Relapse

It's been a while once again since I posted, but I felt this was relevant. I want to talk about relapse. I know this quarantine hasn't been fun for anyone. I know it has been especially tough for people that struggle with eating disorders. Quarantine has brought on relapse for many people, including myself. I'm embarrassed to say it. But I've relapsed. The signs started to show when I was on my own for a lot of meals in England. I wouldn't finish all of it or maybe I would miss breakfast once a week. I also didn't have a care team in place. Things got nasty when I had to come home from my study abroad and suddenly I was with my thoughts for most of the day. I gave my eating disorder space to breathe, let her come back into my life. Come back, she did. She came back in full force and wrecked my mental health. Now I'm going back to residential. I'm both upset and glad I reached out for help. I don't really want to get better, but I know life is better when I'm in recovery.

This isn't all about me though, I want to try to make things educational. So here are some warning signs someone is slipping into relapse:

• Therapy/nutrition sessions have stopped
• Exercise has become a necessity
• Foods are being labeled as good or bad
• Wants to eat alone/avoids eating out
• Becomes more closed off and avoids feeling emotions
• Rigid eating patterns
• Perfectionistic attitudes
• Relying on external compliments for validation

These are just a few examples of course. But look at yourself if you've struggled with an eating disorder. Are you doing any of these things? Maybe it's time to reach out and get help. If you notice a loved one doing these things make sure you're there to support them. 

What is ARFID

It's been a while since I've posted because I am now abroad in England for the semester, and I'm no longer required to write this blog for class, I am doing it on my own time.

ARFID stands for Avoidant/Restrictive Food Intake Disorder. From my time in treatment, I met people struggling with ARFID but thought it was just picky eating. It wasn't until I did research recently that I learned it's so much more than that.

ARFID is a more recent diagnosis and unfortunately, that means there aren't a lot of specialists or research in that area. It is like anorexia in that there are limitations to the type and amount of food consumed. It differs from anorexia because ARFID is not about body image. 

According to DSM-5, ARFID is diagnosed when there's a clear lack of interest in eating, avoidance based on sensory characteristics, significant weight loss, failure to achieve expected weight gain, nutritional deficiency, dependence on oral nutritional supplements, and there is no disturbance in how the body looks.

Here's a quick list of warning signs and symptoms of ARFID:

• Dramatic weight loss
• Vague gastrointestinal issues
• Fears choking or vomiting
• Lack of interest in food
• Difficulties concentrating
• Sleep problems
• Feeling cold
• Dizziness
• Fine hair

I decided to make a blog entry about ARFID because I think it's more common than known. I wasn't formally diagnosed with ARFID during my 12 months of treatment, but after learning more about it, I've realized that my eating disorder wasn't out of the ordinary. I wasn't alone like I thought I was. There needs to be a bigger understanding of what ARFID is in the world. Of course, there are stigmas to get through about mental health in general, but more people need to understand what ARFID is and how to identify it.  

Here are a few links to learn more about ARFID

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid

https://www.waldeneatingdisorders.com/what-we-treat/arfid/

Some days aren't easy CW: talk of food

I'm writing this post after struggling through lunch and want to just move past that, so I decided to write about it. First of all, me just wanting to push past the discomfort is me avoiding my emotions and I'm trying to sit in those. I thought this would be an interesting post because it's important to recognize the ups and downs in recovery.

I wanted sushi for lunch and had my heart set on it, but they were out of rice so I had to practice some flexibility in the moment. I got a "Mexican bowl" that had a base of lettuce, pico de gallo, cheese, guacamole, corn, and beans. I don't personally like loose corn or beans but I needed protein and a starch. I also got a root beer and a bag of chips. I finished the chips with ease. Then came the bowl. I suddenly wasn't interested in it. My appetite had gone. I started eating it and really didn't like it. I started to get anxious. I need to finish my meals. Relapse is the scariest thing in the world right now and I'm not letting myself fall back into those patterns. I got a little shaky as I do when I'm anxious, and my stomach started to flip. I told myself I needed to eat and finish this stupid meal.

I didn't finish the meal. I took a few more bites and decided to throw it away. Sometimes you have to eat things you don't like. Sometimes you just feel like you can't. I decided I'd buy some dumplings. I threw away my bowl before checking to see if there were dumplings. There were no dumplings. I got even more anxious, my backup plan had failed. The shakes and nausea increased. I got a quesadilla. These are easy for me to eat. My anxiety had taken over my stomach at this point and I felt like I was going to hurl. I sat down with my quesadilla and turned on Saturday Night Live. I finished half the quesadilla and threw out the rest.

This is an example of practicing flexibility. When someone doesn't like what they have to eat, they get something else. Even though I ate and I'm pretty sure I met all of my exchanges for this meal, I'm still really stressed. I had that voice in my head telling me I don't need to eat and to just forget about it all. That's what's scary. That voice is still there. I'm trying so hard to live without it, to shut it down every time it comes up, but it's hard and exhausting work.

Basically, even though I'm doing well in my recovery, there are still hard moments. Moments I think I need to be back in treatment, moments I'm scared someone will send me back to treatment. I'm not going back. I never want to go back, and not because it's not a fun place to be, but because I don't want my eating disorder to send me back. I hate her more than anything in the world and I look for the day I will live without that voice in my head.

Eating Disorders in the LGBTQ+ Community

It's unfortunate but true. Eating disorders are big in the LGBTQ+ community. According to the National Eating Disorders Association, 42% of the males that have eating disorders are gay, and gay and bisexual boys are significantly more likely to restrict, purge, and/or use diet pills to control their weight. Gay males were seven times more likely binge and 12 times more likely to purge than heterosexual males. Women that identified as lesbian, bisexual, or bicurious were twice as likely to binge at least once per month in the last year than heterosexual women.

Because eating disorders are often about changing the way one's body looks, people that suffer from body dysphoria, the feeling of one's identity not alining with their body, are at a higher risk for developing an eating disorder. Trans individuals will try to change their appearance through dieting and exercise to resemble the gender they identify with.

There are a few reasons for the development of eating disorders in LGBTQ+ individuals:

• Discrimination based on gender or sexual identity
• Bullying because of sexual identity
• Internalized negative beliefs
• Unrealistic body image ideals or goals that are prevalent in LGBTQ+ cultures
• Trauma
• Fear of rejection
• Psychological stress related to a disconnect between gender identity and biological sex
• Not being accepted by friends and/or family for sexual identity

Overall, eating disorders don't discriminate. They affect each and every identity. I thought I couldn't have an eating disorder because I was masculine presenting. There's a stigma around eating disorders, but specifically around men with eating disorders. The world acts like eating disorders don't affect men. Because of this I convinced myself that I couldn't have an eating disorder because I'm not feminine. It took me a few weeks of treatment to accept that I could have an eating disorder even if I dressed like a 12-year-old boy. 

Function of Emotions

At my treatment center, we learn a lot about emotions. One of my favorite lessons was the function of emotions. My treatment center lives by the idea that every emotion holds a function, and because of that there are no good or bad emotions, just emotions. What does this mean though? It means that your sadness is showing you something, your anger means something, your contentment is telling you something. Below is a list of emotions and what function they might tell you.

• Anger
• There is an injustice.
• Something is wrong with the situation.
• Sadness
• Something is important to you.
• Keeps you focused on what is important
• Fear
• Something is wrong
• You're in danger
• Anxiety
• You need to prepare for something
• Something is not right
• Guilt
• You noticed you need to fix something
• Disgust
• You need to be protected from something

People with eating disorders often struggle with how strongly they feel their emotions, so they turn to emotionally driven behaviors or avoidance strategies. In recovery, it is important to learn how responses to emotions are driving symptom use. 

Treatment Recap

Last Thursday, I discharged from treatment for the last time. I am determined to make this my last discharge. Last time I had an official discharge it was after eight weeks of intensive outpatient and I relapsed a month later. I'll lay out the timeline for you.

New Year's Eve of 2018 I had an intake in New York. They recommended I step into Intensive Outpatient (IOP) as soon as I return to Boston. For the first eight weeks of my sophomore spring semester, I walked 20 minutes to treatment and then 20 minutes back three times a week for three hours each day, not including seeing my therapist and dietician there outside of programming hours. I discharged from that level of care in March. I was in IOP for eight weeks.

After leaving, I relapsed and fell into old habits and took on new habits like calorie counting and using coffee as a hunger suppressant. In April, a therapist told me to go into residential, I said no. I had a month left of school and I wasn't willing to leave. So I entered Day Treatment Program (DTP), also known as Partial Hospitalization Program (PHP). I stayed in DTP at the Boston site until mid-May. I begged my therapist to let me stay in DTP and not send me to residential. Once my finals were over, she told me I had to go. I said no once again. I had a trip planned for the end of May I wasn't willing to give up. The compromise was that I would continue treatment in New York and then go to residential after my trip. I was in DTP there for four weeks.

In New York, I was doing a lot better. So much better that my treatment team considered not sending me to residential after a few weeks. But there is nothing for me in New York, no matter how much I try I can't find a purpose when I'm there. I begged my therapist to send me to residential because I would rather be in a residential treatment facility than in New York. In early June, I left New York City for Philadelphia. I was in DTP in New York for four weeks.

I don't like to think about my time in residential. It's not a fun summer getaway or summer camp like we would joke it was. I did really well during my first two weeks. Then my anxiety got the better of me and every other day I was either vomiting I was so anxious or having a panic attack. This went on for two weeks until I got on more medication. After my new meds kicked in, I started to do better and show a lot of progress. I got to see my family once a week at best. One thing I missed the most was my music. I had to move my room four times. I grew a lot. I was in residential for six and a half weeks.

I went back into DTP. But my anxiety got terrible again, and I was vomiting at least once a day every day for seven weeks. No doctor could tell me what was wrong with me. I ended up going to the ER, and they dismissed me and gave me medication that didn't work. While back at the New York site, I tried my best to continue my recovery while in this state of constant illness. All I wanted to do was go back to Boston and be where I feel at home. I was in DTP for four weeks this time around. I then went to the Boston site's DTP for one week.

Finally, I was back in IOP. At this point, I was exhausted from treatment. I had already done one round of IOP, two full rounds of DTP, and a stay at residential. I just wanted to be done. By my second week, I felt like if I had discharged, I would be fine. But my insurance gave me a certain number of days and my therapist wanted me to use all of them. I sat through the same group therapy sessions week after week, looking forward to the one day of art therapy I got a week. Last time I discharged from IOP I was terrified. This time I was ready. After seven weeks I discharged from IOP once again.

I spent 34 weeks of 2019 in treatment. It's not the most exciting way to spend the year. I wish I didn't have to go through all of that, but I'm glad I did. I used to have this metaphor about how recovery is a marathon. The marathon goes through the woods; you don't know the trail; you don't have a map, you've never trained, sometimes you need to walk, at one point you twisted your ankle. The finish line is there though. No matter how long it takes you to run the marathon the finish line will always be there. The finish line is so close for me. I'm at the point in the marathon where I start to run faster and harder because I see that finish line.

Signs Someone in your Life is Struggling

People that suffer from eating disorders often go without being treated. Why? Because the people in their life don't know the signs. That's what this blog is all about, recognizing the signs. For me, I didn't believe I had an eating disorder because no one told me I did. I was waiting for someone to ask if I was okay or to tell me I needed to seek help. The longer an eating disorder lives, the harder it is to recover. I want to help anyone reading this learn what to look out for.

1. Weight
If one is obsessed with weight, needs to reach a goal weight, weighs themselves regularly, etc. they may be struggling with an eating disorder. If there is a noticeable change in weight (either gain or loss) that is a sign they may be struggling as well.

2. Exercise
Working out every day no matter how they feel, if they're sick, in pain, exhausted, not in the mood to work out, that's a sign. If they are skipping events, or not seeing friends because they feel the need to work out, that's also a sign. If they're working out to compensate for something they ate or something they're going to eat, that's disordered. This is something that society has taught to be normal but it's not healthy and is, in fact, a warning sign. Becoming obsessed with fitness trackers can also become an issue and lead to harmful behavior like calorie counting (calorie counting is also a sign).

3. Needs to have control over their food
If they are uncomfortable eating out because it's not what they made, or having something they didn't plan on eating.

4. Regimented eating habits
If they only eat at certain times, or only eat what they consider "safe foods" (for me it was grilled cheese) and never eating outside of those times. If they only use a certain plate or utensil to eat that may be a sign.

5. Food rituals
Food rituals can be hard to spot sometimes. They can be as simple as eating slowly or taking small bites, or they can be more extreme like cutting up food into small pieces or mixing all of their food together. Food rituals are a big sign of eating disorders, they're used to decrease anxiety felt while eating.

6. Body checking
Body checking is often pulling the skin to check fat on the body, but it can also be weighing oneself regularly, pinching, and checking their size frequently.

7. Intermittent fasting or dieting
This is a loud sign of disordered eating. If they are going a day without eating or skipping a meal every day, that's a very clear sign. Claiming to be vegan or gluten-free may be a reason to cut out food from their diet.

Of course, this isn't a definitive list. There are more signs out there. Here are a couple links I used for this blog with more information on what to look for.
https://www.nationaleatingdisorders.org/blog/7-signs-your-friend-or-loved-one-might-be-struggling-eating-disorder
https://www.livescience.com/36205-eating-disorder-signs-symptoms-anorexia-bulimia.html
https://www.health.com/health/gallery/0,,20665980,00.html?
https://www.self.com/story/10-subtle-signs-someone-you-love-might-have-an-eating-disorder

As you read these warning signs, don't forget to check in with yourself. If you think you've been doing any of these habits, ask for help. Simmons has a great dietician that's at the health center and the counseling center has therapists on call if you need a professional to talk to. Additionally, there are multiple helplines.
(800) 931-2237
(866) 418-1207
(630) 577-1330
(505) 891-2664
(617) 558-1881

Don't be afraid to ask for help. As my dietician told me, no one regrets going into care. You can also talk to me, writing this blog has made me a lot more open about talking to people about my struggle and recovery and I'm open to talking even more.