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.

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.