NEDA Week 2018 – Treatment myths and truths + an overview of options

Fortunately, there are a variety of resources out there for eating disorders treatment. Unfortunately, there are many stereotypes, worries, and false speculations about what treatment actually involves. I think it’s so important that what really happens with treatment is put out there. I want to encourage others to seek help by showing that it isn’t quite as scary as you may believe. This will be two-fold: dismissing the myths and talking about what types of treatment are available. A note: most of the myths will pertain to groups, IOP, PHP, inpatient, and residential, considering many fears come from being around others with EDs.

Everyone will be underweight. I felt this way, too. The media perpetuates this by showing emaciated suffers and focusing on weight loss. The truth is that most eating disorders don’t need a weight diagnostic. Even those who struggle with anorexia, like myself, aren’t always underweight. I have met a huge variety of shapes and sizes in my treatment experience. The ED may tell you this is a lie, but I can pretty much promise it won’t be the case. Even if that were true, especially with inpatient, it doesn’t make your struggle any less. People have been nonjudgmental of weight in my experiences, too. Also, body type does NOT determine sickness at all.

I’m not sick enough. Whether this applies to residential, outpatient therapy, or even seeking help in general, it isn’t true. If you believe in any capacity that you may need help but simultaneously “don’t need it” given your perceived lack of severity, please still reach out. These are signs that point towards that. Your struggle is enough, period. You deserve help, period.

Going means I’m weak. Making the choice to get better is the absolute strongest thing you can do. Recovery is hard, there’s no sugar-coating it. Take that glimmer of hope and longing for things to be better. It’s worth it. You don’t need to continue living this way for 6 months, a year, or 20 years.

I’ll be the oldest, only guy, “least sick,” largest, etc. Eating disorders are very diverse. They affect all races, genders, socioeconomic statuses, ages, etc. Even  if you happen to be the only one in your specific group, you aren’t alone. There are millions just like you, and that can be comforting.

If I’m not in residential or inpatient that means I’m not really sick. Residential and inpatient are not some badge of honor that proves you’ve become bad enough to have an eating disorder. Most people never end up there and that has not a lot to do with their amount of struggling. The important thing is getting the level of care you need and receiving help ASAP, even if you “just” need outpatient.

I will just be constantly eating. It absolutely will feel like this sometimes, especially when in IP or residential at first. What you’ll soon realize, though, is that you have so much more than meals and snacks. You’re kept busy with groups and all of the activities that are going to help you grow in recovery. Eating is a necessary part of treatment but the other work you’ll do is just as important.

All we’ll talk about is eating. Holy hell thank God this isn’t true. Behaviors are surface level. There It’s like an iceberg. You see these awful things on the outside, when what’s causing all of it really needs exploration. I’ve never spent that much time focusing on the food, minus nutrition groups really. It’s just not the main focus, even though it is ultimately an outcome we’re working towards.

No one will believe I’m sick. The thing about treatment is that no professional would ever recommend it for someone they don’t believe is struggling enough to need it. You don’t go through assessments for no good reason. The fact that you go into treatment means that you need the help and that you are sick enough.

No one will ever understand. I was convinced of this when I was first sick. I never thought I would find people who truly got it. That immediately changed my first day of PHP. Suddenly I had 5+ other people who could relate to me so well. I think it’s one of the most beautiful things about treatment.

There will only be anorexics and maybe bulimics. I haven’t been in any treatment setting for very long before I met people who didn’t struggle with anorexia or bulimia. Many have EDNOS (now OSFED) or BED as well. Another thing I’ve learned is that I can connect with any of the diagnoses. It doesn’t matter what the official label you carry is or what your behaviors are. The underlying problems are very similar.

It will be too hard. This will stretch you big time. There will be tears, maybe lots of them. You’ll want to quit, sometimes every day for weeks. You’re not going to like it and will sometimes hate treatment. Regardless, you have the power to press on and keep fighting for yourself. If it were easy that wouldn’t bring change. Trust me, you CAN do this.


Now I want to give just a quick overview of treatment types, mostly based off of my own time there.

Outpatient therapy and dietitian. This is exactly what the name implies: seeing a therapist or dietitian in the office on a regular basis.

Outpatient groups. These groups are made up of many people with eating disorders and may be a therapy style, experiential, art, or other type of focus. I would say that support groups fall under here, too, although those are typically free of charge. These are both a good stepping stone for someone who has never been in a setting with others before. I think the connection and similarities you can find are very helpful.

Intensive outpatient – IOP. Typically IOP will be for around 5 hours a day, covering one meal and one snack. This varies by facility, of course. My center goes 11-4 three days a week. Besides meals and snacks, there are a few groups a day. Some offerings include group therapy, nutrition, experiential/outings, art, and yoga.

Partial hospitalization – PHP. This is similar to IOP but is more intensive. It usually runs for 2 meals and 1-2 snacks. I’ve been to one that was M-F 8:30-3:30 and another that ran every day 10:30-5:30. The setting can be a psych hospital, residential, or just an outpatient center. It allows for the most structure and support that doesn’t involve staying somewhere.

Inpatient – IP. Inpatient, like it sounds, involves being hospitalized, usually in a psychiatric unit or hospital. This is typically shorter term and mainly for stabilization. It’s required if there are any medical problems that would be difficult to manage in another setting. There is a full-time medical staff with 24/7 support as needed. People with other diagnoses are on the units as well. You attend ED groups and support groups part of the day and then general groups as well. Where I was, the average stay is 1-2 weeks and then step down to another level of care like PHP, or even going to residential.

Residential. This is the longest-term and most intensive treatment. Program size varies, but it involves living in a home-like setting for around 30 days minimum. You are completely removed from the environment that allowed you to grow sick. It’s a huge adjustment but also is very effective because of the radical change. Like IP, there is also 24/7 support, but not the same level of medical care. You have to be medically stable in order to be admitted. Sometimes they may bump someone to IP if they need it. Residential tends to be much less restrictive than inpatient. You are able to go outside, do outings, start back with some exercise, and even get solo passes.

Transitional living. For those who live far away and are unable to travel back and forth to treatment, some enters offer transitional housing. In my case, we lived in apartments not far from programming. It offered a supportive environment while still allowing autonomy. I did this after residential, which was a great way to slowly transition back to real life. Some places only do this for PHP, but others allow IOP patients to stay as well.

I hope that this information has been helpful. Feel free to contact me if you would like to know more about my experience or have any questions regarding treatment. I will try to help in any way that I can. 

 

When treatment (and ED) multiplied

Two months ago, I only had therapy every other week.

Just over one month ago, I saw a dietitian weekly and therapy biweekly.

One month ago, I added a doctor to the mix. Around that same time, I switched therapists and began attending one group per week.

Two weeks ago, I attended a couple more groups.

Last week, I had activity therapy, R’s group with snack, art therapy, nutrition and yoga, and another therapy group with R over Monday and Tuesday.

This week, I was placed on medical leave, attended my first two days of IOP, and had to switch dietitians without any prior knowledge or choice.


It has been an absolute whirlwind. I remember thinking at so many points that I didn’t need this next step, I wasn’t sick enough. I argued, deflected, begged, hid the truth, ignored, and did everything to fight hard against any extra treatment.

I can’t fight this anymore. In fact, if I do fight it will end with me being forced to leave school and in residential or inpatient. This is serious. If I continue to follow my eating disorder it’s going to do a lot more than send me to a higher level of care.

Where I’m at now is a crossroad. I know what will happen if I continue with the eating disorder. It’s safe and familiar and easier. I’ll have the control I crave, watch my body shrink down to an “acceptable” size, and be able to cope with everything in a my life (albeit in a rather unhealthy way). On the other hand, recovery is the unknown. I’ve had some glimpses, but going full in is scary. It could mean a full life where I can become the best me: a nurse, wife, friend, mother, and person, all without Ed. The question now is this: do I stay in the familiarity of my eating disorder and fight all forms of treatment or trust in recovery by fighting my eating disorder? I think I need to at least try option #2, because I can always go back to the ED (as I have now) while recovery will only become less attainable as time goes on.

Life After Residential – 6 months out (!?!?!?)

Holy cow. 6 whole months since I signed papers, hugged the staff and friends, and stepped on a plane to enter back into the real world. It feels like just yesterday and a million years ago. There isn’t a moment where I’m not thankful for all I learned during my time at CFD, because I wouldn’t be where I am today without it. Realizations in the past sis months:

Motivation for recovery lessens when things start to get hard after the “honeymoon phase.” Much like the spiritual high you receive coming back from church camp, the recovery high after residential fades away. Real life doesn’t come with 24/7 support, a ban on any diet/food/calories/exercise talk, distracting table games, lack of mirrors, others who 100% understand you, and therapy every single day. Without the extra push to recover it has been hard to keep at it. I start shifting toward using exercise to cope and believing a little restriction is okay. Thankfully I’ve now learned to keep motivation up by focusing on my goals and doing recovery for me.

I can get out of a relapse. I feel stronger than ever since beating my first relapse. Seeing my weight was a huge trigger, one that could have sent me into a deep pit I couldn’t get out of. Fortunately, I found my strength in myself through Him. I deserve recovery and I have so much life ahead of me. I don’t need to turn to my eating disorder to deal with things. I can fight urges. In previous relapses, I never wanted to or thought I would be able to fight. There was an entire year spent on the edge of being forced into treatment, FV round 2, and residential. I was sick and couldn’t see any light at the end of the tunnel. A huge factor now is knowing what recovery is like: freedom, joy, truly living, despite struggles.

I am capable on my own. I have relied on therapists, dietitians, friends and mentors, the entirety of treatment staff. While that was absolutely needed during residential and as I transitioned back to life on the outside, it isn’t at all realistic or healthy long-term. At some point I had to take control and responsibility for myself. I can’t have therapy everyday. Sometimes I have gone two weeks. Sure I have had days where I needed someone to rescue me, and then I did get support from others. As time has gone on that hasn’t been the case. I journal, manage my emotions in a healthy way, fight urges, talk to friends about anything but my eating disorder. Heck, today in therapy we didn’t focus solely on the ED and I was able to work through anxieties and other things. I really can’t explain how amazing and empowering it feels being able to stay healthy mostly on my own.

I can share about my eating disorder in a way that isn’t a sad story that I feel is burdening others. Before, I told others about my ED and MH issues out of necessity. I needed support and for people to avoid diet talk. Some relationships were built and consumed by my sickness. I felt guilty for sharing my story because I was broken. I haven’t actually told anyone new in person about this yet, but I am planning that very soon. I’ve prayed about it, and I am going to tell my favorite from work. She has noticed the difference in me now and I want to let her in. I feel such joy about all I have accomplished. Why wouldn’t I want to share openly how I have become resilient through God’s strength? Instead of “look what I am going through” it is “look at what I’ve conquered that’s made me into the person I am today.” I am blessed by this change.

There is no perfection in recovery; I am a work in progress. This is kind of cliché but also true. I have had countless slip ups, even in the past two months coming back from my relapse. Just like my self harm recovery, I have days where I follow urges and compulsively exercise/restrict. These things are normal. I can’t expect myself to be completely recovery-minded 110% of the time nor allow others expectations to affect me negatively. I have learned to forgive and accept my failures in the same way I celebrate my successes. It isn’t a linear process in the slightest.

I am different from the girl who left treatment 6 months ago. (Not talking about my body here). My dreams have multiplied as I realize how much more I am capable of now. I am working very hard to not let food be the main focus in my life. Sure, I probably think about it more often than the average person, but it in’t anywhere near when I first left treatment. Until a month or so ago I was still counting exchanges and being rigid in my diet.I have conquered many fears since coming home. Some examples: being able to eat a healthy amount around basically everyone without struggling (much), trying former fear foods, openness about my story, looking at my body in the mirror. I feel so much joy. I never expected or dreamed of this. I wake up happy, enjoy my job, talk with people, find happiness everyday. I definitely had more a more positive mood coming out of resi but not like this. I have grown in self-love exponentially. Overall, I have been able to discover who I really am along this journey (not what the ED made me).

He makes recovery possible. I have struggled in my relationship with God, especially during my darkest points in my eating disorder. I felt abandoned and unworthy of His love. I am just now seeing how wrong I was. He has been there since Day 1. My faith and relationship with the Father is my number one now, not my ED. It is such a blessing.

It’s crazy to think of all the progress these 6 months have brought. I learned how to deal with everything in a healthy way and without relying on the ED in residential; however, this time has been applying those things. Each day I continue on my recovery journey which all began at a house in San Diego.

When you leave residential ED treatment

You dearly miss the people at first and later the support you had.

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You will eventually lose contact (minus social media) with those you were in with.

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Everyone on the outside will have unrealistic expectations.

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You may have unrealistic expectations.

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You’ll wish you could add all the good staff on Facebook.

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You’l miss all (or most) of the staff and maybe even write them letters.

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You’ll be so grateful for the simple freedoms. Hello shaving when you please, long showers, flushing your own toilet, going to your room whenever you want, and leaving the house at will!

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You’ll be completely lost at times and wish you could give those freedoms right back.

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You will absolutely need a good support network of friends – not just your treatment team.

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Suddenly talking about bowel movements and GI issues isn’t acceptable.

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You’ll find the real world to be a scary place and forget how you ever lived in it.

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It will feel strange not having or being able to share your thoughts and feelings constantly.

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There will be bad days and lapses and relapses but this is normal, expected, and okay. What matters is that you get back up and continue to stay in recovery.

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You will get “you look healthy” all the time.

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You will also get comments on your body. Ignore them.

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The worst possible advice will come from people who know nothing about recovery from an eating disorder.

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You’ll begin to find success in the little things, like having one snack, rather than only becoming proud of yourself when you have the huge fear food ten times and go 1000 days without behaviors.

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You’ll realize all those “dumb skills” actually work in the real world.

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You will need all the support you can get. Take the PHP/IOP, extra therapy appointments, and support groups. Not all of us are so lucky.

 

Yes, people will stop asking where you were (especially if you shared it on Facebook).

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Its healthy to distance yourself from sick people – even those you just met in treatment.

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Every single example/memory/funny thing you think of will be residential related.

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You’ll oddly miss vitals checks. Yes there’s something satisfying about staff doing BP, HR, temps and asking you 10,000 times to rate your depression, anxiety, etc.

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You’ll be able to recite any DBT concepts without missing a beat.

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You will miss process group even though they almost always sucked.

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There will be a zillion and one mixed feelings about your time in treatment.

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You’ll wish for more time to explore whichever city you were in.

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The recovery high does fade eventually which makes things difficult.

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Some days you want to go back and others you wouldn’t without a tranquilizer.

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The scale is never a good idea.

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Diet talk is E V E R Y W H E R E outside of the treatment bubble.

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You’ll spend a very long time wondering if recovery is really worth it. (Hint: it is!)

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You’ll miss every single part. (Yes, even the poop checks, being forced to face your biggest fears 6 times a day, and extreme boredom.)

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You’ll realize that you CAN do this!

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My story

*Disclaimer: This is not my entire story. Instead I wanted to talk specifically about my eating disorder journey and what its been like for me, (mostly) uncensored.My hope is that this can give insight to what an eating disorder is really like. Because this is going to have lots of details on behaviors and thoughts, there is definitely a trigger warning. I will not be going into weights/bmi/sizes/etc, however. 

The first time I ever felt badly about my body, I was around six years old. I spent the day with some neighbor kids, swimming at the beach and having a great time. We came home and our moms decided to give the girls a quick shower together to get the sand off. One of the girls spoke up, “Ew what’s wrong with your chest?” In that moment I realized I was different. I was born with a sternum deformity called pectus excavatum (PE). Of course, having nothing to compare it to, I never saw my chest as abnormal. That moment, however innocent and seemingly insignificant, was the seed that planted body hate for me.

I can’t remember a time growing up where I wasn’t considered skinny. Adults would always tell me how lucky I was and that I needed to keep the weight off as I grew older. Skinny wasn’t just a compliment to me; it was my identity. At some point I decided I absolutely wasn’t allowed to ever get to a point where people didn’t call me skinny.

There was never a time I was okay with my body. Yes, I felt better about myself when I got the skinny complements. That didn’t fix the negativity. It honestly just made it worse. I received more and more negative comments about my PE as I got older as well. Adding that and the belief that I was nothing without being skinny to an already low self-esteem didn’t work out well for me.

In 8th grade I finally decided to do something about my “disgusting/weird” chest. I went in that December for surgery where they inserted two bars to pop out my sternum into a normal position. I hoped that this would clear up any and all body image thoughts I had. It ended up doing the opposite. My PE was considered very severe. Because of how deep it was, my heart was enlarged and pushed to the side. My lungs were also shrunken. These both were a huge part of the reason I’d stayed so underweight and malnourished all those years. Once my body was in better shape I gained weight – and fast. I couldn’t deal with it. Suddenly I wasn’t skinny but average. No one gave me compliments on my size anymore. I had lost a huge part of my identity, self-worth, and slightly better view of my body in just a few months.

The next few years brought an interim period. I didn’t lose any of the weight I so desperately wished was gone. My body hate never wavered or went away, and really just grew. I hadn’t started using any behaviors yet, but the ED thoughts were there.

The timing around here gets hazy. I’m at the point now where I can’t remember when the switch from unwell thoughts to using behaviors came about. It wasn’t like I woke up one day and decided to become anorexic and boom I was sick.

I had so many bottled up emotions, along with the ever-present self-hatred. My eating disorder started as a way to feel better about myself. If I could just lose that weight I’d hated for years, then I would magically be happier and confident. The main factor, even more than building self-esteem, was harming myself. I felt such strong emotions: guilt, depression, anxiety, perfectionism, hatred, loneliness. By starving myself and running my body ragged I could take care of some of the discomfort I felt. 

It all began innocently. I wanted to lose the unnecessary (in my mind) weight I gained after my surgery. My first goal was just a few pounds. I figured that once I got there I would certainly feel better and just maintain after that. I was clearly wrong.

I started counting calories. I wouldn’t say I was actively restricting quite yet, but I was very hyperaware of everything I put into my mouth. My view and reason behind exercising took a 180. I played soccer from eight years old up until fall of junior year. It had always been 100% about fun. Not once did I wonder how many calories I was burning or how much I needed to work out in a day or week. I practiced and played games to the best of my ability. During my last season, however, that all changed. I began pushing myself harder than before and would also workout outside of practice and games. If I ate “badly” during the day, I work myself past the point of exhaustion that night at practice. Soccer wasn’t all that fun anymore.

In addition to the extra exercise, I mildly restricted. Within a few months those coveted few pounds were shed. I was on top of the world. I had this great sense of pride that I couldn’t get anywhere else. After so many years of hating myself, completely hating my body, and feeling hopeless about any of this ever changing, it did change. I loved it.

I continued with the mild restriction and use of exercise to lose (at this point maintain) weight. The stress of starting early college my junior year was catching up with me. I could never perform well enough to satisfy my own perfectionistic standards. This only fueled my depression, anxiety, and other negative thoughts. There was, in my mind, just one thing I could control: my weight.

I set calorie limits for myself each day. I began running on the treadmill. It was a huge relief being able to focus on anything other than my inadequacies. To me, this was the best way to cope.

My weight fluctuated and lowered a little bit more, but not a whole ton. By the summer before my senior year I actually gained some back. The stress of school was gone which helped stop some of the negative thoughts I was having. I definitely wasn’t following a very healthy eating and exercise pattern at this point, but it also wasn’t so bad. I exercised to burn calories, but only felt the compulsive need to after eating “too much” food. None of the depression, anxiety, or self-hatred lessened here. In fact, they all continued to grow. 

Fall of senior year was technically the true beginning of my eating disorder, but I don’t really like that way of viewing it. I was sick before this. I already had a distorted view of myself, disordered eating habits, tons of ED thoughts, spent hours in front of the mirror body checking, and used exercise in a compulsive way. It all just happened to get worse at that time. 

The fall was a crazy adjustment. I now had classes at a career tech center in allied health, on campus at the community college, and a few in my high school. To say I was overwhelmed and stressed is an understatement. That coupled with the fact that I had gained back nearly all of my weight since first trying to lose led to eating disorder thoughts and behaviors like I’d never had before. It wasn’t until then that my parents noticed something was wrong. I hid it very well previously and continued to shield them from the truth as it all progressed.

My new purpose in life was to take back control of my weight. I was more carefully counting calories than I had before. Not only did the amount of food I was allowed shrink, but the variety diminished as well. I exclusively ran on the treadmill as my form of exercise. I would set a calorie goal for each time I got on. This always ended up in me pushing myself much further than my body wanted me to. At the end of each run I would continue well past my goal. Every single second, every calorie mattered. This all did the trick when it came to my weight. I was now slightly under what my previous low was post-surgery. I felt good, but not great. Every single time I looked in the mirror I saw fat. I body checked often and cried as I saw my body expand throughout the day. I felt the fat growing on me every single bite of food. My body was shrinking but the body dysmorphia was not.

My parents now knew something was going on. When I was at home, they watched a little more closely. This contributed to me restricting more at school, but that was also driven by a new ED-fueled fear. I no longer was able to eat where anyone, namely strangers, was watching me. I had lunch some days in a little cyber cafe on campus. There were a total of five seats, all facing a window, that I had to sit in if I was going to eat anything. Even then, fear paralyzed me. I was bringing a very small amount of food anyways, but I usually only consumed about half of what I packed for myself. 

I was falling into anorexia. My daily routine was becoming more disordered. I would skip breakfast, eat maybe half of my lunch (usually only fruit and veggies), take a few extra laps when I had time in college, eat a decent yet impossibly large dinner, and then work it off on the treadmill. It was all paying off. I lost almost enough weight to put me “below normal.” I was ecstatic. Meals became a battle in which the ever diminishing healthy part of me lost. My clothes no longer fit as well. People were complimenting me again. I felt on top of the world. The restriction and exercise became my new highs. I weighed myself at least ten times a day, and let the change determine how much I could eat or had to work off. I would see my size drop in the mirror after exercise and then gain and grow flabbier for each bite of food I consumed. All I could hear all day long was the ED voice. Concentrating on anything else, even my beloved schoolwork, was impossible.

After the first of the year my current therapist (seen for depression, anxiety, and self-harm) recommended I switch to someone specialized in eating disorders. In a sick way I was satisfied with that, but also very much in denial. My parents knew for sure that this was a problem and they supported the move. My new therapist helped to an extent I suppose, but not enough to keep me from falling deeper down the dark pit that is an eating disorder.

I honestly don’t know how I survived the last trimester of senior year. My cognitive ability was almost nonexistent, so the fact that I still graduated with a gold cord astonishes me. I exercised every single day. My runs became longer and more intense. I had my “little black book” where I would record every single calorie consumed and burned off. I won’t go into specifics of how I managed it but the nets ranged from negative to in the hundreds. I lost more weight, enough that my dress for graduation was already baggy on me even though I had just bought it. I still looked in the mirror and saw fat everywhere. There were days I would cry over an apple. I was miserable but the euphoria of restriction and compulsive exercise coupled with an overpowering ED voice shielded me from realizing it.

The eating disorder consumed me entirely. I was past the point of only wanting to lose a portion of the weight gained post-surgery. I wanted it all gone, and fast. My goal now became the admittingly unhealthy weight I was before I had the correction done. I ignored the fact that I was now an adult, not a 14 year old, and believed I would be more than fine. Once I had the number set in my head nothing would stop me. That summer was rough. My parents desperately tried anything they could to get me to eat. It became a constant power struggle, me against them. I found new ways to restrict and exercise without their knowledge. I would do anything, even hiding food in my napkin, pockets, or bra. I stayed at the table longer than anyone else, picking at my food and then tossing the rest. Even when my mom and dad caught on, I had no shame or remorse. They began to have me eat out at mainly fast food restaurants quite often, which only made me exercise and restrict more after and increased the thoughts. All the while, I continued to hate myself more. Nothing made me look in the mirror and actually like what I was seeing. The only time I could actually appreciate my body at all is after a long run or period of restriction. The physical effects of my illness seemed to grow each day. My hair was coming out in chunks. I injured myself all the time. I was cold in the middle of summer. My face grew gaunt and I looked dead. I was always dizzy and passed out frequently. My already frequent bruising was now much worse. I was weaker and more fatigued than I ever had been. My fingernails were now always purple due to decreased circulation.

In the end of June I went for 5 days to Disneyworld for HOSA nationals. I restricted more during this time than ever before since my mom and dad were no longer watching. Walking the park also burned a very large amount of calories without me ever having to step on the treadmill. I knew I must have freaked out the other girls and my teacher but I didn’t care. I have little memory of the trip because I was very malnourished. Competing in my events was so hard that I could barely manage. I stepped off the plane even closer to my end goal. A week later I had my wisdom teeth taken out. The ED snatched this opportunity up. I was in plenty of pain for around a week which meant no exercise. I more than compensated by using the pain to refuse nearly all food. This went on for two weeks as I milked the whole “my mouth hurts” excuse. I had hit my lowest weight and was mentally in a very dark place. I couldn’t have gotten out of it on my own if I wanted to.  I distinctly remember my mom coming into the bathroom and crying over how much my hips stuck out. Soon after she called Forest View.

I spent the last month of summer where everyone dreams of being, in partial hospitalization at a mental hospital. I was there 8:30-3:30 five days a week. My first day I was forced to say it out loud. I was in such denial. I couldn’t be sick. I certainly wasn’t sick enough to be there. I said it though, through tears, “I struggle with anorexia.” I was so stuck in my ways. I refused to finish any meals my first two weeks. I didn’t even touch any ensures when they “offered” me one after every refusal. I would come home each day, not follow my meal plan and exercise to make up for the “insane” amount of calories I was forced to consume. I lied to get away with the running, telling my parents that it was okay and my doctor approved. I cried every single day. I didn’t take treatment seriously until the second week. The doctor told me flat out that if I were inpatient I would have a feeding tube. I had lost weight, which really excited me at first. He then gave me a few days to turn this around or I would be forced inpatient. That scared me because it could also lead to him saying I couldn’t go to college that fall. After that meeting I started to really try. I actually did get plenty out of the ED groups and met some very sweet women there. I felt like I was a part of something and that I wasn’t alone in my struggles. I slowly accepted my diagnosis and the necessity of recovery. I left PHP the week before classes began and I truly felt I had it all taken care of. I had a reason to continue recovery (school) and a new therapist. Plus, my parents would be on me, so how could it be that bad?

Those first few months were pretty decent. I still attempted to follow my meal plan. I wasn’t exercising nearly as much. I loved my new therapist and felt like I was really getting work done there. More importantly, I became a youth leader which gave me a valid reason to recover. Thinking about the girls helped me push through some tough spots. Despite all that pushed me towards recovery, I began to slip at the end of the fall semester. I was over-stressed and felt out of control. This time I really had to hide my restriction and exercise, since my parents were still so worried about me. I eventually was “strongly persuaded” to start eating again if I wanted to go to youth camp in January. I had a short-term reason to recover and I did my best to go for it once again. This lead to refeeding symptoms that I had to deal with completely on my own. I went to camp and shortly after began to grow more into my sickness. 

I could be a youth leader without recovery. I could do school without recovery. Why did I need to recover? Granted, neither of those things I could give my all in or do well, but in my mind this made sense. So I just continued to pretend I was in recovery when I needed to be and act out on the disorder the rest of the time. I struggled in silence. My parents knew absolutely nothing because I was a pro at hiding it. I told only a few friends and my therapist the truth. By the beginning of summer I was basically at the point of needing treatment again, which I refused. We had NTS camp in June and I was not missing it for anything. The determination to go gave me enough motivation to do slightly better. I skated by and entered camp a complete mess. Looking back, I most definitely shouldn’t have gone. I couldn’t even take care of myself that week, let alone be there for five girls. It was another amazing time lost to my eating disorder. I have nothing but regret now. My girls deserved better and I should have been in treatment.

The one good thing that came out of NTS was motivation to recover (again). I was on a spiritual high and I felt I could totally do it. I was right for maybe a week. I worked ~30 hours or more per week as a housekeeper which was wonderful for my eating disorder. Not only was I burning calories all the time, it also meant many meals and snacks away from my parents’ watchful eyes. I barely ate a thing during all of those long shifts. It ended up really hurting my work performance. The front desk would ask me to do something and five minutes later I would completely forget what it was. I even had a hard time remembering the sequence to cleaning bathrooms even though I had known it for months. I was also exhausted, weak, and passed out multiple times, mainly when cleaning the showers there. As the summer ended, my therapist pleaded with me to go back into treatment. I refused and refused but by the second half of August I agreed, surprising my parents more than anything. They were ultimately very supportive after the initial shock. I was so tired of everything. I didn’t have enough energy to refuse it. I wanted to be able to go to Calvin in a few weeks. I had to go or I truly felt I would die, so off to Forest View I went. Oddly enough, my reason to pursue recovery was also a huge cause of me getting so stressed and deep into the ED again in the first place.

The week inpatient was a complete joke and bandaid. I ate 100% of all meals and snacks simply out of fear that I would be tubed or forced to quit college. It wasn’t easy, given how much I was restricting prior, but I managed. I even convinced myself that this would be different. I was going away to college and that was such a huge thing that I couldn’t blow it with this stupid eating disorder stuff. So, once again, school became the sole motivation for recovery.

I had about four days at home before moving into the dorms. I spent them soaking up quality family time. That didn’t give me too much time to worry. I was so sure I would have this under control. The excitement of college well overpowered any uncertainties. I somewhat got used to practicing my meal plan on the outside, packed up, and left for school.

New home, new dining halls, new therapist, new dietitian, new people, new classes. All of the newness distracted me for a while. I followed my meal plan for the most part that first week or two. I had a dietitian and therapy appointment weekly. I felt really on top of everything. I even told a few people at school so that I could have some support and accountability.

Everything caught up with me really quickly. I honestly wasn’t prepared for college. I was in no way solid enough in my recovery to handle the stressors, so I just didn’t. Being thrust into a new world with constant comments from others on weight, size, diets, and calories was a harsh new reaity. I once again found myself cutting out foods. This time around it began with severely limiting my variety. I literally had the same exactly lunch every day for the entirety of my first semester. My dinner would consist of a small portion of chicken, veggies, and fruit. I skipped out on snacks. Yoga became a part of my daily routine, but I would only allow myself to do weight-loss videos. I used a calorie counting app to help me stick to limits I set. My parents were worried about me constantly, but it was so easy to hide how I was really doing. I only saw them on weekends, so I would simply allow myself just enough food for them not to freak out then go back to restriction. By the end of September I was well on my way back to where I had been a month before.

The very last weekend in September, just a few hours into dorm retreat, I ran collided with a guy during capture the flag and broke my nose, suffered a concussion, and fractured my orbital socket. I ended up needing surgery and missed 3.5 weeks of school. During this time I was home, which I guess was good for my recovery since I was forced to eat and keep from exercising. I was suffering so much mentally though, and I knew that the second I got the chance to I would go straight back to the ED. The amount of stress I was under trying to make my work up was unreal. Instead of fueling my body, I continued to starve and abuse it. I couldn’t deal with my size compared to everyone else on campus or what I used to be. I gave up counting calories and just resorting to eating almost exclusively fruit, vegetables, and chicken. I was still doing the weight loss yoga. My grades slipped lower than I’d ever experienced in my entire academic career.

By November I had lost a significant amount of weight, worrying my dietitian and therapist. ED thoughts were stronger than ever before. I was sicker than I ever was previously, yet I was within the healthy BMI range. Because of this I was in complete denial and refused to let up on my goal of shedding pounds to reach my goal weight once again. At our appointment the first week of November, my therapist told me I had to go get a medical check-up and bloodwork or she would start the process of forcing me to leave school. Panic set in instantly and I headed to health services. My labs and everything were generally okay, much to my surprise. Even so, this was a wakeup call and moment of clarity. I saw a 0% chance that I could do this on my own. The healthy part of me knew I needed treatment. I wasn’t going to make it through the semester without being forced into treatment, so why not go in voluntary instead? I was also terrified that if I didn’t get help now I could end up dying from this disease. That weekend I went home and told my parents everything. I blindsided them and I truly felt bad for that, unlike all the other times I numbed the guilt out. At the same time I was so confused and worried myself that all I wanted was comfort and support. We made a pretty solid decision that Sunday for me to take a medical leave. Deciding to enter treatment and lost school was by far the hardest thing I’ve ever done. At that point I had no solid plans, a quickly shrinking amount of time to have in treatment, and I hadn’t even told my friends, treatment team, or school. 

I cried so much during my appointment with my therapist the next day. I skipped all of my classes since I really couldn’t deal with any of it and I would be leaving soon anyways. She kept repeating how proud of me to make this decision for my health. I made an appointment with student services the next day and a follow up with her the day after that. The reality of it all shocked me. I gained courage that day to tell a few people close to me what was about to happen. They were supportive but also really sad. My meeting with student services was sobering. I was again praised for making the best decision for me, signed a few papers, was given a move out date, and sent out with a “good luck” and information for when I got back. My RD and I had a short talk later that day and I found out everything I needed to do in regards to moving out of the dorms. My parents decided the next day would be it, only 9 days after I was warned about the possibility of forced leave. I met with my therapist that morning and cried more than I ever have in session. Her pride in me helped so much, even as we both struggled through tears. I gave her a hug and went on my way into the unknown. Soon after, we packed up every possession in my room, said goodbye to my friends, and began the trip home.

I bawled the entire ride home and for the whole rest of the day. I also was attempting to research as many treatment centers as possible. I really preferred a smaller center, although at that point I was desperate enough to go almost anywhere. I had no luck for two days. Every place was full, had too long of a wait time, or didn’t accept my insurance. On Friday I had all but given up and decided to try one of the places my therapist gave me the name of, Center for Discovery. I sent an email about it and got a phone call within an hour. The intake woman calmed most of my fears by telling me I could come within a week. It was finally real. The program was exactly what I had hoped for, small (only two other girls were there at the time with a max of 6 residential and 2 PHP), in a home environment, individualized, with some freedoms as you moved up levels, and the added bonus of being in the warm SoCal sun. The hugest blessing came when I found out that 1. my insurance would cover 100% and 2. CFD was going to pay for my very expensive, last minute plane ticket. I was filled with anxiety but also peace. I was finally going to get real help. I had a solid chance of recovering for real. After years in sickness and finally realizing how miserable it was, I cried for joy over this opportunity. I flew out on November 19th, two days after my 20th birthday and not even a week after my first contact with CFD.

I knew from the beginning that going to residential was going to change me, but I don’t think I ever anticipated or imagined the amount of progress I actually made. Its actually very hard to be too concise about everything I learned in treatment. I made a promise to myself that I was going to avoid all supplementation and unfinished meals. I didn’t want it to be like Forest View. I needed it to not be. I was challenged more in my time there than ever. It certainly isn’t easy challenging behaviors and thought patterns you’ve had for so many years. The first week broke me in many ways. I wasn’t moved up a treatment or exercise level and I was extremely defeated. How could I have made so much progress (n my mind) yet stay stagnant according to my treatment team? I fell into a depression and lost much faith in myself. I wondered if I could really do this and whether my hard work even meant anything. Not being able to go on the outing that weekend on one of the girls last days was one of the worst moments the entire time I was at CFD. By the next week, however, my attitude changed. I realized that I couldn’t rely on others to determine whether I was successful or not. I was the one who needed to recognize my own progress, so I did. I began a list of things I accomplished each week that I still do today. Its been very healing for me. I put every ounce of myself into recovery. I not only completed assignments and goals set by the treatment team, but went above and beyond enough to receive the nickname of Challenge Queen. I wore it with pride. Each day in treatment brought new successes, although not without hard times and setbacks. I was fine with the imperfection for the first time in my life. I cannot ever be expected to perfectly recovery. It just isn’t possible. As the weeks went on I led many groups, went on outings and passes, supported and helped the other girls, took walks in the mornings to see Napoleon the majestic cat, challenged myself with food, worked on my autobiography and timeline, learned and practiced coping skills, practiced yoga in a healthy way, decided to stay an extra week to best benefit my recovery, and much more. Explaining all I learned from CFD without writing an entire novel is hard. Easily the most important realization from residential is that I want recovery for me. I am not working at this for outside motivation. I finally believe that I deserve it wholeheartedly and I am doing the best I can to stick to that each and every day. After hardest and most rewarding 5.5 weeks of my life, I headed home.

I can’t sit here and talk about how amazing things have been since coming home without acknowledging the struggles. There have been many setbacks, hard days, return of strong ED thoughts, some lying, plenty of body checking (if only the real world had little mirror access like at CFD!), terrible body image, meals and snacks where I barely followed my meal plan enough. Being at school where I was so sick before is especially hard. At the same time, these two months have been better than I could ever imagine. I am so thankful for recovery. I am becoming myself again and I love discovering who she is without being so consumed by darkness. This is the healthiest relationship I’ve ever had with myself. I am learning to love my imperfections. The joy I feel now cannot begin to compare to the false euphoria and trickery of the ED. 

The hardship having an eating disorder is something that I, at one point, found very hard to deal with. My cognitive function has not improved even with refeeding. I’ve lost many relationships and hurt the ones that survived through it all. I spent years of my life not living at all. I broke my parents’ and friends’ hearts over and over. Nearly three years of schooling were almost ruined. My faith in God suffered and I am only beginning to repair it. My body has lasting scars, not only in the form of stretch marks. Vacations, camp, Disneyworld, college, and every day consumed by the ED. My depression and anxiety, body image, self-hatred, and hopelessness grew exponentially. Even with the extent of the damage anorexia has had on my life, I am actually thankful for it in a way. I’ve learned more about myself and become more resilient. I have met amazing people and formed great friendships along the way. My new passion of mental health and eating disorder awareness never would have come if I wasn’t ever sick. I’ve grown stronger. I no longer ask “why me” and instead accept that this all has happened for a reason. 

I’ve discovered, over time and especially during wall work at residential, what things led up to my eating disorder. There are many specific events but I really feel that a few negative core beliefs were the biggest factor. What I came up with is that I’ve always felt inadequate and unworthy, even back to some of my earliest memories. It really makes sense that someone believing those things so strongly would turn to an eating disorder for comfort. It gave me a purpose to live and one way I could be proud of myself. Knowing this now is helping me fight back and know what situations and emotions will trigger me the most. I am also trying to use affirmations and faith in God to pull me through dark times since it fights against those negative beliefs.

I am not going to be Emily the anorexic who dies from her disorder. I won’t define myself as anorexic at all. I am so much more than my eating disorder! My story is not over yet and this will one day not be the defining part of it, just a chapter. Its been a big part of my life but I have faith that won’t be the case forever. I will continually put in the hard work for recovery and treat myself with compassion and kindness. Recovery isn’t the easy choice by any mean, but it is absolutely the best one.

I’m not the “me” that I started with

My friends say my eyes are brighter

I’m not the “me” that I started with

I’m freer, and I’m wiser, and I’m stronger

We are crushed and created

We are melted and made

We are broken and built up, in the very same way

What I thought I could handle

What I thought I could take

What I thought would destroy me leaves me stronger in its wake

Crushed and Created – Caitlyn Smith

My Residential Experience – Day 1

Today marks two months since I was admitted to Center for Discovery, so I figured this was a perfect time to begin talking about my experience in more detail. I’ll be including pieces of my journal entries and anything I felt was important during my time there. It may get hard, confusing, saddening, joyful, frustrating, and silly. This is real and raw. This is my residential story.

I was admitted into CFD on November 19, 2015, but the story to get there began 6 days earlier. I was exhausted from searching and contacting so many different treatment centers. Every single one was a dead end in some way: long wait list, insurance wasn’t accepted, huge and impersonal, on and on. I decided on a whim and last effort I would contact the one Sheri had emailed me about, Center for Discovery. I sent and email and waited. Not even ten minutes later I got the phone call that would change my life forever.

Not only was the lovely admitting lady at CFD giving me a chance, she vowed to fly me out and have me admitted by the end of the week. I was overwhelmed with emotion and gratitude. I finally had hope, although fear accompanied and nearly overshadowed it. I spent the  next few days preparing mentally and packing. Early the next Thursday my dad dropped me off at the airport.

The first flight felt much longer than two and a half hours. I grew more anxious with each passing minute, plus a rather irritating kid was next to me eating the whole time. My layover in Denver was pretty short and since I was so into my ED despite choosing to go to treatment, I didn’t eat a thing. If the first flight felt long the second was an eternity. I was actually shaking a little by the end of it. I really didn’t want to get off the plane at all. I knew my life was about to change. I wasn’t going to come back from California as sick as I was. Although I wholeheartedly wanted that with most of my being, part of me wanted to turn around and head back to my same sick life.

God sent an angel, AKA the the best house manager/one who keeps everyone afloat, R! Talking with her while waiting on my luggage helped calm my nerves at least a tiny bit. I immediately really liked her. She was funny and welcoming. We spent the whole half hour ride talking about different things, and she pointed out some landmarks along the way. I was amazed by the beauty of San Diego, and also grew more comfortable speaking with her. By the time we got to the house it felt less like I was going to prison and more like I would be at a home where people truly cared. She answered so many of my questions and calmed fears. I am forever thankful for that first hour after I landed.

Once we arrived at the house I was given a quick tour. I remember immediately thinking how lucky I was to be in such a homey and beautiful place. Every staff I passed gave a warm welcome. I was absolutely terrified of meeting the girls so I tried to hide from them as we passed by the milieu. Weird, I know, but I was certain they would hate me or that I’d be way much larger than them or any number o things that could go wrong. I think part of that was how some people at FV were. I didn’t want to deal with a situation like that for a whole month. Once I got through the tour it was time for all the assessments. I also gave up my cell phone and personal belongings so they could be sorted through.

I remember being very overwhelmed that first day. It felt like never-ending assessments with all of these people I wasn’t sure whether to trust or not. My ED was screaming the whole time that I needed to walk out the door. Those first couple hours at the house were scary. I began by meeting with the nurse, S, and Dr. S, the MD. I loved S right away and felt a little better. Dr. S was really nice as well. Next came a meeting with my therapist C, which wouldn’t have been too bad if not for the fact that they made me eat snack during it. I got to choose anything to eat (not a luxury in the ED world!) and I nearly broke down just from that. I ended up with a granola bar and spent the entire hour nibbling at it. It was only the second thing I’d had that day. I liked C, but I was consumed in the ED so I didn’t feel so great while we talked. All I know is that we managed to get through all o the questions and I was sent to the next person. The dietitian N was next. I immediately liked her, until she explained the meal plan. They work off an exchange plan where you’re able to split up your exchanges any way you please throughout the day, minus dinner which has a pre-decided entree and sides. It was so different from anything I’ve had in the past. I HATED it. I cried and struggled to plan even the one day’s worth of meals necessary. Luckily she was patient and helped me out. After N, I was done with assessments for the day and was able to go into the milieu and meet the other girls. Cue anxiety!

I didn’t actually sit down again until dinner. It was kitchen skills night which meant we got to help in the kitchen. I was put right in and began chopping veggies. That was a great intro because it allowed me to be around the other girls without the awkwardness of sitting there with nothing to say. The diet tech that night was also so peppy and friendly that I felt at ease. Dinner wasn’t terrible at all! I thought I was going to die beforehand, but it went fine. I really enjoyed that we ate family style with staff. We had conversation the whole time which helped with my strong ED thoughts. The meal went much better than I thought. I was supported and explained anything I had questions on. After dinner was free time in the milieu.

Thank Jesus for how amazing LK and RB are. I couldn’t have asked for two better girls to start treatment with. They answered my questions and offered support. We watched some good crime shows, laughed, and got to know each other that night. Looking back now, I am so thankful there were only three of us my first week and a half. It was so calm basically the entire time. We each had our own couch (its the little things :P), got along perfectly, were supportive of each other, and became close. If I was instead thrown into the chaos and craziness of 5 people who were neither stable or able to get along like my last week there, I would have ran right out.

I met and got to know one of my favorite staff members overall after dinner. T was the nurse for second shift. If I wasn’t sure that the staff at CFD were amazing before, she sealed the deal. I needed an EKG but we ended up spending a good half hour talking back in the med room after. She is one of the sweetest women I have ever met. She truly helped me relax and feel comfortable. At that point, without meeting even half the staff yet, I wrote in my journal that CFD has the best staff ever. Oh how much that statement would come true during my time there.

I went to sleep that night smiling and thanking God. Yes, I was at a treatment center for an eating disorder that I wasn’t so sure I needed to get rid of. Yes, I was about to embark on the hardest journey of my life. Yes, I was thousands of miles away from anything I knew. Even so, I fell to my knees, in tears, in awe of the blessing I had received in coming to CFD. I knew I’d made the right decision, both in seeking treatment and choosing this place to come to. It was the first time I realized that I would come home changed for the better and that I truly wanted that for myself. I cling to these hopes with all my being to this day.

Planning for success at college.

I thought I would take some time to explain all of the resources/plans I have at college to keep me on track in recovery. By no means do I feel it will easily, but I feel very confident that I have the most care and best care available. My opinion on that may change after meeting my new therapist and dietitian. Even if they aren’t the right fit I will work to find someone who is. Anyways, here’s my list:

Therapy 1x per week. This is so essential for me. I honestly wouldn’t have gotten through last year without talking with J each week. Individual therapy is important and allows me to talk through whatever thoughts I have, whether it be ED, depression, anxiety, or even a random SH urge. I also get to check in and if my therapist sees a downward trend she can help me get out of it. I’m also a huge fan of therapy homework. S is my new therapist here on campus and she seems wonderful. I’m hoping she will be a great fit and I love that I get the perks of academic assistance (ie taking a test in a room with less people because 90 kids in a class makes me anxious or even if I need a break from class one day)

Dietitian with weight tracking. Yes, I am seeing a dietitian. I was the girl a year ago who claimed I was above having a meal plan, hated the dietitian I met with, made excuses to never go again, etc. Forest View this time around convinced me to change my thinking. That was actually a big part of why VH let me go so soon. He wanted me on a meal plan and being weighed often so that a relapse could be detected early. It makes sense. I’m open to it and glad to be going. I think since she’s also at the school I’ll have more help with meal planning. Plus I can hopefully resolve my lactose issue or confirm that I am intolerant and plan accordingly. I hope to see her weekly or at the very least be weighed weekly. I’m not sure how that will go but I see her this week.

Following my meal plan (yes for real this time!). I could technically say I folowed my meal plan for about a week last time, but even that’s a streth. Obviously, that needs to change this time around. I’ve had success for the most part so ar. I know it’s not going to be easy, espeically with my lactose resttriction, but I am willing to make it work. I’m hoping that with my dietitian I will hit 90% each week. That’s the goal for now because I know I will screw up sometimes or the dining hall might not have something. I’m going to try my best regardless.

Daily recovery devotional/work in recovery books. Faith and ED recovery go hand in hand. I really can’t tell you all the ways being in God’s word fights the ED thoughts and puts me in better spirits period. It’s wonderful. My goal is to start each mornign in the ED devo book J gave me and work in my recovery workbook daily as well. If I focus on that it will give less time for the ED to take over.

Coping skills. I have so many coping skills this time around. I bought lots of markers and pens and coloring books. I find that to be so helpful. I love listening to oworship music while doing so. Yoga will be a regular part of my day as soon as I pick up my mat from home. Crosswords and other logic puzzles are always engaging. Anything on my computer from netflix to playing sims to just browsing. I have made sure there never will be a time I don’t have something to distract me. This means distraction when I have meals alone as well.

Accountability. I will fill out my meal plan record every week and show my mom, therapist, dietitian. My mom texts me a few times daily to see if I’m on track/having a  hard time, which is wonderful. I’ll have my dietitian and therapist to be honest with. I would love to have someone at Calvin know what’s going on. I’m waiting on that for now but hope to tell someone part of this soon.

Outside support. For now, at least, I’m going to be relying the most on outside support in my mom, Livvy, Lily. It’s hard, but I want to do my best to stay on track and reach out if need be, even though they can’t be physically here.

I have infinitely more resources and options for treatment her. My hope for this year is tgat I get unto a good, healthy groove and use all the help I’m given. As J said at our last session, God put me here at Calvin for a reason. He knew I needed more help and the fact that everything is so close and there are therapists and a dietitian here is amazing. I don’t want to follow the ED’s plan of slipping below the radar into relapse anymore. I have hope that however hard, recovery is still worth it. Here’s to a fresh start and an amazing, healthy, reviving year!