My best friend L is visiting me for the weekend.  She's never seen my new place and she needed a weekend away, so I invited her down.  We've had a nice time thus far--she got to meet J, and we went out for dinner at a local Indian restaurant.  She'll be here through tomorrow.

It's been really nice to get to spend time with her, and just relax and talk.  But having anyone come to visit, especially when coming off of more ED struggles, is tough.  It's not just the food thing as it is having to share my space with someone and having my usual routines disrupted.  I love having L here, so that's not the issue.  But all of a sudden, there's someone else in my space, and I have all of these little quirky habits that don't always mesh well with visitors.

My learning flexibility is a good thing. Yet it's still hard for me to adjust to new things.  {{Wait, someone with anorexia having trouble with change? That doesn't sound right...}}

I'm mostly used to doing my own thing on my own time. To being in charge of the TV remote.  It's not the easiest thing to adjust.  At the same time, it's something I know I need to do.  I get way too easily attached to my routines and rituals.  It's part of my personality.  That chair I sit in on the first day of class? That's the same chair I'll use for the rest of the year.  Most of the time, these habits are pretty harmless.  After all, exactly where I sit in class probably didn't have that much of an effect on my learning.  But the problem is that I get almost unspeakably anxious when I have to sit in a different chair.

Granted, I have plenty of habits, rituals, and compulsions that are harmful in and of themselves (hand-washing, cleaning, that whole eating disorder thing).  For the majority of my habits, though, it's the thought of changing them that causes all hell to break loose.  It's that I find them too meaningful and perhaps too helpful.  So when things get changed, I tend to find it difficult.

I'm actually doing okay food-wise today.  I've been eating what I need to, if not always at the exact right time.  That structure is probably what is saving me right now.  That and friends and good times and yarn.

One of my favorite blogs is F*ck Feelings, and last week, they addressed fear and anxiety. Although not fear per se, but rather our fear of fear and anxiety. Oh dear--I'm making this quite a bit complicated. I'll let "Dr. Lastname" from the blog introduce the subject for me:

Fear isn’t all bad (e.g., fearing snakes goes a long way towards keeping you from poison venom). On the other hand, fear itself is stressful and painful, so our first instinct is to avoid it, no matter what…which is, of course, when things start getting really frightening. No matter how much we want to protect ourselves or those we love, it’s not gonna happen, so we have to accept the unavoidable scariness of life (and anacondas). It won’t necessarily calm you down, but it will give you the strength to do what matters, fear or no.

Anxiety sucks. There's no getting around that. Anxiety is also pretty normal. It's when we organize our lives around avoiding or neutralizing that anxiety that it becomes really problematic. Of course, it's easier to say that when you're not anxious all the freaking time, but that's a bit of a different story.

I'm good at avoidance. Like really, really good. When I get really stressed, I turn ostrich-like and try to avoid whatever is freaking me out. If I'm anxious about making a phone call, I put it off. And off and off and then even further off. If I'm anxious about what I'm going to eat, I used to avoid eating, or eat only a few specific foods that provoked the least amount of anxiety. If I'm anxious about what might happen if I don't exercise, I just make sure I exercise. The more I avoid these things, the more fearful I become. It becomes more and more certain that something bad really will happen if I make that call, eat that food, or skip that workout.

From the time I was 13 or 14, my life has been dictated by anxiety, be it OCD-driven (mainly germ and contamination fears), about school/work, the eating disorder, or something else entirely. Through recovery from my eating disorder, my anxieties about food haven't gone away. They're still there. What I've learned in my recovery is how not to let my anxieties about food dictate my life. And the more I disregard the dictates of my eating disorder, the less important those dictates really seem.

True, the eating disordered fears still occupy way too much room in my skull. I still do a lot of things to avoid fears about eating more than what my meal plan ways, or exercise less than the maximum I'm allowed, or eat something that isn't the lowest-calorie version. Some of the reason I haven't challenged these is that they really haven't gotten in the way of most of the things I want to do. The other reason is that, well, I'm scared. I know the anxiety won't actually hurt me, but I don't relish the idea of provoking the anxiety demon. Best to let it sleep, right?

Except that I can't recover if I allow these pretty major fears to dictate my actions. All I can do is confront these fears and stop letting them tell me what to do.

My history of OCD and current experience of Generalized Anxiety Disorder have made me very, very familiar with obsessing and worrying. It is, quite possibly, the world's most pointless activity--especially since I don't have any control over the things I'm freaking out about!

So when I saw a PsychCentral post on how obsessions can be productive, I had to read it. Because I was convinced the authors were well and truly full of shit. Obsessions make me so anxious I puke. Obsessions make me wash my hands in Clorox, make me run on the treadmill for hours, make me starve myself for days in preparation for a meal out with friends. How could obsessing be productive?

I'm still not convinced that the obsessions themselves are productive, but it's a matter of channeling that productivity into something worthwhile. My friend Jeff Bell calls it The Greater Good. In the PsychCentral post, which reviewed the book Brainstorm, blogger Susan Perry had this to say:

Writers and other artists are often desperate for fresh inspiration and renewed motivation. By learning concrete ways to tap into the brain’s potential, Maisel’s readers can better move forward in whatever realm they care most passionately about. What the Maisels are talking about here is another way to look at flow, or focus, or deep engagement, or mindfulness. Even if they’re not all defined as precisely the same experience, there’s no particular need to pull apart the threads of difference. They’re all extremely positive states of mind, ones that creative people often crave and benefit from.

PRODUCTIVE OBSESSIONS (paraphrasing Maisel):

1. Are not always easy or fun; but ease, fun, and joy may be part of the process.
2. Are fueled by good reasons, not only love and passion.
3. Need to be strategized. To be continuously effective, you need to plan what you’ll do when you feel anxious or at a dead end.
4. Require stretching. “Expect the emotional equivalent of aches and pains,” writes Maisel.
5. Necessitate switching gears between your normal life and your obsessive life. Learn to do so with the least time wasted and “no internal drama.”
6. Need to be monitored. Learn to pay attention to your state of mind, taking breaks when needed, or devoting a full week to your obsession when that is what’s called for.
7. Are risky. “Take the risk that your project may not prove as important as you had hoped,” notes Maisel. “Take the risk that it will prove exactly as important as you had hoped, taxing you with its difficulty and troubling you by its felt significance.”

As I read through this list of seven things, I thought about how true it was, especially for my blog. It is exhausting and frustrating at times--the writer's block or, at other times, the flooding of ideas--and I think about my blog a lot. It's also true of my life as a science writer and my work as an advocate in the field of eating disorders. I think about these things all the time anyway- I may as well make some good come out of them.

The other reason I was glad to read this was that it showed me that my propensity to obsess about basically everything could actually be a useful skill. It can allow me to immerse myself in my work, focus on one subject and become and expert. Things like this blog and my writing career let me use my skills for good instead of evil.

How do you turn your obsessions into something productive? Share your thoughts in the comments!

Earlier this week on Twitter (do you follow ED Bites on Twitter? You know you want to...), I ran across an interesting article about why some antidepressants don't work in some patients. The article was published last week in the research journal Neuron and is titled "5-HT1A Autoreceptor Levels Determine Vulnerability to Stress and Response to Antidepressants." (Clicking the link will take you to the free full-text of the article.) I'll let the opening of the article's Science Daily press release explain the research for me:

An excess of one type of serotonin receptor in the center of the brain may explain why antidepressants fail to relieve symptoms of depression for 50 percent of patients, a new study from researchers at Columbia University Medical Center shows.

...Most antidepressants -- including the popular SSRIs -- work by increasing the amount of serotonin made by cells -- called raphe neurons -- deep in the middle of the brain. Serotonin relieves symptoms of depression when it is shipped to other brain regions.

But too many serotonin receptors of the 1A type on the raphe neurons sets up a negative feedback loop that reduces the production of serotonin, Dr. Hen and his colleagues discovered. "The more antidepressants try to increase serotonin production, the less serotonin the neurons actually produce, and behavior in mice does not change," Dr. Hen says.

Seeing as anti-depressant therapy hasn't shown much promise in the treatment of anorexia nervosa (although it does appear to help treat co-morbid conditions like depression and anxiety), this research could help with the development of new treatments for AN. It also seemed like a good a time as any to discuss the links between serotonin levels and eating disorders. In a 2005 review article, titled "Serotonin alterations in anorexia and bulimia nervosa," Walter Kaye wrote that people with either anorexia and/or bulimia showed alterations of brain functioning in specific neural areas:

Importantly, such disturbances are present when subjects are ill and persist after recovery, suggesting that these may be traits that are independent of the state of the illness. Emerging data point to a dysregulation of serotonin pathways in cortical and limbic structures that may be related to anxiety, behavioral inhibition, and body image distortions...Alterations of these circuits may affect mood and impulse control as well as the motivating and hedonic aspects of feeding behavior. Such imaging studies may offer insights into new pharmacology and psychotherapy approaches.

The serotonin/anorexia connection has been researched over the years (searching PubMed for "serotonin anorexia" gives you over 700 results), and the most recent thinking goes something like this. People with anorexia are generally thought to have unusually high levels of serotonin in their brains, and high levels of brain serotonin have been linked to anxiety and obsessionality. An old BBC article titled "Genetic clues to eating disorders" has a quote from Janet Treasure that explains some of the link:

People with high levels of serotonin are prone to anxiety. Dr Janet Treasure, director of the eating disorders unit at the Maudsley, believes this could be behind anorexic patients' ability to suppress appetite. She said: "In anorexia nervosa the drive to eat can be inhibited, but we know that in normal people who are starved they will kill each other and do all sorts of morally repugnant things, and eat all sorts of foodstuffs that you wouldn't normally touch.

"Yet that doesn't happen in anorexia nervosa, so there's some aspect of the appetite system that isn't working."

The unit looked at the biology of stress mechanisms, in particular the fight or flight response. This is where the body prepares itself for action when confronted by a stressful situation. Heart rate and blood pressure rise and two of what are usually humans' highest priorities, eating and reproducing, are put on hold. It is possible that anorexic people are chronically in an acute state of stress reaction - they are constantly in a fight or flight state of mind.

And by restricting food intake, people with anorexia can lower the amount of serotonin their bodies can make (serotonin is ultimately derived from the essential amino acid tryptophan). This actually makes people with anorexia feel better. However, the brain begins to sense the decreased serotonin production and tries to maintain homeostasis by increasing the number of serotonin receptors. Thus the brain is back at Square One, as it is producing less serotonin but is using the decreased amount much more efficiently. So restricting doesn't feel as good, and the (obvious!) solution is to eat even less. And thus that negative cycle is born and the anorexic becomes trapped by their own brain chemistry.

Refeeding would then increase the amount of serotonin in the brain before the brain has a chance to decrease the number of serotonin receptors. This could be the neurological equivalent of All Hell Breaking Loose and could very well explain why refeeding is so distressing, although I don't think there has been any formal research done on the subject.

In bulimia, the serotonin problem is reversed. People with BN appear to have much lower than average levels of serotonin in the brain, which may be temporarily increased by binge eating.* Purging increases levels of vasopressin, which can have a euphoric and sedating effect, thus making the binge/purge cycle addictive much in the same way that starvation becomes addictive in AN. The chronic low levels of serotonin in BN also explain why SSRIs can be effective at reducing the urges to binge and purge.

Of course, plenty of people cross over from anorexia to bulimia, and I haven't the slightest idea of how serotonin might affect that crossover. So many brain systems are thrown out of whack during an ED that I don't know an exact answer will ever be found.

*The story is, as usual, a little more complicated than this, but the basic idea is the same.

I've heard talk of the greater good plenty before. People donate money for the greater good. They "take one for the team." And so on. The idea is that a small, personal sacrifice right now will yield greater benefits in the future.

I'm pretty talented at delayed gratification--in fact, I'm pretty sure it's the only real way I know how to gratify myself. Outside of the fact that I've managed to equate denial with happiness, I really get the idea of the greater good. I get how it works, and I like the idea. Because it isn't all about me.

To some extent, I thought the eating disorder was operating on the plane of the greater good. I was denying myself something now (food, rest, free time), for a tremendous payout later (feeling like I was good enough). The eating disorder really didn't work like that, as my self-denial was really an attempt to nullify the anxiety I felt about needing anything. The end goal was subsumed in the here and now minutiae of anorexia, the calorie counting, the tallying of sit-ups and push-ups, the Holy Grail Quest for calorie-free food.

The writer of an OCD blog, titled "Beyond the Doubt," used the idea of the greater good in his own recovery from OCD, and has a developed website called Your Greater Good. The idea is that the OCD rituals feel good right now. They make the anxiety better, and are classified as a "good" choice. However, in the long run, the obsessions and compulsions only make you feel worse. They don't free you from what you fear; instead, they tether you to it even more strongly than before. This makes engaging in OCD behaviors not such a "good" choice. The idea, then, is to find something of greater good than your rituals, something that can provide perspective and motivation to allow you to make the more difficult decision to resist the anxiety.

I've found this idea to be tremendously helpful to me in my own recovery. I enjoy the advocacy work that I do, and it's not about making the eating disorder "worth it." It's about making the pain of recovery worth it. Much of the time, my greater good has nothing to do with eating disorders. It might be the opportunity to travel. It might encompass being there for a friend. A huge motivator for me is that I promised Aria I would never, ever leave her again. That keeps me going when few other things can.

So what's your greater good? How can you use it to keep moving forward in recovery?

This is a question I keep asking myself: where do I draw the line? At what point are certain behaviors healthy (such as exercise, or being careful about what you eat), and when do they tip over the line into obsession and disaster?

Motivation may be a part of it. Are you doing this because you want to, or because you have to? How would you feel if you stopped? But then, we have all sorts of wonderful ways of deluding ourselves that it's often hard for a person to understand the situation from a neutral viewpoint.

Case in point: a man has been on a 30-year running streak. In the past 30 years, he has not missed a single day of running. Period. Ever.

Writes his daughter in a Wall Street Journal article (excerpted in the story above):

When he travels overseas, my dad, who is 66, plans layovers so he can get in a couple miles around the concourse, lest he miss a day to the time-zone shift. During blizzards, he wraps his feet in plastic bags, pulls galoshes over his sneakers and screws in cleats for traction. Then he waits for a snowplow to pass his front door, so he can follow in the freshly cleared path.

My father, Dr. Harvey B. Simon, practices internal medicine in Boston and teaches at Harvard Medical School. Rationally, he knows that running 10 miles a day, every day, for three decades is not great for his ever-more-creaky body. He’d never advise his patients to do it. In fact, he’s written several health and fitness books stressing the virtue of moderation in exercise. And yet….

He’s run with broken toes and the flu and a nasty infected heel and near-crippling back spasms. He goes out before dawn in every kind of weather; he’s become such a fixture in the neighborhood that a couple times when a freak thunderstorm has rolled in, strangers have driven out to find him. They didn’t know his name. They just knew he’d be out there, plodding away, and figured he might appreciate a ride home.

My thinking? This guy has clearly crossed the line. I think he is suffering from an exercise compulsion. The problem is that (if you glance at some of the comments) the voices of people telling this guy to stop and reevaluate--or even the frank "I don't think this is healthy or benefiting you whatsoever"--are drowned out by a "how fantastic that someone at his age is so fit!"

When I was exercising for crazy hours, and even now as I try and figure out what's a healthy amount of exercise and what's not, I was uniformly praised at my "dedication" to fitness. At being a "fixture" in the gym. No one asked, "Don't you have anything better to do?" No one asked, "Do you like all of this exercise?" No one asked, "Are you in pain?" Nope. It was all back-patting and high-praising and I could justify this to myself. How could my behaviors be harmful, I thought, if they're being praised? If they are almost normal? Plenty of other people I knew spent hours in the gym each day- which might not have been healthy, either, but again the praises kept coming.

Our culture isn't helping this. No one raised an eyebrow at my bizarre eating habits when I first got sick or when I relapsed. Or when some of my co-workers have done similar things (and I'm not just referring to the Big Fat Loser contest). I might not say anything because it's none of my business, nor am I in a position to do so, nor can I be entirely sure of the whole situation, but I do NOT praise potentially unhealthy behavior.

Defining "health" and even "obsession" isn't going to be cut and dry, a sort of universal for all of humanity. But having some sort of grip on when you've passed the tipping point could benefit everyone. Our society has passed that point a long time ago- just look at the Holiday Hypocrisy, those interminable stories about how to avoid "packing on" the single pound that most people gain. That's an obsession, and I don't think it's healthy.