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

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. 

What my recovery looks like to me

It is soon approaching Eating Disorders Awareness Week (20th-26th February 2012.) And it was suggested by a fantastically inspirational Blogger and You-Tuber; Rachel who's Blog Lost in Translation can be found here (I highly recommend you check her out!), that I write a bit about my reasons for recovery, what it looks like to me and why it is worth it.

To be honest I find this topic quite difficult to write about, because, beneath the obvious (and equally important) surface reasons for recovery such as improved health, emotional stability, a meaningful life and mended relationships there is a unfathomable search for who I am, my genuine self, which until found, will always compel my ED to rear its none to pretty head again. This is what my recovery looks like to me. It is the arduous search for, and discovery of a true identify not associated with my eating disorder and a conclusion which sits happily within my heart.

I am still most defiantly searching, and for this reason I do not consider myself recovered, even though I am ‘Clinically’ recovered from the criteria which bind me to a diagnosis. I am still scaling the walls of the dark well of my eating disorder, but I now have a torch, a pick and a rope and am clawing my way out, slowly.

I am quite enjoying finding out whom I am all over again. It’s great to have the opportunity, a wonderful mental health team, (some) support from my family, the head space and physical health to fully apply myself to this life-changing task. It is a full time job, and much like Gretchen Rubin, who spent a year exploring what her life meant to her and what makes her happy through her ‘Happiness Project’ blog (Another MUST READ!) I am allowing myself the time this year, and possibly even next year to find what makes my life worth living, what will get me out of bed each morning, what makes me happy.

I have been told that every fragment of your personality, your "self," serves to create the whole of your genuine self, therefore I do not ever want to forget my illness or the profound effect it has had on me, so, for me recovery is not about leaving ED behind and closing the cover on that part of my life. Instead, by acknowledging it and RADICALLY ACCEPTING that it has been part of me, that it happened, and that it was, at one stage the only way I knew how to cope, I can find solace and strength to search for a better way to cope with the emotions which fuelled it.

The genuine self is going to look and feel different for every single person, but the one thing that all will have in common is that the genuine self is the recovered self. By creating and accepting the genuine self, we become functional, healthy adults capable of facing life’s hurdles. 

Your genuine self will be unique to you. You may share similarities with some folks and be extremely dissimilar to other folks, and yet both groups of people can be your friends. When I have solidified my genuine self, I hope be able to recognize that everyone else around me also has a genuine self. People need not share the same thoughts, beliefs or opinions on any subject, let alone all of them. By embracing my own genuine self, I’ll suddenly be free to embrace the genuine selves of those around me because they will no longer represent a lot of work – I will no longer need to change them or convert them to your my of thinking. I’ll be content to allow them to be exactly who they are while I continue being exactly who I am. And if, or should I say when, I encounter someone who wants me to change, I’ll weigh their request against my genuine self and be able to determine whether or not that aspect of me is open to change or not. Sometimes these scenarios might mean that a particular person will chose to avoid me because of my refusal to bend to their wishes, and my genuine self will be okay with that. I’ll know that their boundary was unhealthy and that it’s probably best to end the association with that person.

The genuine self, for me at least, is really a remarkable sense of inner peace and tranquility. It doesn’t mean that I’ll have earned a pass into Nirvana or Utopia. Nor does it mean that my life will be a constant state of "smooth sailing." There will still be upheavals, fights, moments of extremes – that’s part of life and it cannot be changed. With the solidity and security of my genuine self, though, I will be able to weather those ups and downs with the calm and peaceful understanding that, no matter what, I will conduct myself in accordance with the beliefs of my genuine self.

This is what my recovery looks like to me, and remember, your picture will be different and unique and life-changing and most of all, deeply personal to YOU. 

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. 

Black and white thoughts, searching for the grey!

Today I was faced with a stark reality check.  I do not have the objective ability to have a balanced view of situations and am thus ruled my my dichotomous thinking. 

Under extreme stress, I find it can be comforting to oversimplify.

I will eat, or I will not eat.

I will live, or I will die.

This rational streamlining allows a sense of peace in the midst of turbulence. Yes, there are plenty of things that are black an white. Simple things. Is the toaster plugged in? Is the door locked? 

But the reason we have words like maybe, probably, partial, more, less, etc. is the grey is all around us. Everything has details, data, different ways to present and interpret the details and data, these different ways of presentation and interpretation is what causes grey.

When the stakes are not quite so high, perhaps a little room for the middle ground would be advisable. There are more choices than you think.A little "wiggle room" goes a long way when navigating through people, events and circumstances. Very little in my own life has ever been distinctly good/bad or black/white in any way, shape or form. Most things are just a subtle shade of gray when examined closely.

So much of the world is best described in an analog way not a digital way and definitely not in the binary way. So much is best described as a continum: I will not eat, I will eat a tiny bit, Iwill eat a moderate amount, and so on with an infinite variety of amounts.

Either / or is just the easy way out. I must leave a little room for humanity to breathe. If the middle ground is removed, how many of us still stand? My life is too complex to be able to discount gray areas in order to accommodate absolutes built on foundations that aren't solid simply because I am are either too fixed in my ideologies to be able to critically assess a situation or too intellectually lazy to do the heavy lifting, so to speak, when it comes to handling difficult ethical dilemmas, I simply use a catch all.

Prozac Mind

Oh wow, what an odd week this has been. Trepidation and deregulation have burdened my mind with troublesome thoughts, causing me to suspend life and live apprehensively, awaiting some unforeseen dreadful event. The sensation lies deep in my thoracic cavity, somewhere between my heart and soul, like a boil ready to burst and spread its nasty disease to all unlucky enough to be nearby. 

My family are worried, heck my WISE MIND is worried too, but at both ends of the pole, the two destructive EMOTION/RATIONAL MINDS are at war. Devoid of emotion my RATIONALITY states that “all is lost, there is no hope, no-one wants you around, and no-one even likes, let alone loves your fat ass!” With that spurring it on, my EMOTIONS are loaded to attack and pounce on an opportunity to destroy myself with all the vigor and drive needed to succeed. So what’s stopping me? 

My exhaustion is. I have barely made it out of bed all week, too afraid to even go to the kitchen or bathroom for fear that something will happen, afraid of others and ashamed that they might see me this way. Surface to say, food is not high on my agenda. I haven’t eaten a real meal for days, and I am scared at the all too familiar glory I feel from my hunger pains. “Success!” whispers my ED in a snaky slighter of a voice! “Keep it up and soon you won’t feel anything except thinness and happiness!”

As long as I can stop myself from binging I think I will be ok, just until I see my Consultant on Monday and therapist then too. Just have to keep myself safe and out of the kitchen, away from temptation. Restricting is less destructive for me than binging and purging.

The dose of Prozac (20mg) makes me nauseas anyway so eating is not all that appealing to me right now, Add the intense anxiety I feel and a weak stomach is an understatement. Food repulses me at the moment. Long may it last!

Emotional Stability at Christmas

Christmas is a stressful time. Even those without a mental health problem find the holidays difficult to get through, so it goes with out saying that, when an eating disorder is thrown into the mix too, there are bound to be problems.

For me and many others, there is a sadness, grief and loneliness behind my Christmas cheer. My disordered family is thrown together and the intensity nearly always bubbles over into arguments and squabbles. I am deeply ashamed to admit that there is still a stain on my family home's sitting room wall, where I threw a glass of wine at my sister one Christmas, missed and instead imprinted a cherry red mark on the cream wall as a memento of my rage!  

Late nights, rich food, extra alcohol, traffic and crowds, shopping and finances, cooking and cleaning and all the other tasks of Christmas, all make this time of year a protracted emotional time.

There ARE a few things which DBT offers us for a successful way to ride the holiday wave. I personally am concentrating on  COPE AHEAD. The more I plan for and organize the less likely that something unformulated will shock me into an emotional backlash. All my clothes are washed and outfits put together. I have made plans for friends to ring me on Christmas eve, Day and Stephen's day as supports and handy excuses from the dinner table. 

I am putting together a wellness toolbox to bring with me as part of SELF SOOTHE. This box is a little like what you might bring to keep a child entertained on a long car journey. I have knitting, coloring pencils and paper, magazines and books. I also have my DBT notes and MINDFULNESS exercises. I have 6 reminders on my phone which simply say 'Check-In'. these are to remind me to recognize my anxiety and take regular MINDFUL breaks throughout the day. I find things always seem less overwhelming after a few deep breaths.

I will also be practicing RADICAL ACCEPTANCE. I need to have realistic expectations. My family will not suddenly change into the perfect Brady bunch overnight. And if I can ACCEPT that my family are not perfect I think I have more of a chance of dealing with the potential holiday fallout.

I plan on respecting my values. I do not want to compromise my recovery 'just because' its Christmas. I am going to eat intuitively. So if I am hungry and dinner is not ready yet... well sorry, but I will eat anyway! 

Christmas is supposed to be a happy period and therefore a perfect5 opportunity to make new better memories for future years, so ACCUMULATE POSITIVE EXPERIENCE is another skill. I am going to spend time at the end of the day to reflect on what things went well and add them to my positivity book.

Are there any other tips you guys have?

MERRY CHRISTMAS EVERYONE xxx

RADICAL SELF ACCEPTANCE

If I let myself, I may start to believe that the magazine cover girls (whose photos are air-brushed and trimmed in, mind you!) are the norm and that the rest of us are somehow deeply flawed. What I get then is the soundtrack of "I hate myself" or "I hate what I see in the mirror" playing over and over again in my head, fuelling my endless dieting cycles and painful frustration.

If I am to have any measure of success, it is crucial that I permanently press stop on that soundtrack and work to genuinely accept my size and, by extension, myself. For someone who has been listening to this self-disgust soundtrack forever, size acceptance is pretty scary. Does accepting yourself the way you are imply that change may be impossible? 

What I am trying to say is that; denial is not acceptance. Rather, self-acceptance means adopting a NON-JUDGEMENTAL STANCE toward yourself. It's the ability to see things as they are in the moment without harmful, self-critical voices interrupting your view of yourself.  Self-acceptance is instrumental to reaching your healthy, natural weight. Size-acceptance means focusing on the things you like about yourself while working to modify what you don't like.

This process is at the core of the dialectic of CHANGE/ACCEPTANCE. If I get back to a DBT skill of weighing up the PRO'S and CON'S of tolerating distress, I must ask; "How well has not liking myself worked so far?"  The truth is, it hasn't. In fact, if I dislike my body, it's that much easier for me to abuse it.

If I try to apply this to my own life and situation, I feel less able to be as practical as is needed to fully commit to this. Maybe the skill TURNING THE MIND might be of use here as I prepare myself for acceptance of my body. I must turn my mind towards accepting the reality that my natural weight and size are not what I feel they should be. I am not part of the 5% of women who are long, lean and have model measurements. Therefore I must commit to choosing that my reality is that I have hips and broad shoulders which are all part of being a woman.

I am not happy with my legs, they are riddled with varicose veins and often retain water. That is a fact. Starving myself is not going to change it. So for today, I am making a commitment to RADICALY ACCEPT that these things are part of me, I may not like them, nor say that I am happy about them, but they are there.

RADICAL ACCEPTANCE

I often wish I could change the past and make it perfect. I feel like I am attempting to paint a masterpiece of which I am so proud of and is so wonderful, but the ground work for it has been tarnished and what went before has destroyed the base that I now am working off. But in reality, ‘perfect’ is a fallacy, because, no canvas is ever bump free, and anyway, why would anyone want that? There would be nothing to catch the light!

I understand that there is nothing that anyone can tell me to make my past seem more perfect, because, in short there is no way for that to happen. Here is where the skill ‘RADICAL ACCEPTANCE’ can help, if I could only get my head around it.

The introduction of this skill was very turbulent in our group, with many willing to learn about it, but in practise not quite able to put the skill to use just yet. I personally can see the benefit of acceptance, but every time I try to apply it to my life I am met with a niggling voice, complaining that I shouldn’t sit back and accept all the injustice in my life, I should stand up and make noise about it! Give out, make a scene and don’t take it lying down!

So what is ‘RADICAL ACCEPTANCE’? It is an honest acknowledgment of what is going on inside you, and a courageous willingness to be with life in the present moment. You can accept an experience without liking it. In fact, let’s say you are feeling stuck in anxiety and disliking the feeling. RADICAL ACCEPTANCE includes accepting both the feelings of anxiety and the aversion to it. In fact, acceptance is not real and not healing unless it honestly includes all aspects of your experience.

The difficulty with ‘RADICAL ACCEPTANCE’ is that it requires patience and ability to be present with your own emotions. Both of which, for me, are very hard to learn also.

I find that at the moment, all I can do is be happy with what I am trying to achieve right now and be proud of every little achievement I accomplish that I wouldn't have been able to do skilfully before. All that matters, in reality is the here and now, you have to be here now in order to live now! The past is nothing that we can work with, and in a perfect world, nothing that we should concern ourselves with.

Things of the past have influenced me as a teen, a student, a daughter, a sister, a friend and now as a woman. The past most defiantly still influences me and the person I have become. Therefore I cannot simply put it out of my head and forget about it. It is part of me.

I also think that as I have gotten older, I have learnt the importance of reflection. Take for example, my situation with University; I often feel it unjust that my fellow classmates have all graduated and are now moving on to exciting careers and new stages in life. I have felt that that is where my life should be, that I am a failure for having to drop out two years ago when I became unwell. It reached the point that I could not be there as a friend for them and congratulate them on the amazing success of completing a degree in Occupational Therapy. I was green with spite and envy. I denied myself the opportunity to be happy with them in their success and lost some friendships in the process.

If I am to apply the skill of ‘RADICAL ACCEPTANCE’ to this situation, I must change my reality of the situation. Okay, I may have had to drop out, move home and be admitted to a mental hospital for five months. But I wouldn’t be getting the help I am now if it were not for that series of events. I would not be facing up to my problems in the hopes of someday living symptom free. That series of events HAS happened and cannot be changed, I CANNOT turn back time. All I can do is deal with events which crop up NOW, in this moment and plan to cope with those that may arise tomorrow. Notice how I am not saying it was fair that I have this mental illness, or that I like it (in fact, I hate it!) I am simply acknowledging that it is something that happened and that I can do nothing about other than work my hardest now so that it does not continue to affect my life in a negative way. It doesn’t mean that the feeling is “right” or “wrong.” Nor does it mean that I must be passive, and not take actions that might be helpful.  ‘RADICAL ACCEPTANCE refers to my relationship with the reality of “what is” in the present moment. By arriving honestly and with openness to this moment’s experience, I might just have a chance to create the possibility of then responding with wisdom and compassion. 

These big things in my past are my biggest barriers, my biggest burdens. But, it is more so my attitude towards these big things in my past that hinder my recovery.

Mindfulness In Action

'Serenity' 

Remember when you were a kid, and you got a new toy for Christmas or a birthday, and the whole world of time stopped while you played and became totally engrossed in the process of discovering how it worked and what you could do with it? Well, after my not-so-successful attempt to PARTICIPATE in a mindful eating exercise earlier today, I remembered how I used to get so involved in arts and crafts that time would slip away before I knew it. 

Until recently my ability to concentrate on a hobby or on anything much was zero-to-none. And while I was acutely unwell I simply just did not see the point in trying. But I slowly built up my tolerance and frustration since those lonely fives months in hospital and began to partake in activities which tested my concentration. Most notably reading and writing, but art is also one of them. 

I dislike doing things I am not very good at, and oftentimes I will not do something at all if it will only turn out mediocre. My judgments of myself get in the way. Therefore I was surprised to find out this evening, that I really enjoyed drawing this picture, so-much-so that I found myself lost in time for a little while. I was PARTICIPATING. I was so fully engaged in 'the flow' of drawing, that 20mins were happily spent mindfully attending to each stoke of the pencil on the smooth paper. I had to make a choice as to which color to use and where to put a mark on the page. 

For 20 mins I wasn't annoyed by unpleasant thoughts. Of worries about the future, or flashbacks from less happy times. I wasn't afraid of the food slowly digesting in my stomach or planning ways to rid my body of the calories. I was simply present in the moment, participating and acutely aware of how I was doing it.

'Participation' Is Torture

This week we have been set the goal of in incorporating the 'What' Skill (from the Mindfulness module) PARTICIPATION into our everyday lives. Thing is, with every good intention of being a diligent member of DBT group therapy, I made a plan. But annoyingly, I keep forgetting to fully participate in a task in order to be mindful to my experiences. 

"I used to think mindfulness is some form of passive observation… it is NOT passive.  In fact, mindfulness requires you to be both the participant and the observer simultaneously.  In this way, you are the observer of your experience at the same time as you are the experience itself.  As thoughts, feelings, and sensations naturally arise, they arise with the same vessel that observes them.Mindfulness is not a denial of your experience and a retreat into nothing but detached observation.  It is a type of open observation that is experiencing that which it is observing." Laura Schenck MA

Some skills from DBT are like little treats for the soul, while others are more akin to TORTURE! This is one of them. When you are fully awake to an experience you have actively spent a good proportion of your life trying to avoid, it is not a nice experience to then have to be aware of all the unpleasantness.

Does that make sense? I can't seem to explain what I mean in the way I want to. For example, a way I have tried to incorporate participation into my life this week, is to fully engage in eating. I really tried hard to experience every morsel of food. To taste the differences between sweet, bitter and salt. I noticed the variances in temperature and texture. Then I switched from external stimuli to the internal. To my thoughts, judgments and emotions.

Here is where the problem with this skill arose for me. No matter how hard I concentrated on noticing my thoughts, there was a strong resistance to participate in the task any longer. It was too hard to observe, then describe, then participate with eating when my head was screaming floods of guilt. 'Fat cow' 'You have no self control' 'You will be alone forever' 'This is what you deserve, fatness and unhappiness' .... 

This skill needs practice I think. And its not what I want to do. Its hard and annoying, but I guess if I was to pull from another skill, and weighed up the pros and cons, is it harder to live with an eating disorder or to just practice this skill?