asked.

My dad asked what I was making (he helps me with accounting), and I told him.

I also added, "I can't believe they're paying me that much! It's almost ridiculous!"

He said, "Clearly, that's what you're worth."

I said, "But it's $XX/hour!"

"You're worth it."

Obviously, I was. They wouldn't be paying me the rate I quoted if they didn't put the same value on my work.

It's something I have trouble with--valuing myself and my work appropriately. I think I inadvertently cheapen myself. I'm not that good and it's not that difficult or that much trouble. Except that it is. Or that other people think it is and are willing to charge for it and actually get paid for it. I'm afraid of doing that--of finding and asking fair market value because I really don't think I'm worth it.

If I hadn't asked my old writing teacher, I never would have asked enough money. I never would have valued myself properly (partly out of ignorance, partly out of fear).

It's a huge learning curve. And it's scary to think that my skills are worth it. But I guess they are.

Losing your "self"

2011-09-14T00:36:00.001-04:00

Although this article was more geared towards parents, I think it really helped me understand a lot better about what the hell was going on in my head during the worst of the eating disorder.

An excerpt:

An interesting area of research known as “theory of mind” posits that your child’s brain really does change as his or her weight dips below the starvation level. Theory of mind researchers are studying the eating disordered person’s ability to read facial expressions to intuit mental states, sometimes solely by looking at the eyes of the person they are with. They’re finding that this ability falls victim to starvation, just as does the body’s ability to maintain strong bones, keep warm, or grow lustrous, healthy-looking hair. A starving person has difficulty attributing emotions, beliefs, and desires to themselves and to others. Without this ability, it can be hard to function smoothly in the social world.

...One test the researchers used showed both people with anorexia and recovered patients film clips of social interactions between people. Test subjects had to scrutinize facial expressions, body language, conversation and context to read complicated emotions such as desire, embarrassment and hostility. When a teen with anorexia looks into her worried, and frustrated parents’ eyes, can she recognize the emotions written on their faces, and compare it to feelings she has experienced herself? Researchers noted clear deficits in this area among anorexics. The test was able to distinguish those currently suffering from anorexia and those who had recovered. So the good news is that this weakness in processing emotion seems to get better with recovery.

Ulrike Schmidt and colleagues are now readying a paper for the International Journal of Eating Disorders that looks at theory of mind in relation to bulimia. In her tests, Schmidt and her colleagues examine study subjects and the ability to attribute mental states to others and ourselves, which they call “mentalizing.” Interestingly, when a group of patients with bulimia were given this test, they were better able to recognize negative emotion than the control group. Schmidt and colleagues have detected enough of a “distinct socio-cognitive profile” among bulimic patients (translation: they do read and process emotions differently) to merit further research.

The fact that patients with anorexia who have recovered seem to regain their ability to recognize and attribute emotions to others, Banker notes, indicates that this phenomenon could well be a temporary lapse into autism-like cognitive behavior. “When someone’s in a state of starvation that kind of empathic, or higher-relational function shuts down,” she notes, news she hopes will “reduce the personal hurt” that comes with the territory of helping a loved one battle anorexia.

Basically, when I am in the grips of the eating disorder, my "self" shuts down. It's like my own self is too difficult, too expensive for my starving brain to maintain. And so it goes to ground. Hibernates.

When it does come back, it's like your hand or foot waking up after falling asleep--pain and pins and needles. That this phase is likely necessary doesn't make it any easier. What also doesn't make it easier is when you realize just how long you've been absent. When it suddenly hits you that all your similarly-aged friends are married and having babies and you're still not quite figuring out this whole thing the world likes to call "dating."*

It makes me want to get a t-shirt that says "Excuse me, but my brain was on a prolonged leave of absence."

The irony is that my life looked pretty normal. Graduate degrees, jobs, things like that. It didn't look like I was missing out on a whole lot. But I realize that I never really went through the process of making friends and meeting people for almost a decade. Add in the fact that my natural skills at these tops out at "total suckitude," and it's not hard to see how you find yourself at 30, rather adrift in the world.

Even more ironic is that the eating disorder can start to seem like a good solution. If I shrink my world back down, I'll go back to being oblivious about what I'm missing. Not a bad solution, at least in the short term. Until you realize that going back will mean that even more time has passed and you are further and further behind where you want to be in life.

I think this is the "mourning" the therapists tell you about. You don't just mourn the loss of the eating disorder, you mostly mourn the loss of everything that went along with it. The illness keeps you charmingly oblivious to, well, everything, and only as you come out do you realize what you've been missing.

*Honestly, what keeps my sanity is looking at mating rituals in the animal kingdom. I can put them into context that way. Clearly, I'm a nerd...

Sunday Smorgasbord

2011-09-11T22:45:00.001-04:00

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.

Eating disorder patients battle insurers over care.

The Importance Of Values In Eating Disorder Recovery.

New research project to support young people suffering from eating disorders.

Mirasol Eating Disorder Clinic files for bankruptcy.

The children who fall victim to anorexia.

Angry parents say child weighing scheme risks eating disorders.

A haunting dispatch from inside the hospital that saves children. The article also contains one of my favorite quotes from a recent ED article: ‘Anorexia isn’t the slimmer’s disease, it’s the biggest killer of all mental health illnesses. To suggest it’s about people wanting to look like someone they see in the media trivialises it, but certainly I think that those images don’t help.’

Good, brief description of FBT from the Eating for Life Alliance.

Play Games, Treat Anorexia (my latest for Psychology Today--the actual magazine, not my blog).

Bone health in anorexia nervosa.

Spain wants EU call for online anorexia crack down.

No memorials for me

2011-09-11T22:09:00.000-04:00

It's pretty much impossible to escape the fact that today is the 10th anniversary of 9/11. It's also pretty much impossible to miss all of the memorials. Many of them are heartfelt and sentimental, but I won't be watching any of them.

I'm not anti-memorial, but this date is one of those things I really don't want to remember. It's something I remember all too well.

I could tell you that I had just dropped out (basically been kicked out) of college because I was deemed a danger to myself because of my anorexia. I could tell you that I had essentially stopped eating and was weak, depressed, and losing touch with reality. I could tell you that my dad had called around 9:30 am and told us we had to turn on the news. Didn't matter what channel, this thing was everywhere. And I watched buildings fall with a strange sense of numbness because everything was numb because I was weak and crazy and dying.

What I will tell you is this: the only thing I ate that day was a few carrot sticks. Adding mustard seemed too complicated. I will also tell you that, as I nibbled my carrots and watched TV, that all I wanted was to trade places with someone who had died in the buildings or airplanes. Because I didn't want to face inpatient and gaining weight. Because I was so depressed I didn't care. Because I would much rather have died than dealt with all of this.

Which is why watching any sort of memorial really doesn't help me. It dredges up memories I'd frankly rather forget.

Maybe one day I'll be able to look back and be grateful that I wasn't killed in the tragedy, and that my mindset is so much better now. But not now. Not today. And that's why I'm not watching any memorials.

Backseat drivers

2011-09-11T00:01:00.001-04:00

I was reading a memoir of chronic loneliness (Lonely by Emily White), and she was discussing the genetic predisposition to loneliness. She described it as having a backseat driver in your life. Emily was still the driver of her life, but she also had a backseat driver (the predisposition to loneliness) who was shouting out directions.

Of course, you usually don't always know that your backseat driver is an arrogant ass who really doesn't care where you're driving. If you're me, you might be confused about where you're going or how to get there. As much as you might dislike the person giving directions, you're simultaneously grateful to have directions. So you follow along.

Sometimes, the backseat driver gaines in power and influence, and all of a sudden he's sitting in the passenger seat. As Emily said, sometimes the backseat driver even grabs ahold of the wheel from you and is driving the damn car.

The ultimate goal of treatment is to wrest control back from the backseat driver You might not always be able to toss the SOB out of the car, but you can turn up the radio to drown out his directions. Or you can work to push him back to the backseat, and ultimately to the trunk.

Genetic predispositions work this way. They rarely start out by suddenly grabbing the wheel away from you. Rather, they creep up in importance and influence. We do, ultimately, remain the driver of our lives, but as anyone who has followed GPS directions only to end up at the wrong place knows all too well, bad directions can lead to a very different road traveled.

Our predispositions towards eating disorders or anxiety or bad boyfriends tend to nudge us. They change what environments we're likely to seek out, and our environments can provide new backseat drivers (or new directions for the existing ones). They can be annoying passengers in our lives, but there's also not a lot we can do about them. We're often stuck with them for the ride.

The goal is to diminish their influence. Most backseat drivers I know don't change no matter how many times you tell them to shut their traps. It's much easier to deal with them effectively once you know that they're a) a backseat driver and b) know that their sense of direction really sucks.

Of course, throwing your backseat driver in the trunk can leave you directionless. This makes the asshole in the trunk all the more appealing. It's much more appealing (and less anxiety-provoking) to have someone in control and telling you where to go than for you to be driving the streets of a neighborhood you don't know in the dark. Directions--any directions--seem ridiculously helpful.

Maybe they are, but I have to keep reminding myself that the backseat driver never asked where I wanted to go. He's not interested in that. He just wants to drive. So I can't necessarily get to where I want to go by listening to the jerk.

I also have to remember that the wannabe driver is going to be trying to give directions for a good long time, and that he might figure out how to get out of the trunk and back into the car at some point. I have to be ready for that. I have to get my own directions and be confident in that. I also need a killer playlist for my iPod so I can drown out his racket.

Perhaps I've taken the metaphor farther than it was meant to go. But I think it explains a lot about remission and recovery in EDs. Lock the bastard in the trunk and drive secure. Also be prepared for him to bust out and try to drive your car again. Remember this, however: you are the driver. You get to pick where you want to go. All sorts of things are going to give you a nudge in one way or another. But you're always the driver.

Disconnected

2011-09-08T00:31:00.002-04:00

I've been feeling rather disconnected from things, almost as if there's a pane of glass between me and the rest of the world. I think the grim slog through recovery and meal after meal after snack is taking its toll. Plus, I think I'm already starting to sense the change in seasons, with the cloudy, rainy weather where we are combined with the shorter days. It just has me in a funk.

With work, I had a really busy week or two that's been followed by a really insanely slow week. This always makes me anxious. I like to stay busy. I do much better mentally if I'm solidly busy. Not so busy that I start to panic about whether I can manage things or get them done, but also enough so that I don't have lots of extra time to start and think about finances, about how everyone else's career seems to be going more smoothly than mine, etc, etc, etc.

It's sort of like how dogs need chew toys or else they eat the furniture. Dogs are going to chew on things, so they may as well do it on something non-damaging. My brain is the same way. It's going to be churning and thinking regardless, so it's much better if it's thinking about something productive (career stuff) than non-productive (senseless worries about money). When I'm focused on my goals, I don't have time to engage in the compare-and-despair routine.

With all of this--recovery exhaustion and increased anxiety--I've sort of found myself engaging with others less and less. You probably noticed that the frequency of blog posts has gone down. Some of it is that I am too tired to write, or I don't feel I have anything to say. And I just care less about being around other people. It's a LOT of effort for me to be social, so unless I push myself, I start to isolate. If being social didn't help me so much, it would probably be a lot easier.

Then, when I am out, it feels hard to relate to other people. Their issues are so different from mine: kids, husbands, and other things with which I have zero experience. What stresses me out is so different, and it makes me feel more than a bit alienated. I mean, I'm 31 and still looking for a gold star when I eat cake. Kids? I can't imagine...

Hence the disconnect. Sometimes I feel that it's easier to disconnect from everyone than to try and connect and still feel that something's missing. And there are days when I almost don't feel I have the energy to make the effort.

I'm not depressed, I don't think. I function. My mood is generally not all that bad. There's definitely a dip from normal, but nothing like I'm going off the rails. I'm (mostly) coping. I just still get so tired sometimes of how hard it is to put one foot in front of the other.

Because we all need one...

2011-09-06T12:06:00.000-04:00

I think this is going to be my new theme song:

Thanks to Miss Mary Max for alerting me to this special gem...

Sunday Smorgasbord

2011-09-05T00:46:00.001-04:00

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.

A substantive and methodological review of family-based treatment for eating disorders: the last 25 years of research.

ED treatment improves impulsive behaviors in people with AN and BN.

CDC Statistics: Mental Illness in the US. Impaired neural processing of social attribution in anorexia nervosa.

Eating Disorders May Affect Oral Health.

Spatial orientation constancy is impaired in anorexia nervosa.

"We can all be pretty but beauty is an action." Ad campaign sets out to undo the thwarted definition of beauty.

Risperidone no more effective than placebo for adolescents and young adults with anorexia.

"How Can I Become More Resilient?" It's a good question for those of us working on recovery...

The impact of an implicit manipulation of self-esteem on body dissatisfaction.

Biology, Not Just Society, May Increase Risk of Binge Eating During Puberty. (um, no kidding?)

Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: Implications for DSM-5.

What Full Recovery From An Eating Disorder Means.

Wasting Time: Symptom and Enemy of Anorexia.

When eating too healthy becomes harmful. The subtitle says that orthorexia "...may lead to mental stress." So does being in a traffic jam. I'm thinking they should have been a little more specific. Also, EDs aren't about wanting to lose weight. That can be part of it, but a focus on weight loss is not universal to EDs.

Interesting discussion on the root of "guilty pleasures."

Before and after

2011-09-01T21:25:00.000-04:00

I was reading the blog Dances With Fat earlier and I stumbled across this quote:

Also consider the possibility that there’s no such thing as “before” or “after; maybe there’s only “during” and maybe we are all perfect exactly where we are right this minute.

It's something I struggle with--wanting things to be finished and complete. I don't like the idea of being "in recovery" or "working on recovery" because it's so nebulous. Exactly what's my status here?

I like things in my life (not surprisingly) to be nice and neat and even. Considering myself to be in process or en route is a much less defined category. I want the end result, not the half-finished product. It's much eaiser to report on something that has happened or will happen than something you're just "working on." It's unfinished. Messy. I don't like that.

In reality, though, we're all works in progress. Life is really never finished. Yes, things start and stop all the time, but there's never really an "after," at least not a definite one. There's just "now." And now has to be good enough.

Monday Smörgåsbord

2011-08-29T23:51:00.000-04:00

It's once again time for your weekly Sunday Smorgasbord (delayed by only 24 hours), where I trawl the web for the latest in ED-related news, research, and more, so you don't have to.

Join me at FEAST's first-ever conference in Washington, DC this November.

Will Students Take a Mental Health Test?

Aetiology of anorexia nervosa: from a "psychosomatic family model" to a neuropsychiatric disorder?

Live in Australia and want to participate in a clinical trial of outpatient treatment for anorexia? Here's your chance.

Relevance of Social and Self-standards in Eating Disorders.

Eating disorder side effects in men.

Illness perception in bulimia nervosa.

Distinguishing between introversion, shyness, and social anxiety.

Characteristics of suicide attempts in anorexia and bulimia nervosa: a case-control study.

Dieting women may lose bone mass that doesn't return.

Knowledge of eating disorders among collegiate administrators, coaches, and auxiliary dancers.

Who Says You’re Fat?

Ghrelin and anorexia nervosa: A psychosomatic perspective.

Guide Dogs for the Mind Gain Popularity.

Study finds fat acceptance blogs can improve health outcomes.

How psychotherapy changes the brain.

Brief update

2011-08-29T18:31:00.000-04:00

Well, I have survived this week's natural disasters: an earthquake and a hurricane. If there were locusts, I would have thought the horsemen of the apocalypse were galloping by.

Power came back on at my place this morning, it was back at my parents' yesterday. My freezer didn't thaw too much, so I hope everything will be okay.

Your smorgasbord will appear tonight.

Glad to be back!

Ain't no hurricane gonna get my recovery

2011-08-27T00:38:00.000-04:00

So. If you're in the US, you've probably heard about the massive hurricane that's hitting the East Coast. And I'm in its path. That means I've stocked up on bottled water (I think I found the last pack in my town earlier today), peanut butter, protein bars, baked beans, and tuna--for me AND Aria.

I'm guessing we're going to lose power and that cooking is going to be a bit creative the next day or two. I'm staying with my parents since they have a generator and I don't, so I'll at least have a bit of juice. It also likely means NO INTERNET and limited phone, since I don't want the battery running dead. In the mornings, we're going to fill all the bathtubs in case we lose water so we can flush toilets, etc. Basically, when you combine the brains of three obsessive and perfectionistic people, you can ensure that all your bases are going to be covered.

So here I am, trying to fit both my job and my recovery into this madness. Yes, I know, I should be worrying primarily about my recovery, but I also have bills to pay. Trying to get copy in on Monday could be an interesting adventure. I suppose that this could be an optimal time to drop the ball on recovery. Stress? Check. Legitimate disruption of food schedule? Check. Lapse? Let's not tick that box.

But I've taken every precaution and have no reason not to stay compliant with my meal plan. There will definitely be extra stress. I try to stay practical: not eating won't help anything.

I may or may not be able to blog again for several days. So for all of you East Coasters, batten down the hatches and hole up with your can openers. For everyone else, enjoy a meal that doesn't come from a can and think of me. :)

Learning from relapse

2011-08-26T00:45:00.000-04:00

This is actually a post I've been meaning to write for a while: the curious upside to relapse.

Before I go any further, let me say that I don't advocate relapse, I'm not saying you should try to relapse just to "see what it's like" or to stare the demon in the face and see who blinks first. I'm also not saying relapse is inevitable.

It is, however, exceedingly common. So common that I don't know anyone who has recovered without at least a minor relapse.

But here's the thing: although a relapse isn't good, it's also not 100% bad, either. Your first task when you find yourself slipping is to pull yourself out of the hole. Then, I've found it helpful to identify triggers and potential turning points where I could have done something differently. From a number of these dissections, I've learned some things that have ultimately helped my recovery.

Relapse can show you where your recovery is weak. For some people, it's PMS. For others, it's work stress. Or kids. Or breakfast. Or whatever. These things can be easy to overlook or shrug off. But a relapse can give you a chance to address these, head-on.
Relapse can force you to re-evaluate your goals. Maybe you love your job but it's stressful as hell, and a relapse is showing you that all that stress isn't healthy. Or that your college major isn't what it's cracked up to be. Relapse can be an opportunity to rethink things with a fresh set of eyes. If high stress and low sleep are demanded by your job or major, it might be time to rethink just how much you want to be on that path.
Relapse can remind you just how bad the illness is. We forget, sometimes, just how crappy we feel when entrenched in the eating disorder. But a period of wellness followed by a return of symptoms helps drive home the difference that recovery can make.
Relapse can be humbling. Humbling in a good sense. It's easy to think that we'll be fine, that there won't be any problems, that we don't need extra help. And then comes a little friendly reminder that we do, in fact, need support and lots of it.
Relapse can let you refine your treatment. It's easy to coast through and think that everything is fine. And it's hard to see the need for change when things are going well. Obviously--if things are going well, you don't want to change that. But a relapse can be the extra nudge you need to switch medications or therapists, try a new treatment approach, or otherwise shake things up.

The idea isn't to just let relapse happen. If it does, however, you can use the experience to build up your recovery, rather than using it as an excuse to let everything decay.

What are some of the things you have learned from relapse? Share in the comments!

Recovery as a gift

2011-08-22T23:21:00.001-04:00

Some days, I think recovery can go shove it. The process sucks. It's expensive, time-consuming, and it makes me really, really cranky. Like, you know, it's doing right now.

On other days--days when I feel more positive, well-rested, and can take the long view--I can see that recovery, naturally, doesn't totally suck. Especially on days like today when I'm crotchety and short-tempered, I need to read things like what my friend says about how recovery is a gift:

When we stop letting our eating disorders determine our self worth and begin to focus on health, it’s easier to make time for ourselves – no longer over-committing to others or trying to find meaning simply in what we mean to others.
Recovery allows us to re-set our priorities. Rather than believing that the only thing that matters is losing x pounds, or running some arbitrary distance, or. . . recovery allows us to see that there are friends who love us, healthy goals to achieve, and life that needs to be lived.
Recovery gives us the opportunity to talk out long-buried issues and to grow from our past rather than always living in it.
Recovery can teach us life skills. Whether it’s saying no to that one last thing, speaking up when we need support, using yoga/meditation/journaling to gain perspective, or something else altogether, identifying the simple steps needed to get through an anxiety attack, an evening with a large group of people, a moment, an hour, a week, or a year, the process of recovery enables us to draw on a variety of techniques and skills that – sometimes, at least – it seems like others don’t draw on.
Recovery allows us the opportunity to construct life on our terms, and to see that there are times when we’re not going to have control – and that those things are okay.
Recovery lets us learn more about the parts of ourselves that we’ve buried – and often, while this can be related to pain, it’s the strengths that we’ve given over that we’re able to reclaim.

I don't think my eating disorder is a gift, mind you, but I also think that recovery can force us to reconsider some fundamentals about who we thought we were. I'm still a workaholic and overachiever (I'm writing this after a 12+ hour day, and I'd have kept working except I'm working on that sleep thing), but I'm also much more willing to take a break. I also have an identity outside of my occupation. Before the ED struck, all I cared about was schoolwork. I wrecked friendships and had a bloody miserable time in high school and college because of it.

Also before recovery, I never would have had the guts to quit my previous path and apply to writing school. I was going to be a researcher. End of story. That had been my path since I was 12 (the subject had changed slightly, from genetics, to biochemistry, to virology, to public health), and it never occurred me to question that. I did enjoy the work and the field, but I never would have asked myself if there was something out there I might enjoy more. Then again, I never would have had so little to lose by making the decision unless the ED had sucked all of that away.

An ED is a nasty thing, and no matter how many people I help, I'm never going to say that I'm glad I developed anorexia all those years ago. But I can also be grateful for the lessons of recovery, however horribly and awkwardly I might have had to learn them. That, I think, is the moral of the story. Use the crap of the eating disorder to fertilize something better in your life.

Sunday Smörgåsbord

2011-08-21T23:20:00.000-04:00

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.

Young vegetarians prone to binge eating, says new study.

Back to school fuel: how restrictive diets can compromise student performace.

Thoughts on recovery from a recovering mother.

The brains of people with BN process emotional information differently.

Psychophysiological responses to idiosyncratic stress in bulimia nervosa and binge eating disorder.

Male Athletes Struggle With Eating Disorders.

Binge eating in binge eating disorder: A break-down of emotion regulatory process?

{{Sorry- it was a really slow news week.}}

Decision fatigue

2011-08-21T01:42:00.000-04:00

Every day, we make tens of thousands of decisions, most of which we're not aware of. Shoes or sandals? What pair of socks? Paper or plastic? The list is endless. Not all of these decisions are obviously decisions--our brain likes to take shortcuts. If there's snow on the ground, I'm obviously going to choose shoes over sandals. That one's a no brainer. These shortcuts are essentially an energy saver- our brain is a limited resource. It can only do so much thinking. To save time (and energy), we have habits or patterns. We drive the same route to work. We flip through the channels in the same order. We eat the same flavor of ice cream out of the same bowl with the same spoon. Okay, maybe that last one is just me. Decisions are hard to make.

It's why, ultimately, we're creatures of habit. Simply, it's easier.

Scientists have come up with a name for why we get so tired after we have to decide something: decision fatigue. It's the subject of a recent New York Times article:

Decision fatigue helps explain why ordinarily sensible people get angry at colleagues and families, splurge on clothes, buy junk food at the supermarket and can’t resist the dealer’s offer to rustproof their new car. No matter how rational and high-minded you try to be, you can’t make decision after decision without paying a biological price. It’s different from ordinary physical fatigue — you’re not consciously aware of being tired — but you’re low on mental energy. The more choices you make throughout the day, the harder each one becomes for your brain, and eventually it looks for shortcuts, usually in either of two very different ways. One shortcut is to become reckless: to act impulsively instead of expending the energy to first think through the consequences. (Sure, tweet that photo! What could go wrong?) The other shortcut is the ultimate energy saver: do nothing. Instead of agonizing over decisions, avoid any choice. Ducking a decision often creates bigger problems in the long run, but for the moment, it eases the mental strain. You start to resist any change, any potentially risky move — like releasing a prisoner who might commit a crime. So the fatigued judge on a parole board takes the easy way out, and the prisoner keeps doing time.

The highlights are mine.

That's my default mechanism: when I'm stressed, when my brainpower is at an ebb, I default into anxious rituals of indecision. ED behaviors are a way to avoid any choice. They're ritualized, prescribe. Once they start, they continue of their own accord. They let the world pass me by without ruffling my feathers.

It also seems to me that the ED is a way to avoid decision fatigue. When I'm in AN mode, my decisions are much more limited. Eat only the lowest calorie options. Say no. Weigh myself again. And again. Get back on the treadmill. There's no decisions involved*, just commandments. That life is on autopilot, and it's uniquely positioned to limit decision fatigue.

I don't have to face the anxiety over deciding what to eat and when, and even with what utensils, because I eat the same thing, every day, on the same plate with the same cutlery. I don't have to decide where I want to go out to eat because I'm not going out to eat. If I do have to go out, I order the house salad, dressing on the side, and a Diet Coke. No menu (or decision) required. My life becomes prescribed and circumscribed by the anorexia. It's a hellish existence, a very limited one, but then there's this: it's easier.

Author Barry Schwartz calls it The Paradox of Choice. If you haven't read his book, definitely go do so. I think it goes a long way to explain some facets of ED thinking.

Besides being fatiguing, decisions are usually anxiety provoking. Most decisions actually result in minimal anxiety. After all, wearing the wrong pair of socks can make your feet sweat or make your shoes look funny, but this rarely results in lasting harm. The problem with decisions--the reason I think they provoke anxiety--is that they're a turning point. Once you've chosen a car, it's hard to un-choose that. Ditto for the socks, once you've left the house if you're not carrying a spare pair.

An eating disorder is the ultimate un-decision. You avoid everything. Sure, it saves you the anxiety over actually making a decision, but it also costs you a lot, too. Recovery means learning to face the decision anxiety and accepting it as part of normal life. I'm guessing lots of us retain our mental shortcuts and rituals that help us avoid anxiety (and decision making), but our brains take on lots more.

Have you developed strategies to deal with decision fatigue? Do you find yourself falling into similar traps? Share in the comments!

*At least, no real conscious decisions.

Sole Sisters

2011-08-19T00:05:00.000-04:00

One of my good friends was recently diagnosed with breast cancer and is now undergoing chemo. I'm not exactly sure how the whole "shoe" theme got started (I think she and another one of her friends had an identical pair of loafers that they both wore the first day of chemo), but it's taken off. We all wear our loafers on her chemo day to show our solidarity.

I don't know if ballet flats count as a proper pair of loafers, but they're the closest thing I've got. I also don't think this is an actual chemo day, but I didn't get around to taking the damn picture until now.

With that said:

I love you, Charlotte.

Rethinking "extras"

2011-08-17T10:55:00.000-04:00

When I went on vacation last week, I knew there was a lot of activities I would want to do. I spoke with my therapist about being more active than usual, which she said was fine, as long as I ate more to compensate. So I ate a bit off the meal plan, and all worked out well.

We've discussed this in the past, the idea of eating "extra." That is, eating outside of scheduled snacks and meals, or eating more food than "required" at those times. Not surprisingly, this freaks me out. I've never been a rule-breaker. The very idea terrifies me. Part of it is the sense that the rules are the rules, and you don't break the rules. If I do think a rule is silly, I often am too anxious to go outside the prescribed letter of the law anyway. I rely on rules (many of them self-imposed, but rules nonetheless) to help me cope with anxiety. Breaking a rule is anxiety-provoking in and of itself. Breaking an ED rule is even more so.

But my therapist raised a really good point.

It's not "extra" if you're hungry or you've been more active. That food is necessary.

I've often complained to her about how horrible I feel when I eat food that isn't on my meal plan*. And almost every time, my therapist said that my weight stayed the same and so my body needed every calorie. This meant that those "extras" weren't extra at all--they were more like little "necessaries."

Oh.

An extra is eating some dessert because it looks good, even though you've just had dinner and aren't all that hungry. It's finishing all of your favorite entree at your favorite restaurant because you love it, even though you started feeling full near the end. That sort of thing. Eating in response to hunger is never "extra," even though the food may not appear on any piece of paper.

The obvious solution would be a new rule to "eat when hungry." Except implementing this rule means changing the old rule of "eat what's on the plan," which means facing the anxiety of rule-breaking AND change, neither of which I do well at. I also mistrust hunger signals and never quite know (unless I'm ready to gnaw on my neighbor's arm) if I'm really hungry or just think I am or if what I think might be hunger means I should eat something or get something to drink or just suck it up.

Quite a quandry.

*I'm guessing right now that I'm going to get comments saying I should ditch the meal plan. The problem is that I would likely undereat without the guidelines. My instincts on what I "need" to eat aren't the greatest. A meal plan can be a double-edged sword, but I think the positives outweigh the negatives at this point.

Sunday Smörgåsbord

2011-08-14T23:58:00.006-04:00

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

{{It's a little shorter than usual this week--a combination of not as much news/research published and the fact that I was on vacation. My apologies.}}

NIMH defines mental illness as a "disruption in neural circuits." I doubt this definition will be the be all, end all of what we know of mental illness, but it's a start.

Overvaluation of shape and weight among overweight children and adolescents with loss of control eating.

Getting Back On The Wagon: Success, Failure And The Cycle Of Change. I'm not a huge fan of the "stages of change" model for EDs, but I do think it's important to remember that relapse doesn't mean starting over.

An Investigation of Goodman's Addictive Disorder Criteria in Eating Disorders.

Listen again to BBC Cornwall's recent phone-in on eating disorders, with expert input from a local psychiatrist. BBC Audio is limited to folks in the UK, however.

The new link between gut-brain axis and neuropsychiatric disorders.

Confusing Medical Ailments With Mental Illness.

Retrospective Maternal Report of Early Eating Behaviours in Anorexia Nervosa.

Is obesity really contagious?

Poor Decision Making in Male Patients with Anorexia Nervosa.

Internalizing and Externalizing Behaviour Problems in Childhood Contribute to the Development of Anorexia and Bulimia Nervosa-A Study Comparing Sister Pairs.

American Indian/Native American women have higher levels of disordered eating than white women, according to a new survey.

Jess Weiner (a nationally known body image advocate) does a 180 and writes a piece called "How Loving My Body Almost Killed Me". It should also be noted that she's launching a Conscious Weight Wellness^TM (yep, already trademarked) speaking gig, announced the day after the article, only reinforcing the idea that weight loss sells (honestly, I do believe the marketing idea came after her desire to lose weight BUT still). Also, pre-pre-diabetes didn't "almost kill you." Just sayin'. Sorry- I'm a cynic.

Back from vacation

2011-08-14T01:40:00.000-04:00

This past week, I was on a short vacation. It was nice to have a break from the daily grind, and it also explains why posting was so light recently.

Overall, the trip went really well, I think. I was probably more active than usual, and I tried to respond by being more flexible about what I ate and not freaking out at ordering higher-calorie items in restaurants. No, it wasn't perfect, but I was much more relaxed on this trip than previous ones.

It's late and I'm tired, so I'll provide a more detailed feedback later.

Average vs. Normal

2011-08-11T01:42:00.000-04:00

I was talking with my therapist the other day about the difference between "average" and "normal." On a mathematical level, the two words are intimiately linked. On an etymological level--or at least the way many people with EDs think of or use the words--they have slightly different implications. I want to become more "normal" with respect to eating and exercise habits,* but I was also afraid that lessening my perfectionism would make me merely "average."

I'll be honest: I don't like being called "average." It makes me squirm a bit. Much of it is my own rather demanding personality--if I'm average at something that means people are doing better than me. I took plenty of statistics classes in grad school. I know that the very way "average" is defined mathematically means that most of us are average at most things. In some areas, it doesn't bother me to think of myself as average. I know I'm an average driver. I would be flattered to be thought of as average as drawing (I have a problem with depth perception that makes things look wonky) or, for that matter, most sports.

I don't hate to be called average because of some deep-seated need to be special. It's that my deepest fear is that I will be a failure. I'm also a perfectionist. That means I have always equated average with failure. To be average means I have failed. If I don't have a large piece of who I am staked on that factor, like driving or drawing, I can dismiss it without much of a twinge. But in those areas in which I've invested a lot of time, effort, and money, it becomes a lot harder to just accept average.

It's a perfectionism and self-esteem thing, I think. I need outside feedback because it's hard for me to judge if I've done a good job or if I'm good enough unless someone specifically tells me. It's never happened internally. If I'm average, I don't really get meaningful feedback, so I seek to excel. It does away with the anxiety of not being able to judge myself and my performance.

For some reason, normal doesn't have the same connotation. It means (to me, anyway) sort of a shortcut for as expected. My bloodwork is normal. My weight is normal. That sort of thing. It has more of a positive spin than average, which in the US is code for "meh" at best.

The moral of the story really isn't to delve into my strange, dark fears (though I'm aware that fear of failure is very common. Shall we say "normal"?) and admittedly rather messed up way of thinking, just that switching words around can make a daunting task (ie, recovery) seem a little easier to tolerate.

*Yes, most people in our culture are pretty messed up around food. I guess I mean normalized eating rather than "normal" in the sense of that's-what-everyone-else-is-doing normal.

**I know, I know. Normal is just a setting on a washing machine. There is no one "normal" weight or way of eating or whatever. I guess normal is another way of saying "within reason" or "in a way that isn't harmful to your health."

Sunday Smörgåsbord

2011-08-07T22:02:00.000-04:00

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.

UCLA Study Seeking Individuals with Anorexia.

Evidence suggests that body satisfaction is inversely related to BMI increase.

Fertility and prenatal attitudes towards pregnancy in women with eating disorders.

Disordered Weight Control Behaviors in Teens: An Under-Recognized Factor in Child Obesity Epidemic.

An investigation into the relationship between eating disorder psychopathology and autistic symptomatology in a non-clinical sample.

Dieting starves your brain cells, turning neurons into self-cannibals, which cranks up hunger signals.

Emotional expression, self-silencing, and distress tolerance in anorexia nervosa and chronic fatigue syndrome.

Top 10 Cracks That Crack (and Other) Addicts Fall Through on Their Way to Recovery. I think a lot of these suggestions are useful for ED recovery, too.

Women with bulimia show difficulties with impulse control and emotion processing in fMRI scans when faced with food.

Gross AND hazardous: Why do a colon cleanse?

Another article proving that weight loss surgery is not for everyone.

Psychosocial determinants and family background in anorexia nervosa-results from the Stockholm birth cohort study.

Position of the american dietetic association: nutrition intervention in the treatment of eating disorders.

Leptin Levels Are Associated With Decreased Depressive Symptoms in Women Across the Weight Spectrum, Independent of Body Fat.

How I got an eating disorder at 62. A wonderful, balanced, accurate article on EDs in older women from a woman who is living it.

Intuitive sleeping?

2011-08-05T23:10:00.000-04:00

I've never been a good sleeper. Even when I was younger, it always took me well over an hour to fall asleep--pretty unusual for an 8-year-old. But my brain just doesn't shut off. Even if I'm not worrying per se, I can't stop thinking.

As I've gotten older, my circadian clock has shifted to be ever later. I can fall asleep fairly easily as long as I don't head to bed until at least 2am. A lot of times, later. I've tried forcing myself to wake up early in the morning in the hopes that then I'll want to fall asleep earlier.

Nope. Didn't work.

Just as I haven't yet mastered the art of intuitive eating, I apparently having mastered intuitive sleeping. It seems obvious that you would fall asleep more easily if you're really tired. You would think, right? Not always, though.

I don't think that being an extreme night owl is wrong or bad, but it's not always convenient when you're trying to keep regular work hours. I had hoped by having a little less sleep for a few days that I would get tired earlier. Except I didn't. If I just stayed up until I really felt like going to sleep, I'd be up until the middle of the night.

Which has ultimately led me to the conclusion that I need more structure to my sleep schedule. On the one hand, going to bed earlier means that I will probably be tossing and turning for many hours. On the other hand, if I don't start going to bed earlier, then I'm never going to actually start getting to sleep earlier. I just get so insanely frustrated when I'm utterly exhausted, but my eyes won't stay shut.* Sleep meds just don't work for me, either. If they do help me sleep, they turn me into a total zombie the entire next day, which sort of defeats the point of taking them.

Right now, I'm just hoping that more concerted efforts to sleep right will help. Otherwise, I'm getting seriously frustrated.

*Sometimes, I have difficulty sleeping because I'm still hungry, but even when I get something extra, I still can't sleep.

Nose job lessons

2011-08-03T23:54:00.000-04:00

I don't know if you've seen the headlines (the story has been making the rounds in the psychology circles for the past day or two), but a study just came out that looked at the relationship between body dysmorphic disorder and nose jobs. The study found that one-third of people who wanted a nose job for cosmetic reasons had moderate to severe symptoms of BDD. Of those who wanted a nose job for medical reasons (to improve breathing, etc), 2% had been diagnosed with BDD.

Except that's not how the study was reported. Instead, headlines like "Nose job patients often mentally ill, study says." An excerpt from this piece below:

Of patients who were seeking the procedure to correct a breathing problem, only about 2 percent showed symptoms of BDD. But of those who wanted a nose job for cosmetic reasons, 43 percent showed symtoms of the disorder.

BDD was especially common among people with a history of mental illness, as well as those who had already had a nose job and were seeking “revision” surgery.

The problem, as John Grohol pointed out on the World of Psychology blog, is that "symptoms of BDD" aren't the same as being diagnosed with BDD. It's a subtle difference in words, yes. But it's a major difference in what we're actually talking about.

I had symptoms of the flu several winters ago. High fever, muscle aches, chills, feeling utterly crap, all with a sudden onset. Classic flu symptoms. Except a flu test revealed that whatever I had wasn't the flu. It looked a lot like the flu, it had the same symptoms as the flu, but it wasn't caused by the influenza virus.

Someone can have symptoms of depression (low mood, feeling hopeless), but not actually have clinical depression. Same with BDD. Same with EDs, too. The scales and questionnaires used in research aren't diagnostic tools. They can give you an idea whether you should see an actual living, breathing professional for evaluation and a potential diagnosis, but they don't say whether you actually have the condition.

It's not the public's job to know this. I'm not saying scientists shouldn't use these measures simply because they are so frequently misinterpreted by laypeople and journalists alike. But I am saying that journalists and editors need to know the difference. It's responsible reporting.

It happens with eating disorder stories all the time. Most commonly, it happens when people conflate disordered eating with eating disorders, or the scores on a survey with an actual diagnosis. The problem is that most people don't know there's a difference between these two things, or that the difference really matters.

Of course we would expect that people seeking nose jobs have higher concern and focus on their appearance. They are, after all, dropping thousands of dollars in an attempt to, you know, look better. But focus on your appearance isn't the same as BDD, and it's offensive to those who are suffering to make the two things equivocal. It's like saying someone who is obsessed with their weight has an eating disorder. They're not the same. At all.

We need to start distinguishing between these two things so that we stop trivializing deadly mental illnesses as little more than cultural fads.

The New Normal

2011-08-02T23:29:00.030-04:00

In the book I was reading the other day (that I blogged about here), there was another quote from a cancer patient about how she coped with all of her treatments.

She said that cancer had become "her new normal."

I related a lot to that. Recovery has to become my new normal. For so long, the eating disorder was "normal." Even if I could see that my behaviors were bizarre (eating cottage cheese, curd by curd, with a fork), they were normal to me. The hours of exercise? They were just what I did. And it's hard to know exactly how crappy you feel when you don't have anything to compare it to--at least, not that you remember. The eating disorder is crazy-making, it's bizarre, but it was also completely and utterly normal.

Much of the work I'm doing now is making recovery my new normal. Breaking those old ED habits and making recovery stuff seem the normal, natural thing to do.

It's hard, when you look at recovery every from a practical standpoint. The endless appointments: signing in, sitting in offices, reading ancient issues of Time Magazine. Then there are the other food issues, like eating five or six times a day, grocery shopping, meal planning, cooking. There's also finding ways to fill your time that you used to spend exercising (or binge eating and purging).

You start to look normal, and maybe even start to act somewhat normal. Not that this is bad, but it doesn't mean that your ED is gone. It doesn't mean that the ED is gone or even feels like a piece of history. The ED feels normal and "standard" for a long time, even after the behaviors are long gone. It's much easier for the brain to "learn" ED behaviors than unlearn them. Fear is a strong learning mechanism, and it helps the ED stuff become engrained in our brains. Recovery behaviors don't have that strong fear driving them, and so it takes much, much longer for them to become as solid as the ED was.

Over time, recovery is starting to become my new normal. Not that I don't reserve the right to piss and moan about cooking and food prep, or about the anxiety about not having my food rituals. Part of what makes recovery get easier is that you simply get used to it. The hard part is getting used to it, but the good thing about the brain is that it can get used to anything. It adjusted to ED and it will adjust to recovery.

Sunday Smörgåsbord

2011-08-01T00:07:00.000-04:00

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.

My dear friend Charlotte and her daughter Georgie are featured in this Telegraph (UK) article (it's the only part of it worth reading, between the photos and the comments, yikes).

Genetics Complicate Recovery from Eating Disorders.

Should I Ask About Eating? Patients' Disclosure of Eating Disorder Symptoms and Help-seeking Behaviour.

Leaving the sport, gaining an eating disorder.

Components of Shame and Eating Disturbance Among Clinical and Non-clinical Populations.

Two Friends Help Others With Eating Disorders.

Differential Neural Responses to Food Images in Women with Bulimia versus Anorexia Nervosa.

Woman's death a wake-up call for Nevadans. It would be nice if media stories could get beyond the idea that eating disorders are more than a way to manipulate body weight, though. They're not really helping the major argument of the piece that EDs are real illnesses whose treatment needs to be covered by insurance. Sigh.

Factors Associated with Emotional Well-being in Primary and Secondary Caregivers of Patients with Eating Disorders.

Genes play key role in making people susceptible to eating disorders.

Physical appearance as a measure of social ranking: The role of a new scale to understand the relationship between weight and dieting.

Why Comfort Foods Are So Comforting.

Motivation-focused Treatment for Eating Disorders: A Sequential Trial of Enhanced Cognitive Behaviour Therapy with and without Preceding Motivation-Focused Therapy.

Is The Idea Of Health At Every Size Just Permission To Be Fat?

Disgust Sensitivity and Anorexia Nervosa.

Does Rehab Work as a Treatment for Alcoholism and Other Addictions? You could write similar things about ED treatment, too.

Serum amylase in bulimia nervosa and purging disorder: Differentiating the association with binge eating versus purging behavior.

Social Programs to Reduce Stress May Also Lower Obesity.

Avoiding the truth

2011-07-30T00:55:00.000-04:00

Alongside the truism that knowledge is power lives the fact that ignorance is bliss. Especially when it comes to knowing the truth about ourselves.

I ran across a blog post that discussed why people avoid the truth about themselves. A recent study in the Review of General Psychology identified three main reasons (as distilled by the PsyBlog folks):

It may demand a change in beliefs. Loads of evidence suggests people tend to seek information that confirms their beliefs rather than disproves them.
It may require us to take undesired actions. Telling the doctor about those weird symptoms means you might have to undergo painful testing. Sometimes it seems like it's better not to know.
It may cause unpleasant emotions.

I think this phenomenon really captures why it's so hard to begin recovery. You have to face the truth that you're sick, that you don't control your eating disorder, and that you're going to have to begin the very unpleasant process of actually stopping behaviors. It's a monumental task.

Recovery means accepting some very unpleasant truths, and it's not something I always feel up to. The problem is that ignoring the truth doesn't make it any less true.

Humans have a particular blind spot for identifying their own foibles. Remember, though, that it's our own cars that have blind spots, and not anyone else's. We can avoid the truth by creating our own alternate universe. Most of the time, the differences are really subtle. We're not that late, at least, not very much, or at least not when it's really important. Doesn't everyone have odd eating habits? There are plenty of people who weigh less than me that are doing just fine. But as the ED progresses, the alternate universe begins to look more and more like the Twilight Zone. Everyone else can eat this food without gaining weight, but I can't. Chap Stick might have calories, so I can't use it. I can't stop exercising or I'll gain 20 pounds.

If we really stopped to ask ourselves about how normal our routines really were and what would happen if they suddenly changed, we would have to face the truth that our eating disorder was far more problematic than we would like to believe. Add in a healthy dose of anosognosia (a literal inability to understand that we're ill), and our brains can spin a web of lies and half-truths for years.

Recovery means admitting that we've been living a lie. It means facing those fears of food and dissolving those routines and rituals that have kept our sanity intact. It means entering a world of the unknown.

It's much easier to just avoid the truth, put our heads in the sand like ostriches and just ignore everything.

The truth catches up to us, eventually. It dogs our steps. It scares us senseless.

Here's the thing that truth doesn't tell you: facing it head-on and chin up isn't as scary as we think it will be. It's unpleasant, but stripping the lies from our lives (the lies we tell others, yes, but also those lies we tell ourselves) gives us a chance to face life on its own terms. It shows us that we are much stronger than we think we are.

Time-lapse recovery

2011-07-27T23:55:00.000-04:00

I wish I had one of these videos for my recovery:

You know, being able to speed up time and watch things unfold, rather than just waiting around for infinitesimal changes that no one notices, not even yourself? Changes are easier to see when you're watching someone's recovery, especially from farther away and with lots of time in between measurements. But living recovery--watching it up close and personal, day in and day out--means that it rarely feels like things are changing, even if they are. Hence the desire for the time-lapse video.

I guess the good thing is that an oak tree doesn't have the awareness to navel gaze and wonder why the hell it takes so long to get from an acorn to a giant of the forest (or a suburban front lawn).

Wisdom from books

2011-07-27T00:44:00.001-04:00

When I had a few minutes in between things at the conference I was at this past weekend, I tried to fit some fun reading in. So I was reading a non-fiction book about cancer (I'm a dork, this is proof) that was really fascinating, and I came across a passage that really struck me.

First, a bit of background.

Cancer drugs typically kill a fixed percentage of cancer cells. To make the math easier, let's just make it 90%. If your initial tumor had 1000 cells in it (most tumors are much, much bigger, but again, the math is easier this way), after one chemo treatment, you would be left with 100 cells. Another round, 10 cells. Yet another round, 1 cell. Finally, a fourth round to obliterate that last bit of cancer. It takes the same amount of drug in each round.

Doctors use hormone markers to monitor treatment progress in some cancers. As the tumor shrinks, so does the amount of hormone in the blood. Back in the 1960s, scientists worked to reduce those hormone levels, but they never pushed to eliminate them entirely. Either they didn't think it was possible, or they didn't think it was that important. When one doctor did continue dosing his patient with toxic drugs to remove all traces of hormone, he was sacked from his job.

This brings me to the passage I want to quote:

But the story had a final plot twist. As Li had predicted, with several additional doses of methotrexate, the hormone level that he had so compulsively trailed did finally vanish to zero. His patients finished their additional cycles of chemotherapy. Then, slowly, a pattern began to emerge. While the patients who had stopped the drug early inevitably relapsed with cancer, the patients treated on Li's protocol remained free of disease--even months after the methotrexate had been stopped.

Li had stumbled on a deep and fundamental principle of onvology: cancer needed to be systematically treated long after every visible sign of it had vanished. The hcg level--the hormone secreted by choriocarcinoma--had turned out to be its real fingerprint, its marker. In the decades that followed, trial after trial would prove this principle. But in 1960, oncology was not yet ready for this proposal. Not until several years later did it strike the board that had fired Li so hastily that the patients he had treated with the prolonged maintenance strategy would never relapse. This strategy--which cost Min Chiu Li his job--resulted in the first chemotherapeutic cure of cancer in adults.

{emphasis mine}

I'm pretty sure most readers wouldn't have been struck by the parallels to eating disorders, but I was. Most people think that once all visible signs of the eating disorder are resolved (weight is normalized, binge eating and purging have stopped, etc) then you can stop treatment. The eating disorder is gone, right? You can't see it any longer. How can it be there?

But if the thoughts and urges are still there, if the fears and compulsions are still there, then the eating disorder is not gone. You have to keep chipping away until everything gets down to zero. That's how you get to full remission--not by stopping at "good enough" and "almost back to normal." True, it's not possible for all cancers, and it isn't yet possible for all eating disorders, nor can we say for certain that someone with an ED will never relapse, but that's no reason not to try.

Sunday Smörgåsbord

2011-07-24T22:57:00.000-04:00

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.

Binge eating to officially be declared a mental disorder.

From Seattle: Family-based treatment helps teen with eating disorder.

Effects of analytical and experiential self-focus on stress-induced cognitive reactivity in eating disorder psychopathology.

Addictive Personality? You Might be a Leader.

Dr. Lucene Wisniewski on Eating Disorders.

Don't assume guilt for your child's anorexia.

Predicting how much impact mental illness has in a person's life.

Association of Candidate Genes with Phenotypic Traits Relevant to Anorexia Nervosa.

Extraordinary microscopic food photographs.

ED recovery improves family climate, says new study.

Nick Watts of Men Get Eating Disorders Too writes for Mentally Healthy Magazine on the rise of EDs in men.

Finding independence from your eating disorder.

The 2 to 4 digit ratio (2D:4D) and eating disorder diagnosis in women.

ED behaviors can be harmful but not always obvious to others.

The clinical utility of personality subtypes in patients with anorexia nervosa.

Missing Gene Helps Mice Run for Hours.

Identifying eating disorders and compulsive exercise in pre-professional ballet dancers.

Dr. Daniel Le Grange on ED Research at the University of Chicago.

Sex differences precipitating anorexia nervosa in females: the estrogen paradox and a novel framework for targeting sex-specific neurocircuits and behavior.

Decreasing dietary restriction will help decrease bulimic behaviors.

Brief Update

2011-07-23T17:56:00.000-04:00

I only have a few minutes, so here are the highlights:

Yesterday, the maintenance guys at my place sliced through the cable line, so I got to spend all day yesterday without Internet, phone or TV. So I went to the library for a while (to get at least a little work done), where I also checked out some DVDs to watch, etc. I was far more lost without the Internet than the TV, although I did flip my set on once or twice totally forgetting that there was no reception. Oops...

But before I lost all connection to the "real world," someone found my profile on a science writer's website (I had honestly forgotten it was still up) for the DC area and was in desperate need of a freelancer or two to write up a conference summary newspaper thing for a medical conference in DC this weekend. It's only for conference-goers, so no, you won't be able to read it, nor would you want to. It paid well, and my financial situation hadn't turned around much since I told the universe it could go f*ck itself, so I took it. I'm finishing up today's work right now, and then I'll be spending another weekend at the Best Friend Hotel. Although I'll be working all day Sunday and Monday, then heading home late Monday night.

Tomorrow, I'm told I get to cover the sessions on obesity! *headdesk*

Now that the financial situation no longer totally sucks, my anxiety has eased somewhat, which helps. I'm still really tired, and I had hoped to take a long nap this weekend, but will just have to wait.

Anyway, I have to run.

Rose-colored ED goggles

2011-07-22T01:23:00.000-04:00

We've probably all done it: had some nasty side effects (or a health scare) due to ED behaviors and then vowed to do better next time. Except next time comes and we're still doing the same behaviors. Raise your hand if this sounds familiar. I know my hand is raised.

Of course, people with eating disorders aren't the only people to do things like this. We all do, it's just that people with addictive-esque behaviors tend to do it more frequently. The question is why: if we know an ED behavior will make us feel like crap, why do we keep doing it?

The answer is simple. We don't remember the bad bits (the ER visits, the being too weak to drag ourselves off the couch), we remember the good stuff (how good it felt to see the numbers on the scale going down, the endorphin highs).

Researchers studied a group of college-aged binge drinkers to figure out exactly why they continued to binge drink even when they regularly blacked out and wound up with a nasty hangover. From a news story on the study:

The college students rated the upsides to drinking as more positive, and more likely to happen in the future. And the researchers call this positive outlook "rose-colored beer goggles."

"It's as though they think that the good effects of drinking keep getting better and more likely to happen again," Diane Logan, study author and a UW clinical psychology graduate student, said in the statement.

And by letting the good times roll, some of these students lose perspective on the bad times. The psychologists found those that experienced small to moderate negative consequences from drinking didn't consider the episodes so bad, and didn't think they were likely to experience them again. The authors call this effect cognitive-dissonance reasoning.

Like I said: sound familiar?

It's easy to romanticize the eating disorder in our heads. It wasn't that bad and damn if we didn't feel better. Certainly parts of my eating disorder felt better than recovery, but they were both small and fleeting. When I do the math--total up all the negatives and all the positives--it's much easier to see that the bad times were both a) actually quite bad and b) lasted a lot longer than the good times.

I think I forget this. The other factor that accelerates my anorexia amnesia is that the anxiety relief from ED behaviors is immediate. The nasty bits, the health issues and general life destruction, often take a lot longer to kick in. So our brains immediately remember that ED=feel better while forgetting that ED=feel worse, too.

Said one of the study's authors:

The authors hope their findings will influence alcohol counseling programs at universities. "We should take into account how people don't think of negative consequences as all that bad or likely to happen again," Logan said.

It's a lesson I think the ED community could use, too. A lot of sufferers (and I include myself in this) hope that by sharing all the nasty bits of the illness, we can prevent others from going down the same path. After all, how many times have I said that if I only knew how damaging the ED was going to be, I never would have started down this path. Except that I probably would have told myself that I wasn't stupid enough to let it get "that bad." And I'm guessing those who knew a lot about eating disorders were the same way.

Taking off the rose-colored glasses hurts. It's not pleasant. Or easy. But it is necessary.

More birthday thoughts

2011-07-19T23:26:00.010-04:00

It was interesting: on my birthday, I saw a sign about ordering alcohol. It said "You must be born on or before this day in 1990 to order alcohol." I laughed at first--I've now officially been legal for a decade. That got me thinking to my 21st birthday, which is when I stopped cold.

I spent my 21st birthday in the hospital, my first stay for anorexia. I had been admitted the day before. I remember trying to talk my psychiatrist into letting me have a can of Diet Coke as a special treat. He said yes, but the message didn't make it through to the nurses who said no. I pitched a fit and ran to my room, crying.

It's been ten years since then. I've wavered from not thinking I had a problem, to thinking I would kick this thing in a snap. Now, it makes me tremendously sad to think how much of a daily struggle it still is. I have good days, yes, but a lot of days are just a grim slog. I never thought my life would get so consumed for so long by this thing we call anorexia.

In many ways, that day in the hospital feels like just yesterday. In other ways, it feels like a million years ago. Again, I waver from thinking what's the point of recovery after trying for so many years, and thinking that surely now I'll kick this. I guess part of me keeps hoping that eventually I'll get so sick of my eating disorder that it will just magically cure all of the fears and behaviors. It's a nice thought, except it doesn't really work that way.

Mostly, I'm just tired. Tired of having to fight all the time. I want to be able to stop thinking about eating disorders and recovery, just for a few days. I want to walk around in public without wanting to run and hide because of how disgusting and huge I feel. I want to order off a menu without internally freaking out. I want to stop feeling so torn about, well, everything.

I had hoped time would start to heal things, and it hasn't. People tell me "This too shall pass." Except there's no signs of this passing and it's been over a decade. And I'm starting to get really frustrated.

I probably shouldn't write blog posts when I'm literally exhausted--it makes everything feel so overwhelming.

Sunday Smörgåsbord

2011-07-17T23:37:00.000-04:00

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.

Perception of emotion and bilateral advantage in women with eating disorders, their healthy sisters, and nonrelated healthy controls.

Rise in male eating disorders tip of iceberg says BEAT.

Predictors of Treatment Acceptance and of Participation in a Randomized Controlled Trial Among Women with Anorexia Nervosa.

Too perfect? Clinical perfectionism in an achievement-oriented society. Audio interview--I haven't finished listening to the entire interview, but it sounds interesting!

How fear perpetuates low food intake in anorexia nervosa.

Ipecac syrup to be behind the counter to reduce abuse.

Dimensions of depression in people with eating disorders.

Bulimia Seems to Weaken Brain's Reward Circuitry.

Development and validation of the Detail and Flexibility Questionnaire (DFlex) in eating disorders.

Sugar substitutes don't fool brains. When task-exhausted, brain's pre-frontal cortex performs better after real sugar.

Predicting non-suicidal self-injury in women with bulimia nervosa.

What could salt and prozac possibly have in common?

The Impact of Bulimic Syndromes, Mood and Anxiety Disorders and Their Comorbidity on Psychosocial Impairment: What Drives Impairment in Comorbidity?

High Levels Of Regular Physical Activity May Be A Useful Intervention To Prevent Panic And Related Disorders. I think this study also shows how exercise dependence functions in many people with eating disorders: previous studies have shown higher levels of anxiety and obsessionality in people with exercise dependence.

Rating of Eating Disorder Severity Interview for Children: Psychometric Properties and Comparison with EDI-2 Symptom Index..

Genetic Association of Recovery from Eating Disorders: The Role of GABA Receptor SNPs.

Gut feelings: the emerging biology of gut-brain communication.

Smoking for weight control and its associations with eating disorder symptomatology.

College students' definitions of an eating "binge" differ as a function of gender and binge eating disorder status.

The role of perfectionism, dichotomous thinking, shape and weight overvaluation, and conditional goal setting in eating disorders.

All the 'Harry Potter' movies relived in a five minute emotional look back. (video)

Birthday thoughts

2011-07-16T23:07:00.000-04:00

I not only had birthday cake...

...I also had seconds!

Happy birthday to me!

Getting back to work

2011-07-14T15:35:00.000-04:00

I was sorting through some of the links I had bookmarked on my Twitter page this morning, trying to use the current lag in work to get some other stuff done. Like looking at random web pages I had one marked as "potentially useful."

Which is how I found this blog post from PsychCentral on creativity and work. The blogger quotes author Elizabeth Glibert:

Always, at the end of the day, the important thing is only and always that: Get back to work. This is a path for the courageous and the faithful. You must find another reason to work, other than the desire for success or recognition. It must come from another place.

It has a lot to do with writing and the creative life, yes. But it also has a lot to do with recovery.

Many of us start down the road to recovery (if not dragged there, kicking and screaming) mostly because we want to feel better. The ED is making us miserable. This isn't to say we're especially keen to stop ED behaviors--an eating disorder does have an adaptive function, after all--but we generally get sick and tired of being sick and tired.

Which makes for a rude awakening when we realize just how miserable recovery is. It's why many of us find we need the support of a hospital, treatment center, and family/friends. Recovery is making us even more miserable than the ED (as if that were even possible!), so clearly our goal of feeling better was misguided. So we piss and moan, something I'm rather expert at.

Get back to work.

I love writing, yes, but the process isn't always pleasant. I regularly sit down in front of my computer feeling like my brains have turned to spaghetti and I have totally forgotten how to put a simple sentence together. The only solution is to start writing. Get back to work.

Nor does recovery always seem intuitive or natural or even always more pleasant than the eating disorder. I've fantasized about "taking a break" from recovery or trying to get people to understand just how hard recovery is. But easy isn't the point, nor is other's recognition. The hard work of recovery doesn't stop with a pat on the back or even a trip and fall.

At the end of the day, there's only one thing left for us to do: get back to work.

Dear Universe, kindly go f*ck yourself. Love, Carrie.

2011-07-12T23:19:00.002-04:00

I think my feelings about recovery are echoed in my feelings about life right now. I feel almost like I'm banging my head against the wall. I'm frustrated because I feel I'm throwing all my effort in and nothing seems to be happening.

This month has been way off the mark, financially. As in: I have yet to earn a single cent since July 1.

Yikes.

I've been doing everything a good freelance writer should do, but still, no nibbles. Just rejection emails that keep piling up. If they were letters instead of emails, they would be a fire hazard by now.

And so it goes with recovery. I'm doing everything I'm supposed to--every last meal, snack, and hated glass of juice--and yet all I feel is foul, disgusting, and frumpy. And, oh yes, that other "f" word: fat.

There have been other things going on in my life that aren't helping, but those won't be mentioned for privacy reasons. I've found out that more friends than I can count are pregnant or getting married or doing something else significant with their lives. And I'm bitching about Ensure.

I know a lot of this is my insecurities writ large: that everyone is going to see the nasty, awful person I really am, that I'm going to be a failure, that I'm going to be alone. Those kinds of insecurities. And they're all hitting at once. I'm frustrated that I'm not "over" my eating disorder. Part of me (okay, most of me) wants to go running back right now because then at least I wouldn't care so much. There would be less food and more exercise and everything would just be okay.

Rationally, I know that's a load. The ED might make everything feel okay or seem okay, but it doesn't actually fix anything. It does seem to take the edge off, though. At least then I could slash my grocery budget, right?

::eye roll::

The most frustrating bit is that I'm doing everything--everything!--I can and it's just not enough. Everyone loves to repeat the platitude, "Just do your best." But what if "the best" just doesn't pay the bills? What if "the best" still leaves you miserable, only now, you're fat and miserable. What then? Does anyone have advice for those days? When nothing you do seems to make any difference?

I feel like I should just delete this whole post. That it doesn't belong on a recovery blog. That I'm supposed to have a positive spin on things. You know, like "I guess I'm just going to lift my chin and try again tomorrow." What I want to do tomorrow is hide under the covers. And maybe throw something breakable. Yeah, that sounds more like it.

Sunday Smörgåsbord

2011-07-10T23:02:00.005-04:00

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.

50% of eating disorder carers (usually parents) exhibit clinically significant anxiety and/or depression.

Why does exercise make us feel happy and calm? (And why it can become addictive).

'It's like there are two people in my head': A phenomenological exploration of anorexia nervosa and its relationship to the self.

Why Our Ideal Self Seems Further Away For Us Than Others.

Is childhood OCD a risk factor for eating disorders later in life? A longitudinal study.

Kids' weight report cards don't make a difference.

Family work in anorexia nervosa: A qualitative study of carers' experiences of two methods of family intervention.

Meeting Marya: Letting go of eating disorder paraphernalia.

Immediate cognitive effects of repetitive Transcranial Magnetic Stimulation in eating disorders: A pilot study.

Rethinking Addiction’s Roots, and Its Treatment.

Perfectionism as a mediator between perceived criticism and eating disorders.

Sneaky Signs of Teen Eating Disorders.

How do eating disorder patients eat after treatment? Dietary habits and eating behaviour three years after entering treatment.

Being thin doesn't always mean you're healthy. The correlate is also true: being fat doesn't always mean you're unhealthy.

Cognitive interpersonal maintenance model of eating disorders: intervention for carers.

Eating disorders in different cultures.

People with eating disorders likely to die earlier.

Digital Domain: The Therapist Will See You Now, via the Web.

Eating Disorders Often 'Overlooked' in Elite Athletes.

Looking for interview subjects!

2011-07-09T22:10:00.000-04:00

Hi everyone!

I need to ask for your help. I'm currently working on a book called Decoding Anorexia: How Science Brings Hope to Eating Disorders, and I've finished most of the research, and I've moved on to starting to collect interviews from people.

What I think is one of the best parts of the book is that I want to blend scientific expertise from researchers, clinical experience from clinicians, and wisdom from sufferers and loved ones. As part of that, I need to talk to you, my readers.

I have a tentative list of people who I'd like to talk to about the following topics:

someone who has been diagnosed with anorexia but lives in a non-Western culture (or a culture without the extreme pressures to be thin)
someone who can talk about how learning about ED science has been helpful in their recovery
a parent/child who have both had anorexia. I'd like to find a duo in which both people are willing to be interviewed, but I'm also interested in talking to single members where this is the case.
someone who has experienced exercise addictions/compulsions as part of their ED
someone who has been diagnosed with anorexia that then morphed into bulimia/BED
someone who can talk about relapse and what they've learned
someone who with a history of anorexia who is worried about passing anorexia on to their children

Several caveats:

I may or may not be able to interview everyone who volunteers. It has nothing to do with you, and may simply have to be a writer's decision on my part.
Just because you are interviewed doesn't guarantee your story will be used. Again, that's part of the nature of writing.
If you are under 18, I will need to get permission from a parent or guardian. It's a legal issue.
If you have any questions about the interview process and how the material might be used, please email me and we can discuss this further.

Now that you've read all of the fine print, if you're interested in contributing, please email me at carrie@edbites.com so we can discuss things further and try and set up some interviews. This probably isn't a complete list of everyone who I will want to interview, but it's hard to tell until I start writing more. I look forward to hearing from you!

Please feel free to share this on Twitter, Facebook, blogs, etc. I really appreciate it!

Why ask why

2011-07-08T22:11:00.000-04:00

It's a question I've asked and been asked many times: why did I develop anorexia? Of course, I wanted to know because of my own natural curiosity; I also wanted to know because I thought it was my key to recovery.

The idea was predicated on a simple assumption: if I could understand why I was starving myself, then I could stop.

The problem is that this assumption isn't correct. After all, we know why the pancreas stops producing insulin in Type 1 diabetes, but that knowledge doesn't magically jump start insulin production. Even from a behavioral perspective, understanding our motivations doesn't always mean we can just change. Most smokers know that lighting up isn't healthy, but this knowledge doesn't necessarily mean they'll quit.
Today's Fxck Feelings blog had some similar advice, to a girl who liked to date men already in relationships:

As such, asking why you’re attracted to pre-attached guys is about as dangerous as asking why you love Martinis; it allows you to study and indulge your predilection until you find an answer that will make it easy to stop, which won’t happen, and in the meantime, all your research is just fodder for rehab.

Accept the fact that the answer will never come or, if it does, it will change nothing, and it will never be easy to stop.

This comment answers the question of why so many of us get trapped in the never-ending quest for "why." Simply put, the search for why doesn't require us to stop the problematic behavior. After all, we can't stop (according to the theory) because we haven't answered the "why." So there's no point in trying. Yet we get to tell worried friends and family that we're in therapy, that we're "working on it." Meanwhile, we don't have to challenge these behaviors.

I'm not saying that we shouldn't ask questions, just that "why" might not be the most useful. I think better questions to ask might be:

When am I most vulnerable to using behaviors?
How can I get better? How can I stay better?
What are warning signs of illness returning?
What are the benefits I get from the ED?
How can my friends and family provide support?

I don't think understanding the why behind an illness hurts. After all, understanding that my eating disorder is triggered by not eating properly helps me make serious efforts to actually eat properly. My problem with asking why is expecting that the answer will automatically lead to significant behavior change. It's a nice theory, but I think it's an overly optimistic view of how the brain works.

It also makes the assumption that people with eating disorders are able to see their behavior rationally--and that's often not the case. Nor are ED behaviors choices. They're much more like compulsions. When I have OCD compulsions, I don't give a damn about why I'm doing what I'm doing. I can even understand it. But in the moment, all I want to do is feel better. Eating more and gaining weight freaked me out. The why didn't matter. My brain never even got to that point.

We don't need to understand exactly why we're doing something in order to stop doing it. Understanding why might be a nice bonus, but it's not necessary. Maybe my next question is: why do so many people insist on asking us why?

Upside down time

2011-07-06T23:40:00.000-04:00

I was watching a Bones rerun the other day, and there was an interesting dialogue between the main character, Temperance Brennan (aka "Bones"), and one of the night guards where she works. I tried to find the exact diaglogue, but it didn't seem to be online, so I'm going to have to summarize here:

The guard told Bones about a study in which a group of men wore special glasses that made the world appear that it was upside down. After three days, the world was right-side up again. When the men took their glasses off, the world once again appeared upside down. Again after three days, their brains caught up and the world appeared as it should have.

It reminded me a lot of recovery.

I got so used to seeing the world with the ED filter on. Food was bad, scary, and needed to be avoided. I isolated myself from others. I lied and cheated. How I saw the world depended on my eating disorder. If I got upset, the ED calmed me. It was a pretty dysfunctional system to be sure, but I eventually got used to it.

When I started recovery, the glasses were uncerimoniously yanked off. The world just felt "wrong." Without the ED buffer, I was terrified of everything. I couldn't get over how bizarre it felt to actually sit down to a meal. To eat in a restaurant. To order something off a menu besides a garden salad with no dressing. When things went pear-shaped and the eating disorder was gone, I had no idea what to do.

My world was upside down.

The problem is that the world can stay upside down for a really long time, even longer than you or I might think it "should." Nor is there always anything we can necessarily do that will make life right itself any faster. Simply, it takes time for our brains to adjust. Not only does ED recovery mean that our brains have to renourish themselves, but we also have to lay down new pathways that atrophied during illness or never formed in the first place.

I wonder what the men in the study (if the study was even real or went down like it did in the dialogue) thought during those days after they took of their glasses. Did they wish for them back? Would putting the glasses on again have made the world look right-side up again? How would this affect the length of time for the mens' perceptions to normalize?

Our brains are wonderfully plastic. If you want to know exactly how plastic the brain is, read the book The Brain That Changes Itself. But just as my brain learned to be afraid of food, it can unlearn that. Or at least, it can learn to challenge those fears even if an initial jolt remains. In the Bones study, the mens' brains eventually figured it out. Up is up. It took time, lots of time. I have no doubt plenty of them tripped and fell. Again, that's part of how we learn. Food isn't scary. It's necessary. It just is. Life doesn't need to be avoided. Keep the glasses off and the brain will learn.

Apologies...

2011-07-06T12:10:00.000-04:00

Hi everyone.

Sorry for the almost complete lack of posts over the past few days--my cousins were visiting from out of town, and by the time we got done for the day, I pretty much collapsed into bed. Blogging was pretty much the furthest thing from my mind at that point!

We had a really nice couple of days, and they left this morning. This means that I will be back to my normal blogging schedule this evening (assuming I can stay awake that long!).

I missed you all and hope you had a wonderful holiday weekend.