by Amy Stringer
TW/CW: eating disorders, anorexia, food rituals
Disclaimer: I have very intentionally not talked numbers in this post as I know this can be very triggering for other sufferers of eating disorders. That being said, I do try to be quite descriptive and if you are suffering from an eating disorder currently, this may not be the post for you. FOr everyone else, let’s go.
There’s someone in my brain who isn’t me. Of all the disorders, Ed talks to me the most.
I’ve been dreading this one. You see, an eating disorder is an incredibly secretive thing, full of deception, and to talk about it almost feels like I’m invalidating it’s existence. But it’s real and it’s serious.
Ed feels like he is both your best friend, and your worst enemy at the same time. He wants what’s best for you; thinness, beauty, a sense of control, even at the cost of your life. A systematic review, published way back in 1998 found that eating disorders, in particular anorexia nervosa, ranked alongside substance use disorders as the psychiatric conditions with the highest mortality rate. In 2014, a meta study was published stating that borderline personality disorder, anorexia nervosa, depression and bipolar disorder had the highest suicide risks. In those with an increased mortality rate, reduction in life expectancy was significant, around 10-20 years. I wonder what happens if you have a combination of these disorders… would your life expectancy decrease by 40? That’s a sobering and possibly irrational thought.
I spoke about the stigma around bipolar in my posts about Po, but I’ve never really seen that as a barrier with Po. With Ed though… I can’t even begin to explain but here goes.
Just eat. Just eat. Just eat. As if it’s that simple; and people wonder why they could go years not knowing their friend of family member was suffering. When this is response you’re faced with, it can be hard to open up.
“What do you mean you have an eating disorder? You look so healthy”
Healthy. One common expectation of someone with an eating disorder, anorexia in particular, is that they look skeletal or emaciated. I was never skeletal, despite my efforts. I was thin, and at some point I was underweight, but you wouldn’t look at me and think, or possibly believe, that I have a pretty serious eating disorder. Healthy. Ed hates healthy. And whose place is it to say that you’re healthy based purely on the way that you look? Because of this I had this idea in my head that if I didn’t meet the DSM-5 criteria for anorexia, then I was fine, healthy as we say, and that I didn’t have an eating disorder at all. A psychologist later told me that was wrong but I’m still not quite sure I believe her.
“Have you lost weight? You look great!”
Another common misconception about eating disorders is that they stem from a place of vanity. This is absolute horse shit. When my eating disorder started my life had just been completely turned upside down. I barely knew who I was anymore and everything was wildly out of control. Ed helped me. He helped me gain control of something again, this is what eating disorders, or at least anorexia, are usually about. He felt like a friend, whispering sweet nothings in my ear and that’s how it set in.
“You need to eat some meat, you’re wasting away”
To be honest, this one is extra triggering as a vegan, partly because obviously I’m not going to eat meat, but also because that is not why I don’t eat meat. My veganism has absolutely nothing to do with my eating disorder, and I was vegan long before I became unwell.
“You look like you could use a burger”
Others seems to have this idea in their head that those with eating disorders are attention seeking. In some cases, sure, it might start this way, but this is not the norm by any means. Attention is the last thing we, as eating disorder sufferers, want. It is the last thing Ed wants, which is one of the things that makes writing this post so hard. Telling people means people will watch you eat. Telling people makes it harder for the eating disorder to survive, and that is not what Ed wants. Ed wants to stay in the shadows, controlling you right under everybody’s nose.
Where did my Ed come from?
During world war two, there were a lot of experiments done on those who refused to fight. One such experiment was the Minnesota Starvation experiment which sought to study the physiological and psychological effects of starvation (brutal, I know.)
They started off by feeding these men a diet consisting of 3200 calories per day. Once a baseline had been achieved, they then reduced these calories to follow to semi starvation diet, around 1570 calories per day, for six months. After this, the men were put through a rehabilitation and weight restoration phase, with observations being made throughout the experiment.
What did they find?
Well, they found a lot of things. The men underwent many physiological changes, including marked decrease in body temperature, physical strength and stamina, increased body hair, lowered heart rate, and extreme weight loss. But the changes didn’t stop here. Those running the experiment also found that the participants developed a preoccupation with all things food related. The hunger turned them obsessive! This included but was not limited to thinking about food all the time, obsessively planning meals, and savouring the few meals they had. Participants also experienced many emotional and cognitive changes such as impaired thinking/concentration, depression, anxiety and reduced alertness. This state was later termed “starvation syndrome.”
What does this have to do with me?
Now, this is where things get really interesting (to me at least). I may have mentioned in previous posts that right after the attack I lost a little bit of weight. This wasn’t the whole truth. I was already a healthy weight, and then I very quickly lost a decent chunk of weight due to lack of desire for food (from the depression) and increased physical activity (to cope with the depression). I wasn’t “underweight” (this is purely measured by BMI, I know, not great) at this stage, but I was close. According to my psychologist, during this period I developed starvation syndrome, which went untreated and eventually morphed into the full blown eating disorder I now refer to as Ed. It was now that I learned that you can develop an eating disorder later in life.
It’s hard for me to talk about my experience because I wasn’t really aware it was happening until recently but I’ll try my best.
The first time I remember wanting to lose weight was after my first anti-depressant made me gain back all the weight I had lost during my depressive episode. This was pretty devastating to me, and I can recognise now that this was an effect of starvation syndrome. I became obsessed with “getting my abs back”, taking control over my appearance.
A little down the track, in maybe 2017, I was pet sitting for a friend. It was for about a week and I would walk the dog twice a day for around 45 minutes and it was then that I started counting calories and exercising more. My friend also had digital scales (I didn’t) which meant that I started tracking my weight. Once I went back home I bought a set of my own. It felt good being able to see exactly how much went in and approximately how much went back out again. Being able to control this difference results in this amazing feeling that is difficult to describe, like a feeling of power… but different.
I don’t really remember much between then and when things started getting really bad last year. At some point I downloaded a weight tracking app, further feeding that sense of control, that would give me little weight loss targets and a date by which those targets could be reached. I started to live by this app. I did everything I could to reach those milestones including drastically reducing my caloric intake.
At my worst I was eating only around 30% percent of the calories I need just to exist. This meant I could lose weight without even exercising and I weighing myself every day to make sure that happened. I became underweight fast and I was fainting often from simple things like standing up too fast. I wasn’t exercising excessively and I wasn’t not eating at all, but I may as well have been.
I would skip breakfast, and usually I would take a small Chinese take away container of leftovers from the night before to work for lunch. I would very specifically eat exactly half of this and throw the rest out and that’s all I would have until dinner time. I live with my partner and so at dinner I would lie and say I ate a lot during the day as a way to justify my small dinner portions and I would eat about the same amount as I ate at lunch. It’s hard to gain back that trust, but we are getting there.
I developed these obsessive habits, some of which are still with me. I would use an app to track every single calorie that went into my mouth. I would (and still) use a specific fork, a specific glass, a specific mug for different things; usually the smaller ones. I would, and I still, measure my rice when we have rice dishes, keeping to only a small “allowed” amount. I generally would only eat if I was going to be observed so as not to arouse any suspicion, but it was easy enough to avoid this at work/uni. As I already mentioned, I would weigh myself every day. Now, as per my treatment, I try to do it only once a week (apparently avoiding it entirely is bad too). I would (and still) spend a LONG time getting ready, trying on multiple sets of clothes and getting really upset if something didn’t fit right or if I could see my stomach sticking out even a little bit. I would scroll through the eating disorder hashtags on Tumblr (which exist by the way) and use this to trigger myself into doing better with Ed. There is a strong sense of competition that comes with an eating disorder. You see someone smaller than you and all of a sudden there’s this fire in you that propels you to want to get smaller than them. I would withdraw from social outings, and avoid eating out because take away or restaurant food is harder to track and usually you’re expected to finish your meal.
The worst part about it all is that it works. When Ed says I’ll feel better if I can get myself under control, he’s 100% correct. You do start to feel better, and it stays that way as long as the number on the scale keeps going down…
Some time before November last year I admitted to myself that there was a problem, but before this I was very much in denial. I wanted to try and manage it myself.
It didn’t work.
In November, I went to my GP and got a referral (which you need for this also) to see a psychologist and a dietician. I couldn’t get any appointments until Feb and I DREADED it.
By the time I got to treatment I (or Ed) really didn’t want to be there. The thoughts had gotten so bad that Ed was all I thought or cared about. I wasn’t ready to get better, I had gained weight over the holiday period and I wanted to lose that first. But after speaking with the psychologist and having her validate my eating disorder (I still didn’t really believe that I had one) I decided to try.
I had to see the psychologist, and the dietician and the doctor every week for the first four weeks. After this I had to see the doctor every week and then one of the either the psychologist or the dietician every week, so they would alternate.
When I got into treatment and had my diagnosis, the psychologist started me on a program called CBT-E, which is cognitive behavioural therapy enhanced (or something), and it’s a program that can be tailored specifically to tackle eating disorders of all varieties. I mentioned in my Po post that I bought the book on bipolar, well I bought the book on this too so I could better understand my treatment program. It’s called overcoming binge eating. I could talk for ages about this treatment so I think I might do that in another post as this is already quite long.
I was in treatment for a couple of months before I ran out of work and it just got too expensive but my psychologist gave me a bunch of print outs so that I could continue my treatment on my own, and of course, I have the book. It’s been up and down but I’ve been very slowly working my way through the book and the exercises and while Ed is still very much a part of me, I feel like I have some level of control over at least my eating habits now, not so much the thoughts. Ed is about control, and he still frequently seeks to take control over my eating especially if my life at any moment feels a little bit chaotic.
If you think you might be struggling with an eating disorder, it’s okay, there is help available. The new eating disorder plan gets you a referral 40 sessions with a psychologist or a dietician in a 12 month period. Depending on who you see/where you go, medicare will rebate some or all of the cost. All you need to do is see your GP and explain your situation and together you can work out an eating disorder plan.
You are not alone, you do NOT need to be emaciated to have an eating disorder and you deserve help. No one should have to live like that.