*please note, there will be some cursing due to the emotions/thoughts coming through in this subject

Psychiatrist, May 2014: “I want to talk to you about this place called Forest View..” –> Began PHP at FV July 31, 2014

Therapist, almost all Summer 2015: “We need to consider returning to FV so you can get into a better place by the time you go to Calvin.” –> IP at FV end of August 2015

Therapist, November 2015: “You need to really consider a higher level of care. I cannot let you continue in this semester if things don’t change very soon.” –> residential November 19, 2015

Same therapist, Novemeber 2016: “You’ve gotten to a point where I am no longer able to see you. It’s time for a specialist in EDs.” –> new therapist, then groups, then IOP

Dietitian, April 2017: “You aren’t there yet, but if things keep going the way they have been we might want to consider some other treatment options over this summer.”

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The very first time a higher level of care was mentioned, I was not expecting it whatsoever. For one, I didn’t see him often and had only had him as my psych for around 3 months at the time. I had little ability to judge his level of concern. It didn’t help at all that my therapist (in the same office, mind you) was basically the opposite of concerned. Side note, she didn’t know I started PHP until afterwards when my mom called (pissed aha) to cancel all future appointments. Anyways, I’m sure that there were some subtle signs I simply missed back then. That first time became a learning experience.

I had been seeing J for nearly a year before FV was brought up. I had numerous “scares” where I could sense that I was slipping into the too-sick-for-outpatient zone. Each time, I would convince myself, and ultimately her, that I was able to do this on my own. If anyone has read my posts from my year as a youth leader, you would have seen this in  action. I could barely take care of myself for long stretches of the year, let alone my 4 main girls. It was a mess that should have been taken care of much earlier. By the time youth camp was over, so was any grace for falling more into the eating disorder. It was crunch time, just a month before college. Every visit, I would deteriorate while J’s face filled with more and more concern. I knew something was very wrong, but couldn’t see it clearly. I wasn’t in much shock once FV was mentioned. It made sense, given all of the concerns she had voiced. Realizing what was coming ahead of time led to compliance and a readiness for what was to come (although this was also met with crazy amounts of anxiety/fear).

I didn’t get very far into the semester before my new therapist at school showed the signs. Even though I hadn’t known her long, it was easy to tell when she was either shocked or significantly concerned with what I was saying. Don’t get me wrong, I was still surprised to a degree, but that wore off almost immediately. Things moved quickly after that, and I was off to California in (what seemed like) no time at all.

Round two of my therapist at school recommending higher treatment was less of a shock than the fall before. First of all, she had very limited availability. It was obvious that therapy every other week for maybe 45 mins wasn’t cutting it. Once the topic came up, I actually thought that I would be sent straight to PHP. Thankfully that didn’t happen. I called the very next day to get things set up, and began my journey from groups to IOP and back again.

When “more treatment” was brought up a few weeks ago, I almost laughed. I only somewhat noticed that our sessions were heading in that direction. R does a damn good job at hiding when she sees things going downhill. I sat there just staring. How the hell was I there yet? Honestly, I mostly pushed it off. This wasn’t anywhere near as severe as the other times. Her words were so vague, and I believed that “more treatment” just meant IOP, aka not a big deal.

Expecting these conversations ahead of time did little to reduce the denial that comes when anyone tells me how deep I am into my ED. Acceptance is the last component that comes before I finally am able to make a change. Sometimes this comes shortly, like before residential. I was at CFD just two weeks after I had the first conversation with S. The first and second time, however, denial led to avoidance of treatment for weeks/months. Unless there is a way for me to be forced into treatment, I don’t believe I’ll ever be able to enter it until I start to see how much of a relapse I am in.

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The above was written earlier this week, but Tuesday my suspicion became more true.

Dietitian, April 26 2017: “You are declining fast. If you continue this way for the last 4 weeks of school, you will end up in residential. You may not be “underweight” BMI-wise by then but that won’t change the fact that you need help. We could end up petitioning you, if necessary.”

Immediately my thoughts began to race:

• Shock. What the fuck??? How did I get here? There’s no way this is true. R is wrong; everyone is wrong. She’s just overreacting. This is insane. Anyone could look at me and think I’m fine. My weight has NOT gone down, no fucking way.
• Anger. How could she do this to me? How could I do this to me? Why am I so stupid? Why didn’t I fudge my logs and [insert other behaviors here that would increase weight on scales]?
• Disbelief. She’s just lying to me so I’ll eat and get scared. There’s no way she is right. I don’t believe anything she’s saying right now. I didn’t lose weight; the scale at home proves so. Maybe I should get a new scale just to prove her wrong.
• Fear. What if they can actually force me into residential? Is that really a thing? I mean I know I can be kicked out of treatment I suppose or placed into inpatient if it ever got that bad.. If everything is really crashing down on me, I am screwed. What if she contacts my parents? Dr. C? Oh God no. What if this jeopardizes my summer or nursing school?
• Acceptance? Okay, so what if she is telling the truth? That means I really am falling fast. It would mean Ed is lying to me, nothing is as it seems, I’m not really in control. Could this actually be the start of a relapse?

I am currently living in a world full of denial, rationalizations, disbelief, mistrust, etc. None of this could possibly be true. I just don’t see it. The eating disorder is not as big as she made it seem, even Dr. C agrees! My therapist hasn’t mentioned much. My behaviors are not that bad. I am not losing weight, not even a possibility. The supposed “facts” have no real weight right now. Maybe it’s the ED talking, maybe I am worse off than I believe (and that very small concerned voice is right). Either way, I am where I am. I have choices right now, and my end goal is to never hear the suggestion of residential again. Ultimately, the conflicted and confusing thoughts/feelings need to be sorted somehow to make that happen.