Time for change

I messed up again today. Again and again and again. I'm dizzy with regret and the sinking, empty feeling of hopelessness and wondering if this eating disorder will ever be past tense.

Last night, I went out with P to the local bar for dinner. I managed to eat the lettuce out of my salad and half of a plain black bean burger. Much more eagerly consumed though, were the 3 drinks, enabling the inevitable purge of said dinner. We had an excellent time and I met everyone at the bar, just like my old fun, funny, and infectious self. I was happy and animated despite messing up all day yesterday, something I've noticed as treatment has progressed. My mood is generally better and I'm overall happy, excited, and so much more stable, even if the day isn't perfect. We went to bed buzzed, early, and in love. I am lucky to have this wonderful person in my life and continue to remind him as much as possible. I would not be in treatment if it weren't for him.

I was already anticipating a rough day today in treatment today after resolving to give up my resistance and accept the consequences, but I could not bring myself to go to treatment this morning. I call the treatment center at 6:45 am. I can't come in today. I think I'm sick (again). I seriously doubt they're buying all of my sick days, but in my head, I see today and this weekend as a last resort before accepting treatment like I promised myself I would. P leaves for work at 9:00 am and it's off to Kroger I go, a premeditated binge and purge already ingrained in my mind. I woke up in the middle of the night several times, the consequence of too much to drink, and planned out exactly what I'd purchase - what I'd eat on the way to the store as a marker, what I'd eat on the 3 minute drive back.

In the future, I cannot plan binges and purges when left with an opportunity to be alone. Once I plan, it's incredibly more difficult to resist. Once I can envision the taste of the food I'll allow myself, there's no way in hell I won't eat and eat and eat. This is something I really need to figure out, make a plan in writing, and stick to it, if I ever want to recover 100%. Which I Do, So Badly.

Despite having the opportunity to binge and purge for an entire workday, I get lucky today and it's only two cycles. That is, however, two days of binging and purging in a row, a huge deviation from my week-free streak. After it's over, I take a nap, full of nothing but Powerade Zero and a drinking and purging hangover. My mouth still hurts, when I wake up, and even now, hours later. The calluses on my right hand are especially prominent. I'm afraid the skin around my mouth is visibly and noticeably chapped and red. I'm physically a mess. I drag myself to the gym and hammer out 45 minutes on the eliptical, then 8 miles on the treadmill. P comes home and I walk the dog for another 2 miles. 16 mile equivalents. I haven't kept anything down today. I'm sitting on my computer, blogging and drinking my sugar free chai with booze now, but with dinner in the fridge. When will my heart stop? Probably soon. I must eat.

So, Monday will be the day I start fresh and actively participate in recovery. Is that what I'm going to keep telling myself? That's the way recovery went when I was on my own - I'll do it tomorrow, this weekend, next week, next month. I can't live like that. I can't live like this. Time for change.

Giving in to treatment

Well folks, all it takes is 2 inches of snow, the shutdown of an entire city, the recognition of an overuse injury rapidly developing, and a few minutes of free time to reflect and realize I haven't truly accepted treatment for my eating disorder. I have been cutting any and all corners, continuing to destruct, and forcing my boyfriend to hear me purge our homecooked dinner. I cry after, overwhelmed and hopeless, collapse on the couch, and simply give in.

Yes, I have a severe and destructive eating disorder called anorexia nervosa. The end of my snow day yesterday was spent throwing up my measly 300 calorie dinner and any snacks to follow. I am a slave to this routine, no matter how much I think I've accomplished in treatment. I ran 11 miles, walked 4 more, and kept next to nothing down. Where is my dedication and resolve? Where has my motivation and positivity escaped to? Will I ever get better at age 26 with the ability to bend over and empty myself completely, as naturally and effortlessly as breathing or walking?

Today has been no better. I write from the eliptical, having already walked 6 miles, run 4, and binged and purged in the solo-occupancy bathroom at school since everyone else is at home, relishing their second snow day. Tomorrow I am going to wake up and run my 6-6.5 miles before treatment as usual, but I'm not going to drink a diet soda and a 40 ounce Nalgene of hot tea on the drive in, wear 3 shirts and 2 pairs of pants with keys and a cell phone in my pocket for weigh in. I am going to accept whatever results from abandoning my usual routine and start fresh, honest. No more skimping on my 2 tablespoons of butter, choosing the lowest calorie options for all snacks and meals, purging Boosts in the parking lot corner, or projectile vomiting lunch onto the interstate on the drive home. I will come home from treatment, painfully full, but compliant. I may walk the dog for 4 more miles if the weather is nice, to exercise her, not myself, and I will not run or eliptical another mile. I will eat dinner. I will keep dinner down. 

I will hate all of these compliant changes, but I will not be actively wasting my money and time in treatment. If I cannot do this, I will lose my boyfriend, my mind, and potentially my life. If I cannot do this, I will accept residential treatment. I cannot stand to live like this while everyone else lives their life at a normal BMI and happily. I'm terrified and I do not know of what. This is low. This is bottom. Nowhere to go but up.

Tips to reduce the binge/purge urge

Snow day alert! This means two important things. The boyfriend's white dog looks brown and I have a whole day to blog and reflect!

Today, I want to focus on several tips we discussed yesterday at treatment to reduce the urge and ability to binge and purge. Since this topic hits very close to home for me as an Anorexic binge-purge type, I was really interested in the discussion and hope to provide some helpful hints to anyone who may suffer from bulimia or is prone to binging and purging.

I've discussed briefly in several previous posts how triggering the process of weight gain and eating a lot of calories is to my binge/purge habit. Yesterday, sitting on the couch with P, I delved a little deeper into my binge/purge issues. I told him I didn't want to open a bag of mixed nuts in the kitchen on account of I'd want to eat the whole thing. He laughed and said, that's what you should be doing! It certainly makes sense to someone who doesn't know the extent of the problem and only knows you need to gain weight to eat a lot of something with a lot of calories. 

Unfortunately, eating an entire bag of mixed nuts, calories aside, would not work for me. It's practicing the binging I'm so prone to, and also not practicing self-control and preventing the loss of control feeling associated with binging and purging. Instead, I need to learn to listen to the new hunger and fullness cues that I've been experiencing through treatment. Hunger cues are wonderful and I'm actually excited to be writing this blog at 11:20 am (after having breakfast around 7:00 am), and feeling hungry again already, without having exercised. I feel comfortable relying on them to accurately instruct my body on how much I need. In the beginning of treatment, I was never hungry, though I'm not sure if this was my eating disorder or my half-starved body speaking. Regardless, this is no longer the case, and a huge achievement for me. 

For those of us prone to binging and purging, binging, or purging through self-induced vomiting, here are some of the tips to reduce or prevent these urges. Some are very small, but may have some impact on your process to recovery, even if just preventing an episode for 15 minutes. 

Preventing the opportunity to binge/purge

• Identify what time of day and what situations you are most prone to binge/purge.
• Plan activities, outings, events, anything to keep you busy for every 15 minute increment during this vulnerable time.
• Schedule someone to be with you at all times. Do not let them let you out of their sight.
• Choose an accountability partner. Take them to the grocery with you while shopping, or go alone but take a certain amount of money that won't allot purchase of binge food, or provide your accountability partner with all receipts.

Preventing the urge to binge/purge

• Wear a ring(s) on fingers you use to self-induce. This very simple trick has helped me tremendously.
• When you feel the urge, sit with it for 15 minutes. The feeling can subside if we use mindfulness, deep breathing, meditation, relaxation, etc in these 15 minutes and you may feel less of an urge.
• Get online and read a recovery blog like this one. Or check out a Youtube channel like Kati Morton, an excellent and free resource.
• Listen to my recovery playlist or make your own.
• Think of the consequences of your actions on yourself, on others (significant other, family, kids), on your recovery, on your long-term goals.

Keeping yourself safe if you do binge and/or purge

• If you slip up and binge, do not purge. This sounds crazy to me at this point, but it's something I've considered if I have another slip up. If you don't purge, even once, following a binge, your body will feel so uncomfortable you may not ever want to binge again.
• If you do purge (and I am certainly NOT promoting this behavior at all), please replenish your body of lost electrolytes immediately after. Drink pedialyte, gatorade, powerade, or another electrolyte containing beverage as soon as possible. Stay hydrated. 
• Reach out to a friend or your treatment team. Stay safe. 

I hope some of these tips are useful if you're struggling with urges. It's SO difficult to overcome, but you can do it. Today marks one week of being binge/purge free for me - the longest streak I've had since this disease set in many years ago. I think that calls for a snow day celebration!

According to plan

I wake up this morning after a difficult day and, guess what? It's a new day. That's the beauty of recovery, or at least a part of recovery that I have come to accept. It's not black and white and it's not all or nothing. If you're not 100%, you're still on track to getting better.

Recovery is a spectrum, a scale spanning mentally and physically sick to mentally and physically healthy. Between the two extremes, a clear definition of eating disordered or recovered does not exist. That means a rough day and a rough evening do NOT equate to failure, nor should slip-ups provide grounds to simply give up. Instead, slip-ups or bad days or even a bad week equate to getting back on track, identifying triggers and how you diverted from on track, and, most importantly, believing recovery is still always possible.

Anyway. I'll step off my soapbox for a moment to explore how today went compared to yesterday. I wake up at 6:42 am and immediately check the weather since we're in the south, expecting snow, and thus the end of the world. No such luck so I enjoy my treadmill workout, pushing hard for 6.5 miles, checking the forecast to monitor the impending "snow storm", and relish in the fact I'm hangover free! Treatment isn't cancelled by 8, so in I go.

Another new woman starts today after bumping down from inpatient literally within the last 24 hours. She's an older woman with two teenagers and her stories break my heart. Her stories, struggles, and experience, which we hear a limited amount of today, already inspire me to beat this thing into the ground before I, too, have 25 years of hell under my belt. I've been in inpatient or day treatment for almost a month and half now, and this is by far the best group I could ask for. It continues to amaze me how strong, beautiful, and intelligent these women are, whether they're struggling with anorexia, bulimia, EDNOS, or binge eating. It amazes me how similar our struggles are, as eating disorder patients and as women.

Inspiration is followed by morning snack. I get by on the lowest calorie options at all meals, a habit I can't let go of since I"m a Registered Dietitian and out of pure desperation to have some fraction of control. By the end of our second morning group, the snow is coming down in flurries and we're rushed to lunch. Today is prepare your own wrap day and we're instructed to fix your lunch and take it to go.

I'm elated at first. Leaving early! No afternoon snack! NO AFTERNOON BOOST! I don't have to eat my lunch! After managing 560 calories for breakfast and snack, I'm on a restrictive roll. Til I jet out of treatment and hit traffic, the start of what will be a 3 hour drive to crawl the 18 miles home. For the duration of the first part of the trip, I grip the wheel, my lunch starting a hole in my brain and stomach from right beside me. My stomach growls, a sign that treatment is fixing me and equally stimulating the overwhelming urge to stop at a grocery store, restaurant, or what the hell, that gas station to binge and purge.

I'm in tears for most of the trip home. So much time wasted; so much frustration at traffic, food, and myself mounting; and so much emotional drain. I am starving by 2:30 pm so I eat, dumping the contents of lettuce, tomato, cucumbers, cheese, and hummus, but eating the whole spinach wrap itself without being forced to like I am at treatment. I keep it down, tears sliding down my frustrated face. I still keep it down. It stays through the entire digestive tract, hitting me now in the form of toxic refeeding flatulents as I cheerily walk on the treadmill at the gym. The man next to me gets off his treadmill, nose turned upward and eyes squinting. I laugh. Success.

Support is all around you

Today has been up and down and sideways and backwards and forwards and all around. It's almost hard to believe it's the same day that started off with such a strong 6.5 mile run at 6:55 am.

At treatment, I've found meal plan B to be do-able. Boosts, on the other hand, are certainly going to take some getting used to. Today, I managed to forgo Boost until afternoon snack which occurs immediately before departing, thus problematic to say the least to a prolimic. Particularly one keen on purging liquids. Chug Boost, say goodbyes, bring Boost (with most of today's lunch of cheesey, buttery, broccoli baked potato and apple) right back up in a gas station bathroom.

I cannot let this happen regularly, or at all moving forward.Today was too much at once... a bump up in the meal plan, the addition of Boosts, a baked potato lunch that racks up a whopping 1300 calories without butter, and a number to the goal weight - 115. Woof.

Regardless of the major fail after treatment, I can pick myself up and recognize that several important, positive things also happened.

1. My individual therapist commended my progress and let me know the treatment team will be discussing how I progress from here - if it's nearing time to bump back down to outpatient. Finger's crossed here.
2. Masks today in art therapy! Behold the transformation from Vaseline face to mask! 
   
   
   
   
   
   
   
3. After treatment, I met with the director of one of my doctoral programs (I'm in two - Nutrition and Health Sciences is my "home" program, and also Molecules to Mankind, geared to those interested in translational research). Anyway, the director responded to an email I sent announcing that I'm taking a leave of absence from school and voiced concern. It became clear through our correspondence that she's also suffered from disordered eating for years. She's also an overexerciser. We chatted for an hour over coffee and I feel like I've gained a great source of support, knowledge, and experience. 

Steps backward seem to be accompanied by small steps forward at this point. If the weight gain is the only barrier between staying in day treatment and bumping down to outpatient, I'm just going to have to suck it up. Here's to a better tomorrow and no more baked potatoes for a long, long time.

Weekend Struggles

During day treatment, also called a partial hospitalization program (PHP), for an eating disorder, there's a lot of free time. Residential treatment centers allow no freedom to patients - you are constantly monitored, constantly scheduled to be somewhere, have no time to yourself thus no opportunities for slip-ups. In day treatment, we leave the treatment center at 2:30 pm on weekdays and since I'm on a leave of absence from school, I'm left to do what I please. The same is true for weekends.

It's an easy scenario to fall completely off track. Yesterday was Saturday and looked something like this. Wake up at 9:00 am. Make a sugar-free chai latte with almond milk, 45 calories, and eat a tiny handful of peanuts, no more than 50 calories, and do work even though my dissertation stipend has been suspended for now. At 11:30 am, run 10 miles at a 7:00 minute mile pace. Come home energized and feeling great with an awesome lunch restaurant in mind, since I haven't stuck with my meal plan at all today.

Instead? Drunch has been planned in my absence. Drunch is drunk brunch. The restaurant offers brunch food and very cheap mimosas. There are 4 of us and we drink 4 bottles of champagne and 2 fireball shots a piece. I eat 4 sweet potato fries and half of a caprese sandwich, picking out the mozzarella and reducing it to tomatoes, basil, balsamic vinaigrette, and the restaurant's (thankfully) thin wheat bread. 

Drinking does two things to me. It reduces my appetite to nothing, giving me an excuse to be full on booze and not hungry.

Alcohol also reduces my desire to come across as normal with my eating habits - essentially making me not give a shit that everyone sees me restricting.

At 4:00 pm, we are finished with "brunch". My boyfriend (I'll call him P from now on to make him seem more real to you readers), takes us on a tour of our neighborhood to house hunt. He is going to buy a house soon, which is very exciting, and a fun way to spend the afternoon with our two friends, who get really into it. After, everyone is tired from day drinking so we nap.

I wake up at 9:00 pm with a hangover. I pick at snacks... popcorn, peanut butter crackers, cereal... all of which come right back up. Purging is so easy when you're hungover and eating food with liquid. I don't even use my hands anymore, making it such a destructive, addictive, and impossible to overcome habit in recovery. I go back to bed. At 2:00 am I wake up again. The hangover still exist, but has quietly subsided. I prepare a bowl of oatmeal. Eat it. Vomit. Not pretty. I crawl back into bed, a sad and defeated mess. P cuddles me up and we fall asleep until now.

This is not a good day for me. I did everything wrong. Overexercising, drinking til near blackout, severely restricting food intake, and purging anything I ate in the evening. While I am proud I did not engage in binge/purge like many previous weekends, I am still very disappointed in this. I am already facing additional Boosts at treatment this week to speed up weight gain, something I've literally had nightmares about this weekend, and drinking/not eating/purging the weekend away is not going to help with weight gain.

Where do I go from here? In recovery, I am trying to learn from my mistakes and create action plans for future similar situation. Next weekend, I will say no to drunch, and instead voice my opinion about where I would like to go, what I would like to do, how impossible it is for me to "just don't drink that much". I have already figured out that scheduling meetings during the week around 3:30 pm or 4:00 pm for school or the various projects and activities I'm involved in helps reduce engaging in symptoms after day treatment, so I will continue with that. 

I will not consider this weekend a complete failure. I do recognize a very small, and mostly insignificant in the scheme of things, successes.

• I only ran 10 miles yesterday. Most days, this number is more like 15-16.
• I ordered a caprese sandwich with sweet potato fries because that's what I wanted to eat in the moment. Didn't eat much of it, but still ordered what I wanted, not a salad. 

Small steps, people. We can do this.

Weight Gain Plateau

Hello ladies and gents. Another good day under my belt, even with some unwelcome news at the end of the day. In the past, unexpected stress-inducing news would have sent me into a tailspin of binge/purge, restricting, and running 12,000 miles. Today? It didn't really affect me.

First, the unwelcome news. My weight has plateaued. At what? I have no idea. I do not wish to know my weight, as it's extremely triggering, and not all that important to me. The dietitian blames this on the increased metabolism that accompanies weight restoration, but I know it's because I can't incorporate any more clothing layers before morning weigh in without this.

Refeeding is a tricky process indeed. Severe restriction of calories slows the body's metabolism greatly. The body conserves as much energy as possible for essential processes - keeping your brain, heart, organs, and peripheral muscles functioning. Everything else slows down. Metabolic rate [non-science speak: the amount of energy (calories) needed to simply exist], lower blood pressure, lower heart rate. Low and slow. 

Non-eating-disordered women in their teens to mid-20s may burn up to 1500 calories just being. Add activity and you've got a lot of calories to eat just to maintain, girl. Those who restrict experience a decrease in metabolic rate. During recovery, additional calories may shock the system at first, a dangerous phenomenon known as refeeding syndrome, but once the body becomes used to a more normal intake, metabolic rate rebounds. We take advantage of the adequate energy, burning through it and happily functioning somewhat close to normal. 

An increase in metabolic rate with an increase in caloric intake causes a weight gain plateau after the initial phase of treatment and refeeding. So it's true. I've either plateaued, or I simply haven't gained much weight at all. For me though, it's less important to gain weight and more important to normalize my relationship with food. I am not obsessed with being super skinny - or at least that's what I tell my out-of-touch-with-reality-self. I want to be in shape, athletic, run as much as a I please, and forgo binging and purging for the rest of my life. To me, that is successful recovery from this eating disorders.

Anyway, on to the unwelcome news. Next week, as a result of this plateau, I bump up to meal plan B from meal plan A. In food exchange speak, that means an additional fat and dairy with breakfast and lunch. Nothing extreme, or even noticeable if I'm not counting calories, but additional food nonetheless. Aaaaaaaaand, I'm also adding a Boost to both snacks during the day. 360 x 2 = 720 more calories. Per Day. More Than My Daily Caloric Intake Before Treatment. 

Okay, that initiates panic. I have to stop with the numbers already. I think I will have to do some negotiation with this new development. I'd so much rather eat an additional 720 calories of delicious food than drink 12 ounces of Boost Plus. Not ideal. I've deviated from the point of this post. I'm making progress. Taking things in stride. Treatment is so much easier when you're compliant, follow the rules, and accept that you have to make these changes in order to get out. 

I'm still going to have an excellent weekend, show up on Monday, and deal to heal.

Accountability

I've had three awesome days this week. Then today - Thursday, day 4 of treatment this week. day 4 of no purging at all. Also, the one year anniversary of meeting my boyfriend. Our dateversary. Hopes are high. We're eating dinner out tonight. I'm excited, not nervous. All is wonderful. Treatment Is Working.

Reality.

My cell phone died in the middle of the night and my 6:40 am alarm did not go off. I wake up to my boyfriend's alarm at 9:00 am, a full 30 minutes after I'm supposed to be at the treatment center. It takes over 45 minutes to drive there, and I'm still completely uncomfortable with the amount of food we're required to eat throughout the day unless I've run at least 6 miles first.

Panic.

What to do? Go in late? Make up an excuse? Do I still need to go to treatment? I can eat on my own. Maybe I'll stop going to treatment, back to school. Back to life. I'm fine. I'm healing. I'm good. Quit treatment. My phone dies and I wake up a little late, and this is where I end up. I don't need to be in treatment anymore. Red flag perhaps?

So.

I ride the wave of motivation and a very successful streak and call the treatment center. I won't make it today. I tell myself, I'll be totally fine on my own all day, alone from 9:30-6:00. I am out of bed as my boyfriend leaves for work at 9:30 am. I feel great. I can do this. It is easy for me to eat and not purge at treatment, so it will be easy today, too.

Today.

I go to the grocery store for chai tea mix. I'm addicted to it and I'm out. I withstand the first urge to buy food to eat and purge. Then, an exciting task. I go to Lowe's and make a duplicate key to my boyfriend's apartment. He has suggested this, and it makes me very happy. I drive home. Make a chai latte. I wait to have breakfast til noon. Oatmeal, splenda, peanuts, more 45 calorie per 1.5 cup serving of chai latte. I forget the chai latte makes purging easy peasy. Perhaps I do not forget this at all. Too much liquid with food so I have to purge aaaaaaaaaaaaand.... the familiar story beings. I spend most of my dateversary eating my boyfriend's food... powdered donuts, oatmeal, pancake batter, peanut butter crackers, pop tarts, chips and hummus, cereal... and throwing it up. Buying more. Throwing it up.

I take a 6 mile walk mid-day. Come home empty and famished. More. I regain control again by late afternoon, nap for an hour, go to the gym down the street. 9 more miles. 15 on the day.

I come home from the gym to an excited boyfriend, who actually gives a shit that we've been together for a whole year, and find flowers and thoughtful gifts. He asks, jokingly, if I ate a whole bag of powdered donuts because he notices the brand on the bag is different than it was when he left for work. I am caught. I confess. He's mostly unaware that my eating disorder sometimes involves eating 5,000-10,000 calories over a short period of time and throwing them all up.

What does he think? It's actually not a big deal at all. He does not think I'm completely crazy. He accepts me no matter what. Back on track. Incentive to get better. I love him and what we have and I cannot fall into the trap of purging. I cannot waste my days shoveling food into my mouth - food that burns me because it's too hot, food that's past its expiration date, food that's been left out over night, food that no one else would ever think about eating, food that I don't even like. I cannot waste more time hunched over the toilet. I cannot waste more life like this.

Another slip up. But dealt with in honesty, acceptance, and the viewpoint that this will happen and it won't mean I'm not making progress. I will go to treatment tomorrow, I will be honest and accountable with my boyfriend, my family, my therapists, my treatment-mates. And someday, when this is all said and done, I will be able to eat two or three powdered donuts on the 1-year anniversary of meeting the best person in the world, the person I could see myself with forever, and have it be just that. Donuts. Food. Fuel. Life.

Momentum

I'm scared to write this already today in order to not jinx what I'm feeling right now, but I'm still riding an awesome wave of motivation. I think a lot of this has to do with overcoming a rough week last week and beginning of the weekend, but separating myself from slip-ups and getting back on track. I think dealing with backwheeling in a positive, motivating way shows significant progress in overall recovery. We've also had several lovely additions to the day treatment group yesterday and today, rescuing us from a group of two last week.

I'm feeling so much progress during day treatment. Much more than I expected so quickly. Here's how a day looks like for me:

7:00 am - run my 6 glorious, wonderful and allotted miles. It's still dark and chilly outside at the beginning of my run, an awesome and motivational atmosphere.

8:10-8:45 am - drive to treatment, sipping hot tea, and worrying slightly about making weight.

9-9:45 - breakfast. Before every meal, we do a hunger/anxiety rating. 0 corresponds to starving and 10 to enormously full for hunger, 0 to completely calm and 10 to get me the fuck out of here anxiety. I start most mornings with a 7/2. Not hungry,  not anxious, but finish 100% of my meal and move on with my day.

9:45-12:40 - group, snack, group.

12:40-1:30 - lunch. Today my stomach growled around 12:30, even after breakfast and a snack. This is true progress in the girl who didn't eat before 2:30 pm a few weeks ago.

1:40-2:40 - group, then it's time to leave.

After day treatment, I know to keep myself busy. Today, for example, I had a meeting with a leading eating disorders research scientist about a project I'm just starting on to increase my experience in the field. It's my goal to land a post-doc in eating disorders, so this opportunity is extremely important to my future career and invaluable motivation to get through treatment and fix myself ASAP.

Another key aspect of my renewed sense of motivation is the group composition during treatment. One of the girls who started yesterday really came out of her shell today and the other very poor soul who started yesterday was moved to residential. She was not in a good place and really affected group morale yesterday. Today, another new woman started. She's in her 30s with 5-year old twins and a husband, and a raging bulimic (self description). She also battles multiple addictions and this is her first bout of treatment. I love her already and forsee a lot of awesome and relevant and mature discussion with her in group.

As you can tell, I'm feeling good. 100% of meals at treatment and dinner to boot. I do continue to struggle with sobriety and overexercise (I write this from the eliptical), but my head hasn't seen the inside of the toilet in going on 3 days. Recovery is a choice, and I'm making it. And sticking to it.

Hope

Today has been a perfect day. It's only 5:00 pm, so there's still room for error, but the progress and positivity I feel within myself is as hot as today's 60 degrees in January.

I'm writing this on my smartphone as I walk my pup in shorts and a t-shirt.

I'm not thinking about how many calories I didn't purge today. I'm not thinking about the pounds I inevitably gained from my week long nightmare called binge-purge. I'm looking around me at the beautiful blue, cloudless sky, the buzz of the city, and the fulfillment I've found. 

It's gotta be a combination of the sunny weather, an awesome Sunday with friends yesterday, and a hell of a lot of perspective at treatment today with the addition of two new ladies to our day treatment group, in the throes of a serious and heartbreaking struggle. 

Seeing these young ladies in such isolating and internal pain is difficult for me as an extrovert. I wear my heart on my addicted, self-loathing sleeve, and I find myself with an excellent support system because of my outgoing nature. Treatment is easier for me because I know I'm a Mess with a capital M. I don't know what hurts or what I'm covering up and numbing with my eating disorder and addictions, but I know how to communicate with anyone to figure it out. I was, perhaps, at one time, as closed off and terribly sick as these women, but I can hardly bear to see someone younger than my baby sister refuse to eat, in tears, shaking with fear and anxiety. 

I am so lucky to have chosen treatment and been able to afford it before descending into the depths these girls find themselves. From here on out, I must find it within myself to set the best example I can, pull them out of their shells, and show them how to live. While also showing myself.

Binge. Purge. Repeat.

The past few days have been Disaster. For every step forward, it seems there are 12 steps back (not a sobriety reference). I know there are difference between slip-ups and relapses, but I fear this falls under the latter. I've binged-purged 5 of the last 7 days and purged on the other 2.

I had reduced the binge-purge cycle to 2-3 days max during the first weeks of treatment, but as I'm eating more and focusing on weight gain needed to return to outpatient, I'm overwhelmingly triggered. I'm also alone this weekend, which never helps. Excuses aside, I've decided to do some investigation into what exactly causes the descent into the binge-purge cycle. I strongly believe if you can understand the underlying cause, you can work towards preventing the outcome.

In treatment, and over my 9 long years of personal experience, I've nailed down the cause of the binge-purge to several possibilities. I am a firm believer it's a combination of factors that differ by individual and by circumstance. Here's what I've come up with, and an explanation of each.

1. Binge-purge as an addiction.

Addictions are physiological. In other words, once an addiction develops, it involves changes in brain neurotransmitters and chemicals, making it a hard-wired process and super difficult to overcome. In those with bulimia, catecholamine (particularly dopamine) and serotonin concentrations may be lower, predisposing them to compulsions and anxiety. Combined with poor appetite control, and you have a recipe for binge-purge.

I often feel my tie to bulimia is a simple addiction. I binge when I am not hungry. When I have nothing to do. When I feel so inclined to do so, I cannot resist. When I know it's harmful to myself and other, harmful to my treatment, harmful to others, but I cannot NOT binge or purge. They're a packaged deal for me. With binging comes purging. I have never binged and not purged. These days, I rarely eat and not purge.

2. Binge-purge as a physiological response to starvation.

When the body is starved of essential nutrients for a prolonged period of time, it compensates by craving food. Any food. All food. Binging of food. But only in bulimia is the binge phase followed by the inevitable purge. I have also experienced the strong physiological drive to binge. When my body is completely void of nutrients - after an overnight fast, no breakfast, and 12 miles of hard running, I have to eat. I have to. There are no other options. And more often than not, this I have to eat turns into an awful and ugly binge-purge cycle, keeping me alive, but avoiding living.

3. Binge-purge as a response to triggers (HALT and others).

Many therapists or treatment modalities attempt to identify triggers for individuals with anorexia, bulimia, or binge-eating disorder. HALT is an acronynm for the most common triggers identified, common to almost all addictions. Hungry, Angry, Lonely, Tired.

Once triggers are identified, emotional and behavioral responses to these triggers can be adapted to prevent the common response: starvation, binge, or binge-purge. This form of treatment provides the foundation for cognitive behavioral therapy (CBT), a widely used (and successful) treatment for bulimia. I'm not sure how much I buy into this theory. I do agree that triggers can set us off, but I also think the core of binge-purge is rooted much deeper than a simple.. I feel tired.

I believe the binge-purge cycle may be the most destructive, self-deprecating action that characterizes eating disorders. Few things are more demeaning, degrading, embarrassing, than spending a significant amount of time eating in secret and bent over a toilet. Destroyed knuckles, bad skin, red eyes, sore throat, broken stomach, broken soul. None of these come close to outweighing the one-pound weight gain of a binge. None of these come close to addressing underlying issues, fears, and emotions.

I hope I can break out of the current cycle and get on with treatment.

Music Therapy, A Recovery Playlist

It's a toss up which I enjoy more - running or music. Generally, both go hand in hand, for example "I love this song because it's perfect for my running playlist!". Part of recovery, though, is disentangling eating disorder symptoms like excessive running, from healthy parts of life like music.

To help me start, I've decided to put together a recovery playlist. I also included explanations for why I included each song - whether it's lyrics really hit home, or if it's simply a beautiful piece of music. I encourage you to assemble a recovery playlist for times you may need a little extra support or if you're just looking to chill out and relax. Enjoy!

1. Bonobo - Terrapin - This lovely song is one of the most relaxing tunes I've ever come across. When I'm feeling frustrated, anxious, angry, nervous, or overwhelmed, it can calm me down almost every time.

2. Classixx - Holding On - A dance-y tune guaranteed to get you moving. The chorus, "I been holding on, and I can't take it anymore" repeats throughout the song, a good mantra to beat your eating disorder.

3. Telepopmusik - Breathe - One of my all time favorite songs. There's nothing to do but believe, just believe, just breathe... And a cool video.

4. RAC featuring Kele and MNDR - Let Go - Seriously strange video, but a great tune. Light and funky.

5. Alt-J - Dissolve Me - I love this song, mostly because of the lead singer's voice, but also because of the lyrics and meaning, if you can figure them out.

6. HAERTS - Wings - I listen to this song almost every day and it's happy and fun and always lifts me up. Bonus? HAERTS are excellent live. Check em if you get the chance.

7. Francis and the Lights - Like A Dream - How can you not like this song? One of these days my mind will stop racing, and I'll get me some sleep. Cause I'm ready for the big time, is it ready for me?

Each of these songs reminds me that recovery will be sweet and something to work for. No matter how difficult and hopeless it may seem on the long journey there. I hope these songs can help you feel a little something - whether it's a push towards seeking help, a boost during recovery, or support no matter where you are in the process.

The Art of the Meal Plan

While I haven't been formally diagnosed with an eating disorder until my recent acquisition of anorexia nervosa, I've experienced every diagnosis on the eating disorder spectrum. I strongly suspect my core diagnosis is and has been bulimia. It seems I've just gotten so good at it, I'm able to stay at a BMI that qualifies me as AN.

In all honesty, I wear my anorexia badge with pride, a reflection of my success at eating disorders lately. This is a statement I will surely regret in the future, but for now, I am happy that I am so malnourished, so thin and so bedraggled, that I have achieved this gold star of approval. What I fail to consider is that in recovery, we with anorexia must Eat A Lot.

Breakfast

2 starch

1 dairy

1 fruit

1 fat

Lunch

3 protein

2 starch

1 dairy

1 vegetable

1 fruit

1 fat

Dinner
3 protein
2 starch
1 dairy
1 vegetable
2 fats

And
2-3 snacks throughout the day

Each patient has a plan tailored to her needs with snacks and supplements (Boosts or Ensure) as needed. Snacks and supplements are added or subtracted to meet weight gain or maintenance goals during treatment. Everyone must meet the basic, minimum food group exchanges.

Physiologically speaking, high calorie meals are required to ensure calories in exceed calories out, especially with the 6 10 miles I'm allotted doing every day, necessary for weight gain. The contract I signed when bumped up to day treatment listed 2-4 pounds per week as a weight gain goal. There are 3500 calories in 1 pound, so to achieve a 2 pound gain, an excess of 7000 calories per week is required (1000 per day). 4 pounds per week? That's an extra 2000 calories per day.

The average 26 year-old female of my height and weight burns approximately 1290 calories per day doing nothing. These calories are expended through basic metabolic processes like breathing, muscle turnover, and heart contractions. If you're ambulatory, up and moving through daily life, with no additional physical activity, this number jumps to 1548. If you're me, running 10 miles every single day, this number jumps to 2225 to maintain weight. Add the 1000-2000 extra calories per day to gain 2-4 pounds per week, and you're looking at a daily caloric intake of 3225-4225, also known as a bulimic nightmare.

To me, consuming and holding down 4225 calories is more physically and emotionally difficult than any 15 mile run. Meals of cheese, pasta, sandwiches, milk, and dessert served at the treatment center are ridiculously triggering to all of us. As a professional bulimic (prolimic we'll say), it is overwhelmingly difficult. The internal struggle to eat the meal is the first challenge. The physical and mental challenge to hold the food in my stomach immediately after eating is the second challenge. But the third is the worst challenge.

Treatment concludes a mere hour after the horrific lunch meal and I am sent home with a snack. This has ended the same way every day, except a few. I drive away, clutching the snack, and devour it within a mile of the center, still painfully stuffed from lunch. I stop at the nearest gas station, purchase a diet coke in size bulimia, chug, and purge on the side of the road. It's 2:45 pm at this point. I see snack, lunch, and even the string cheese from 11:00 am emerge, clearly undigested.

Relief. Temporarily. Hungry Again. Binge. Purge. Repeat.

I have learned it is unclear how to refeed a prolimic. I do not know how many calories I retain or if my weight fluctuation from day to day sets off red flags to the treatment team, but I fear residential... babysitting treatment... may be the only way. 

I welcome any comments or suggestions from readers on how to conquer the process of weight gain and refeeding in those who are prone to purging. I'm afraid of this vicious cycle and must stop in order to make any sort of progress through recovery. 

Recovery Walker

It's finally Saturday and my first weekenparticularly  starting treatment. I wake up with the tiniest headache, but feel like a million bucks after dinner with friends and an early bedtime last night.

First thought - what's for breakfast? - followed by - weekend long run without a booze or bulimia-induced hangover?! - followed by - unlesguy cut running by half by didn'tsday (consistently), .ll be shipped off to Residential. That, my friends, is a BUZZ KILL.

So. I go for a walk with the lovely, body-secure Lula, a babe of a Husky/Samoyed mix with flowing white figurativautiful blue eyes. Let me tell you, she is a show-stopper folks.

It helps to walk, but I don't know what will happen if I don't get a little run in, especially since the understand. derstorm this morning has given way to 60 and sunny in early January. I take maybe three days off per year, almost always due to crippling hangovers, traveling, or big events like weddings. Today, I limit myself to 6 miles, a feat in itself and sit down to watch some football with friends until it's time to attend a friend's boyfriend's birthday dinner.

Something I've learned in treatment is how common fear of social eating is for those with eating disorders or disordered eating. At face value, I would never considered that a particular symptom or behavior of mine. Until I consider what normally happens at dinners out. I don't eat all day, run even more than the standard 12 miles, order the lowest calorie option on the menu (salad, soup, steamed vegetables, etc), 3-4 drinks plus whatever I had before dinner, and get blackout drunk. So while I'm perfectly comfortable attending social dinners or gatherings focused on food and eating, my friends and boyfriend are always on high alert. I'm consuming negative calories regardless of my chosen entree, and drinking to keep up with the heaviest hitter in the group, usually a 200-400 pound male who orders an appetizer, entree, and dessert to share with no one. I will go shot for shot with the person in between dipping my fork in fat free dressing and picking lettuce leaves out of cheese and any salad toppings that aren't vegetables. And I'm naive enough to think that this eating disorder is mine and mine alone and no you can't possibly understand.

At this particular birthday dinner, I do particularly well. I order just two drinks after the beer I had befpre dinner and a black bean burger with a side salad. I cut the burger in half, eating 2/3 and the whole salad during a painstakingly slow hour. Everyone else finishes 30 minutes before me and when I finally throw in the towel, the guy next to me asks what I didn't like about my dinner. Better than the ever dreaded, wow you were hungry or great job that we ED-heads dread, but also a wake up call my idea of a lot of food is so far from normal.

Treatment Day 5

Well friends, today marks the end of the first week of day treatment. I haven't worked this few hours in well...ever...but I'm more tired than I thought possible from spending my days like this:

• 8:30-8:45: weights (blinded)
• 8:45-9:45: breakfast (2 starches, 1 dairy, 1 fat, and 1 fruit)
• 9:50-11:00: group session
• 11:00-11:15: avoiding snack til caught doing so today (so from now on ... a snack)
• 11:15-12:30: group session
• 12:40-1:30: lunch [misery inducing meals of fruit, dairy, vegetarian entree (potato drowning in cheese and butter, sandwich drowning in cheese, soup and salad drowning in cheese... note to self: don't choose cheese for snack, buy gas-x), dessert]. Woof. 
• 1:30-2:40: group session
• 2:40: snack and freedom

Lots of sitting. Lots of cheese. Exhaustion inducing.

My weight hasn't increased since starting outpatient in December due to maintaining a Nazi exercise routine of 8 miles in the morning, 2 miles with the dog after treatment, and 6 hard miles at night, so it's off to inpatient if I haven't reduced exercise by half and attend an AA meetings by.... Next Wednesday says my therapist. So now I comply despite the fact my stomach no longer works and food comes right back up, a second reminder that this much cheese should be illegal.

This week, a lot has changed for me though, despite little progress on the gaining of weight. My diagnoses are officially Anorexia Nervosa, Depression, Anxiety - a triple threat for someone who's struggled to admit to any problem for the past nine long years. In some ways, it's a relief to see those words on paper, confirming I'm sick enough to be sick. I've wrapped my head around the necessity of eating, my abuse of alcohol, and that my moods are out of whack, depicted by my interpretation of physical manifestation of moods in art therapy (followed by a treatment-mates).

These breakthroughs/progress leave the exercise addiction as the last and most difficult piece of the eating disorder mantra to change. Purging at will is another dangerous habit that obviously must change, but I cannot purge during inpatient hours, and my medication to help prevent reflux should kick in this weekend, so my feelings are optimistic that it's more of an interim consequence.

I look forward to, and am equally terrified of, the freedom afforded by the impending weekend. I have dinners already scheduled for evenings and I spend days with the boy I love who still managed to loves me back. Structure and plans boost my mood and keep me busy and accountable, reducing the likelihood of getting off track. This weekend, I am optimistic about concrete progress during the week and the ability to choose how much cheese I eat.

We don't realize the importance of things until we must forego... coffee, Diet Coke, choice.

Here's to a successful and recoveryfull weekend!

Treatment Day 1 (TD1)

Well folks, turns out 26 isn't too old to get in trouble! Treatment Day 1 (TD1) started with a bang for this eating disorder senior citizen. I was plenty used to trouble and reprimanding in my rebellious years, so I suppose life goes full circle more often than not. Here's how it went down.

Up til 1:00 am last night. Alarm at 6:25 am. Up and at em....................
   ✓ 5.25 hours of sleep
   ✓ Hangover
   ✓ Bags under eyes
   ✓ 22 degrees (wind chill 6 degrees) outside
   ✓ Run 7 miles at the gym
   ✓ Drive to treatment

I arrive at 8:15 am sharp to knock out the paperwork requirement, but spend 45 minutes hanging out with the building security guard waiting for staff to show. Guard and I put our heads together and decide to call the main phone line in case a staff member snuck in. Low and behold, the center voicemail confirms: weather delay on account of we're in the South and it's Cold Today.

So what does one with an eating disorder do with an extra hour and change? Why, she grabs the running shoes, socks, shorts, and dark memoir from her car, and hops on the treadmill in the building gym of course (for 1.5 miles til she's caught cruising at 8.3 miles per hour).

Using symptoms, they say! ooops.
Proceed to weigh in. Weight loss, they say! Double oooooops.

Am I going to be kicked out of treatment on my first day? Nope, but I will be supplemented with 360 calories of Boost Plus. At least I can choose if I would like chocolate or vanilla. Vanilla it is.

In hindsight, I shouldn't have consumed -700 calories yesterday and run 7 miles this morning. My stomach doesn't appreciate the Boost, then the extraordinarily large baked potato + butter + broccoli + cheese, string cheese, and apple for lunch, but understands what making my own meal plan and rules accomplishes. Nada.

Something did go well today though. I suppose it's only fair to mention successes and breakthroughs amidst the negative nancy-ness of this post. It comes in the form on art therapy, which I really love. Check out our group (well, it was just three of us today) mandala. We started with a circle and ended up with....

Okay, that's all the positive I have in me. After we are cut loose at 2:45 pm, I fail again, drinking diet soda and coffee and eating peanut butter crackers and oatmeal until I hands-free purge. It bothers me that the potato and apple consumed at 12:40 still come up at 3:30 (and again at 9 pm).

Free time means I walk 3 miles with my boyfriend's dog, learn that treatment is cancelled tomorrow because it's Still Cold, and wind up with more free time. I write this blog post from the treadmill at the gym, walking 2 more miles after running 3 in 20 minutes.

I feel tired. I must eat dinner. I will drink tonight. I must get better.

Reactions to change include slip ups

Periods of time leading up to a big change are particularly difficult. Sometimes the change is scheduled or anticipated like accepting a new job or going to college. Sometimes the change is unscheduled, but inevitable, like admitting a problem, accepting help, or entering treatment. No matter the pretense, a big change is difficult and can initiate a cascade of emotions or fears.

A change curve demonstrates the most common reactions to change. As an exercise for myself and to help define each concept, I'll give examples of response behaviors under each category. For me, each step in recovery has been a change and extremely triggering, but exploring reactions may help overall progress in recovery and prevent relapse.

Resistance: Process where the ego opposes conscious recall of anxiety-producing experiences

• Arguments regarding seriousness of eating disorder, addiction, or condition
• Hiding symptoms and tricking or lying to others about behaviors
• Refusal to participate or comply with treatment

Denial: Defense mechanism involving refusal to acknowledge painful realities, thoughts, or feelings

• Conviction the problem is under control
• Using functionality in other areas (academics, work, athletics) to deny problem
• Anosognosicism: unawareness or failure to recognize one's own problems

Commitment: Being bound emotionally or intellectually to a course of action or to other persons

• Complying with treatment recommendations and meal plans 
• Attending treatment regularly and recognizing its benefit
• Being up front with others about the problem and/or course of treatment
• Demonstrating actions or outcomes in attempting to achieve goals

Exploration: seeking and understanding new ways of doing things

• Understanding how and why to change habits 
• Looking forward to changing behaviors and maintaining changes for the long haul
• Making a plan to optimize recovery, promote wellbeing, and prevent relapse

Anyone making a big change can benefit from identifying behaviors that would fall under each category of response to change. Focus on commitment and exploration, while identifying how to minimize resistance and denial. Identify treatment strategies, support groups, individuals including friends and family, and resources (exercise, yoga, writing, journaling, hiking, fishing, biking, boating, outdoors) that will assist you in making this change. 

Most importantly, change for YOU. Do not include anyone or anything else in your list of reasons to get help and start living. YOU are worth change. YOU are worth success. YOU are worth recovery.

Health insurance, medical leave, and making no money

Today was supposed to mark Day 1 of day treatment, but as we all know, plans do not always fall into place accordingly. Low and behold, taking a leave of absence in graduate school (unless you're birthing a child) suspends health insurance. Pretty intuitive when given some thought, but probably not something considered before making the painful, difficult decision to tackle more intense treatment.

The decision to switch to day treatment was not an easy one for me. From the get-go, all of my doctors, therapists, and folks at the treatment center recommended the most intense level of care, but I declined because, well, I can do this myself damnit. Turns out, denial and borderline ignorance served me about as well as it has over the past 9 years.

Surprise!

While I failed outpatient treatment, I've been lucky to have a team willing to be flexible and accommodating with the demands of being a doctoral student, teaching a class, and assembling a dissertation. These are difficult, stressful, anxiety-provoking demands for the average Joe. Add treatment for an eating disorder, substance abuse, and obsessive exercise, and you have Way Too Much On Your Empty Plate.

So, in light of my plate and recommendations from the powers that be of treatment, I will suspend my student stipend for the next two months to just do me. It's scary and disheartening and feels like giving up, but also comes with a sense of freedom, hope, and motivation. 

In light of challenges, I am deciding to see opportunities. I will be too broke to binge eat and purge. I will not be in my office, leaving quality time for just the two of us, me and my dissertation. I will have time to push myself to recover, challenge my thoughts, and develop and indestructible rapport with recovery, including a plan for relapse. 

I will eat. I will run (less), I will live.

Hello blogmosphere!

Tomorrow, I start a day treatment program at one of the country's most respected eating disorder treatment centers. Whew, I actually said it, sans freak out.

First of all, I know I am so lucky to have resources, time, and support to undergo this level of treatment. To those of you struggling on your own, I encourage you to reach out to whatever type of support if feasible for your financial, school, work, or living situation. Any help is better than no help. Maybe this blog is a start.

To give you a little history. During the past four weeks, I have participated in an intensive outpatient program at the same center. I received treatment for anorexia binge-purge type, overexercising, and alcohol abuse after experiencing heart palpitations and developing a heart murmur, but still failed to reach goals. I'm a Registered Dietitian and have a Master's Degree in Nutrition, but I cannot seem to practice what I preach. In light of treatment, I am currently taking time off from my doctoral program in, you guessed it, Nutrition.

After 9 years of struggling with myself, it's time to take my health into my own hands, feet, and typing fingers. I'll need a little extra support during this step-up in treatment, so I'm turning to anonymous blogging. Things I hope to accomplish are:

1. Help me.
2. Help you.
3. Recover.

I also hope to tackle my most challenging behavior, a wicked addiction to running and exercise, and turn my obsession with burning calories into talent. While lofty, my goal is to participate in the USATF Women's Open 5K Championship in 2014 and see where I can go after that.

I hope you will follow my journey through recovery and that my words can help you, too. Please leave any positive comments, links, advice, recommendations, questions, etc., and I'm happy to answer.

Best wishes and thoughts.