Is this relapse? Plus treatment lately and a new plan of action

*I will do my best, as always, to keep anything I believe is triggering out of this post; however, I want to put a warning for the general behaviors and thought patterns that will be mentioned. There are no numbers or specifics ahead*

So.. I don’t want to be writing this post, but then again does anyone? Is it everyone’s dream to slip back into something that’s nearly taken everything from them multiple times?

I don’t see this as so bad.. but I have been in denial before. The signs are there, but I haven’t been able to admit it yet. Instead I’ll write about it here.

  • The number of exchanges I’ve had is making K and R concerned. It’s below a percentage of my CFD mealplan that’s just not okay with them.
  • It’s scarier to eat the amount of food I normally do and the maximum has been lowered. This goes along with the above.
  • Other than when I’m at home (and even then, truly) I eat the same things over and over. I actually at the same protein for 4 meals in a row this weekend/yesterday… so that’s a pretty good explanation of where I’m at.
  • The possibility of a higher level of care has been mentioned more than once. I hate that. Bring on the guilt/shame…
  • I am hungry. I know this sounds weird to determine how well I’m doing, but I haven’t had hunger unless I’ve restricted since this summer.
  • Going along with the hunger, I feel full much faster than before. This has to do with the amount of food my body is used to which is much smaller than before.
  • Some physical symptoms have returned or worsened: feeling cold, hair falling out, dry skin, dizziness, headaches, weakness. I also have a hard time with concentration and thinking in general.
  • I’ve always loved yoga, BUT it may be getting out of hand at this point. The intensity has increased as well as the amount. My team isn’t happy about it and I see Dr. C this week so I’ll know of any changes then.
  • My weight is down. This is not an indication for everyone. For me, it is. Once my weight gets to a certain range, I end up in treatment. Note: this weight range is well above underweight, just proof that you don’t need to be a low BMI to be sick enough for a higher level of care. If it continues I know somehow I won’t make it outpatient. Still, I have a certain “healthy” goal for myself, so I’m stuck and Ed is enjoying this decline.
  • Many (most?) of my waking hours are controlled by ED thoughts. They’re in the background always. R once told me you can have close to 12 hours of disordered thoughts per day and I would say I’m getting there.
  • Rigidity is getting worse. I have to do things exactly the same to feel in control. This extends to everything from specific exchanges per day to amount of exercise.
  • The last time I ate out was on Thanksgiving and I felt like I was going to die just by going there. I was intent on skipping church 2 weeks ago because my parents wanted to do lunch out. I faked sick until they finally decided against going.
  • Once again, I am staying in my room more and more, I haven’t even gone to the library to study or something just to be somewhere else. I also have skipped all floor dinners and eat alone too. I was already pretty isolated before but it just gets worse when I’m more into the ED.
  • Rationalizing is my current superpower. It’s okay I skipped X because it’s close to X meal. This was just one bad day. A little weight loss is fine. I can find an excuse for anything and everything.
  • Spending time at home brings lying, manipulation, and lots of sneaking around. I don’t want my parents to know what’s going on. The idea of having to eat more there is terrifying, so instead I find ways around that.

I don’t know exactly what to do right now, but something does need to change. My future is on the line now. It isn’t like Fall 2015 where I could take off a semester for treatment. I’ve not yet come to terms with all of this. What I do know (and don’t want to admit) is that this is relapse. It isn’t just “not doing well” or “struggling some.” It’s time for me to get back to a stable point where I can start spring semester in the best health possible.


 

I’ve had 2 very hard days of treatment. Thursday was a little bit of a wake up call. R had some no BS words for me. On my red, yellow, green, and in between scale, she believes I am now firmly planted in the red. This means full relapse. I do have one category after red, which is when treatment becomes necessary and nonnegotiable. She also said I cannot stay here, especially with the real semester starting so soon. After this we talked about what my options are currently. I ended up deciding to step up groups on the two days each week I am already there. I don’t fully want this or believe I fully need it, but I’m agreeing because waiting will only make things worse. Spring semester is coming fast. I have to be stable. The only real goal she gave was to increase by 1 exchange until Monday and then add another exchange. That didn’t really happen..

Yesterday was rough. I knew it would be going in. I had no doubt that there would be difficult conversations and possible ultimatums. I wanted to tell myself this wouldn’t happen, though. I wanted to prove to my team that I didn’t need the extra support. That didn’t work one bit.

First, I met with R for lunch and therapy. I barely had the right amount of exchanges for the meal and had to many Ed thoughts to finish. In IOP I would have been given a supplement. Here, she couldn’t force me but reminded me of that fact anyways. She was concerned with my exercise. Her emphasis on weight is that it’s not the only thing they are considering. I know this logically, I just don’t believe it. Unfortunately, she will also be contacting Dr. C so she’s in the loop about my treatment plan and struggles. The message she tried to instill in me was needing to trust my treatment team. I absolutely agree here, especially with K. Why would I ever listen to someone if all I see if them lying? I’ve got to work through these Ed thoughts that tell me otherwise.

K and I met right after. I really liked a metaphor she used. If you imagine a raft in a river, it will continue floating down the river unless you do something about it. You can paddle slowly and stay in place, or work really hard to swim up the river. Recovery is like that. Without the hard work, you aren’t going to make it. She was not happy with my weight or the way that I keep rationalizing/arguing that it’s okay. I was pretty surprised to hear that, in her opinion, if I drop much more I could be put inpatient (or residential). My immediate reaction was huge disbelief. I still don’t get that at all, especially if it were inpatient. Like I’ve heard (and hated) before, my healthy weight for my body probably doesn’t fall here. It’s a bad sign if the only way I can maintain it is by doing what I am now. Another interesting point she made about weight is that she would never want me to continue gaining. Sometimes that’s all I have believed about dietitian’s goals for me. I need to bring up my exchanges, and even though it isn’t much I feel hopeless/fearful/disgusted about the increase. Like I’ve heard a lot lately, she ended with reminding me that I cannot survive here, at least not for long.

After both appointments I joined back into the group one of my favorite activity therapists I have ever met was running.  I’ll call her K-AT here to distinguish between her and my dietitian. She’s known me for even longer than R, ever since my first FV days. The other two girls left the room for about five minutes, and she took that opportunity to have a little heart-to-heart. The first thing she did was ask me what I am doing here. I knew exactly what she meant. Honestly, I don’t really know. It seems like It’s been getting worse for a long time but also all at once. She fully believes in me and said that I can turn this around, I have it within me, and I need to remember that I am going to be a nurse. She reminded me that I am a child of God and so loved, needed, a masterpiece, and fearfully and wonderfully made.Another thing I really appreciated was that she challenged my thoughts about treatment being a waste if I just ended back here again. Despite all of the encouragement, I felt like she was almost disappointed. It was a look that I saw before, right when I decided to go to residential. I don’t think she truly is judging me or anything. My guess is that’s just her concern shining through. Our conversation started the tears. I haven’t cried in therapy since summer when my grandpa died. It feels raw and vulnerable and a little scary. I’m very thankful I was able to spend that little chunk of time with her. I know that she will also be the best person for me to have lunch with Thursday.


My new plan:

  • Monday and Thursdays will be my treatment days
  • This Thursday I have lunch with K-AT, a group where a girl I was in IOP this summer is coming to talk about her strength in recovery, therapy with R, then group therapy and art.
  • Monday is lunch with K, therapy with R, then joining in for all groups of the day. I told her yesterday to make me supplement if I don’t finish, since that would happen if I did it in group lunch. That was the brave thing to say and I have a feeling it may happen..
  • Next Thursday is my first group lunch (not excited/totally freaked out) and the full day of IOP minus therapy
  • Up until the semester starts, I’ll continue with this schedule. After that, I have Thursday’s free. It may be a full treatment day, but nothing has been talked about yet.
  • Basically I’m doing IOP two days a week without calling it IOP and being pulled out for therapy/dietitian. This means no switching to the IOP dietitian though hallelujah!!

If you made it all the way to here you deserve a medal. It feels really good to write that all out and kinda process it here while doing so. I’ll be sure to update on how everything goes and just overall progress too. This feels different than every time before, so I don’t know what all will happen.

Do I REALLY have an eating disorder?

This may seem like a pretty strange question, considering a large part of my blog is to talk about my experience of living with an ED, among other things. You may also guess that this post could only refer to that period before I ever entered treatment. While I’ll be talking about that experience too, the major focus here is about what types of thoughts I’ve had throughout these years. That includes now, over 3 years post-diagnosis.

I’ll start at the beginning. Denial was the main factor in the feelings back then. When I switched therapists for the first time, I was sent to someone who “specialized” in eating disorders (which is a whole story for another day). I consistently referred to it as “eating issues” like I was simply not able to eat sometimes. That made sense in my head because I could realize some things I did weren’t the most normal, but they weren’t that abnormal. One day, my psychiatrist handed me a pamphlet for Forest View. He said that he would recommend looking into their eating disorder program and thought treatment there would be a good option for me. I stared at that thing and gave him a very interesting look, I’m sure. How was it possible that I may have an eating disorder? I promptly shoved the brochure in a drawer once I got home and tried to forget the conversation even happened. Slowly, “eating disorder” was brought up more – in therapy and subsequent psych appointments as well as by my parents. Everyone seemed to be in agreement except for me. Fast forward about a month when my mom was frustrated enough to call FV and set up an assessment. This began my first time in treatment.

The next period of acceptance came upon entering into PHP. My very first meeting with the psychiatrist there brought my new diagnosis: anorexia nervosa. He said it in such a way that took me by surprise. I don’t even know this guy and hadn’t spent more than 20 minutes when he decides to drop that on me? I was confused, frustrated, terrified, and in such disbelief. Mind you, I already had my first introduction into the ED program at this point. I don’t remember much of that first day anymore, but one thing will stay with me probably for the rest of my life. My case manager had us all go around and introduce ourselves and state what disorder we were struggling with. This was about an hour after talking to the psychiatrist, so the idea of my diagnosis hadn’t even sunk in yet. When it was my turn, I said my name but immediately froze after that. I couldn’t do it. Admitting meant something was wrong and that I was actually sick. I hated that idea. She didn’t let me skip the second part of our introduction. Instead, she talked about how the first step to recovery is recognizing you had a problem. Finally, in the smallest voice possible, I did it: “I have anorexia.”

Much of my denial is still spent on believing I’m not sick enough. This time, it isn’t about having an eating disorder in the first place. Instead, I cannot believe that I’m ever bad enough to go to treatment again. I don’t get worried that easily, most of the time not until it’s too late. By then I have absolutely no chance of turning things around on my own. Note: while I’m struggling with the idea of where I’m at now, I have begun to see that it isn’t entirely okay.

The other side of not believing I have an eating disorder isn’t exactly denial. It feels much different. I cannot count how many times over the past year these thoughts have come into my head. It often is triggered from a therapy appointment, check up with Dr. C, completing food logs, or even writing a blog post. I get this strong feeling I can’t quite explain, but it leads to the thought that I can’t have an eating disorder. This is more than not being sick enough. I start to believe that I have a choice here, and if I just choose to change, then I’ll be normal. This also leads me to think that I made this all up; I’m just over dramatic; this is all some big lie. When this comes around, it basically goes against the reality that I’m facing. It doesn’t make sense logically, not in the least bit. If I really were some imposter, wouldn’t a treatment provider somewhere along the line have noticed? In those moments (or longer), it’s as if nothing in the world could convince me otherwise. This is something that comes and goes pretty randomly. When it is there, I question who I am and how terrible I must be to spend all of this time and money on some diagnosis I don’t have. It’s like I’m invalidating myself. What I’ve come to realize, however, is that this is not me. In some convoluted way, Ed uses it to his advantage. I feel anxious and tons of guilt/shame every time, which fuels the fire. It’s almost as if I have to prove that I actually am sick. Obviously (in Ed’s world) that means more behaviors. This cycle tends to be short thankfully, but I would say it occurs at minimum once a month.

It’s an odd thing to be so convinced that you don’t have a disorder when every single sign points to it. Both before and after, I don’t think all of the therapists in the world could truly prove to me that I do have an eating disorder. Today, I know that’s what this is and I’m getting a little closer to recognizing I’m not in a good place. This could easily change. Next week, or month, or day, or ten minutes from now I may be once again filled with disbelief. When that happens I need to ground myself in the present and remember what I’m fighting against, so I can know what I’m fighting for.

 

2018: intention, goals, and word of the year.

2017 was a pretty rough year. Much of the focus (and problem) has been my eating disorder. I’ve spent around four months in treatment: IOP, a few month break, residential, PHP, and IOP again. Now, I’m struggling again. Amidst the hard things, growth has come too. I’ll talk more about this in a post soon. I want to make 2018 different and the best/healthiest year yet.

Goals for the year:

  • No treatment!!! I have spent the past 4 years in at least one form of a higher level of care. It’s hard not to feel like a failure when I think of this. I don’t want my life to revolve around my eating disorder in this way again. However, I want to promise myself and my team that if treatment becomes necessary I will go.
  • Thrive in nursing school – both semesters. I have so much to look forward to with school this year. Spring is pregnant women, infants, children, and adolescents. I’m especially excited for this semester because my top choice is to work at Helen Devos Children’s Hospital in the NICU or pediatrics. I also have labor and delivery on my list. Overall I thing it will be a great time. Fall will be young, middle, and older adults. We’ll be doing med-surg. This should be interesting while working in the ICU. Overall, I have a ton to learn and work more towards my dream.
  • Start to develop a healthier and relationship with and view of my body/self. This is a tall order considering I can’t remember a time when I felt too positive here. I want to make this more open-ended because even a small step matters. I know that recovery will help to grow here.
  • Isolate less. Whenever anxiety, stress, depression, and the ED are stronger I tend to isolate. I spend so much time in my room that I get nervous to venture outside. I want to tart doing things with others again.
  • Blogging much more – at least once per week. I feel good when I blog. It fills me up, whether it’s another TFHR, awareness post, or really anything. This is my favorite creative outlet. Being intentional about my time and penciling this in is important to me.
  • Try to keep more on top of anxiety/stress. This is one challenging task while I’m going through school. I have to take more time to use skills and thought stopping. If I can manage this, I know it can decrease my ED at least a little.
  • Get through this target/focus of EMDR. I feel pretty hopeless about this at times. 3 months sometimes seems like too long. I have to extend myself grace here and put my all into this. I have to believe I deserve freedom.
  • Take more pictures. I haven’t picked up my DSLR in a year, maybe more. The motivation jusst isn’t there, yet I do truly miss it. I know that I’ll fall back in love with it again.
  • Increase me and decrease Ed. Stop being one foot in and one foot out. Become intentional about recovery and make it a priority. How much I’m struggling determines nearly everything in my life. The ED has power over me. If it continues I will end back in treatment. I may never be able to finish nursing. Recovery will save me.
  • Less “blah” time on social media. I tend to spend a lot of time scrolling through social media. I sometimes get a little lost in it. This isn’t the healthiest considering some things people post. Instead, I could read a book, blog, play sims, etc. I want to fill my time with these instead.
  • Journal more. Journaling also benefits me greatly. I love to get out my thoughts and feelings on paper. This is also a really great way to remember events and look at both my growth and struggle.
  • Take it one day at a time. I tend to be future and past focused. This keeps me distracted from the here and now. I can’t keep worrying about the future to the point of stunting my own growth. I think I could decrease my anxiety this way too.
  • Smaller, specific goals:
    • eat my meal plan to the best I am able
    • have more meals in the dining hall
    • attend floor dinners – at least 2/month
    • reach out more to friends
    • set study/school time and fun time as well
    • go out with friends more often – at least 3/month to start off
    • Be honest in therapy, dietitian appointments, visits with Dr. C, and meetings with my psychiatrist
    • check in with my goals and intentions at least once a month
    • use my DBT skills
    • continue attending groups, biweekly therapy, and weekly dietitian appointments for as long as I need
    • eat at least 5 times a day
    • come up with more goals as necessary 🙂

Intention for the year: work on not allowing numbers to control me anymore. I set this 2 weeks ago in group. I definitely am controlled by a variety of numbers currently. My grades determine how I view myself. Weight (estimated mostly or accidentally saw at an appointment) shows how bad or good I’m doing. Amount of calories burned and time spent exercising show how close I am to my goals. Exchanges met show my progress. This will be a pretty huge shift in my thinking and behavior. It won’t be easy at all. Changing something that has significantly impacted my life for years is radical. I’m ready. Numbers are just numbers. They don’t prove if you’re a good or bad person. It doesn’t even completely show how I’m doing in recovery. They don’t really matter.

Word of the year: WORTHY. I also chose this 2 weeks ago. For years, my word has been resilient. I’ve tried to live that to the best of my abilities, although that hasn’t been simple or easy. I wanted to change it up (I’ll certainly still focus on resilience, though). Worthy extends to many areas of my life. For so long, I’ve never viewed myself as important enough to matter. I feel too inadequate. Deep down, I don’t fully believe I am worth of recovery. I’m not worthy enough to go through EMDR. People shouldn’t care about me. I need to change this all. It will be hard work. I’m ready, or at least I’ll try to convince myself that until I believe it 🙂


Do you have any goals or intentions for the new year? I would love to hear them!