I gave in.

I sit here, pushing aside the shame I feel in order to be honest, because maybe that honesty will help someone else.

On the outside, oh how I try to fight diet culture any chance I get. I wear my “No one cares about your diet” shirt with pride, share at least one or two posts a week, follow all the right body-positive Instagram accounts. I can explain how most diets are garbage and either don’t work long-term or lead to eating disorders.

I continued with this facade for the first two weeks of this year, when I had actually dove head-first into exactly what I stood so firmly against.

It was the day before New Year’s eve. New year, new you, or so they say. Somehow, our culture has decided that January 1 is the perfect time to start a new diet or “lifestyle change.” If you have a TV, social media, coworkers, etc I’m sure you’ve heard and seen a million options out there. As I sat on Facebook, yet another diet ad came onto my screen. I usually am so great at ignoring them, but not then.

Soon, I was interested enough to take a short quiz. I didn’t find anything wrong with the curiosity. I think part of me believed it would be obvious BS and I could move on. I finished the quiz and got the good news: I could reach my goal – and only by February with the app’s help! It hurts to admit how much that excited me.

When the app offered me their services free for 2 weeks I jumped on it. I imagined how much happier I would be after I dropped some weight and got to that magic number. I felt excited for an opportunity to transform the negative view I’ve had of my body since my most recent relapse and journey back to recovery.

This past Thursday marked 3 weeks since I sat in my therapists office and deleted the app with her. I knew I wasn’t strong enough to do it alone, and considering they offered an additional 3 weeks when I tried to quit, I’m glad I had support. I have managed NOT to download or sign up for it (or a program similar) since that day. Let me tell you, that has been a whole lot harder than I ever imagined.

Since I’ve been away from this program a few weeks, I feel in a much better place to critically analyze some aspects of it. Some are simply a byproduct of diet culture, but a few were pretty significant in my opinion.

  • Separated foods into good, okay, and bad categories while also giving limits to amounts of these foods. This is pretty typical when it comes to weight loss websites/app/diets. The thing that bothered me the most about theirs is that nearly every carbohydrate choice I could think of, even things like whole grains were in the “bad” category. Essentially they were asking me to avoid carbs unless they were included in fruits or veggies.
  • Set my daily caloric limit to the same nutritional requirements of a toddler (and added exercise on top of that). I completely get that this is a weight loss thing and they wanted me to hit this magical goal in x amount of time, but most calculators I have seen before wouldn’t go for this amount. It just surprised me in a not so great way.
  • Had a real person following along and praising me for completing less than the above amount some days. Honestly this may have been the most shocking part of it all. I was really starting to struggle with restriction at the time and she actively encouraged it. To top it off, she wasn’t a dietitian, nutritionist, etc. If I had a patient who told me they had that amount I would definitely be concerned, because it honestly wasn’t safe.

I see the ad for this specific app at minimum once a day, or more depending on how often I get on my phone. Sometimes I can ignore it, but often I think of the “benefits” and wonder if my team was truly just overreacting. The way it would reward me for avoiding specific foods, exercising, or staying within calorie limits filled me with pride. That truly was a huge positive for me and maybe the thing I miss the most.

These people who make different diet programs know exactly what they’re doing with marketing. They offer amazing results, use guilt and rewards (sometimes at the same time – “you’re doing SO much better than last week”), and convince us that changing our appearance is going to make a difference in our lives. Anyone can fall into the trap.

What I’ve realized through this journey is the praise I received still didn’t get rid of that negative voice. Losing weight and essentially ramping up ED behaviors only has set me on the path to relapse, not happiness. I am working to get back on track and away from all of the BS diet culture throws at me.

*Note: I do not feel like actually naming said app is helpful to anyone. I definitely wouldn’t want to see more people fall into it like I did. 

Last day of IOP?

I’m really scared going into today. As I sit here typing, the IOP team is deciding my fate. I learned yesterday that this would be the case. It’s been a long time of (in their eyes) me needing a higher level of care but avoiding it. I am 95% sure they’re going to recommend PHP and I have little fight against that. I could technically refuse, but I also just can’t. What choice do I really have when they’re not going to let me continue IOP?

I’m guessing that either today or Monday will be my last day, and then I’ll be forced to start partial. I’m so scared for a million reasons. It may be the least disruptive option for treatment right now, but this is going to be terrible all around. My parents are going to freak and yell and scream and try to refuse. I truly can’t afford it at all. Not only is it expensive (though at least covered by insurance), but I would have to quit working or cut back by a lot.  I don’t know how Im going to continue paying for treatmdent in general but that’s an added stress.

I’ve been trying my hardest to avoid answering the main question on everyone’s mind: can I make this on my own or do I need a higher level of care? I think the answer may be no, but only because of time constraints. I have 5.5 weeks until school and I guess it might not be possible to get to a good enough place by then. I haven’t told anyone this and can’t even accept it myself.

I want to shut down or skip treatment or not ever show up again. Part of me still hangs on to the hope that things will get better, so I am going to try. I am at least making myself stay for lunch. If I can’t handle everything after that I won’t push myself. There’s a lot of stress and hard decisions coming and maybe a break for the rest of the day would be okay.

My only hope is that somehow things work out and that it won’t be as bad as I think.

I have to do hard things

I haven’t been doing so hot. I’m trying to accept that this is relapse and not just a slip backwards. If it was just a small slip, I probably would have crawled back out of it by now.

Things have become more crucial at this point. My team has been more concerned lately, and last week I got some news that I’m not thrilled about. My eating disorder has always included solely restriction and exercise, so my weight trends can be predictor of how I’m doing, to a point. It has been trending down for a while now, and I am now out of the range my team sees as good for my body. I only just found this out last week.

Thursday was rough. I had my phone session with K, lunch and therapy with R, and IOP stuff the rest of the day. I wasn’t fully expecting the news they both shared: I am on a weight gain protocol, starting today. In our treatment facility, this means that if I have lost weight or maintained below the cutoff I will be given an ensure on top of my meal plan. I’ve voiced my opinions of Ensure before, but I’m definitely more upset about the principle of being forced to have them (if needed) and not the disgusting taste.

I know what to expect today. My eating wasn’t great over the weekend. I don’t believe I necessarily lost, but I also am 99% sure I didn’t gain. Ed thoughts are strong. All I can think about is having to supplement. I imagine how I could be defiant and just refuse, but I know that can only lead to a higher level of care or being kicked out of IOP/outpatient.

I don’t have any options other than fight. I have to do the hardest thing and drink the damn Ensure. More than that, I need to find motivation to put serious effort into my recovery. Slipping more jeopardizes all of my dreams. It’s time for Emily to become stronger than Ed again.

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.

Where I’m at – end of exam week 5/17

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I’m feeling vulnerable and raw, so here goes. This picture is real life right now. No filter, no editing, no posing to make things seem better than they are because it really has been a shitty time.

It’s not quite 6 am. I have been up basically two days straight, minus a few broken hours of sleep Monday night. I have barely eaten with all of the stress I’m under.  I am studying for my exam at 9 and attempting to work on a week overdue essay. I still have one more exam tomorrow and the task of moving out my entire dorm by 4ish.

I question myself constantly: how did I, a once straight-A, hardworking, enthusiastic, and successful student come to this point? The answer (almost solely): my eating disorder.

I always assumed that nothing could possibly get worse than Fall of 2015, before residential. I struggled hard my first semester at Calvin, but I gained so much momentum in recovery through treatment. Things went well up until the end of this past Fall; then enter IOP and groups, improvement, and once again relapse. I have never been so low on motivation, dealt with this amount of stress, had my depression and anxiety affect me quite this way, or relapsed so significantly so fast. This combination naturally compounded into a miserable experience, particularly the last 2 months or so.

I am surviving and that is it. I feel like giving up most of the time. My behaviors, thoughts, lack of following my mealplan, etc have lead to a pretty desperate situation. I had two choices: gain motivation and stay outpatient or enter a higher level of care. Nothing seemed to help where I was headed. Everything only intensified, leading to pretty drastic (to my treatment team) weight loss. Last week we made an agreement that I reluctantly obliged to: lose absolutely no weight through the week/in the future or I would be forced to have a phone session with my mom. Monday that’s exactly what happened.

The conversation itself didn’t end terribly. She was upset with my lies and hiding everything, but also offered her support. We mentioned a higher level of care, but she did not know I had already contacted CFD and found answers. Through the remainder of therapy and my dietitian appt my concern only grew. It clicked that even with my mom’s support I no longer felt confident in my recovery. I made the decision that afternoon to return to residential. I called her that night and began the truly difficult conversation.

Residential feels like giving up in ways. I hate knowing I need more help.. The one thing that has brought comfort is the support from those at treatment. My therapist and dietitian both are happy with my decision, although they wouldn’t make it for me. Group was also very affirming today. It is the right choice. There will never be a good time to go away for treatment, but this is my time. I am too exhausted, too sick, struggling way too much to function. It’s time to put recovery first and begin to break free once again.

 

I know EXACTLY what’s coming

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

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

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

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

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

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


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

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

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

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

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

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


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

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

Immediately my thoughts began to race:

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

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

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.