Prioritising and coping with change
The first eating disordered behaviour that I changed was, necessarily, restricting. During my adolescence I also struggled with bingeing, laxative abuse and overexercising, but for the last few years restriction has been the major issue. Changing this was only the first step in a very long process, but it was also the most important, because it was the most immediately medically dangerous behaviour. Making myself increase the amount I was eating up to a weight gain intake was scary as hell, and I think one of the most important things I did to cope with this was to accept that I was going to feel incredibly anxious, and plan ways to distract myself in advance. In the past, I would decide to try and get a handle on my eating disorder but totally underestimate how difficult it would be psychologically, so when I increased and started feeling like climbing the walls I would panic and slip back into my old behaviours.
It took me a while to realise this, but eating disordered behaviours do not solve eating disorder related anxiety. I always assumed that an appropriate response to feeling scared of eating and gaining weight was to eat less. That’s akin to an alcoholic trying to solve the problems created by their illness by drinking more. The only way for someone with a substance addiction to recover is for them to abstain from their substance, because only then can they reverse the physical damage and work on any related emotional problems. Similarly, eating disordered behaviours are not the answer to being terrified of gaining weight. It’s well known in the treatment of phobias that exposure is the best way to overcome a fear, and that avoidance just increases that fear to the degree that it takes over a person’s life. This is complicated in eating disorders by the fact that the biological changes in brain chemistry associated with eating disordered behaviours increase eating disordered symptoms, including the warped perception of size, anxiety around food and weight, obsessions and ritualistic behaviours and inability to concentrate on anything other than food. Eating disordered behaviours spiral in on themselves – in my case, when I was close to my target weight and moved to York, I thought losing 5lbs would make me feel calmer because I would have more ‘breathing room’ between me and this scary weight. Doing that only made me scared of going over my new, lower weight, so I lost more weight, and more and more and eventually I had to go home because I was too ill to function.
So, one of the ways I coped with the anxiety of increasing my intake and gaining weight was to write down the reasons why hanging on to the anorexia made things worse in the long term, and reading them back every time I started getting overwhelmed. A copy of this list is on this page of my blog. Another thing I found helpful in dealing with the early stages of recovery was, quite simply, preparing myself to feel like crap. I tried to find people who had already been through the process of weight restoration, asked them questions, thought about the things that had triggered my own relapses in previous years, and made sure I had contingency plans for if they happened again. Years of mental health problems meant that my confidence in my ability to cope with life was rock bottom, so it took a lot of effort to keep myself calm and just sit with the anxiety. Working on my problem solving skills was really useful as well. I’ve noticed in the last few months that my blog posts tend to follow a pattern – 1) this is what is happening, 2) this is why it’s happening, 3) this is how I’m going to stop it/have stopped it happening. I think this is a reflection of the fact that I have worked really hard to change my default response to problems from feeling hopeless and overwhelmed to actively trying to solve them. The way you approach problems isn’t necessarily to do with your personality, sometimes it can be the case that you have been beaten down by things again and again and don’t have any belief in the idea that you change things anymore. But nine times out of ten there is a way you can either solve or tolerate a problem.
Once I started gaining weight, I began getting frustrated with some of the less directly dangerous but still eating disordered behaviours I had. These included things like: weighing food obsessively (even things like lettuce and mushrooms, which was clearly unnecessary calorie wise), weighing myself every day, reading triggering material like my mum’s diet magazines (even if I had no intention of following their advice), using the same cutlery every time I ate and panicking if it wasn’t available, always needing my food to be really hot, avoiding certain foods because I was scared that they wouldn’t fill me up until my next meal, overloading on vegetables, not eating after a certain time in the early evening, turning down social invitations if they interfered with my meal times, and periodically getting scared of all the food I had in my possession and throwing most of it away. Some of these cleared up with time and better nutrition – for example, now I am able to keep chocolate in the drawer next to my bed without it ‘calling me’ to throw it away or eat it all at once. This is a very welcome development 😉 However, I did need to put some effort into cutting out other behaviours. Weighing myself was the first one I tackled. I kept my scales because I was monitoring my own weight gain, but for the first month I asked my mum to keep them in her room and collected them the night before I was due to weigh myself. I cut down to weighing myself twice a week at first, then to once, and now I only weigh myself once every 4-6 weeks. After a few weeks of noticing that my weight increased much more slowly and predictably than I thought it would, I felt less anxious about getting on the scales and I thought I could trust myself to keep them in the bathroom without getting on them every day. They are still in my bathroom now and I don’t really think about them any more.
One behaviour I found really hard to stop was weighing everything I ate. I would prepare myself to cut back to only weighing dry carbs, do great for a few days, then one day when I was particularly anxious I’d weigh something ridiculous like a tomato and find myself back to feeling like I ‘needed’ to weigh everything agian. I think in this case the thing that worked was continually catching myself and trying again. It was frustrating because every time I slipped back I would be just as anxious about stopping again, so it felt like I kept going back to square one. I wasn’t though, because I was constantly accumulating proof that the world didn’t end if I didn’t know the exact weight of my sweet potatoes or whatever, and after trying to eliminate this behaviour for months eventually I managed to make the changes stick.
Exercise and orthorexia
A lot of people seem to develop new eating disordered behaviours even in recovery, myself included. When I got my periods back in July I took this as justification for allowing myself to sign up with the local gym. I was a keen runner when I was younger, I enjoyed it and tried to keep it and my eating disorder separate, but I did have an intermittent problem with overexercising. Like a lot of people at this point in recovery I had been dealing with weight gain for months and was accepting of it, but I really wanted to tone up a bit. I was sure I could deal with it and not let it get out of hand. This was a mistake. The time I spent at the gym and the intensity of my workouts escalated, I found myself getting minor injuries and still forcing myself to carry on despite the pain, if I couldn’t get to the gym for whatever reason I would become really anxious and my period disappeared again. I was eventually forced to stop when I injured my hamstring so badly that I couldn’t walk for a few days and had to rely on painkillers to get anywhere for the next fortnight. There was no way I could go back, and I had to deal with the resulting anxiety. My period turned up again after a week of not exercising, so it solved that problem at least! After a month or so of not being able to exercise I realised that things had gotten out of hand and that I probably shouldn’t go back when my hamstring had recovered. It took two months before I could walk without pain again. Now I let myself go running in the countryside near my house, twice a week for thirty minutes and absolutely no more than that.
I’m including that as an example of the sort of problems people can face in recovery when they try and put conditions on weight gain. Many people seem to fall into the trap of deciding that they will accept the need to gain weight as long as they can exercise and only build muscle, or if they can do it purely on an organic/clean/vegan diet. Exercising and eating healthily might be great for the general population, but people with eating disorders need to learn to deal with being at a healthy weight WITHOUT trying to relieve the accompanying anxiety by restricting their diet or obsessive exercise. Having these loopholes in recovery means the eating disorder has room to creep back in. Orthorexia – an ED in which the person is obsessed with healthy eating – can cause malnutrition and serious vitamin and mineral deficiencies, even if someone is at a healthy weight. Low fat diets are associated with depression and loss of periods – again, even at a healthy weight. Overexercising when at a healthy weight can lead to injuries, exhaustion, amenorrhea and osteoporosis, and an inability to tolerate anxiety and distress. If you use a behaviour every time you are anxious, your tolerance for anxiety will decrease until you believe you can’t cope with any uncomfortable feeling without using that behaviour. Exercising whilst underweight or engaging in purging behaviours is actually very dangerous, because it puts too much stress on a heart already weakened by the eating disorder. You don’t build muscle or strength, you just damage your body further.
I know, it’s not like knowing the dangers of eating disordered behaviours ever stopped anyone from developing one, but if you are in recovery you need to be honest with yourself about your motivations for any dietary or exercise changes you want to try, otherwise they WILL set you back. There is nothing to stop you trying these things later on in your life, but not while you are gaining weight. Of course, no one can or should sit around at home all day unless they are drastically underweight, things like yoga, pilates and walking – although not for hours at a time – are usually OK once you are not at a medically dangerous weight. But it’s definitely something to be aware of.
Bingeing in recovery
Another related problem that people often encounter in recovery is developing new unhealthy coping mechanisms. Sometimes these are related to the process of weight gain. For example, some people in recovery from anorexia start bingeing. Nine times out of ten this is because they are not eating enough throughout the day – say, if one day someone doesn’t eat enough by accident, they may well binge that evening because bodies in recovery don’t like to be underfed, they are programmed to try and avoid the recurrance of starvation at all costs. If that person then panics and restrict the next day they might binge during the next evening as well, and you can see how it would become a problem. The only way to deal with this is to stay calm and eat exactly as you would otherwise the next day. If you are getting really hungry on your current intake you’re probably not eating enough. I had this problem when I was a teenager, and after years of restricting to compensate for my binges which were caused by restricting, I eventually cottoned on to the fact that if I stopped fighting it I stopped bingeing after a month or so of eating normally. I stopped bingeing when I got back to a healthy weight as well. Of course, some people with bulimia may have emotional triggers for bingeing, but if you are in recovery from anorexia and have started bingeing, it is most likely a biological problem which will resolve itself as long as you don’t start restricting again. This issue can be incredibly distressing, so it is important to get support from anyone in your life who you think may be understanding and supportive about this problem, such as a doctor, therapist or family members.
I am phobic of vomiting so have never had a problem with purging (most helpful phobia ever!), but it’s such an important behavioural topic that I asked the lovely Sarah if she would like to contribute her thoughts on how to break binge/purging cycles:
My first attempt at recovering from anorexia led to a cycle of binging and purging. This became a very difficult cycle to break, but it IS possible. To break the cycle I made my own set of golden rules:
1) Eat: Don’t restrict/stop eating after binging/purging, no matter how tempting it might be. The more you cut back, the more likely you are to binge again. Try to keep to a strict meal plan. Once you get used to eating regularly the urges to binge will become less.
2) Talk: Don’t be alone. Talk to someone after binging/purging, or even better, before the event. It helps to get your feelings out and get back to number 1. Various eating disorders and mental health charities have telephone help lines if you do not feel comfortable talking to family or friends. If you have a professional/therapist to contact, even better.
3) Learn: Look back on the event and think about what triggered this, and what might help for next time. Learn to identify the warning signs (for me it usually trying to restrict, or eating at a weird time, being bored, getting stressed about something), write down what happens. Try to notice what happens.
4) Plan: Identify a plan in advance for coping, and if you feel at risk, plan each hour/30mins throughout the day so that you always have something to do as a distraction. Use number 2 to help. Make sure you have a solid (and sufficient) meal plan, and a list of activities that can help relax/distract you, e.g. listen to music, wash the pots, number 2 etc.
5) Move on: Don’t dwell on binging and purging incidents or let them dissuade you from eating again. It’s happened and you can’t change this. Learn from it and move on. The best way to stop it happening again is to take lessons from it and carry on eating properly. It’s ok to make mistakes, but use them as learning experiences.
Self induced vomiting is dangerous, as is binging and other forms of purging. All are more likely if your weight is low or you are not eating properly (or both!). The best way to avoid both is to eat a healthy balanced diet and maintain a healthy weight. It takes time and practise to break this cycle, but it CAN be done. Don’t be afraid to ask for help along the way.
Sarah has written a book about her recovery, which you can buy here. Thank you Sarah!
Not all new self destructive behaviours which spring up in recovery are food related. People in recovery from anorexia are apparently especially prone to developing problems with alcohol. Self harm and drug abuse are other common ‘replacements’ for the anorexia. It’s easy to see why it happens – eating disordered behaviours calm anxiety and mask depression, so when you stop these behaviours you have to learn to cope with distressing feelings. If you are not prepared for this you can easily slip from one set of self destructive behaviours to another. In the past I have had issues with alcohol abuse and self harm. It is really important that you take anything like this just as seriously as the eating disorder. Self harm, alcohol and drugs all change brain chemistry and can escalate to potentially fatal levels, just like eating disorders. I absolutely believe that full recovery is possible, but you need to be really vigilent for anything self destructive you might be doing to alleviate anxiety or other distressing feelings. Learning to sit with them rather than react to them is incredibly difficult but it IS possible, and it gets easier with time and practise. CBT (cognitive behavioural therapy) and DBT (dialectical behavioural therapy) related techniques, especially those associated with mindfulness, can be a great help in working out ways to tolerate distress. This is a really good website for learning more about these skills.
A relapse prevention plan can be invaluable in monitoring your progress physically, behaviourally and emotionally, in picking up on new problematic behaviours and to give you early warning of potential relapses. I created mine in the first few months of my recovery when I still had a lot of weight to gain. Now I look at it at the end of every three months to review my progress and make goals for the coming months. You can see my relapse prevention plan here.