Healthy Weight Loss After an Eating Disorder.

****TRIGGER WARNING**** Weight, BMI and ED behaviours mentioned.

As some of you may know, I have been purge free for the last year now (can I get a whoop whoop!) which is a HUGE personal achievement after years of bulimia ruling my every waking hour. The only thing is, I unfortunately am still not 100% ED behaviour free. I am still over eating and sometime binging, although nowhere near as frequently as before now I don't have a 'release', a way to 'get rid' of that post binge, horrible full feeling. None-the-less all that chomping on cream cakes and late night pizza parties have taken a toll on my body, my health and on my emotional well-being.

I knew my clothes size had gone up but I had gotten used to it going up after re-feeding. So I was NOT prepared to be told my BMI was in the overweight section during a recent Dr visit. I was shocked. She recommended cutting back on the sweet stuff and taking up exercise. 

In the last two years I have gone from being under weight for my height; bringing with it all the negative health risks that go along with that, to being over weight for my height, which has brought about some unexpected twists to my long list of maladies. My blood pressure is now high for the first time ever, I have nasty stretch marks on my legs and boobs. My iron levels are all over the place and cant make it up a flight of stairs without feeling like my heart is going to explode. 

Now I must say that I am not obese or anywhere near that category on the BMI scale (not a reliable scale I know, but I use it from time to time) I am just tipping into the overweight category. I'm super tall (5''11) so I tend to carry weight easily without knowing it, especially if I am not weighing myself, which I haven't as it used to be a major trigger in the past.

My Dr and I came up with a plan. Go to weekly weight watcher meetings, do one fitness class a week and get back running twice a week also. And also check in with her monthly to discuss any returning ED thoughts or behaviours. She also singed me up to an 8 week mindfulness programme to re-assert myself with awareness skills which will allow me to notice any negative thoughts creeping back in. A solid plan I think. My team believe in letting me make my own choices, including how I life my life. I love how they don't coddle me or insult my intelligence. I told them that I felt I could trust myself not to take the weight loss to the extreme and they agreed with me.

So I joined my local weight watchers last Thursday and found it really motivating. I've been cooking healthy home-made meals everyday from scratch, taking into account all the food groups and incorporating knowledge I learned from nutrition sessions over the years. Nothing is off limits, just eating in moderation. My goal weight gets me down into low end of the healthy weight BMI section. 

I'm back to tracking my daily food intake and now add values to everything I eat in the form of weight watcher pro points. The Weight Watchers program is based on a points system. Food items are assigned a point value, and based on your current weight you are given a daily allowance of points to consume. Weight Watchers also encourages a continuing education in nutrition through weekly meetings, which also offer support and accountability. The Weight Watchers program encourages slow and steady weight loss, but like any diet plan it has its dangers....

The main concept in the Weight Watchers diet is portion control and limiting the daily intake of calories. Each food item is given a point value based on the number of calories, fat and fiber it contains. Many vegetables have no points while a piece of pizza will have five or more, depending on the size and toppings. The problem with this system is that it recognizes points instead of the quality of those points. Two points is two points whether is a cookie or a small serving of low-fat cottage cheese with pineapple. The latter is the healthier choice, but the system sees them as equal. It is up to the individual to make healthy choices.

I have some peeves with adding these values to foods but I think I will do a different Blog entry on that though ... I can ramble a bit if you don't know!

Okay, so in the interest of accountability I am going to do a weekly weigh in on here to chart my weight loss. I do like a chart, I'm a numbers geek and proud of it. So here is week one.

I would really love to hear your thoughts on whether weight loss can be achieved in a healthy way when there is a history ED and disordered eating.

Stay mindful xxx

Compassion for my Past Self

What if we looked at emotional sensitivity as simply another way to experience life? I would like to live in a world where there is more than one way to be social. 

The expected way to relate to others comes through external channels, such as other people, home, school, work and the general public. These come with a prescribed way of acting and being. 

But what happens if it’s impossible for you to swallow an approved social remedy? We feel like we are missing out on life because there seems to be a piece missing. We compensate for the overtly stimulating world with coping strategies. I turned to food, study and avoidance. They became the rules by which I could function for a time. They were my compensatory methods for living in a world full of difficulties. In a world which is overwhelming, emotionally over-stimulating, and just too demanding, this was a smart strategy; I had to establish a way I could live amidst a world of social encounters I couldn't relate to. 

Food was my numbing essence, it was comparable to a resolved hug from a caring parent, full of comfort and compassion and unconditional love. I ate until my world made sense again, until I felt the familiar pain and stretch in my stomach that reminded me that I was a living, breathing human being. The food passed my lips like smooth caramel that cascades from high up off a wooden spoon as it’s ladled from a hot sauce pan and falls back into the sweet sticky mass.. I ate to fill the missing piece I lacked in life. I ate until I felt like a full person. 

The release after overeating came like the shutter release on an old manual camera. All it took was one finger gently pressing down on the right spot. The picture of the inside of that toilet bowl will be burned into the back of my mind forever. 

I wasn't a natural academic. I worked hard to find the peace and control good grades offered me. It was a steady focus I could control. It also gave me an excuse to practice my third coping method; avoidance. I arrived to school early most days, and rarely went home before 8 pm  The library and study rooms became my best friends. I loved the stillness; I loved the silence they offered. Finally I found a place that didn't overwhelm me. I had my own small place which I inhabited. Yet due to dyslexia, I couldn't always concentrate on school work for long periods of time, so often I would read or day dream about the stories I read. I became aware through literature how the characters in the books dealt with life. I was drawn into the safety of the stories and the friends I gained by scanning each line. I learnt how to be from those books.

Even when it came to sport, I avoided team games and opted for swimming. It was a solitary exercise. When I put my head under the water, the world became still and quite. The gentle echoes were comforting and safe for me. And this way less people asked questions as to why I came into school so early. I could cry easy in the pool and nobody knew. 

As I look back at my teenage years I can see clearly that I have always been a very sensitive person, easily overwhelmed and highly emotional. I didn't know that then though. I just thought that my general ‘being’ was wrong and non-functional. 

Okay, these coping methods were never going to useful forever, but in a way I am sort of proud of my little adolescent self. She found a way to survive, to live and to get by in a scary lonely world. So now I don’t look back with scorn at my past behaviors  I look back with compassion for a girl who didn't know any other way to stay alive. And in twenty years I will look back on what I will have learnt and see that right now I am doing the best I can do right at this moment. I will always face difficulties, I don't like to think I will be this way for ever, but the harsh reality is that

Pros & Cons of Tolerating Distress

I will keep this short. I have been putting off doing this for so long. It's fairly self explanatory in it's title, but the problems lies in ACTUALLY doing it. I have been avoiding doing this for my target behaviors for months now, so here it goes! I am only able to do one for the moment, but I have five behaviors I need to do this for!

Target behavior #1 - Binging. 

Resisting binge.

• PROS:

1. Feeling of accomplishment over skill use.
2. Saves money.
3. Healthier body and mind.
4. I eat to give myself MORE energy. When I become too full, I LOSE that energized feeling.
5. I might be able to change my state of mind and continue my life normally without putting on excess weight
6. I will learn to experience the distress and deal with it in time.
7. Feeling of self control.

• CONS:

1. I will feel the emotion I want to avoid. I wouldn't feel the 'food high'
2. I will be irritable.
3. I will feel deprived.

Giving into urge to binge.

• PROS

1. Instant relaxation.
2. Comforted.
3. Get medical attention
4. Escape emotional suffering momentary.

• CONS

1. Will trigger an urge to purge.
2. Waste of food/money.
3. Weight gain.
4. Self hatred
5. Only hurts me, pain, digestive issues.
6. Does not solve problem

Target behavior #2 - Purging


Resisting purge.

• PROS

1. Will keep the nourishment from the food.
2. Will learn to deal and manage 'full' feeling.
3. Will give myself a chance to use DBT skills.

• CONS

1. I will feel very high anxiety.
2. I will feel dirty, lazy, ugly, fat.
3. I will have to sit with the distress, and feel all the food in my stomach.

Giving into urge to purge.

• PROS

1. Get 'rid' of food and not gain weight.
2. It is a quick and easy way to get the food out.
3. I feel in control.
4. I know my stomach is empty.
5. Its a way to punish myself for negative thoughts/behavior.

• CONS

1. Will damage teeth.
2. Does not get rid of all of the calories.
3. Makes me feel week from dehydration.
4. Dizziness and headaches.
5. Heart palpitations.
6. Gives me spots, dry skin and causes my hair to fall out.
7. Sleep issues.
8. After a few days - swelling in legs
9. Constipation.
10. Reduced appetite which will lead to further foody behavior 

Regular Eating Pattern

I am having a rough time with my BULIMIA this week, but really, I don't want to dwell on negativity and destructive behaviors in this post. You are an intelligent reader and hence I assume you can understand what devastating effects an eating disorder has on anyone unlucky enough to suffer from one, without the need for me to point out the finite and mostly dirty details. 

Instead, I want the spotlight of this late-night post to shine on a combination of resources which can be used to combat the BINGE/PURGE cycle. I am not saying that I have mastered them all, far from it, but I have tried some with great success. And the way I look at it, at least trying some of these suggestions has to be better than continuing to destroy my body and mind with self-inflicted agony.

The first thing I have (tried) to do is introduce a pattern of regular eating. It is the single most important element of overcoming Bulimia in my opinion. Its different for everyone, but for me it means containing my eating to three planned meals a day plus three planned snacks between main meals. By eating this way it displaces the urge to and action to binge. My approx daily plan looks like this:

 8.00 A.M.: Breakfast

10.30 A.M.: Morning Snack

12.30 P.M.: Lunch

 3.00: P.M.: Afternoon Snack

 6.30: P.M.: Dinner

 9.30: P.M.: Evening Snack

I have left no more than 3.5 hours between meals/snacks as I know that that is my limit when trying to curb binges, and also the ideal time frame to  master EMOTION REGULATION. Any longer and I turn into the wicked witch of the west. Fact. Although this is set in stone, and has to be for my recovery, I do change it up a bit a weekends and if I am out and about at a commitment. Sorry therapist, I have a life. I try my hardest, (but don't always succeed) to not skip any meals or snacks though.

Where possible I do make eating my number one priority each day. My food diary and meal plan also take time, but I realize the importance of monitoring my food intake and being mindful to my emotions around food. I try to plan, plan and plan to plan! This includes having ample amounts of my "safe" foods in the house such as oats, fruit, skim-milk and rye bread. I am comfortable with these foods. I tend to plan the night before what I will eat the next day and jot down some ideas on my food diary. For example, tomorrow I am having Salmon, peppers and quiona for dinner.

I also restrict eating to the kitchen table or sitting room. Never my bedroom. Crumby bed sheets are really not attractive. I try to eat at a table which is out of arm's reach of further supplies of food. And while it might be tempting, and I am so guilty of not following this one, It is important to focus on eating and not distract with TV or internet. 

Limiting my amount of "trigger food" by not having any in the house it a safe bet to stop me impulse bingeing  So I plan my shopping, make a list and stick to it. 

The best thing I find to do when that niggle of an urge comes on me is to get out of the house and not take ANY money with me, and stay out until the urge goes away. This really is my 'go-to' STOP method. But everyone will have something different.

Dance of Life... ZUMBA vs BALLET

Yes you read that right... I went Zumba dancing this morning! Finally a form of exercise where curves actually HELP you get fit! Apart from the fact I am far too 'white' for this class, I found I wore a gentle smile for most of the class. I struggle to recall the last time I smiled so unenforceable and with such genuine enthusiasm. It reminded me of happier times.

Dancing has been part of life for as long as I can remember. These memories are both sweet and sour as any classical dancer will dearly  understand. Being tall and awkward did me no favors in Ballet, and compounded my body hatred, yet the freedom that comes from dancing is hard to express in words. It was an emotional release for me.

In terms of size and shape, my dance class was like a school classroom; there were girls of all different weights and sizes, gifts and talents. There were the tall girls like me,  shorter ones,  skinny girls and larger ones, and then the spot in the middle average girls... the list goes on. When we were younger, we were the size we were  due to hereditary inheritances and the lifestyle we have grown up with. But as we got older, we  became more aware of size and shape, and then constantly worried more and more about it. 

It wasn't easy developing before my classmates, and having to strip off to tights and a leotard certainly made me feel worse. I was put at the back of the class because of my height, and I remember staring at the small frames in front of me, still petite and childlike, and compared my budding breasts and forming hips to theirs. I thought I was fat. No-one told me it was normal, if just a bit early for a girl's body to change that way. I still felt like a child, but looked like a woman and it affected my self esteem drastically.  Did it give me my disorder? the long and short of it is no, but it didn't help me to feel good about my body.

For all the negative aspects to ballet, I still loved it. I was good at it too, passed all my exams and preformed in shows. Not only did it keep me fit, but it stimulated my creative nature and mind. At one stage I was dancing 4 days a week. I would dream of it at night, and made good friends from it. Dancing is a unique form of exercise because it provides the heart-healthy benefits of an aerobic exercise while also allowing you to engage in a social activity. It is also especially stimulating to the mind, and one 21-year study published in the New England Journal of Medicine (Click here for the full link) even found dancing can reduce the risk of Alzheimer's disease and other forms of dementia in the elderly!

This morning brought back the positive internal feeling I loved as a child when I danced, and along with all the benefits listed below, I had fun! 

Why dance? Here's why!

 1. It gives strength to the lungs and the heart.

2. It strengthens the body's muscles.

3. It minimizes the chances of the disease osteoporoses as it makes the bones stronger.

4. It increases the flexibility, agility and the coordination in the body.

5. It increases the spatial awareness. 

6. It enhances physical confidence.

7. It enhances the functionality of mind and the nervous system.

8. It enhances the expenditure of energy and its flow in the body.

9. It can help you loose/maintain weight.

10. It enhances overall well being.

11. It increases levels of self-esteem and confidence.

12. It improves your social-life

So go dance. Go BUILD A LIFE WORTH LIVING!.

Shameful Emotions

"Please not again!"

Today , being Tuesday, it was once again time for my weekly dose of skills training. I have grown to quite like our little routine of learning, and even though some of the other service users do my head in, I am finding myself more tolerant of their perceived annoyances. I am genuinely interested in how they are getting on with their skill use, even when the unrelenting crisis's overtake our sessions (which happens nearly every week!) I am overcome with empathy and understanding for them rather than intolerance and frustration. I like to take this as a sign of progression on my part, as I am not as wrapped up in my own internal suffering as I have been in the past. 

We are still on EMOTION REGULATION and have finished the first goal of UNDERSTANDING and NAMING EMOTIONS. We got given this massive set of notes on the topic of describing emotions and to be honest I didn't read it all, I've had much too much of a crap week for reading such patronizing handouts. I just flicked through it and stumbled across a very adequate-to-me section on SHAME. Its my primary emotion. My weakness. My downfall.

Shame is recognized as a powerful, painful and potentially dangerous emotion,- especially for those who don’t understand its origins or know how to manage it. Unlike guilt, which is the feeling of doing something wrong, shame is the feeling of being something wrong. When I experiences shame, I feel there is something basically wrong with me. I constantly compare some aspect of myself or behavior to a standard and nearly always feel like I do not live up to that standard. Guilt can be positive, it’s a response of psychologically healthy individuals who realize they have done something wrong. It helps them act more positively, more responsibly, often to correct what they've done. But shame is not productive, shame tends to direct individuals into destructive behaviors. When we focus on what we did wrong, we can correct it; but when we’re convinced that we are wrong as a result of shame, our whole sense of self is eroded.

Shame is the substructure for SELF-INVALIDATION I feel. It feeds the drive to 'pile misery on-top of misery' as Marsha would say! When I feel shame, I believe myself unlovable, that I do not live up to expectation, that I am a failure, unworthy of life. With these thoughts circulating around my head, it becomes a good deal easier to contemplate and justify the destructiveness of self harm. Yes I know I have not referred to my ED as self harm before, but in reality, it is, I need to stop telling myself otherwise.

I actively avoid intimacy with others and have only superficial relationships most of the time, which always deteriorate in times of stress. Isolation and loneliness are serious consequences of my shame. Self-condemning attitudes and negative self-talk reinforce the shame and ultimately lead to self-loathing and self-sabotaging ED behavior.

So much goes into expelling the energy of SHAME. The expressions and actions of my shame control my life most days. It could be hiding the after shocks of a binge, or avoiding others, terrified they know about my Bulimia. I often find myself avoiding myself too, switching off, dissociating from my shame, ignoring my emotion.. This shutting down effects me greatly. I spend hours sitting in front of a screen, looking at moving pictures but not taking anything in, lying for hours, not washing, not eating, not peeing, just fighting to push away the shame. 

It upset me to realize this SHAME hold so much power over me. But some glimmer of hope was illuminated during the teaching part of today session when we learned about challenging negative thoughts with the basic CBT model and also the DBT skill of OPPOSITE ACTION.

The idea of exposing myself to the horrible feeling of shame scares me to my core. But the main thing I must remember is that OPPOSITE ACTION is only for when the emotion does not fit the fact. So my challenge this week is to figure out a transgression for which I feel I could practice this skill, engage in behavior which sets off shame over and over. I must also go ALL THE WAY by not apologizing or trying to make up, and change my body posture to look innocent, maintain eye contact and keep my voice steady and clear.

Some ideas I might try;

• Leave a dirty plate in the kitchen overnight.
• Return an item to a shop.
• Ask for help from a friend or family member.

PLEASE take care of your body!

We are back to EMOTIONAL REGULATION this week. I like this module, and it is not too triggering for me either. I am a firm believer in returning to basics during a state of emotional deregulation, so it makes perfects sense to me that I must consistently make sure the base of my emotional pyramid is strong and stable.

The PLEASE Skill is about taking care of your mind by taking care of your body.

PL – Treat physical illness. This is about looking after yourself if you are unwell, seeing a doctor and taking meds as prescribed. I find I am grumpy when sick with a headache or flu, so I am more emotionally venerable. I also get very deregulated around my time of the month, but if I validate my pain and take care of myself I can avoid behaviours which I may not be proud of.

E – Balanced Eating. Okay I’m not going to lie here and say that this is something I do…. I have bulimia. But I understand the theory. Balanced glucose levels most certainly even out emotional responses to situations. Someday I might just be able to achieve this one!

A – Avoid Drugs and Alcohol. I was surprised at how much avoiding excessive amounts of alcohol has helped me to stay out of trouble. All of my suicide attempts have been after drinking too much. I simply cannot over drink until I get a handle on my emotional liability. I don’t miss it too much and certainly don’t miss the hangovers!

S – Balanced Sleep. Sleep is just so important in regulating emotional responses. This has some serious research behind it too. Too little and you are leaving yourself open to irrationality and too much has been proven to increase negative emotions. Sleep hygiene is a bitch but it works. Sleep is a big one for me. If I do not get enough sleep on a regular basis, I get irritable, short-tempered, my judgment is less good and I get upset much more easily. I have to work on it all the time.

E - Exercise. This is another no-brainier, if anyone knows the magic motivation skill for this please let me know! I try to walk/cycle everywhere, and love to run and do yoga.

I guess looking after the basics is the main reasons people go inpatient or into residential treatment, It re-sets a base level from which you can really start to therapeutically manage emotions and behaviours. Most of this is common sense, but for me at least its dramatically boosts my mood. 

Let me eat more Prozac

I am all motivated today. Maybe its the increase in medication. I saw my Consultant Psychiatrist yesterday morning and we agreed that I have been tolerating the 20mg of  Prozac (Fluoxetine) well enough for the last two months to double the dose to 40mg. The plan is to gradually get up to 60mg which is the evidence based dosage for bulimia nervosa. According to Healy D (2004) Let them eat Prozac. New York: New York University Press. pp 124–148.

"Fluoxetine dramatically, by 40-50%, decreased the frequency of panic attacks in two controlled trials of panic disorder patients. In three double-blind trials, fluoxetine significantly decreased the number of binge-eating and purging episodes of bulimia nervosa. Continued year-long treatment of the patients, who originally responded to fluoxetine, was more effective than placebo for the prevention of bulimia nervosa episodes."

I have to say that I am somewhat at ease taking a drug which has so much empirical research to back it up. My Doctor instilled confidence in me that I will see results when the dose is high enough. She described how she has seen it herself and has faith that it will work in conjunction (of course!) with DBT.

I feel a lightness coming back to my sprite. As if the fog is clearing and I can breath easier. It is most certainly due to the three pronged treatment approach (medication, DBT, and the right attitude.) Without each of these aspects in my treatment plan I have seen the devastating result of self destruction.