Treatment Options for Binge Eating Disorder

Question from a lovely reader this morning: 

I was wondering what the treatment options are for Binge Eating Disorder. Obviously there are different severities of the disorder and different treatments needed for different people on a case-by-case basis, but I was wondering if maybe you could summarize some of the options out there for some of us.

Basically what I’m saying is, I have Binge Eating Disorder, and it is currently running and ruining my life. I really really need help but I want to know what I’m in for. Is inpatient a thing that happens with BED, ever? Is it usually therapy? What goes on for a typical patient, what is considered “severe,” etc…. I don’t know if there’s one good question in there to answer, but I’m really hoping you might have a bit of input, given that you are a) in recovery and b) on your way to becoming a therapist.

All right, guys. Here’s the truth. Binge eating disorder (BED) has been around for a LONG TIME, but only recently has it officially become a mental illness diagnosis. Research still remains relatively new, but it is emerging! In fact, studies indicate that more people suffer and will suffer from BED than Anorexia Nervosa, Bulimia Nervosa, or Eating Disorder NOS. 

Okay, so how do I know if I have this thing?

First of all, this NOT intended to diagnose. These are simply the guidelines. 

As taken from the DSM-V (released in May, 2013). 

  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
    2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
  2. The binge-eating episodes are associated with three (or more) of the following:
    1. Eating much more rapidly than normal.
    2. Eating until feeling uncomfortably full.
    3. Eating large amounts of food when not feeling physically hungry.
    4. Eating alone because of feeling embarrassed by how much one is eating.
    5. Feeling disgusted with oneself, depressed, or very guilt afterward.
  3. Marked distress regarding binge eating is present.
  4. The binge eating occurs, on average, at least once a week for 3 months.
  5. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Specify if:

In partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time.

In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met ofr a sustained period of time.

Specify current severity: the minimum level of severity is based on the frequency of episodes of binge eating. The level of severity may be increased to reflect other symptoms and the degree of functional disability.

Mild: 1-3 binge-eating episodes per week

Moderate: 4-7 binge-eating episodes per week

Severe: 8-13 binge-eating episodes per week

Extreme: 14 or more binge-eating episodes per week

My biased opinion on the new diagnosis:

Binge-eating disorder embodies a long overdue addition to our mental illness realm. This disorder is prevalent among both sexes and seems to be the most common eating disorder. Furthermore, binge-eating seems to carry more shame than other eating disordered behaviors, because it is the  “opposite” of what an eating disorder typically does, which is create and facilitate weight loss.  Beyond dieting measures, few people actually receive clinical help for this issue, even though it can be just as fatal and deadly as its other eating disorder counterparts. I think the DSM-V did a good job in explaining the binge-eating disorder diagnosis and creating a sustainable criteria. However, I disagree with the severity quotients. I do not consider just 1-3 episodes of binge-eating as “mild.” Maybe once a week can be considered mild, but three times a week comprises nearly half the week.

Okay, so I want help…what if I have very limited to no money? 

Schools and universities: Most provide free mental health services as part of the overall tuition. This is where I initially started my recovery process as a young adult. Unfortunately, I was denied treatment simply because I was so active in my disorder, but they were able to provide me with referrals. If you are in middle/high school, there are guidance counselors and school psychologists available. Again, this is a good way to get started and obtain referrals for community resources. You never know. Some work on symptom management and reduction. It’s always worth a shot. 

Low-cost therapy: If you live in a metropolitan city, many agencies and even private practitioners offer sliding-scale therapy based on your finances. Other than absolutely free, I’ve seen sessions run for as little as $5. I currently intern for an agency that charges approximately $25-40 per hour. I do not recommend going directly to inpatient without working with a trained outpatient therapist, unless you feel you are in a medical or psychiatric emergency. A trained clinician will be able to assess your situation. Sometimes, inpatient work is necessary, but this tends to happen in extreme cases. 

Eating disorder support groups: There are an abundance. Google is your friend. 

Oa.org (I have written extensively about this Twelve-Step organization modeled after Alcoholics Anonymous. Please refer to my blog archives or email me if you have any concerns. Most people in the rooms identify themselves as compulsive overeaters and have struggled with binge eating. There are online meetings available for those who cannot be physically present).

Eatingdisordersanonymous.org (similar to the OA but lesser-known. I have no experience with this organization, but it caters to the entire eating disordered spectrum).

Community therapy groups. Again, use Google. I know therapists who run groups for as low as $10-$15 for 2 hours worth of eating disorder psychoeducation, interventions, and support. 

How do I find a therapist?

First of all, there are so many ways. If you have health insurance, look into your options. You may need to talk with your doctor to see what kind of help is available.

Typical therapy consists of weekly sessions, although it is not uncommon to have more or less frequent ones (ex: 2-3x a week or 1-2 times a month. It depends on the severity. Explore with a therapist. You don’t have to know what kind of care you need just yet. That’s their job). 

Therapists.Psychologytoday.com is a good place to start. Or simply Google “eating disorder therapists in (your city).” Look up their credentials. Make sure they are licensed. Call them and inquire. You are potentially a paying customer. You are allowed to be nosy and inquisitive. You deserve the best quality of care! 

I highly recommend finding a therapist who specializes in working with eating disorders. Graduate schools and training programs skim over this disease and few really comprehend the emotional and physical toxicity eating disorders can cause on individuals and their treatment. When making the first contact with the therapist, here are some sample questions to ask: Do you have experience working with eating disorders? Which ones? I have a problem with bingeing; do you know effective treatments that may help me? What is your theoretical orientation? What do you think of the word, “recovered?” 

Cognitive-behavioral therapy is an evidence-based treatment commonly used for bulimia and binge eating.  This therapy targets dysfunctional thoughts and beliefs and helps to identify and conceptualize the binge-eating pattern. Eventually, the client learns his/her triggers and learns appropriate ways to handle them. Ideally, one learns how to cope without food as an emotional mechanism. CBT will also work on rigid distortions about one’s body weight, dieting, perfectionist thinking, and desire for control, all of which are prevalent in BED. CBT sessions are structured, require a relatively high level of motivation, and often include homework.

Dialectical-Behavioral Therapy is similar to CBT except that it focuses exclusively on mindfulness, emotional regulation, and radical self-acceptance  It was designed for treatment of Borderline Personality Disorder, but it has been used in eating disorders and substance abuse populations as well, simply because many individuals with these diseases cannot understand how to live in the present moment and accept what they cannot control. I am personally a huge fan of DBT and am working with a client with Borderline Personality Disorder right now using some of these interventions. So much of her inner self-loathing models that of the eating-disordered mindset. 

Family therapy is often used with adolescents. This systemic therapy takes on the pretense that the eating disorder embodies a familial issue, rather than an an individual one (similar to other addictions). This therapy exhibits the roles each of the family members subconsciously (or consciously) assume in order to maintain the eating disorder homeostasis. This type of therapy has been very effective for treatment of anorexia, but less research has been shown on success rates regarding binge eating. 

What about rehabilitation centers or inpatient care?

I regret to inform that I am NOT well-knowledged on either of these options. However, I do recognize that both of them are typically used in severe cases, and yes, most centers to treat the spectrum of eating disorders, including BED and compulsive overeating. I HIGHLY recommend working with an individual therapist before exploring more intensive care (unless, of course, you are facing a severe medical or psychiatric emergency or simply believe you CANNOT wait any longer). However, he/she will be able to provide you with options, referrals, and a general opinion. 

Rehabilitation centers are extremely expensive, although some do offer scholarships and financial assistance. You will have to do your research. Some have extensive waiting lists. These treatment centers typically offer group and individual therapy, nutrition and meal planning, expressive therapy, weigh-ins, family meetings, etc. 

Again, I am not an expert in either of these options, so I recommend that you consult a medical doctor or mental health professional if you need assistance. 

Will medication help me? 

Maybe. You need to consult with a medical doctor or psychiatrist to obtain a full assessment. The research is mixed. However, because BED is highly correlated with other disorders, especially depression and anxiety, medication may provide some relief, especially if one of the disorders triggers and amplifies the eating disorder.

SSRI’s (antidepressants) remain the standard treatment of choice for eating disorders.

Toparimate (Topamax) has also been used in the treatment of bulimia/binge eating, although it is designed as an anticonvulsant medication for seizures.

Side note: When taking medication, it is BEST to always be working alongside a professional clinician doing some kind of psychotherapy work. The MOST effective evidence-based studies with medication include a therapy component. We all know magic solutions do not exist in a pill. 

Can I just do this on my own? 

Maybe. Plenty of people do! Plenty of people don’t! You are no more inferior or superior than anyone else if you can do it on your own or not!

What are some ways to “do it on my own” right now?

1. Find a way to EXPRESS. For me, it’s this blog. For you, it may be private journals, song lyrics, poetry, artwork, painting, talking aloud in the car about it. You will be FLOODED with thoughts if you don’t have some kind of way to make them tangible.

2. Start a gratitude list. Write down as many things as you can. Add at least one thing everyday. Spend as long as you need to add to it. But keep adding. It will get easier. Life will seem better.

3. Buy some books. I recommend anything by Christopher Fairburn (the scientific pioneer of bulimia/binge-eating treatment) or Geneen Roth (the more holistic, natural author of compulsive and binge eating). Check out Amazon. Browse a library. Books helped me tremendously at the beginning. It was so reassuring to read those pages and just feel like someone finally understood.

4. Do your own CBT! Go to this website: http://media.psychologytools.org/Worksheets/English/CBT_Thought_Record.pdf

These worksheets will help you link your thoughts/feelings/experiences. And they’re free! Commit to a week of doing this. See how your perspective shifts.

5. Learn how to deep breathe. Sounds cheesy. Sounds cliched. But people wouldn’t be doing meditation for 348349837439874 years if it didn’t work. Get into yoga. Or just lie naked on your bed and inhale for as long as you can and exhale for as long as you can. Repeat.

6. Do. Not. Starve. Yourself. Under. Any. Conditions. That. You. Have. Control. Over.

7. If you have an iPhone, download the app, “Recovery Record.” It’s free and you can record your meals, track your feelings, jot down thoughts, and watch your progress overtime.

8. Practice positive affirmations. Every fucking day. Collect quotes. I became a quote-fanatic when I first started recovery. I needed that inspiration and motivation.

9. Know your triggers. And make a plan. Whether you follow it or not is a different story, but have some kind of realistic plan for what you will do in a certain situation (ex: at a restaurant/party, alone at home, when eating a favorite food, etc.) It’s important to recognize your triggers. You may have dozens of them. That’s okay. Awareness is key at this point.

10. Recognize the process. It’s shitty; I won’t lie. But in that shit lies some beautiful diamonds. <—- That’s an awkward statement, and I’m tempted to delete it, but whatever. It’s the truth. You just have to keep going. It could take months or several years. Every process is unique. None of them are “better.”

*Some questions to get you started. Some points to ponder (Ps: I’m making them all up on the spot, but I’ve gotten pretty good with my therapeutic open-ended questions, so hopefully these get your noggins thinking). 

What thoughts run through my mind right before a binge? During? After? The next day? 

What’s going well in my life right now? What do I want to change? 

In what ways does bingeing affect my overall functioning and well-being? 

In what ways has my bingeing served me? Harmed me? 

What fears do I have about giving up bingeing?

How would my life be different if I didn’t binge?

 

What feelings cause me discomfort? How would I tell my best friend to cope with those feelings?

If my five-year-old self could see me during a binge, what would he/she tell me? 

What am I willing to do to work recovery? MAKE THIS ANSWER AS ELABORATE, DETAILED, AND SPECIFIC AS YOU POSSIBLY CAN, BECAUSE THIS QUESTION WILL CHALLENGE YOU EVERY SINGLE DAY AND POSSIBLY MULTIPLE TIMES A DAY. 

What challenges do I anticipate during recovery?

 

 

 

Whew!! I have probably forgotten things, but it’s nearly midnight, and I’m waking up early tomorrow to run my first expressive therapy group! I was going to do this post sometime this weekend, but I figured if I could potentially influence just one person tomorrow, it will have been worth it. 

Please never hesitate to ask questions! I know how isolating and overwhelming eating disorders are. I will ALWAYS do the best I can to help you in any way shape or form XO 

 

Goodnight to all my beautiful readers. Shine on! 

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when being weak is strong.

Dear Bee, 

Before my clinical training, I wondered how difficult it would be to be present with my clients. With a compulsive-anxious-hyperactive-multitasking mindset, it’s not always easy for me to focus. Fortunately, staying in the moment with them is easy. It is as natural as the words I speak and as natural as the empathy I provide.

It is so easy for me to reframe my clients’ distress. So easy to provide unwavering support and guidance. So easy to point out the dichotomous thinking and negative self-talk. So easy to offer alternative perspectives, and consequently, alternative ways of living and being. We see people differently than we see ourselves. We are kinder on them. We are more loving and generous. We often accept their shame and secrets. In fact, I feel a tremendous sense of gratitude when my clients are able to expose their darkest secrets to me. The ugly ones, the ones that make them panic and cry, the ones that take them to the scariest places. It shows they feel safe with me. It shows a willingness to heal. 

I can help them when I know them. The vulnerable parts of them. 

Honesty is a tough pill to swallow, and those with eating disorders are conditioned to lie. Our disorder, in fact, tells us to lie. Whether we are suppressing our feelings, denying what we ate or did not eat, minimizing or exaggerating our behaviors, we are lying. And God, I used to lie. I lied about my lowest weight (to seem more credible for seeking help). I lied about how little I used to eat (I’ve never purposely starved myself for an entire day). I lied about the quantity of my binges (they were ALWAYS much bigger than I made them out to be). I lied about my feelings, thoughts, and behaviors. I wanted to be the eating-disordered client without the eating disorder. I wanted to be perfect in recovery…and, then, of course, when I was struggling, I wanted to be the most hopeless, impossible case EVER. Had to perfect. Had to memorable. 

When you lie to yourself enough times, it becomes reality. In turn, the truth becomes a terrifying, impossible plague. Lies, on the other hand keep us protected and safe in our own eating disordered cocoons, in our own predictable realities. Lies are controllable; we can be whoever we want to be and do whatever we want to do.

We can live in our constructed fantasy…until we get caught.

I cannot tell which clients lie to me, as I am still building rapport with each of them. I am still getting to know their individual histories and struggles. At this stage, I gather information, come up with therapeutic goals, and begin mapping out our treatment together.

I suspect omission is worse than outright lying. Not telling me pivotal information. Not disclosing something of significance. But that is their right, just as it is mine. Transparency, however, is a strength. A fucking, incredible strength. The ability to be absolutely raw and genuine with another human being takes incredible resilience and courage. It says, I love myself enough to expose this part of me to you…knowing you may or may not accept it. To be honest is to be accepting of one’s self: the good, the bad, the ugly. And let’s face it. We all have ugly. Just as we all have beauty. 

I have therapy tomorrow. I am going to sit my butt on that couch and just be honest. Honest that I spent the weekend feeling triggered. Honest that I’ve experienced some discomfort over my appearance. Honest that my eating hasn’t been regular or appropriate. Why else would I be spending my time and money just to pretend to be okay? Just to try and fool someone who wants to help me?

I would never want that of my clients. 

Today, I did good things for my recovery. This makes me very happy. I treated myself with kindness. I ate nourishing food. I exercised. I stretched. I read. I talked to people I loved. I kicked ass with all my clients, and it felt amazing. I’m signing up to run a group for trauma survivors soon, and I’m excited for that. I told my boyfriend how much I loved him and made wonderful plans for this weekend. I expressed my gratitude to my amazing friends. 

I am feeling good because I want to feel good. 

Overeaters Anonymous Drop-Out

Dear Bee, 

I walked into my first OA meeting in late November. It was cold. Dark. All women. At my therapist’s (routine) suggestion, I went. And I stayed. Because that’s what everyone kept telling me to do. Keep coming back. I planted my booty in several rooms several times a week for the next six months. I spoke. I wrote. I read. I found a sponsor. I worked Step 1, 2, and 3. I found relief. I found answers. I woke up early. I stayed up late. I put recovery first. Undoubtedly, OA helped me during a very excruciating and painful time in my life. 

I no longer attend meetings and have not for the past seven or so weeks. My recovery is stronger than it has ever been. I am in a healthier state of mind than I was before my eating disorder even began. OA taught me great tools, and I gained some wonderful insight and friendships along the way.

I love the philosophy of the Twelve Steps for addiction models, but the structure of OA became too rigid for me. I have a disorder, and I am aware of how it affects me, but I do not have a biological nor psychological addiction to food. I never have. I used food and exercise as a crutch and coping mechanism; in recovery, I have learned how to identify feelings and appropriately manage them. I have learned how to like myself. CBT has done wonders for me in that sense.

I maintained my eating disorder by denying my feelings, settling for people and things that negatively affected my happiness, and fighting for unrelenting control over everything in life. Part of my recovery meant dismantling the rigidity. Only in learning how to equalize all foods and exercise and practicing the method of moderation and intuitive living have I been truly able to make remarkable progress. I stopped the program at Step Four, meaning I did not complete the searching and fearless moral inventory. Why? Because, I realized I needed to stop focusing on my flaws, weaknesses, and vulnerabilities. I needed to LET THEM GO.

Recovery has made me insurmountably proud of my past. Every single choice, good or bad, led me to where I am today. And where am I now? Exactly where I want to be. In a state of mind that I never knew I could have. I am not “passively” existing. I am active and excited. I am okay with being busy and okay with relaxing. I love myself and I can give love freely and happily to others. I am Europe-bound, halfway through my graduate program, one month away from working with clients, in love with the most amazing man I’ve ever met, content with family, happy with my body, gratefully employed, and OPTIMISTIC and EXCITED for life. 

I am not in denial of my imperfections; I never have been. In fact, I had the opposite problem. I was acutely aware of my vulnerabilities and fears, but I was unwilling and unable to let go of them. I let my mistakes define me. I did not do Step Four because doing so would have just sunk me deeper into my own pity party, and I spent many years celebrating my shame. It is time to move on. 

I am a firm believer in the power of group therapy, but this is not the intent of OA. At times, the program made me feel broken; I was a “compulsive overeater,” and it was literally a chronic disease that can only be managed and not beaten. I was never comfortable identifying myself as a disorder. In school, we are literally forbidden from calling people by their diagnoses. I would never say he’s schizophrenic or she’s bipolar…this pigeonholes individuals into a cluster of symptoms. I am Me. I am not ____, compulsive overeater or bulimic or anorexic…whatever. I am ME.

I do believe I can beat my eating disorder; I have always believed that. From day one. Even during my lowest of lows, I always knew I was going to get better. That faith and optimism in myself has kept me going day in and day out. You can all see my progress and struggles outlined here. I am not just rainbows and sunshine. But I am positive about my life. 

I gained a sense of spirituality from OA, and for that, I am grateful. I absolutely believe in the good karma of the universe, and I adopted that as a sense of Higher Power. However, I do not believe in turning my eating disorder over to the universe. Moreover, I never felt comfortable praying to a force greater than myself. The universe has taken great care of me, and I realize that I can let go and release the stress and preoccupation, but I do have the power to control, stop, and CHOOSE my actions. The serenity prayer is beautiful; I may not be in control of much in this world, but I am in control my eating disorder behaviors. I used to think I was helpless and “out-of-control.” I couldn’t stop a binge to save my life. I couldn’t eat a fear food without freaking out. I couldn’t gain an ounce of weight without hating myself.

I gained some responsibility over myself. I learned just how much my eating disorder was influencing my self-esteem, decision-making abilities, and quality of life. I have choices, and to believe that I am powerless makes me feel helpless and scared. 

Moreover, I struggled with defining abstinence from the first day. What am I supposed to be abstaining from? Compulsive overeating. Well, yes. But that sounds rather black-and-white, which opposes the picture of recovery I tried to color. Abstain from trigger foods? When I did this, I underwent just another extreme diet, because suddenly I couldn’t handle anything that I didn’t deem as safe. Once again, I found myself putting certain foods on a pedestal. I kept labeling “good” and “bad” foods, and, in doing so, I developed even more of an anxiety and fear hierarchy. I was told that I needed to avoid the fears rather than face them. In other words, this was maintaining a self-defeating cycle, one in which I believed my body could not handle certain foods due to their alleged toxicity. 

Engaging in an eating disordered behavior is not a failure and perfect recovery is impossible. Slips are inevitable, and I wish OA would take those setbacks more into consideration. I was made to believe that any alteration to my “plan” sent me right back to square one. Indeed, I became caught up in the perfectionistic cycle of counting days and numbers…if I had to be the “best” at an eating disorder, I sure had to be the “best” at recovery as well, right? 

I needed to dismantle perfectionism, and, unfortunately, OA made that difficult. The structure felt so black-and-white. Don’t binge. Only eat at these times. Only eat these kinds of foods. No ifs and or buts. I realize OA does not actually endorse such limitations, but most of the fellowship followed relatively strict rules concerning their food intake. My recovery meant breaking the rules instead of making more of them. I was already living with countless rules that I had created for myself. I needed to learn how to listen to my body and intuition, rather than follow another plan. I needed to learn how to ultimately trust myself, which was one of the scariest, but most worthwhile, decisions I ever made. 

I am not for or against OA, and I have seen it create miracles for some. I met some wonderful people. I love my sponsor and her advice continues to be invaluable.

At this phase in my recovery, I am in no position to say whether or not I will go back to meetings. For now, however, I like the fluidity of my recovery. I like being able to eat what I want, when I want, and how much I want. I am at a healthy weight with a relatively positive body image. My disorder no longer defines or controls me.

I am not “recovered.” I am not cocky nor ignorant about my recovery process. There is an ebb and flow to this journey, and I have hit many rough patches and dark spots along the way. Food may always be my achilles heel…I know how likely relapse can is! However, I have learned an abundance of healthy coping strategies and I will continue with what works: therapy, writing in this blog, reading, seeking support, and continuously making myself feel good.

The best thing I learned from OA was the message of living life on life’s terms, and that’s exactly what I’m doing: riding this delicious energy called life.

No appetite :/

Dear Bee,

You know what I love? Cognitive-behavioral therapy. You know what I hate? Cognitive-behavioral therapy. Just kidding. But I strongly dislike having to memorize seven million CBT techniques in rigid, step-by-step detail for my final next week. Good thing I’m a pro-memorizer. How else would I have survived all those endless multiplication-fact tests, SAT-style exams, and diverse array of college course material ranging from geology to religion to women’s studies to communications?

Anyways, I’m still on this restricted high. Yep. I literally had no appetite yesterday. I skipped lunch, had just nuts and grapes around 4pm, and then a salad later. But, it was all forced. Food is medicine, but I wasn’t hungry at all. Is it still eating-disordered if I’m just not hungry? Normal eaters don’t force themselves to eat when their bodies aren’t telling them to eat. I don’t know. The difference, I suppose between normal eating and disordered eating, in this case, is that I was happy I didn’t have an appetite. I didn’t want to eat.

I went hiking this morning, and again, I woke up with barely any appetite. I finally felt my stomach growl after we arrived at the trail and just ate a small granola bar. Then, I grew hungry around mid-morning. By then, I was actually grateful for a physical reminder that I needed to eat. With an eating disorder, it can be so hard to distinguish emotional from physical hunger, and many times, I ate or did not eat purely based on emotional drives. Because I am trying to honor my intuition at the highest level, this means I need to eat when I’m hungry and change the distorted thought that I am superior by waiting until I’m absolutely famished or that I’m successful if I have an empty stomach or I’m a better person if I restrict my food rather than binge on it. Neither are desirable options. Neither take me to the place in recovery I seek to be.  

I didn’t weigh myself this morning, though, although I still have this weird idea in my mind that I need to lose a few pounds just because. Just because, why? To feel prettier? More confident? Happier? No. These are all fallacies. These are distortions. By now, I know that a lower weight does not correspond to greater happiness or confidence. I haven’t made it this far in recovery to want to throw it all away for a forced and unnecessary weight loss. I haven’t made it this far in recovery to punish myself further. 

My stomach is growling right now. And after I publish this post, I’m going to dress my naked ass and eat. Recovery win. 

Believing that I am worthy

Dear Bee,

I am struggling to believe that I am worthy.

That’s not an eating disordered thought. That’s a life thought. That’s a core belief. That’s something that has existed in me long before I started controlling what I did or did not eat. 

This guy is triggering those thoughts, and it’s nothing he’s saying or doing. When I’m with him, I feel happy and excited. I feel appreciated and valued. It’s when I’m not with him that I start feeling doubtful and insecure. Worried and afraid. It’s pushing through the unknown and the fear that the unknown embodies that is giving me a hard time right now. 

I went to therapy today and discussed these uncomfortable thoughts and feelings. This is a time to be unbelievably joyous, right? One would think. But, I don’t want to invalidate the fears I feel. I’ll challenge the irrational thoughts and distortions, sure, but I know ignoring only makes them come back with a vengeance.

So, here’s the deal: This is someone who is at my level. Intellectually, emotionally, financially, mentally, and physically. In my past, I’ve dated down. Ego boost. Whatever you want to call it. I had the upper hand. It wasn’t ideal, but it allowed me to feel good about myself. I chose weaker men because then I could feel worshipped. I also knew they wouldn’t leave or abandon me for someone better, because hello, I was the best they were gonna get .

Is this sick or what?

So, we talked about this new guy. He’s into me. He accepts me for who I am. He’s amazing, and I wonder why he isn’t snatched up already. Funny. He wondered the same thing about me. I’ve never been in a healthy, egalitarian relationship. I’ve been with my eating disorder since I started dating, and it’s tainted and distorted my self-esteem, intimacy, and perception of love. This, like so many things over the past year, is just another change. Another potential new way of living. Another opportunity. 

Then, I have you. My eating disorder voice. The ever-knowing voice of irrational and illogical reason. Bee. Listen, I hear you. You want this guy away from me. Because he’s good. Great, even. Because he’s going to threaten your existence. Because he already has. You don’t want me with someone, but if I insist on it, you want him to be beneath my standards. So you can stay in my life. So you can make me as skinny as you want. As fat as you want. As whatever as you want. So long as you have the control, you are content. And how do you obtain this control? By making me sabotage myself. By focusing on my appearance, weight, and food. By stuffing or starving or working out feelings rather than coping with them constructively. By perpetuating the self-fulfilling prophecy that I am not worthy. 

There’s YOU and then there’s the reality. And the reality is: I am worthy. I am deserving. I don’t have to do anything to earn those rights. I just have to be me. And this guy wouldn’t be talking to me if he wasn’t interested. If he thought he could do better. If he was planning on finding someone else. He wouldn’t be taking me out to breakfast tomorrow morning because he still wants to see me, even though I have to work early in the afternoon. He wouldn’t be texting me throughout the day, asking what I’m up to, telling me what he’s doing, etc. He wouldn’t be complimenting me and telling me that I’m what he’s looking for.

Whatever this is, I want to ride in it fully. You can hang out, Bee, or not. You can try and make me feel inferior or less-than in some way, but I’m smart and strong enough to know your words simply are not true.

Recapping school, body image, Vegas, my birthday, and listening to my body.

Dear Bee,

 I finished my semester last week. Grades are mostly in, and it  looks like a guaranteed 4.0. Not to boast, but it is not a huge surprise. I am proud of myself, though. I was the kid who won spelling bees, sucked up to teachers, considered a B a bad grade, and took nearly every honors and advanced class available. In other words, I am my own harshest critic when it comes to academic achievement. Graduate school is different from any other educational experience, in that my professors place far less on emphasis on grades, busy work, and those pesky multiple-choice tests. For that, I am grateful, but I still like receiving high marks, even though I know they hardly matter.

I spent the weekend in Vegas. It was fun. It was crazy.  In a very brief synopsis, it involved warm weather, pool parties, nightclubs, my boobs, hooking up with some French-speaking man in his penthouse suite, and lots of alcohol. The adult Chuck-E-cheese, this place embodies a playground/wasteland of compromised morals and reckless shame. Two days is enough…after that, I just need a long shower and mental detox from the insanity.

Moreover, traveling with a group of girls can be stressful, and I’m almost positive I will be ending a friendship with one of them. Why? Because her painfully-obvius insecurity, selfish tendencies, and attention-seeking tactics drove me up the wall. That, and her passive-aggressiveness. Oh, and her mooching! This girl did not want to pay for a damn thing, and yet she had no qualms “borrowing” from anyone else.  

I don’t know if recovery and the journey of self-respect and love has made me less tolerant to deal with bullshit, of if I am simply now more willing to cut ties rather than silently suffer.

And although I struggled with some body image issues last week, I did not suffer much insecurity on my vacation at all.

I actually processed this issue in therapy on Thursday, the day before I left.  The “eating disorder part” of my session went really well. We were talking about my safe foods and my tendency to rigidly plan and control and adhere to a dieting mentality outside of bingeing. She obviously does not want me to have “safe” and “unsafe” foods. I don’t either, but the reintroduction part of bringing these triggering items back into my everyday routine is difficult. Some days, I can eat an “unsafe” food and hardly think about it. But, the context matters. If I am alone and eating an unsafe food, I am in dangerous territory. However, I intend to make my own anxiety hierarchy and use exposure therapy to remove the “fear factor” of these foods. As long as they carry a stigma and remain on a pedestal, I will be on some kind of “diet,” making me more prone to engage in my eating disorder. 

While we were talking, I asked her if she ever fears having a relapse. We have the kind of therapeutic relationship where she will answer personal questions. She said yes. This is a woman with twenty years of recovery. I appreciated her honesty because it humanized her as an individual in recovery. It also signified that she is not above feeling triggered, slipping into the occasional disordered habit, or suffering her own distortions, 

I also asked her what she believes to be the most difficult part, and she responded that, for her, it was about her body image. And then she quickly said, but you don’t have that issue. She is right. Yes, I look in the mirror and believe my legs are too big or my stomach needs to be flatter. Sometimes, I see pictures of myself and instantly start criticizing my body. But, gauging by my friends and the people I know, I think most girls feel that way from time to time.

I never felt the need to “hide” my body by concealing it with layers of clothes. I like wearing shorts and dresses. I can wear a bikini out in public. In fact, I prefer summer clothing over other seasons. Her response? Because you don’t have anorexia. That’s characteristic of anorexia. You hide under clothes, hoping you will kind of just disappear.  

I do not have anorexia, and I never have. I have received a bulimia non-purging type and EDNOS diagnosis. My therapist had anorexia and bulimia. I firmly believe it doesn’t matter which eating disorder you have. Yes, the anorectic mindset may differ from that of the bulimic or compulsive overeater mindset, but the distortions appear the same; the preoccupation is just as mentally taxing and exhaustive; and, most importantly, the shame, secrecy, and guilt are universal. 

Anyway, moving on…

My birthday went really well yesterday, and I felt absolutely overcome by gratitude for all the amazing people and experiences in my life. I am in a good place right now. A great place, even. Sometimes, I wonder why I am so lucky, and then I remembered it is because I am getting exactly what I need and deserve. Moreover, I am becoming more aware of all the blessings in my life, whereas before, I was always focusing on what I didn’t have. 

You have been relatively quiet this week given all the changes in my routine. I have eaten items and meals I don’t normally eat at times I don’t normally eat at, but, for the most part, it’s been smooth. You still want me to clean my plate, but I’ll take slight feelings of fullness over bingeing right now. And, yes, you think I am eating WAY too many carbs, but I know it’ll all balance out. One week of indulgence will not make me gain fifty pounds, nor does it halt my recovery. Normal eaters enjoy food on vacations and on their birthdays. I enjoyed my food, but I did not obsess over it. Once mealtime finished, I focused on whatever I was doing next. This is a huge achievement. Furthermore, for the first time in years,I did not weigh myself the day of and the day after my birthday to measure my “annual progress.” I am extremely proud of myself. 

We often think if we allow ourselves the permission to eat whatever it is we truly want, we will not be able to stop. But, the truth is, my body stabilizes itself. It wants a balance of fine taste with nourishment. In other words, it wants moderation in flavor and ingredients.

We just have to let ourselves listen to our bodies, and after years of ignoring, stuffing, starving, compromising, rationalizing, negotiating, bartering, and pleading with them, listening may just feel too easy. 

As I have heard many times this past year, it is usually better to just K.I.S.S (keep it simple, sweetheart).

Crying in therapy

Dear Bee,

I finally cried in therapy.
It took me six months, a breakup, the loss of a best friend, a job change, the progression of graduate school, and this long thing called eating disorder recovery, but I was finally able to do it.

I was overjoyed! Everyone always talks about sobbing on the couch, but I have never been able to expose my vulnerabilities and just let go like that. Control: it’s my middle name.

I cried as I told her how I talked about my mom and how she told me she would do anything for me and how she will help me in anyway I need…I can’t even believe how selfless she is. How selfless she has always been. How I’ve hardly even appreciated her genorisity, unconditional love, and support. We may be very close and I feel comfortable telling her anything, but I’ve also been moody and irritable, unstable and conniving…my disorder is not to blame for that, but it certainly manifests my worst symptoms.

I’m going to make Mother’s Day amazing for her. I want to make everyday amazing for her.

So, my therapist made a last-minute session for me, because I was just mentally dying. Exaggeration. But I asked her yesterday, and she told me to come on in. She was STACKED with books and worksheets. Told me she had been prepping for an hour to help me out…and so, we talked and I just kept shooting her questions about recovery. We went over the thoughts, feelings, behaviors triangle. We discussed coping skills and deep breathing. Honestly, sometimes I wish I had sought treatment BEFORE starting my program, because everything she teaches me is everything I’m learning. Therefore, nothing comes across as insanely miraculous or awe-inspriing. I could teach CBT in my sleep…and yet, it’s easier to preach than to practice.
I’m glad she’s unconventional, in the sense that she freely self-discloses, laughs and cries with me, hugs me afterwards, and will let me text/call her whenever. This probably fosters some kind of dependency, but at this point, I don’t really care.

Yes, it still overwhelms and somewhat bothers me how much I have to lean on my support. Ironically, even though it is my life passion to become a therapist, I never actually thought I’d need therapy. Seriously. I came in believing I had so much acute self-awareness and insight about myself. That just highlights the state of absolute denial I was once in. After my session, I called my sponsor and told her that, after my few days of skepticism and utter discouragement, I felt ready to put my recovery needs first again. She was pleased and told me that she was proud of me and that this rough patch happened for a reason.

Even though I was completely preoccupied with my disorder, I spent the past few days hanging out with some old friends. I always find it interesting how spending time with people from previous stages in your life somehow takes you back to that time. It’s not necessarily a good or bad thing, but it is a strange phenomenon.

Still being a mild whore, clubbing and partying and (soberly) making out with random guys whose last names I don’t know pretty much every weekend. I’m not sure if this is me…I’m not sure who the hell I am, but I’m obviously still seeking approval, validation, and sexual comfort from others. Trying not to overanalyze it. I need to be easy on myself.

I used to feel so self-conscious dancing and going out with my friends. Strangely, now that’s when I tend to feel the most confident, and I don’t even need a drink in my hand. I like being a sexualized creature, and then, once I sense that’s all the guy wants for me, I hate it. Is life always one big contradiction? Maybe.

Oh, well. I’m off to yoga, and I am so ready for it right now. I’ll ponder the meaning of the saga that is my life later.