Treatment update – IOP round 3

I have a whole ton to update on and a couple posts I’ve drafted, but first I want to touch on a difficult subject that came up yesterday. I’m still trying to accept my new normal for the first few weeks of the semester.

I had an absolutely wonderful day at clinical orientation in the children’s hospital. I’m very pumped for it all. I left in a great mood and just felt positive, but then I looked at my phone. I got an email from R that was a little shocking and very upsetting:

K and I talked and we would like you to be at x exchanges before you stop coming to IOP.  We will extend your time in IOP to 2/15.  If you haven’t been able to reach x exchanges by then we will need to look at having you go to a higher level of care like PHP to stabilize. So,  work hard this week to keep moving forward!

Now I want to back up a little bit. In the beginning of January I stepped up care, attending more groups and eating lunch at treatment. I didn’t consider it IOP because I had other appointments while I was there. I quickly realized that being there the whole time IOP is going on still means I’m in IOP. I think it’s been good for me to get out of my dorm and try to work through some of this. The one thing that hasn’t truly improved (okay, I did have half an exchange increase from 2 weeks ago to last week) is my eating and subsequent weight loss. I don’t know that I’ve had this much trouble getting out of restriction before.

IOP is going relatively well. I’ve had a ton of challenges and mostly stepped up to the plate. Last week Monday ended up being the most exchanges I’ve had in months, thanks to increasing for both my meal and snack at IOP. Even though I do love the therapists and some of the activities, I don’t want to be there any longer than I already have been. I’m ready to focus on school instead.

Originally I was supposed to attend full IOP this Thursday and R would let me know on Monday what the plan would be. Unfortunately, that wasn’t what I wanted to hear. I’m not at all happy with this arrangement. I cried and felt generally terrible upon hearing the news.

I decided that yesterday I would allow myself to wallow. I felt all of the negative emotions that came up – guilt/shame, frustration, fear, hopelessness, a little anger, sadness. I didn’t try to push them down. At some points I felt genuinely sorry for myself. It honestly was a bit miserable. As hard as that was, I believe it definitely benefited me. I got out those feelings in a more healthy way. I didn’t focus on acceptance, which may seem a little counterproductive.

Today, I will attempt to end the wallowing, rationalizing, and planning about how I will get myself out of IOP for the next 2.5 weeks. As my best friend said, arguing against it may result in my team feeling I’m not in a good enough place to continue in this level of care. I really can’t have that happen. (side note: any other form of treatment absolutely will not work with my schedule)

Today, I will work on acceptance. I want to go into tomorrow with the best possible attitude. If I’m going to be forced into IOP, I want to actually gain something from the experience. We’ll see how that goes considering how stubborn I can be (and how loud Ed is now).

I am not where I wanted to be by the time spring semester started. I am not where my team wants me. I am (probably) not in a stable enough place to handle everything. I need to change this so I can be in the best possible place to thrive and not just survive.

This is obviously not the update I wanted to make, but it’s where I am. This won’t be where I am going to stay.

IOP: a fate more difficult than residential

By Thursday, I still hadn’t connected with my emotions, broken down, or processed the fact that I am on medical leave with mandatory (if I want to stay out of further treatment and continue school) IOP. I had so much on my mind that I couldn’t handle it. The time came when I was meeting with the new dietitian. I was randomly called out in the middle of AT/process after lunch. Being under the impression that I was able to continue with L made it a surprise, one that I never wanted. I finally broke over the change and lack of control in my life now. It was then that new L (to make things more confusing of course, ha) confirmed what I had already been thinking about, “this is going to be harder than residential.” We talked about how much of an uphill battle I’ll be facing these next few months. I cried from being so completely overwhelmed. This is a harsh reality to face.

This may seem odd to anyone who has never experienced multiple forms of treatment. Residential means being stripped of your freedoms, weeks or months away from home, and a complete overhaul of your behaviors. It certainly is hard to make an abrupt change and carve out the time to do so, however, one that’s just as cushy as it is drastic. You are stuck in this place that has all of the support you could possibly need, 24/7 to be exact. It’s actually pretty difficult NOT to experience at least some growth, even if that may be forced.

IOP is a 180 from residential. In my case, I will got 3 times a week (M, T, R) from noon until 5-5:30. We have 3 groups plus lunch/snack each day, along with weekly individual therapy and dietitian appointments. The entire rest of the week we are solely responsible for following meal plans, avoiding behaviors, and applying all we’ve learned. There is no one to check in on us multiple times a day or monitor our meals. If I didn’t finish a meal in residential I would only get a supplement. On the other hand, not adhering to my meal plan or otherwise slipping backwards now can lead to forced inpatient or residential and medical leave. I have major work to do and much to lose.

I always assumed my time at CFD would be the most challenging thing I have ever done treatment-wise. How could it not? I traveled across the country and gave up school. Adjusting to the new life that is residential was unlike anything else I’ve experienced. As much of a struggle this all was, it really was the best environment for recovery. In no way is recovery ever easy, but the amount of support in residential makes it significantly more attainable and manageable.

I can fully see how different IOP is. The effort to show up for my recovery is substantial. I have just 15 hours a week in treatment with 3 meals and 3 snacks. I need to make every single second count. The work doesn’t stop there. I cannot go home and just return fully to the ED. Motivation is key and if I fail to find it I am looking at IP or residential in the very near future. No one can make me recover now.

Where do I go from here? I could become consumed by fear and hopelessness, knowing of what’s to come. Giving up is absolutely the easiest option; however, it is not the one I choose to make. I am going to fight. I’ve been through years of struggle – times where I never believed I could make it through, but I did. IOP seems impossible right now and this may be my hardest battle yet. Even so, I will hold on to hope for a healthier future.

 

It’s over (!!) and will be for a while

As of this past Monday, I am officially done with school for the semester. I doubted the entire last 2 months that I would even finish it. I wanted to give up. Sometimes, I wish I would have. No matter what ended up happening, I did make it and I didn’t fail any classes or do bad enough for it impossible for me to make it into the nursing program.

This was my hardest semester. It isn’t easy to complete homework, study, or take tests when your body is malnourished and brain lacking the carbohydrates it needs. No matter how much I know logically, Ed still won a majority of the time. I spent more time taking naps and thinking about food than all of my schoolwork combined.

My whole treatment team has told me the same thing: you have to be stronger in your recovery if you want to successfully complete nursing school. Dr. C talked about how I can’t be so used to lying and cutting corners as I enter into the program. It isn’t okay to hide my struggles and carry it over to my schoolwork then eventually my job.

I will go into this in a future post with my thoughts on everything, but as of Tuesday I will be on a forced medical leave for the interim (J term) semester. I honestly was pretty shocked when Dr. C told me this. She was very close to forcing me inpatient or residential. For now she is agreeing on IOP, assuming I can make progress . This next 5 weeks or so are going to be spent in treatment 3 days a week. I will be able to stay on campus still (which isn’t typically allowed but Dr. C set that up right away).

I have to work my butt off if I want to start classes again for spring semester. It’s scary and hard and I’m not sure I can do it, but I am going to try. Goodbye fun interim class; hello, all of the groups, appointments, challenges, and (hopefully) growth.

 

All the treatment last week.

I am just now writing about all 3 appointments and group therapy that happened last week. I’ll touch on each separately as I’ve made notes for each one.

Tuesday – Group Therapy

I only decided to call and attend group around 2 hours before. I had just finished with my bone scan. My new therapist hadn’t called about me joining group as I hoped/assumed, so I called them back. Having only a small amount of time to worry beforehand definitely made things better.

Going in, all I knew is that the other women would be from IOP and it was likely going to be a small group. I walked in and felt uncomfortable. I didn’t say a word before group and barely even looked up. Thankfully I was able to relax once we started talking and had introductions.

My new therapist, R, leads the group. I’m thankful I was able to meet her before our first session. We talked about values and how Ed’s values and ours differs. It reminded me of our groups with T at CFD, and he was amazing. Our first step was making our own lists of values. For me, I had authenticity, helping others, hard work, compassion, and faith. Ed was perfection, thinness, weight loss, secrecy and self-hatred. Next I made a pie chart of what I out my time in now v. what I hope for in recovery. Mine was drastic. ED thoughts and values took up over 2/3 of my time now and in my ideal recovery <2/3. That gap is scary but also shows me that I need to change. I came out feeling more motivated because my dreams are so much better than this.

Wednesday – Dietitian

It was a hard one with L. Each week has been getting progressively worse in my eating. I’m slipping and I honestly don’t fight back too much. It was time for a reality check and she helped with that. I was  so angry with her (more so Ed was) and argued back and forth on different points. She didn’t let these thoughts get by. I appreciate that.

I found a scale at home and told her about this. I said it was okay to weigh myself since I won’t have too much access. Of course this didn’t fly with her. Part of my goals for the week was not stepping onto it. She asked about my goal weight which I said will make me happier. I had some time assessing the situation and part of me does believe her. A positive that came from our meeting was her feelings about group. She was incredibly proud of me for taking initiative in my recovery.

L’s no BS policy both annoys me and supports my recovery. I need to be pushed. I don’t think I’m able to do this on my own currently. I think realizing this is better than attempting to tackle it myself. One last conversation that killed me was learning L is leaving in January. I HATE change to the nth degree. It

s extremely difficult to find a dietitian in the first place so that’s just another stressor. Overall, the appointment was helpful but scary.

Wednesday – Dr. C

This was only my second meeting with her but I already know she’s going to be a valuable part of my treatment team. She was able to encourage me in many ways. I see her as a cheerleader for my health.

Something I appreciated was her going through all of my blood work. I love to hear it explained since I’d such a health nerd. I’m glad everything was okay. I was worried I would have another thing to worry about but it isn’t. I am okay, for now.

I was comparing last fall to this one when Dr. C stopped me mid explanation. She told me that I’m not as deep into the pit. I can see the light and i am asking for help. I thought differently from that point on. She also encouraged me that I can get through the semester. I had around 2.5 weeks from the time. In reality, that really isn’t a terrible amount of time. I need to believe that I can and I  will. I mentioned taking our J term off and as of now I believe that will happen. I really think I should try to take time for myself. I don’t meed all the interim classes so this year could be the time I put my health first.

Other tips I believe would actually work: get 7 or more hours of sleep, using all  of the knowledge I already possess, set emotions aside and make school and this semester a priority, believing in the real Emily and knowing she’s there. I have to work on separating Ed from myself. My bad enough means medical issues or emaciation. I don’t deserve treatment or want it if I am still so huge. One of the scariest thing she told me is that I need to consider other options. I cannot fathom doing it all over again. I don’t have the time o money to do so. It makes me terrified. I have to break out of the rigidity of the ED or risk more consequences.

Thursday – Therapy with R

I really enjoy R so far. I think she’ll be a great fit for me. Grateful doesn’t begin to describe that considering how little hope I once had. In all honesty, she’s going to help me more than S could. Amain point is that I need to put more into my recovery. I cannot do the same and assume it will be okay. She was yet another member of my team to say no the scale. One of the best things I came out with is all the groups the center offers. They have IOP MTR and you can walk in to any group during the time. I would love to do art therapy or any group with K, and amazing OT from FV. She’s seriously the best. I need to do more. Going to groups, therapy, and a dietitian each week means many more opportunities to dig into my recovery. I will do my very best to fight against Ed.

And that’ all for this week! I think I may end up writing each time I had an appointment or group. I find it therapeutic and a way to keep track of what I’ve learned and felt over time. 

The “T” word

“Am I going to be able to offer you the support that you need, or should we look at other treatment options, IOP, PHP…?”

Well, I certainly wasn’t expecting that one when I met with L last week. I actually haven’t wanted to bring this up on the blog, but it’s been eating at me all week so here we are.

Anyone who knows me or has read here for a while can pretty easily guess my response: “I can’t do it because of school. I don’t need it. I’m not there yet.” Naturally, I made excuses. Were they truly valid? Yes and no. It is important that I complete my classes this semester and next since I need to get into nursing for next fall. I can’t just go off to treatment and have another last year. If it really got to that point, where it was life or death and I was too sick to function, I would go.

School is pretty darn valid. I’m not so sure about the other half of my argument. Last year at this time I was barely functioning. I have little memory of the entire month before I left for residential. I was so sick and stuck in anorexia. It wasn’t just that I needed more support. No, I needed a complete overhaul, accountability, 24/7 support, a variety of health professionals weekly. Sitting in PHP groups half the day or being stuck inpatient wasn’t going to cut it. Residential made sense, complete sense.

Looking at the present I just don’t meet these criteria. I could certainly use more support: therapy every week for starters. I wouldn’t be able to justify the time and money required to do PHP or IOP. I’m not eating enough but I am eating. Yoga is my form of exercise which is used in a (mostly) healthy way. I do not need a more intensive outpatient approach.

Selfishly, unrealistically, I want to get back in treatment. What I would give to have another week with the staff at CFD. What I would give to be around people like me. What I would do to get away from this new story of hell I am experiencing currently.  But I can’t, and that’s it.

I’m doing this all on my own.

A few weeks into residential, my therapist and I were discussing discharge plans. She asked whether I would be able to head back to Forest View’s PHP, then step down to IOP, and eventually go to therapy twice a week with a dietitian, etc. Right away I told her none of those things were possible. I started school the week after I left resi. PHP (and IOP) is 45 minutes away from home, and although it’s close to my school, I didn’t have a car at the time. Of course there is also the issue of school. I had to sign papers that I would come back for interim or forfeit enrollment at Calvin. There is no way I could give up my college career. Her concern immediately grew. Instead of having a month or more of step-down care, I went from 24/7 support to therapy once a week, and no dietitian for the first few weeks.

This was a hard pill to swallow. I knew all along that step-down care wouldn’t ever happen, but being so close to discharge it started to sink in more. I changed and grew immensely at residential, more than anyone expected. I was the girl I had never seen before in my sickness. Even so, the real word is scary. You aren’t in a bubble with people to help you through urges, meals, meltdowns. I no longer had groups with others who understood exactly what I’m going through. I dropped from a safe place into a world of triggers and little help.

I tried to be as optimistic as possible as discharge crept closer. There were looming fears I couldn’t shake: dining hall eating, being back at school in general, the food police, being so fat/bigger than before. I was originally going to leave the Monday before Christmas. That caused me the most worry of all. How would I be able to jump right back into a holiday after only four days out of treatment? My therapist pulled me into her office the Wednesday before I was supposed to discharge and gave me the best news possible: insurance approved an extra week. I cried feeling so blessed by this opportunity. We had to share my decision with my parents. That was a difficult conversation and is still full of negative emotions on their part. I mostly ignored it because to me getting the most time at residential as possible was going to add more confidence and motivation to my recovery.

Unfortunately, nothing CFD did to prepare me for the real world could fully do so. Coming home meant uncertainty and outcomes both good and bad. If I gave up or gave into anorexia I would just end up back where I started. On the other hand, finding the strength to fight with all I am meant finding the girl I had lost so many years ago.

Leaving residential and going straight back to completely outpatient has been challenging. I no longer had the cushy protection to help me not use behaviors or restrict. I wasn’t in treatment for 8 or 4 hours each day. No one was there to ensure I ate enough.

The thing is, by much less support (and more of a drastic change because of it) after residential I have had to own my recovery. Sure, I still had people cheering me on and did therapy, but that was only an hour of professional and then the meals I had with my family, as far as physical support goes. I so appreciate everyone who has been there for me; however, it never will be the same as being in residential or treatment in general. I completely am on my own now.

I have grown but also struggled these last almost 10 months post CFD. I miss it, or at least some aspects. Groups definitely top that list. I feel more alone now that I don’t have people to under­­stand me. (Luckily that is changing as I attend 2 support groups now). I’ve looked through my journals and pictures from residential sometimes and just bawl, longing for any part of that program to return. About a month ago I drove to Forest View and sat in the parking lot. I so wanted to have the safety, support, and even the dreaded ensures. Also, and really surprising/confusing/weird, I miss Dr. VH?!? He was a hard ass and somewhat mean but holy cow do I miss him telling it like it is and threatening me. I honestly thought about checking myself into inpatient and just riding it out for a week so I didn’t have to face reality. I know that’s really not how I felt about inpatient at the time and I don’t plan on returning ever. For whatever reason sitting there brought up all of the good things about my time in that building and blocked out anything bad (aka most everything I experienced). More than anything it was be realizing I was so close to what parts of treatment I missed the most: groups, 24/7 care, supervised meals, being with others the same as me.

I am currently taking some steps backwards as the fall goes on. My thoughts are very negative and consumed by ED, depression, and anxiety. I am doing my best to take care of myself by going to support groups, spending time with people I love, taking another try with a dietitian, relaxing some, and eating as well as I can. Realizing all I have and haven’t done since discharge gives me motivation to keep going. I haven’t had any sort of treatment other than therapy/occasional dietitian, and I have done well without it. I haven’t needed to return to treatment. I have had so much more energy and don’t look or feel like a zombie.

I am very proud of myself for this progress. I’m in no way saying that I’m better than someone who has had step-down treatment after residential. I wish sometimes (especially during lapses in recovery) that I would have been fortunate enough to. I felt that was unfair for a long time. Now, my feelings are very different. I am glad that I came right out. I am continuously choosing and working towards recovery each day because I want it.

I was so certain I would end up back inpatient or residential without any good aftercare plan., but I didn’t. I survived each day and made it through on my own. I continue to do this all on my own. Little by little, I am finding strength on the hard days because I came home from residential and went straight back to real life.

Stages of (Restrictive) ED recovery – where am I?

Lately I’ve felt pretty terrible, not going to lie. I am really sick of recovery, at least parts of it. Body image has been consistently the hardest part and recently is at an all-time low (I’ve said that before but now is the worst I can remember). I’ll talk about that more in a moment, though. Once again I’m not hungry and food doesn’t usually sound good. I have some feelings of jealousy and resentment. There are so, so many benefits and things I am thankful for that can only happen because of my recovery, but those aren’t at the front of my mind right now. I’ve been beating myself up over this. How could I still have negative feelings when I’m this far in (~7 months since starting resi, 5-6 true recovery)?

I ran across an article I have read a few times before, “Phases of Recovery From a Restrictive Eating Disorder.” Every time I previously skimmed this I was either very sick or in quasi-recovery. It scared the shit out of me. I am a very logical person and use it to calm me, but the ED was way too powerful for that to work here. I’m luckily in a much different head space now and can use the information to further not hinder my recovery.

Currently, my biggest threat to recovery is my body image. I only see myself ballooning more and more when that part should be over by now. I see my stomach which protrudes no matter how much I try to hide it, my hips and thighs that are incredibly large, stretch marks multiplying everyday that all the positive spin in the world can’t help, piles of clothing that no longer fits, fat instead of tone, everything larger than ever in my life. At times it takes every ounce of me to stop from tearing away at my skin. I wish, at times, that I could give in or give up recovery altogether just to make it go away.

Reading this article today has given me hope. I first was sure I was in Stage 3, maybe 4 (the ED fueled horror when I feared it may be the case). I’m actually quite certain my body isn’t there yet, but in Stage 2 still. I obviously have not experienced any sort of weight redistribution or really stopped gaining. That alone has caused hopelessness and other negative emotions. Another clue I may not be in 3 is that I feel like my body is off. I have hunger all over the map. I’m having issues with fatigue, GI problems, and food doesn’t give me the expected energy it should. Lastly, I’m barely at 7 months in recovery max with around a month of relapse. It feels like forever but with all the damage I’ve done it really isn’t. My body doesn’t trust me enough to move past the fear of starvation and pain again, and I don’t trust it in the least bit to handle food correctly, keep from forever ballooning out, and give me correct hunger cues.

Initially knowing I had more ahead until my body would be healthy again was disappointing. I have worked hard, yet none of it was enough to make my body okay again? I’ve thought about that more and now see that this is a good thing. I am still not comfortable – with my body or in my body while experiencing physical issues. This isn’t the end, though, which means that it still gets better from now. I can look forward to more acceptance and the return to a new normal in the future. It really helps me breathe a sigh of relief as I’ve felt so hopeless about the future of my recovery.

On the other side of things, I have become more cautious and aware. I had a relapse because of my failure to accept where I was at physically and not attempt to “fix” it. I know now that this is part of a normal process but one that can be a trap from the ED. This is all temporary that eventually will lead to a healthier me, both inside and out. I need to accept and fight the feelings that threaten to send me back into sickness.

Lord knows I am not healed mentally from my eating disorder. In many ways I never will be. The same thing applies physically. My body isn’t in the end stages of recovery yet, but that is okay. I need to give it time. Now is the prime time for relapse. I can’t go down that road again. It was terrible and terrifying all in one. Right now I need to trust: God and His ability to be my strength in this, my body as it heals, that my disordered thoughts are not real, the truth that it will get easier. I am healing each day and reviving myself more and more.

*Note: I don’t agree with all Your Eatopia has to say on this topic or in general. Nonetheless I do believe this is a good resource.