27: Eating Disorder Treatment

I’ve now been in treatment for about a month. My first steps out the gate might be best described more as stumbles and falls, but every scrape I earn on the way down is a badge of honor that I hang proudly in my mental trophy room.

Why? Because each time I slip and fall, I learn something new and often profound about myself. And each time I get back up, I reenforce the fact that I can do this.

I have an eating disorder. And I’m gonna kick its butt!

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[Content Warning: eating disorders, weight, food, restriction, bingeing, treatment]

It’s taken a lot (and I mean A LOT) of work to take my first steps in treatment. As I wrote in my first post about my eating disorder, I spent over a year in therapy after diagnosis of disordered eating before I finally felt ready to start treatment.

“I feel like I’m starting out across a tightrope, and I look down and there’s no net that I can see,”  I stated bluntly to my therapist.

“Sometimes I’m scared and I want to crouch down, grab the rope, and head back to safety. But everyone around me—friends in treatment and recovery, family, my wife, books I’m reading, my therapist—is assuring me that I am safe and there actually is a safety net below me. I just can’t see it yet. I just have to trust and keep going.”

And here’s the thing: no matter how many rational people you have in your court; no matter how logically you look at your eating at times, an eating disorder will try to whisper (sometimes shout) in your ear that those around you are wrong—that you are wrong. Learning to identify that voice takes a lot of work. It takes even more energy and trust to at least ignore that voice, if not fully defy it.

Some days I can laugh in its face and retort, “You are losing and you know it. That’s why you’re so loud. Shout away!” Other days I cower and bow to the voice, agreeing with it for a moment if only to gain some temporary peace.

And it’s strange… treatment is hard. It can be scary. It’s utterly exhausting. Yet so far, treatment has been far, far less scary than my enormous dread of seeking help was.

I spent so long dreading and fighting the thought of treatment, but a huge part of me feels relief at tackling something that I’ve struggled with for eighteen years. While it’s scary to admit I have an eating disorder, it’s also incredibly liberating. As I do the hard work of therapy, it’s often exhausting and sometimes overwhelming, but it also comes with an all-consuming relief that I can’t quite describe.

Initial Steps of My Treatment

1) Six Meals

I started a six meal a day routine, eating three small meals labeled merely as Meal 1, Meal 2, and Meal 3, and three small snacks a day. This is fairly common in treatment. One of the benefits can be reawakening hunger cues that a body has stopped sending for people who have restricted.

I went into the routine thinking it would be very easy, but also feeling like that was a lot of food to eat. (Interesting how an eating disorder will whisper conflicting information in your ear. Once you start to catch on to its little inconsistencies, it starts to lose its grip on you ever so slightly.)

Through this task, I realized that anorexia has played much more of a role in my life than I had realized, and that my bingeing was often a symptom of both conscious and subconscious restricting.

This was a huge revelation for me because: A) I had always thought of it in reverse, that my bingeing lead to restricting out of shame and B) I had the false assumption that someone has to be underweight to be anorexic. (That is NOT the case at all. Anyone of any size or shape can be diagnosed with anorexia.)

I printed out a chart when I realized how difficult it was to remember to eat and how hard it was to hold myself accountable for it. I worked out the math: I needed to eat something every 2-3 hours or so. The only problem? Seeing what I was eating on paper made me fixate too much on WHAT I was eating. But my fear—that I needed to change everything about my eating habits all at once—was unfounded.

My therapist reassured me that we were breaking things into manageable steps. “Right now, just focus on when you eat, not what. Addressing nutrition comes later!” I was so relieved because she was right—focusing on what I was eating in addition to starting this new routine that challenged 18 years of restricting and bingeing was too much. It was setting me up to crash and burn.

2) Talking to my doctor

Another victory came at a follow-up appointment with my primary care physician. This was not strictly part of my therapy, but I made it part of it because I trust my doctor.

Toward the end of my appointment, I had worked up my courage. “There is one more thing. Something I think you should be aware of as my GP.” I took a huge breath and continued.

“I’m in treatment for an eating disorder and I’ve begun a six small meals a day plan in order to return my hunger cues and manage my restricting and bingeing. So far it’s helped a lot to identify that I wasn’t eating as much as I thought I was which was leading to binge eating. So far it’s helped a lot with dizziness and hypoglycemia.”

I paused and finally looked at him.

“That’s great! Most people should be eating 4 to 5 small meals a day rather than the 3 we do. And if you ever want to try medication, there are some that can help with binge eating.”

I could almost hear my eating disorder groan at this response (it had hoped he would shoot me down and I’d have an excuse to stop treatment), but ultimately I was relieved.

“Thank you! I think treatment is going well so far, so I’ll wait on medication, but it’s good to know there are options. Also…” I paused again, looking down at the notes I had written for the appointment, “I… would like to stop being weighed. It’s very triggering for me; It makes me struggle with restricting more. And it’s hard to avoid seeing it on my charts.”

I held my breath the beat it took him to answer.

“Absolutely. No need to take your weight.”

Phew! Another ally in my court.

3) Challenging the voice of my eating disorder

I have made quite a lot of headway in this regard, but am finding it the most difficult part of treatment. For so long, there’s been this negative narrative in my head regarding food, weight, perfectionism, and control. Identifying that voice was an overwhelming experience as I wrote down all the terrible things that voice says to me.

The next step after learning to separate the eating disorder “voice” from my own has been a little harder. I’m now starting to “reply” to it with snark like “Gee, what a terrible suggestion. Thanks, but no thanks!”

And as a close friend of mine pointed out:  the more progress I make, the more my eating disorder is going to fight to survive. It knows it’s losing, and it will do anything to survive.

But joke’s on it—I’m stronger. And certainly sassier!

4) Journalling and continuing to read

I write notes in my journal about what my goals from therapy are and reminders of things to do and not do. That’s been essential to keeping on track and reminding myself it’s okay when I slip up. I also reflect on things I’ve learned in the books I am reading as part of treatment.

Journalling has also helped me to connect some dots on how my eating disorder controls a vast variety of things in my life. I’ve been astounded, for example, to realize how much my eating is tied to my perfectionism and anxiety, and in some ways, my OCD tendencies.

For example, my need to follow difficult tasks through until the bitter end no matter if I want to or not is slowly, ever so slowly budging. I recently had a small but mighty victory of “cheating” while reading one of my books and skipping over a section that was triggering to me. In the past, I would have slogged through that section to be “self-disciplined” (strange as that sounds) even when my mind and body were signaling “This is not what we need right now!”

Journaling also helped me to realize that binge-eating had been a way to stress-stim for me, and that without it I was much more anxious. It showed me that I needed to start stimming as self-care: coloring, squishing clay and silly putty, singing, flapping my hands, holding fluffy stuffed animals, etc.

I see these victories as tied to my treatment in a very real way, and I wouldn’t have noticed them without journalling. The journal also gives me a place to record moments I’d like to share in therapy, and a place to look back on to see how far I’ve already come.

I’ve got a long road ahead, but for now, I am so happy to look back and see how far I’ve already come.