Anorexia and Exercise 2: The lower-level movement trap

I wrote about Anorexia and exercise last week and the case for cold turkey. This post is the follow up to that and it addresses lower-level, movement. If you read the last post and thought “well that doesn’t apply to me because I don’t exercise excessively,” this post is for you.

In last week’s post I explained my jump from an excessive six hours or more exercise a day into cold turkey. Now for the second half of that story.

Anorexia is like the shitty gift that keeps on giving. It seemed that as soon as I had conquered one mountain, another, steeper, one emerged behind it. Stopping exercise was one thing. Stopping compulsive movement was another — and even harder because one cannot use logic to argue as to why it is unhealthy or detrimental to participate in compulsive lower-level movement in the same way as for things like running and formal exercise.

I could see that the amount of exercise I did was unreasonable. I could see how it may have been doing damage to my body. I could see how doing it worked against my goal to gain weight and recover. The same could not be said of that not-exactly-optional dog walk every morning. The same could not be said about the frequent walks to the shops. I could not argue physical reasons as to why continuing to do these things were detrimental to my health. But I knew deep down they were.

These lower-level movement compulsions hide in plain sight and can be harder to uncover than the egregious abuses of excessive exercise.

Lower level movement is still Anorexia-generated, energy deficit orientated, OCD and should be taken seriously.

 


Examples of lower-level movement:

Walking

This one is a killer. Seems so innocent but can be the hardest Anorexia behaviour to overcome for many of us. I had walks that Anorexia demanded that I do every day. Below I outline some more of the specifics around these walks to give some illustration of the OCD element to them, however, some of us just walk for walking’s sake, so compulsive walking doesn’t have to have a rhyme or reason.

Walking the dog — Always a specific route without much variation, and if I did vary it was only to take a longer route. When I moved out of my parent’s house and no longer had a dog to walk, I still did the exact equivalent of this walk at the same time every day.

Walking to the store a specific long route every day — This often meant I had to invent something to go and buy, and then suddenly remember when I had reached the store that I already had enough of it at home so I could turn around and walk straight home. Initially this walk started with the most direct route to the shops. Over time, that route turned into a longer and very indirect path with add-ons and loops. At this point, should anyone else want to walk to the shops with me I would decline and insist on going alone, as I knew that any normal person would wonder why we were not taking the direct route. I’m putting this in there to show more reasons why isolation builds up for activities other than eating.

Walking to various “checkpoints” — E.g. I had to walk to the outside bins location for my block of flats every time I had some rubbish to throw away rather than put it in the rubbish bin under my sink in my kitchen and take it all at once at the end of the week like a normal sane person would. This was so bloody annoying too because I always had to do it immediately regardless of the time of day or night and it bloody rains a lot in England!

Situation-dependent walking rituals — On days when I worked at the pub, for example, I had walking rituals around going about my business at work. i.e. as soon a get there, rather than walking in the front door next to the parking lot, I would have to walk around to the back door. This was approximately a 20 meter difference. A stone throw of a distance. However, I had to do it. I think that it was things like this that broke me down mentally. So negligible. So pointless. Yet utterly unable to not do it. These such rituals existed to every place I visited on a regular basis. As you can imagine, it was pretty tiresome.

 

Housework

Vacuuming the house, cleaning the kitchen, organizing the fridge etc.

This cleaning compulsion was not something I did initally as much as things like walking, but I do get told about it a lot from clients. I see that it emerges more for people who are relatively house-bound, so people who have young kids, or people who live in places where it is raining a lot. When I moved to Manchester and the weather was worse, this cleaning emerged more as an excuse to move when unable to leave the house. In fact, if I am honest one of the reasons that I was keen on us buying the house that we did was because it had three flights of stairs in it. Of course, I developed all sorts of OCD elements to the housework such as having to keep all cleaning products on the bottom level and retrieving and replacing them one at a freaking time to ensure as much up and down trips as possible. Exhausts me to even think about it now!

I’ll include cooking in here. I have heard this from people who have children too, that they like the excuse of having to cook to be on their feet and while this tends to be a duty that falls on one parent more than another naturally anyway in any household. People report getting resistant to offers of help from spouse/partners and almost territorial about the cooking. While on the outside this looks like they simply enjoy cooking, the underlying reason is a perceived energy burn from chopping carrots etc.

I’m going to include running around after kids in this one too, as I recently had a woman email me telling me she is already dreading her toddlers getting older and more independent as her Anorexia likes it that she is on her feet running around after them and tidying up all day. And by the way, as far as her treatment team are concerned, this woman has been fully recovered for five years because she is weight restored. I would argue that weight restored or not, if she is still having to comply to movement compulsions, there is work to be done to get this person all the way to full recovery.

 

Shopping

Arguably this ties in with walking but disguises under another excuse. One very interesting entwinement of behaviours here, is for those of us who have a fear-based reaction to spending money (a common side-effect of Anorexia). What I used to do was if I really did need to buy an item, say tea bags, I would have to walk to every store in town and compare prices. Now as one can imagine, the cost of 40 bags of Tetley doesn’t differ much between Safeway, Tescos, and Wilco, but I had to visit every single one of them. Even worse, if I knew that Tesco sold them 1p cheaper than the rest, I would have to start at Tesco, then walk around all the other stores, then end up back at Tesco.

I know. Exhausting. And all for a cup of tea (which was probably awful anyway because I was only allowed to use skimmed milk).

The reason that shopping crops up for so many of us and turns into an energy-deficit OCD behaviour is, again, because we can hide it in plain sight. Shopping for grocery items is normal. Nobody is going to tell you not to go shopping for food — especially if you are underweight.

Shopping for food is fine. Take the car, and go to one store. No walking between stores.

 

Standing

Well done for spotting that this is not strictly movement. I’m going to tell you about it anyway. It is still a compulsive behaviour for many of us and needs to be outed.

So many of us have twisted rules and regulations about how long we are allowed to sit down during the day. I have lost count of how many clients have told me that the reason that they cannot go on holiday is because they cannot sit down long enough for the plane trip. Of course, they don’t tell their family, friends, and partners this, they make up other excuses.

If you have read any of my blogs you will probably know that I had a standing problem. Or a sitting problem, in that I couldn’t sit. Whichever way you look at it, it was a problem! When one cannot sit, one cannot be very social. When one cannot sit, one’s job options are limited to bartending, waiting, and manual labour. When one cannot sit, it is very hard to be flexible as one has to limit one’s activities to those that will not demand spontaneous sitting.

I cannot tell you how much it opened my world to be able to sit for as long as I liked. It meant I could emigrate to the USA for one. Even more deliciously, it means I can cuddle up with hubby midday on a Sunday and watch a film — these small things make all the difference and spell out true freedom.

 

Fidgeting and pacing

I’m thrilled to say fidgeting never bothered me. But I know plenty of people for whom it is an absolute thorn. Leg jigging, foot tapping etc. Having to get up and down a lot. Like most of these low-level movements it really irritates the person who has to do it, but they are engulfed in fear at the thought of not doing it. This one also gets overlooked as some people to jig naturally.

Pacing should be included here, as I think in a way it is a form of fidgeting. More anxiety ridden, so rather like an escalated form. I know some people are driven to pace when they eat, and this can be another reason that they insist that any eating they do is done in private. For those of you who live alone and are enable to enlist the support of other people to make sure you sit and eat your meals, there are peer support options for this online. This sort of thing was another motivation behind AEDRA, the meal support nonprofit org. that I founded. Sometimes we can eat, just about, but we cannot eat without weirdness. Having someone there to inhibit the weirdness helps.

 

Favoring occupations that allow for movement

This one makes me very sad as it can mean a person’s entire working career is dictated by Anorexia. e.g choosing a lower paid waiting career even when you have the grades/qualifications for a much higher paid desk job.

This was me, fresh out of university, deciding that I wanted to work in the pub serving beers and running plates of steak and chips out to the beer garden all day and night instead of continuing and getting my masters degree. Why did I make that decision? Because one can move more when serving in a pub than when sitting in a lecture hall. It was that simple.

I don’t like working in the service industry. I am also incredibly bad at it. I don’t have the right attitude. Or, as one of my ex-bosses put it, I have a bad attitude. He told me that when he fired me. Apparently telling customers to “fuck off to McDonalds” if they wanted fast service is not good for customer relations. Regardless of how very terrible I was at waiting tables, Anorexia insisted that I torture myself and other people by choosing this occupation.

Not only has my recovery done me a favor, it has saved the rest of the world from enduring me serving them at the pub.


 

All of these lower-level movement compulsions, and any other that you might identify in yourself, serve the same purpose as exercise and higher level movement: they put conditions on eating.

 

Sound familiar? Time to take action to stop

I was floored when post-recovery and talking to other adults with Anorexia I learned that this sort of madness was not unique to me. We don’t tend to talk about this stuff. It is embarrassing to admit. It is bloody insane. I firmly believed that if anyone knew these things I would be locked in a lunatic asylum. I was scared to talk about these things. Now I am glad that I do because it allows other people to out them too.

The best part is that once we “out” them, we have the ability to stop. If they are secret and hidden even to ourselves, we don’t.

When these compulsions exist as our little secrets, trying to overcome them is much harder. Naming them and talking about them is uncomfortable, but in the right environment can be empowering rather than embarrassing. For example, if you are surrounded with other people in recovery in a supportive environment, you know that nobody is going to judge you. You know that everybody in there “gets it” and is working on breaking their very own madcap eating disorder rituals. That is what our recovery Slack group is for.

You don’t need a shrink to stop these compulsions. You don’t need to work up to the right time. You don’t need to spend years talking about them and trying to figure out some hidden meaning. It is an eating disorder generated form of OCD and you can stop. Now.

 

Step One: Identifying Anorexia movement OCD behaviours

These lower-level movement compulsions had been with me to some extent when I had been taking part in excessive formal exercise too. However, when I went cold turkey on the exercise, more movement compulsions flooded in to fill the space left. That was when I worked out that the Anorexia movement compulsion wasn’t limited to “exercise” as such, and it would take any form of movement it could get.

I was determined to put an end to them all, but it was not as cut and dry as stopping exercise as the lines are so blurry with lower-level compulsive movement. Some compulsions were easier to label as “Anorexia OCD” than others. For example the one where I had to walk the 20 meters extra to go to the back door of the pub served no purpose other than movement OCD so that one was easy to label as such. Other ones such as walking the dog are harder, as arguably the dog needs a walk.

Here is what I worked out to help me sift though the movement and separate the innocent from the compulsive:

If the thought of not doing it causes anxiety and stress, then it is a compulsion and you have to stop. 

If the thought of not doing an action made me feel anxious, stressed, cranky, irritable, pissed off, etc, then it was safe to say that my relationship with that movement was contaminated with OCD urges and I had to stop it. Regardless of how “normal” the movement was — walking the dog — no arguments. It had to stop at least long enough for the habit to be broken.

 

How to do you stop?

As mentioned above, bringing the rituals out of the shadows and into the open is a good step. You can use other people to help you stay accountable in a good way.

The strategy that I used was this: do nothing or as little as possible

When my eating disorder told me it was time to do the dog walk: do nothing — let someone else do it, or drive to the dog park and sit on the fence.

When my eating disorder told me to walk to Tesco to compare the price of tea bags: do nothing — buy the ones under my nose and don’t listen to the thoughts telling me that doing so was both a waste of money and lazy. If you cannot trust yourself not to walk around the shops like a nutter then get your groceries delivered.

When my eating disorder told me to be the first person to jump at the sound of the service bell in the pub: do nothing —Let someone else go. As soon as I did this, working at the pub was no longer attractive and I started having thoughts about wanting to be writer.

Basically. Stop jumping though the hoops. Do nothing when the urges call you. If some action is required do as little as possible. The urges pass. If you do nothing the urge to do the compulsion will pass.

Whatever you do, don’t fall into the trap of not taking these lower-level movement compulsions seriously. They will stay with you until you make a determined effort to stop. Of course, you can weight restore while doing these compulsive movements, but that means you are weight restoring under the conditions of the eating disorder. They will keep you on a tightrope weight restored or not.

 

And … don’t get emotionally involved

Easy to say “do nothing,” right? What about the flood of anxiety that hits when you disobey?

Do nothing there too. You do not have to participate in your emotions. You don’t have to get involved. Emotions, like urges, come and go, and they only stay if you step into them and empower them. If you step out of the way, emotions will pass by.  This is what meditation taught me, and while I am not really into meditation as a spiritual practice, as an eating disorder recovery tool it rocks!

One of the most powerful things I ever learned was that my emotions are optional. I don’t have to step in. I don’t have to get involved. I get to make a choice. Learning this made me feel like Neo in the Matrix. I could take control.

For example, the emotion of guilt and panic at the thought of not following though with my standing compulsion. To be able to not participate in that was huge. Powerful. Sit down and shut up.

What was the one thought that helped me step out of the emotions that I knew were not helpful?

Talk to the hand cos the face ain’t listening. 

Mediation doesn’t have to be elegant to work.

Eating disorder treatment has to recognize these OCD-like behaviors

I got an email yesterday from a woman who quit uni because attending classes was interfering with her daily walk that she still has to take. This person has been considered “recovered” from Anorexia for 3 years. Nobody looked past her weight restoration and at her behaviors during her treatment, and she is still having to comply with Anorexia-driven OCD behaviors such as walking to this day. Treatment has to start looking past weight restoration and addressing both exercise and low-level movement compulsions and helping people fully recover.

Treatment needs to inquire. While we are still embarrassed and secretive about low-level movement compulsions, don’t expect us to volunteer them. Don’t even expect us to be honest if asked all the time. Treatment needs to ask. Treatment needs to observe. Treatment needs to use family members and other friends and take feedback and observations from these vital sources too. Treatment needs to take all the help it can get in order to get a complete picture of an individual rather than discard the opinions of family and friends.

I stopped, and so can you

Your eating disorder will tell you that the world is going to end if you don’t participate in all these lower-level OCD like behaviors. You will feel in your body as if the world is going to end when you try and resist the urge to participate in them. I broke into a cold sweat the first time I made myself do in the front door at the pub. I remember it well because it was so bloody hard. But it simultaneously felt like freedom. Freedom to do what I wanted to do and not jump though Anorexia’s hoops all day long.

The front door of the pub was a tiny 20 meter difference that enabled me a couple of years later to fly thousands of miles in a plane without feelings of dread or guilt about having to sit for ten hours straight. It all matters. Every inch you take back from Anorexia counts towards freedom.

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Exercise and Anorexia: The Case for Cold Turkey

Dr: “Are you eating?”

Me: “Yes”

Dr: “Hmm … Well. you are still very underweight, so maybe try eating a bit more?”

Me: “Sure, I’ll try that.”

What my Dr never asked me about was the extent that I was exercising. I was eating, but that was on the condition that I exercised for over six hours a day. In a sense, my Anorexia was hiding in plain sight. I was eating. I could not be accused of not eating. As excessive exercise was not listed as a symptom of Anorexia, however, I evaded diagnosis despite presenting at a ludicrously low weight.

This blog is about the importance of recognizing exercise as a symptom of a restrictive eating disorder. Sadly, even through the importance of recognizing exercise as a problem in Anorexia has been documented for over 20 years, it is still slipping under the radar.


I talk about the exercise component to my eating disorder with a passion because it was the hardest part for me to overcome, and I still think it is the least understood by the majority of treatment professionals and even those of us who suffer from restrictive eating disorders ourselves. I think that if people really “got” the OCD element of Anorexia, then they would understand that the compulsive exercise should be treated in the same way any other OCD behaviour should be treated. And how do you stop an OCD behaviour? You STOP or redirect the behavior. For me this meant going cold turkey on the exercise, which was utterly terrifying. 

That in itself sounds ridiculous to admit. I found the prospect of not exercising terrifying. I’m not exaggerating when I say it was the hardest thing I have done in my entire life. I’ve jumped huge, fixed, wooden fences with ditches underneath at a gallop on a horse many times. I’ve skied off a cornice in a whiteout. Neither of these experiences come even close to the thought of not exercising when I was sick.

Currently the exercise recommendation is a murky grey area in terms of the advice that eating disorder professionals and therapists give people. Most people in recovery from Anorexia are not told anything about whether or not they should exercise. Some are told “moderate.” Some are told to abstain. Some therapists don’t even ask (don’t expect us to volunteer information on how much exercise we do!) This should not be a murky grey area. This should be crystal clear. Nobody in recovery from a restrictive eating disorder should be exercising. It is a symptom of the illness. It is compulsive. It is OCD (study here that explores that idea nicely). It is as bad for us as purging is. It is purging in disguise.

Can you imagine a person in treatment for Bulimia being told “purge moderately,” or, “purge a couple of times a week.” Sounds whack, right? Well, this is the advice we are often given to people with Anorexia about exercise.

Purging is not such a grey area because it is an overtly undesirable behaviour. Whereas exercise is considered a desirable behaviour for the general population. For a person with an eating disorder, however, it can be compulsive — as can all types of movement. I don’t just mean going to the gym and running either. For a person with an eating disorder, walking the dog or vacuuming the house can be compulsive.

Most people don’t understand that even when I had given up (or been thrown out of) the gym and had stopped formal exercise, the compulsion to move continued to exist in practically every move I made. Taking the longer route. Walking rather than taking the car. Getting up and down to fetch things when eating a meal. Never sitting. Always having to stand. Fidgeting. I was not allowed to sit down during the day. If I had to (say a car ride or a situation where I could not stand) I would have to “make it right” by eating less that day. I believe that this is due to the energy-deficit generated OCD that accompanies the illness very strongly for many of us. 

This is hideous to live through. I wanted nothing more than to be able to stop moving. I couldn’t stop moving. I couldn’t even admit to wanting to stop moving in my own head as that felt like some sort of sin in itself. There were too many things dependent on me keeping moving. Mostly my ability to eat at all. It was all conditional. I got to eat only if I had moved enough that day.

The very thought of not doing my walks, routines, exercise during the day could reduce me to tears. I was scared shitless of not exercising. I think in a messed up way, my brain understood that my ability to eat was tethered to my movement conditions, and so it was terrified of not doing these things as it knew if I didn’t I would not eat. And my body was too underweight to not eat. So I was scared of not meeting the conditions as I was scared that would mean I would not be able to eat and a part of me knew that was very bad news because I was already dangerously underweight. That was one source of fear — and a slightly more rational one. The other source of fear was tied into the “weight gain” fear which is utterly irrational as I never, ever liked being underweight. Anorexia gave me a very inappropriate fear response at the thought of weight gain.

Exercise often starts out well intended

Exercise started out innocently well intended for me. I started exercising to make me feel better and it did at first. Initially, exercising also allowed me to eat slightly more. I thought this was a good thing. However, it was only a couple of weeks before exercise had switched to voluntary and helpful to involuntary and detrimental. It no longer made me feel good. That effect had vanished. 

Many of us with Anorexia start off straight restricting. We don’t eat. I was in this camp for the first year or so of my illness. Most of the adults whom I work with also at onset of the illness were straight restriction. If we are lucky, we are given treatment at that time that is effective and that is as far as it gets.

As the years in the illness go on, many of us begin exercising. It is estimated up to 80 percent of people with AN have a compulsive exercise problem. It reduces anxiety at first. It never stays that way. It turns into something almost greater than restricting food for many of us. Another reason we pick exercising up is because purely restricting is not sustainable. We need to find something that allows us some food but doesn’t cause weight gain. Messed up I know, but that is what my brain was telling me when I started a gym membership. Or for some, exercise is introduced because restricting alone is not enough to appease the eating disorder’s demands for weight loss. 

This can work the other way around. I know people also for whom AN started with exercise rather than food restriction initially. This doesn’t even have to be weight-reduction focused exercise. I know peeps who have innocently thought it would be a good idea to join a gym in order to tone up a bit who have developed AN due to unintentional energy deficit and weight loss. 

Compulsive movement in children too young to understand the idea that exercise causes energy deficit is very telling too. Really shows how the disorder generates the compulsion even when the brain doesn’t have a logical explanation for it.

The paths to compulsive movement may be different, but the devastating and exhausting result is the same: we become utterly dependent on exercise/movement.

Depression

Very interesting ideas from a study that looked into the differences between levels of depression high level and low level exercisers in people with Anorexia.

Several studies have shown that exercise has a positive impact on a variety of psychological disorders. Nevertheless, the increased amount of daily activity in the high-level AN exercisers was not sufficient to suppress their levels of depression to values of low-level AN exercisers or controls. In addition to the aspect and function of comorbid depression in association with pattern of high-level exercise as well as an association with binge/purge behaviour additional aspects e.g. level of impulsivity, might help to characterize AN patients to identify more homogenous endophenotypes of AN patients. From an evolutionary point of view, this hyperactivity could be a result of food search behavior]. If in the long-term this is not rewarded by the intake of a substantial amount of food, this phenomenon could explain the increased observed depression in this subgroup.

This addresses the notion that we exercise in order to increase positive mood — an excuse I myself clung on to for years. If I were asked why I ran so much, I would answer that it made me feel better. In truth, I don’t know that this is the case and I suspect that this answer came from something I had heard somewhere about exercise being an anti-depressant. Let’s be clear: I exercised because I had to. I could kid myself that it was because I wanted to, but that doesn’t make it true.

As the study quoted above found levels of depression were higher among AN patients with high-level activity than among AN patients with low level activity. Ha … but that is a chicken or egg discussion! Do those of us who exercise a lot have higher pre levels of depression, or does the exercise induce higher levels of depression due to increased physical depletion?

My personal experience would have been the latter. I have never suffered depression other than the sort that hit about a year into my excessive exercise regime.

One problem with studying these sorts of effects is self-reporting requires us to i) have a level of self awareness that anosognosia often doesn’t allow for, and ii) be truthful about our motivations.

For example, even if I did know that deep down I was exercising because I didn’t have the option or control not to, rather than because it lifted my mood, it would still have been truthful for me to give the answer that I exercised because it made me feel better. That was arguably true either way, but “making me feel better because it lifts my mood,” is different from “making me feel better because even the thought of not exercising makes me feel anxious to the point of suicidal.”

There are theories that we exercise to self medicate. Reduce depression. This may be the original motivation, but in my experience with myself and with those whom I work with, as time goes by exercising doesn’t continue to have this effect. It still makes us feel better, but not in the same way. More in the way that you put clothes on in the morning to avoid feeling all the negativity that might ensue if you were to waltz into work starkers. You don’t put clothes on because it makes you feel “better” you do it because it is required in order to keep everything on the level it currently is.

Try this: Imagine something that you do every day, just like the idea above of putting clothes on, that makes you feel panicked, nauseous, and extremely anxious were I to tell you “You cannot do that thing tomorrow.”

Now to give you some context, I will tell you that I would have chosen hands down forgoing clothing in favor of forgoing exercising. That is how big a deal this was for me.

So the idea that we do it to reduce depression makes sense, but it doesn’t quite hit the mark with me. The understanding is in the details.

The difference here, is that the exercise is being done to maintain a less anxious state rather than to reduce anxiety. Or said differently, to not exercise would create almost unbearable anxiety and fear. It was less the case that exercising lifted my mood and more the case that exercising was something I had to do in order to keep my head above water.

In a sense, after a couple of years, exercising increased my levels of depression because it made me feel more trapped. However, the thought of not exercising was enough to make me feel panicked and, admittedly, suicidal. Exercise was no longer a case of negative state relief. It was more a case of survival.


Sometimes mentally accepting cold turkey is the hardest part

It took me a couple of years to get to cold turkey.  Two years from deciding I wanted to stop exercising to actually stopping exercising. It was incredibly hard to do, as I had built my identity around exercising. I was working as a personal trainer — spending all day every day in a gym. Even worse, I was making a fair bit of money doing it. Anorexia told me I was never going to be good enough at anything else, and that if I gave up my gym career I would end up destitute. Anorexia will say anything to keep one trapped.

I tried initially to stop exercising myself while still working in a gym. That was a disaster and I failed miserably. That is the Anorexia version of an alcoholic working in a brewery. Conversely when I tried to stop exercising without changing my lifestyle things got worse because every day Anorexia told me today was my “last fling” and I would stop exercising tomorrow, and so ironically I ended up doing more, not less. Tomorrow never comes.

As I describe in detail in my book I finally stopped suddenly one day. That day was both the worst and best day of my life. Worst because of the place I had to go mentally in order to make the decision to stop exercising. Best because stopping was the first day of my recovery.

What this means in recovery

Here’s the deal: You can weight restore while still exercising. Of course you can. If you eat enough food, your body will gain weight regardless of how much exercise you do because that is the underweight body’s priority. For this reason, many people argue that they don’t need to stop exercise in order to “recover.”

No. Because recovery is not just weight restoration and getting weight restored doesn’t equal full recovery. Full recovery is the ability to eat without conditions and without fear. Exercise = conditions. In order to be able to eat without conditions, you have to be able to stop exercising and not reduce your intake. It is compulsive and you are not in control. If you were in control, stopping would not make you want to cry and scream.

If you have managed to weight restore but are still exercising: Firstly, good on you for weight restoring — that’s a big deal! Now for the rest of the work. Rest.

It’s not fair. But you have to stop. The biggest irony for me, was that while stopping was so hard, and felt so unfair when I was underweight, after a year or so of not exercising I didn’t want to start it up again. Now, weight restored for years and fully recovered, I can exercise if I want to, but I rarely bother. There is so much more to life.

You have to rest.

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It’s my 10-year Anorexia recovery anniversary!

anorexia recovery

I’ll raise a glass to that!

It’s my 10 year Anorexia recovery anniversary this month, and I’m really bloody excited about it!

Those who know me know that I don’t “do” birthdays or publicly celebrate anything much, but this—overcoming Anorexia—is something I am openly proud of.

 

It started in May 2006

 

In May 2006, I was dying slowly, and I made the decision that unless I could work out how to stop dying slowly, I’d do myself the honor of allowing myself to die fast: suicide.

And I was serious, and I would have done it. Yes, that knowledge still scares the shit out of me. But Anorexia is a slow and painful process and I was so, so done. I’d had the disease for almost ten years and I was tired. I was losing. I knew it was all or bust.

Ten years ago today I was emaciated and exhausted and there was no room in my head for anything other than obsessive thoughts about food, eating, and exercise. These thoughts were like weeds, because they took over my entire existence and left no room for anything else. There was certainly no room for friends, family, career aspirations or dreams.

I don’t know if there is such a place as hell, but being trapped in your own brain by a disease and being forced to think over and over again about food and exercise for years with no hope of ever being able to think anything else is fucking nasty. The brain can be a prison, and mental illness is very real.

I shouldn’t have been able to go so long without adequate treatment, and that’s the reason I’m an advocate for proper treatment today, but that’s another story. The truth is that without getting that low I would never have given myself the ultimatum that caused me to research into and self-treat myself back to health.

 

What was that like?

 

I'm not messing around when I say that I think that cutting off my own arm would have been an easier than putting on weight was.

I’m not messing around when I say that I think that cutting off my own arm would have been an easier than putting on weight was. The human brain is what tells us about pain and survival. If a mental illness is telling you that not to do something, it is just as difficult overcome as a physical obstacle.

Have you read the book (or seen the film) by Aron Ralston titled 127 hours? In summary: Aron is a mountain climber who is climbing alone and falls down a crevice. In the fall he dislodges a huge rock which lands on him, trapping his arm. After days of painfully waiting for help he comes to the knowledge the no help is going to come for him because nobody knows where he is.

His choice: stay put and certainly die of starvation. dehydration, or, cut off his own arm. That’s a huge conflict, as his brain would tell him “don’t cut off your arm,” but then another part of his brain would know that unless he did, he would die.

My experience of Anorexia was a time-lapse version of this. A ten year version. One day I understood that I could either stay where I was and certainly die or go against everything that my brain was telling me was crucial for my survival and see what happened. Don’t underestimate the power of a mental illness. Anorexia told me that unless I did what it wanted I would die—that’s my own brain telling me this, my own thoughts. I had to get to a very desperate place to find the strength to disobey my own mind.

I’m not fucking around with that analogy. One’s brain is what tells one what to fear, how to fear it, and how to react. If your brain tells you something is real, it is real.  Don’t underestimate the power of your brain’s ability to form your reality. This is how mental illnesses work. Anorexia is a disease that affects the brain and turns the sufferer’s perception of food and eating into the inverse of what it normally would be.

So yeah, in some respect the one-time-event pain of cutting off my own arm sounds rather more appealing than years of self-treating myself for a mental illness. Thankfully, it doesn’t have to be that way anymore thanks to the advocates who have forwarded the research and understanding of what eating disorders are and how to treat them. If I were a sufferer now, I would be able to seek help. That’s incredible progress.

Recovery was scary. But I’m so glad I chose that over Anorexia. Well worth it!

 

People, animals, colours … the world.

 

One thing that was really telling along my recovery was in the first year of weight gain I regained some senses, abilities, and sensibilities that I had not realized I had lost. It was rather stunning and very disconcerting, yet wonderful.

flowersWhen talking to people, for example, the experience of being in another person’s presence gradually got richer—to the point I understood I had been only half seeing, listening and experiencing my family and friends for years. Anorexia had diluted my sense and ability to concentrate, care, emphasize, and understand other people.

The same was true for colours. Gradually my world seemed to grow more vibrant, and one time I remember literally stopping in my tracks to look at a colour of a house—one which I had passed every day on my way to work for years but never seen. Anoreixa took up so much space in my brain I guess some faculties had shut down in the same way that my menstrual cycle had dhouseone.

And my animals. I had stopped really loving animals when I was sick. I went from a animal-mad teenager to someone who didn’t really care for them and didn’t have any interest in keeping pets when I moved out of my parents house. One day, during recovery, it all flooded back and I went out and adopted Werm (my dog). I couldn’t understand why I hadn’t wanted a dog all those years. Now I do: Anorexia shut that part of my brain down too.

Those are just some examples of the magic of getting my brain back.

 

And now?

 

In the ten years since then, I began and successfully achieved a full recovery; met my adorable husband; moved to the USA; wrote a book (Love Fat); discovered my dream career path and sprinted along it; and became actively involved in the ED advocacy movement.

I’m guilty of taking my recovery for granted in as much as I don’t think often about how awful it was. Probably because I am too busy thinking about my life now that I have the pleasure of being able to do so.

But sometimes, on days like today, I remember graphically just how it was to live in the hell of Anorexia. And it dawns on me how in love I am with my life without Anorexia. These days I dream big, and I have so much brain-space in order to do that.

Only readers who have had or are suffering from Anorexia or a similar mental illness will truly be able to know exactly what I mean. If you are struggling today with those looping, obsessive thoughts, know that with the right treatment you can be free from them. The human brain is a wonderful thing when it is free from disease as it allows one to see the world in full-blown 3D colour-enhanced glory.

 

Do anything and everything within your ability to get your brain back—it’s so worth it. There are so many incredible things out there for you to think and dream about. Please don’t let Anorexia steal your space to dream.

 

Incidentally, it’s the first ever World Eating Disorder Action Day on June 2nd 2016. I’m thrilled to be a part of it. Join me and some really incredible advocates for a Tweet Chat hosted by Mirror Mirror on June 2nd at 5pm. 

 

Thank you to:

Everyone who read my book or reads this blog and emails me or comments—priceless support.
Mike, Vikki, Bethany, and Candy Alderson for being my ever-supportive family and never giving up on me.
Matt Farrar for loving the crap out of me regardless of anything Anorexia could throw at him.
Every single person in the village of Chute for being an extended family.
All of the IEDA members but especially Amy Cunningham, JD Ouellette, and Jen Haken;
F.E.A.S.T for publishing the information I needed in order to put myself though my own, adult version of FBT.

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Midweek Rant: Rosewood Ranch

An advocate friend drew my attention to a particularly awful website today. It’s riled me up something rotten.

“Love addiction and eating disorders both often start with dysfunctional roles in the family of origin.”

You have got to be shitting me. This is the first line in Rosewood Ranch Santa Monica’s article on Love, Relationships and Eating Disorders. I don’t even know where to start with pulling apart the errors in that opening sentence, and it is only 16 words long! How is it even possible to load so much crap into one short sentance?

  • Love addition and eating disorders listed as if they go together like fish and chips.
  • “Dysfunctional roles?” Whose? The sufferers? The parents? The siblings? The family pet?
  • “Family of origin?” What does this even mean? If I’m adopted my love addiction/eating disorder is my biological mothers fault for giving me up? Or is it pointing to nurture rather than nature? Sounds like they are making this shit up as they go along to me.

Rosewood Ranch is an eating disorder treatment center, and is a prime example of everything that is wrong with eating disorder treatment right now. I’m not even kidding, it’s right here. 

Why is this such a problem? Why does it matter?

Mostly this matters because it is bullshit and we know better. We have the research that shows that these illnesses are genetic in base and are not caused by bad parenting. Treatment centers such as Rosewood Ranch are displaying their ignorance when they publish crap like this online. Ignorance in the medical field can kill—and because the internet exists there really is no excuse for it.

An example to my point here:

So here’s a scenario. I’m a Mum, and I suspect my kid has an eating disorder. I don’t know much about eating disorders so I do what any intelligent person does when they don’t know something: I Google it.

Because places like Rosewood obviously spend more money on marketing than they do on research and education, there is a high chance that they are throwing a lot of cash into Adwords and digital marketing. If their center comes up top of the search results when I Google search “eating disorder treatment,” I’m probably going to click on it. Then, because I don’t know any better, I might believe what their site tells me. I might then send my child to have treatment there—probably at a high cost.

Chances are that I might do all those things and my kid will come out of that treatment program no better at all because Rosewood are not up to date with the most recent scientific research around eating disorders and they don’t know how to treat them. That’s really sad.

But wait. There’s more: the longer an eating disorder is left untreated, the more ingrained it becomes. Not only has sending my child to that shitty Rosewood treatment center cost me a wad of cash, it has allowed his or her eating disorder to have the time to take root. This means that the disease is going to be even harder to treat and could have really dire long term consequences.

Unfortunately this is a very true story for a lot of parents. I know plenty of people who have sent a child to an ED clinic and have spent a lot of money to do so, only to have the child return worse off.

Why is this legal?

That is a really good question.

This is a bit like someone setting up a cancer treatment center and stating the following on the home page:

Parkinson’s Disease and cancer both often start with dysfunctional roles in the family of origin. We treat cancer by addressing deep-rooted family troubles that are the reason that the patient giving themselves cancer.

Would that fly? No. And it shouldn’t fly for Anorexia treatment either.

Want to help put a stop to it?

If you are a sufferer, ex-sufferer, or a caregiver for someone who has an eating disorder and you help change the way that treatment centers like this work join us in the first World Eating Disorder Awareness Day is on June 2nd.

 

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Running Hostage to an Eating Disorder

This is another section of Love Fat that I took out of the book as I rewrote it in another chapter. It is following on from the last post that I published and the topic is my obsession with running. As I have explained before, I now have a healthy relationship with exercise, and if I run, it is usually for less than 20 minutes. However, that has taken a lot of work, and for five yearsin active recovery I could not allow myself to run in case doing so sparked a relapse.

When I tell people that I used to have an exercise problem they usually struggle to understand that such a thing can be life threatening. Exercise is good for you right?

In moderation: yes. When you run for a minimum of six hours a day on little to no food and never take a day off: no. My body was wreaked by exercise, it has taken years to recover, and there are still things that hurt ten years on as a result of the strain that it was put in every day when I was suffering from anorexia.

That said, although I thought at one time I had wreaked my body past the point of recovery, it has done really well. The human body is incredible in its ability to withstand stress and recover. A balanced diet, with plenty of good fats has lubricated my joints and strengthened my bones and muscles.

Love Fat Edit Out: New York marathon and the day that I almost stopped running.

I did not want to run but I didn’t want to stop either. Running was part of my identity, I had not had day where I had not run in the last six years, I prided myself on that record. Who else could run day after day without at day off? Stopping running for one day would end that. Just resting for one day would mean that I had broken the pattern that defined me. Anorexia  has a nasty way of making the sufferer think that the self-inflicted torture is a badge of honor.

Well, actually there had been one day where I had not run. That was back in 2002, after the New York Marathon. The travel to New York from Heathrow had been overnight on the outbound journey but though the day inbound. For this reason, on the day that we flew home I had been forced to take a rest day. Literally, forced because I was on an airplane. No running for 11 hours during the day. In fact, not only that, but sitting still. I had been terrified at the prospect, fractious during the flight and miserable when I understood that I had secretly relished the day off.

The flight home had been scheduled two days after the marathon day. The day after running 26.4 miles around New York I had got out of bed and run again for a couple of hours. I had then toiled the streets of The Big Apple on foot using sightseeing as an excuse to walk all day before taking another run again that evening. On the morning of my flight home, I got up in the early hours and ran for an hour in the freezing cold before rushing back to my hotel room for a shower. Then we were on a bus going back to the airport. new-york-city-marathon-verrazano-narrows-bridge

So, I did run in the morning, but somehow my brain told me that didn’t count. Firstly, I had only run for an hour—way shorter than usual. Secondly, I was on the plane for 11 hours and then home to bed, so that was in total something like an 18 hour break. Oh whatever! Honestly, when I think about it now I don’t give a shit, but in my eating disorder-riddled brain I felt like a failure.

The day after the flight, I almost didn’t do for a run. It was as if that 18 hour break had nudged open a door—I had gone 18 hours without running, could I go more? I remember sitting in this fug of confusion and self doubt. One part of my brain was begging me to throw the running shoes in the trash. You just ran a marathon, people rest after doing that you know! It’s okay to take a couple of days off, your body needs that!

Then, there was anorexia: Put on your trainers and run. You have to. Unless you do, you will lose all your strength. You haven’t come this far just to throw it all away have you?

The trouble is, anorexia is far more convincing than rational thought. So of course I pulled on my trainers and ran. I did my usual route, and then made myself run a couple of miles further to punish myself for even considering taking a day off. Every time I wanted to stop I picked up my stride and my legs bore the brunt of my frustration.

But, as my feet trod the pavement there was a whisper of disappointment in my stride and sadness in my breath. 

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