I thought I would share a treatment story that a listener to the Eating Disorder Recovery Podcast sent me recently.
I am writing you in reply to your podcast on eating disorder treatment failures and your question to share experiences as an adult having been to a recovery clinic. Having had anorexia from 15 years old and still, as a 23-year-old, struggling with it, I have been to a recovery clinic last year, after which I soon moved from Belgium to Sweden to work as a PhD-student in literature (my greatest motivation to enrol in a treatment program to begin with).
Though I got along with eating pretty okay the first two months, a stomach flu caused my doctor to prescribe me a diet of a significantly small amount of white toasted bread for a week, which, in result, caused me to spiral into a relapse, and now, 1,5 month later, I have lost almost all the weight I had been able to put on this last year, my body, which had been tolerating my self-imposed starvation for so long with unbelievable strength, now almost immediately shut down, and the restrictions, obsessions and compulsions are stronger than ever. Hearing that a significant amount of people during my in-patient treatment are going through a similar relapse, I became intensely frustrated at why so many of these patients are seemingly no step farther (mentally, that is) than they were before entering the clinic, so I took a digital plunge and ended up with your Youtube videos. Never having experienced such a view on recovery before, I became increasingly fascinated by your own experiences and approach, and I consumed your two books in about a day (talk about a feast, huh), and, the process of recovery for the first time seeming to be something I can do, I happily embarked on my own re-recovery process now. Moreover, your insights led me not only to apprehend that the energy deficit due to the stomach flu-diet seems to be the main trigger of my relapse, but, more importantly, that I may have never been in recovery at all, despite being in-patient in a recovery clinic. As I said, I am from Belgium, and I don’t know if you’re mainly focusing on American treatments, but perhaps some of my experiences may add to a broader picture of treatment failures.
I think that the best way to describe is to say that it operated, in all aspects, with a BMI scale. There were different rules, concerning for instance movement within and in the gardens of the clinic and going home in the weekend/to town, according to which range your BMI fell in (below 12, 12-14, 14-16, 16-19) with 19 as the goal BMI. Unfortunately, these rules also crept in the rules of the dietician there. There were meal plans of 2000 calories for people from BMI 18 onwards, 2500 if you had to gain weight, and 3000 if your BMI was under 16 – people with a BMI of over 25 were given reduced meal plans of 1800 cal. We were forbidden to go beyond the meal plans, which functioned as our Bibles.
Before I got anorexia, my BMI always hovered between 24-25 (and it was the doctor’s concern of this number which propelled me into my first diet – the onset of anorexia), and, despite becoming horribly emaciated, my BMI never sunk under 18.5. With the meal plan of 2000 calories, I reached BMI 19 within 2 weeks, and, despite it being perspicuously visible that I was sick as hell (excuse my language) and being severely starved (having been living on coffee and two apples a week for the last 4 months), they decided that this meal plan was ideal for me (on top of that, in my first week they told me I could start exercising again, which I questioned myself as I had a severe exercise compulsion (walking 25 km and doing an hour of HIIT every single day for the last year – they found my reaction very strange, because of my history with being overweight). I got hungry, really, really hungry. In fact, I have never been so hungry, not even when living on those apples. But I had to stick to the meal plan – the meal plan was holy (one time, a girl reported she had skipped a meal during the weekend and out of hunger and guilt had eaten more during the day and she was severely reprimanded). I wouldn’t want to go back to where I came from, did I? After weeks of complaining of my hunger to the dietician (which, as you can imagine for someone recovering from anorexia in a clinic in which your lowest weight is embraced as the goal weight of a recovered person), I was allowed to add two extra slices of bread during the day. It did not help.
Now, turns out that everyone on the 2000 calorie mealplan was hungry, because the meals (which were already ridiculously bland, how could you expect someone to enjoy food again when the food is just bad?) were of a portion which could fit ideally in a Weight Watchers diet. They were comically small. On our ‘difficult day’, for example, we were served fries. I counted them. Ten. We got ten fries. Fries being one of my (and almost everyone’s) greatest fear foods, this completely convinced my idea about fried foods. They could only be dealt with with severe restriction – something which leaves me, up to this day, unable to put fries on my plate because I can’t handle the number (fries were my favourite food before I got anorexia, and then ten was about the number I ate as an appetizer on my way back when I went to order the fries before sitting down for dinner). Anyway, we, as a recovery clinic, were part of a greater psychiatric clinic, and on some days we were to eat in the cafetaria among other patients. On one of these fries-days I noticed that these other patients got almost triple the amount of fries that we were served, and this led me to study their plates, which were, every meal, double the portion we, patients restoring their weight, were served. Enough with the fries. Anyway, the hunger led one of the women to binge in the night (though they always locked the fridges and food storages, she managed to find a way in). After two of those episodes, she was sent away from the clinic, but not before being publicly scolded by the dietician and the head of the clinic. It broke my heart.
Binges were demonized by the dietician. Actually, when you told you had deviated from the meal plan in the weekends (when you were home), you were reprimanded for starting to develop BED – for instance, one weekend I told I had bravely added a pancake to my 3 slices of bread, I was told it was getting out of hand. To cut a long story at least a bit shorter, after 4 months I left the clinic with a BMI having gone up 2 points, more hungry than ever, but with the dictum of ‘never add anything to the meal plan, never listen to hunger or you’ll develop BED and that is bad’. Writing it down this way, I now come to the conclusion that I cannot even speak of a current relapse because I have never gotten out of the restricted eating. Up until now, and I’m only starting this approach from this week, but for the first time I feel that recovery can actually be something hopeful rather than depressing.
I’m actually in shock. Uneducated “experts” doing more damage than good. Very sad and only inflicting more ‘rules’ and good vs bad behaviour. No idea
I had the same experience at an eating disorder treatment. I was hungry before dinner and requested a yogurt, and was told that because it was so close to dinner this would be considered a binge (a shockingly inaccurate statement). I was told that my hunger cues were off and that only by strictly following the 1800-calorie “maintenance” plan (because I hit my target bmi) would I re-learn my body’s hunger cues. I too started smuggling food and hiding food in my room. I knew it was wrong, but when I protested that requesting more food should not be shameful, I had no credibility because I was diagnosed with an eating disorder.
I was never hungry in inpatient treatment, but I knew I wasn’t getting enough calories to gain weight, so I stashed extra Ensure in my locker and would drink them before bed
This broke my heart! But I must admitt I’ve lived very similar experiences when being IP seven times in different clinics and hospitals in Spain. It seems to be a “global” approach to ED treatment. I could have written this testimonial myself in terms of both treatment experience and surprise/ gratitude for finding Tabitha’s approach (my life changing and saving). Please keep sharing these stories, and let’s spread the word worldwide!! Global approach to ED treatment should change ASAP!! It’s so sad and unfair that it makes way more harm than good to ED sufferers who already have too much pain to deal with. What can I do to help? I’d love to contribute in any way possible. Love XXX
Reading this story and also being a Belgian, I think I know the clinic it’s about … and I have been there too.
And while my ED history and physical constitution are – of course – different, there are a lot of things and observations I can most definitely confirm! Mainly how all-determining your BMI is and the rigid way in which the staff deals with food intake and calories. Though this clinic (or any IP treatment) has without a doubt helped many people too, I now also sort of regret ever going into residential treatment because getting a meal plan has introduced me to new rules, a new diet, new lines that are not to be crossed under NO circumstances whatsoever …
I have already suffered from anorexia for 10 years now and it was only very recently, since I started watching some YouTube ED recovery accounts and got to know Elisa Oras and Tabitha Farrar, that I for the first time in all my ED years heard about extreme hunger, the set-point theory and the importance of just letting go!! For the very first time I heard things like “you have to eat A LOT” and the message that no restriction, no measuring is needed in recovery (I do not need to recover in a controlled and responsible manner). For the very first time I heard that extreme hunger (something I do feel sometimes but never dared to talk about and felt – feel – ashamed about) is nothing to be ashamed of and not a sign that I’m on my way to exchanging anorexia for bulimia, but is something normal for people in malnutrition and must be respected. In the clinic however, following extreme hunger would immediately be considered a bad sign, something to avoid in the future and would be met with suspicion by both the staff and fellow patients as if you have a hidden agenda.
I find it so striking that it seems that the people who commit to, for instance, unrestricted eating, responding to extreme hunger and just eat a lot of food seem to be on a much better way to (full) recovery than the people I know who have ‘recovered’ on a meal plan and a balanced, controlled diet! The latter category, in comparison, still seems to show behaviour that – now that I can compare with the ‘YouTube fighters’ – implies that they’re less free and still in one way or another in a ‘diet mindset’ or at the very least (much) more aware of food and what the weekly menu looks like.
I have bought Elisa Oras’ book and Amazon has informed me both of mrs. Farrar’s books are on their way from Germany as we speak. I have every intention of showing some chapters to my GP because she also has her own ‘diet mindset’. For instance, one time – on the one occasion I dared to go specific – she told me to perhaps consider more healthy options in the future if I decide to eat something extra in the evening. This was her reply when I told her I had a MINI Milky Way as an extra and how horrible I felt afterwards (I suffered from extreme hunger that evening, but I never dare to follow it and try desperately to keep my response to this extreme hunger within ED-acceptable boundaries). … I felt sooo b.a.d.! Felt like the fat lady on a fair, winner of a pie eating contest! Because, there I was, trying to convince myself that it was okay to have one mini Milky Way and I could even have 10, and a medical professional told me to, in the future, consider more healthy alternatives …
YES, I think professional care in Belgium still has a great deal to learn … but perhaps I’m no one to talk with my 10 years of ED and still counting 🙁
I live in Belgium to. I had inpatient treatment in the Netherlands but it is actually very similar. I was on the highest mealplan they ever made because I didn’t gain as fast as they would like to. I often told them that I wanted something else to eat and not more sandwiches. I ate 18 sandwiches a day and a lot of crackers, puddings and cereal… but I told them that I wanted to eat something else, higher calories and something that I liked. I told them I was soooo hungry but they told me the exact same thing: I couldn’t be hungry, i was just developing binge eating… I came out of the treatment at a “healthier” weight but sicker than ever… when I told my psychologist that I was not feeling happy, I had a hard time they told me that it couldn’t be that bad because my weight didn’t drop that much??? Which lead to weight dropping because I didn’t feel like they would listen to me. Eventually I stopped treatment, they did send my gp a letter where they told her that I was choosing to live with my Ed forever!! I found a new psychologist in Belgium, not ed related, and started my own recovery with the book of Tabitha farrar and a lot of you tube. It took a little bit longer for me to gain weight but I am gaining now and facing fearfoods but also love what I eat. I ate those 18 sandwiches for 6 months and guess what: I cannot see another sandwich.. I want chocolate, fries and pizza… just as I was craving in the hospital! Now I allow myself to eat it…
There is so much wrong with ed treatments. Offcourse I understand that they are offering weight restoring treatment but does that have to mean that they can make us sicker in our heads??
Talk about the lunatics have taken over the asylum. Makes me want to scream and scream until I’m sick…
In my experience (three inpatient intakes), the “normal” eating behaviours that are created and inflicted in the program cause further disordered eating habits and screwed up ideas about what normal is. People come out of treatment way more fucked up than they were going in. There is frequently not enough follow up upon being graduated out of the program, and people are direly under-prepared for the real world when they leave
I have been in both an inpatient & outpatient clinic in the UK. Meal plans are used & as soon as you get your BMI up they want to reduce your intake or at least closely monitor you. I ‘picked’ at food as in I may have just eaten but would go have extra handfuls of things, which I now realise was down to my compulsive exercising but they told me that actually I no longer have anorexia but I am instead bulimic.
I asked what to do about my compulsion to exercise & was told they wouldn’t tell me to stop as that isn’t healthy either. I asked for more help & was told there is nothing more they can do for me.
So here goes the journey on my own…..
So I’m fully weight restored- I’m actually overshooting currently. I’m chubby, but happy and healthy. I have no trace of anorexic thoughts left in my brain, and I can eat whenever I’m hungry and stop when I’m full, without feeling hungry/guilty/etc. I could only achieve this level of complete recovery by listening to my extreme mental hunger and ‘bingeing’ until my weight shot up to higher than my pre-ED weight.
Despite my incredible success, my family still has the nerve to tell me that I’ve ruined my health and that I should have listened to the dietitian and stuck to my meal plan of 2,200 calories a day (for weight gain, might I add). I was underweight and starving on that diet, and the foods prescribed to me were more akin to what you would expect to see on a weight loss plan than a weight-gain anorexia recovery diet. I would never have recovered eating like that, never, and I told my family as much, and they scolded me for ‘believing that I know better than a doctor’ and that I ‘should have given it time to work’.
I’m sorry, but doctors don’t always know everything. They are very knowledgeable people in lots of areas, but that doesn’t mean they’re infallible. If you’re in recovery, and you’re hungry and being told you’re not allowed to eat, get a new doctor. I’m serious. You won’t recover. You might improve, but you won’t fully recover until you give in to your hunger and actually allow yourself to eat.