Difficult nutrition appointment 

Yesterday

I had a very difficult nutrition appointment. First I told him what I was doing with my therapist.1. Every night before bed I am making a note of how I feel, my emotion, for ED behavior (success so to speak). Then I do the same for recovery success. This is to help me get out of black and white thinking: “If I messed up then I might as well go all in” sort of thinking. I did this on Tuesday night. I was surprised that my feelings about the ED were not satisfaction at restricting, feeling a sense of power because of effecting my body and so forth, but instead I felt sad, defeated, trapped, hopeless. I did have a recovery success, sort of; my emotion for that was a feeling of being taxed. It’s tiring trying to recover to be honest. 

2. We are working together to create a list of recovery side effects. That way we can work on one at a time so I could manage recovery more firmly. You see, for me, the side effects of an active eating disorder are familiar, comforting, calming. The side effects of recovery are things like feeling fat, feeling full (which means unsafe, uncomfortable, etc). There are many more no doubt but I asked if my therapist could help me. It’s hard to think of when I’m not actively compliant and experiencing those things. 

She also wanted me to start having my nutritionist tell me the results of my body comps each time. I told him not to a long time ago because I tend to obsess about those things. The other thing is that when my body comps are good, I feel bad, like a failure, and when they are bad, I feel successful. She explained that I have to take responsibility for all this and start working through it. If my body comps effect me then I need to talk to my nutritionist, bring it in to therapy, or whatever… but deal with it. 

Okay, so he told me. I lost x amount of muscle weight and gained fat. That’s one thing body comps show: the ratio of fat and muscle. A normal person’s body burns way more fat then muscle but in an ED body it is the opposite. Even though I typically have a low body fat, I never knew about the muscle part. The body comps are a new way of looking at it. The weight I am losing is all muscle, not fat so obviously the ratio would make fat increase over muscle. Wow, I can’t believe I just wrote all that in a sensible way – thank god for coffee!! Anyway, what I “heard” though was that I’m now a fat blob. My therapist asked exactly what he said. It is “higher”, not “high”. Well, okay, this is why she wants me to address it each time. 

I also told him I want to be completely honest. I didn’t think I could get back on track. Every week I come in and say “I’m going to do it!” And every week I get worse. I can’t trust myself anymore. He asked if I thought I needed a higher level of care but I replied that would be impossible because of insurance blah, blah, blah. (Insert long conversation of me overestimating the risk of losing insurance for iOP, and underestimating the risk of dying because of purging.) I told him my body comps aren’t bad enough anyway and didn’t feel I needed “all that food”. You can imagine his response to that. 

He had a great analogy that makes sense. He asked about how much I pay for gas a week. It’s around $75. He said think of all the driving I do to all the different places I go. He would give me $35 to do it. Yeah, I got it, I need nutrition. Then he said that, based on my argument about not being bad enough to go back to treatment, did I feel I needed to be at the level of $25 a week? Well, he explained it better but you get the point. 

It was hard, all hard, hard, hard, hard. 

I don’t want to go back to treatment. My therapist and I are getting down to the nitty gritty work of eating disorder recovery. I don’t want to risk not being covered by insurance to come back to iOP. 

This morning I gave all this some thought…

Years ago I had a hard time dealing with bipolar. I used to blame all my behavior on having it. When I did this, or that, I would say, “it was the bipolar!” The therapist I had at the time helped me to see that just because I have a mental illness doesn’t mean I am not able to choose what I do, or be responsible for my behavior. And so I learned to take responsibility and quit blaming. Eventually, years later, I was finally able to identify what was bipolar and what I could do. I have no control if something triggers mania but I do have control over taking meds for it and putting myself in a safe place till it passes. Well, lately I am blaming all this on anorexia. “It’s not my fault, anorexia is a mental illness, so I can’t help it.” Seeing the correlation really helped me make sense of my behavior. I have had such a hard time when people say that I can “choose” to eat, “choose” to use tools, and so forth. I feel like I can’t…. but really, why cant I?

The other thing I was thinking about was the treatment program. Secretly a part of me does want to go. But why? I hate it there. It would interrupt what I am my therapist are doing. I would have to start all over again. They would probably put me on a higher calorie meal plan. So again, why? It came to me and was so clear. If I go to a program I can hand over responsibility to someone else to make me eat. One of the hard things in recovery is taking responsibility for doing things like maintaining a meal prescription and exercise prescription. It’s the easy way out. However, it’s only temporarily. When discharged I’d be faced with the same thing I’m faced with now. So why not just cut out that part and go right to being responsible. Yeah….

I got up this morning and ate. Did I eat everything on my meal plan? No. I don’t want to set myself up for failure. For me, purging is simply a side thing to get rid of feeling full, even if all I ate was toast and a couple eggs. However, the more I purge, the harder it is to resist the next time. Also, exercise for me is like heroin. If I do a little I have to do more and more and more and it progresses rapidly. No doubt my nutritionist won’t be happy with my restricting but I have to do this so I can get some success under my belt. My goal for this week (thurs to weds) is to not purge and not exercise. I want to reintroduce eating at regular times instead of letting hours go by. So even though I’m not eating the full amount, I’m eating regular. I want to gain some confidence. The next step is to start stretching my stomach back out. Hopefully I can start that tomorrow or the next day. I know this isn’t perfect but my nutritionist honors effort. There’s been times in the past when I felt like I was stuck and he sat there and listed all the ways I’ve been improving. He’s pretty much the best nutritionist in the world as far as I am concerned! ❤ 

Oh, one more thing. I thought I’d mention this in case it’s helpful to someone else. My therapist said I needed to say, “I’m not going to purge anymore, period.” This is what I explained to her about why that won’t and doesn’t work for me. I’ve done that many times in the past. Then, when I did purge, I was filled with an overwhelming amount of self-loathing and feelings of failure. Crushing is a descriptor of those feelings. Using probabilities work better. If I purge one day, there is a high probability that I’ll purge the next day. However, as time goes by the, the chances decrease. I don’t eliminate the option but work on getting days in between. Days can turn to weeks, and weeks can turn into months. The more time in between, the lower the probability I’ll engage in that again. If I slip, it’s disappointing, yes, but not as crushing. I simply have to start the process again. Make sense? She finally understood. Therapy is a two way street. She has to learn what works for me, just as I need to learn how to communicate with her. 

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