your heart's a mess

http://www.blog.drsarahravin.com/eating-disorders/red-flags-how-to-spot-ineffective-eating-disorder-treatment/

Red Flags re: Etiology

1.) The professional informs the patient or family that the ED is not about the food.

2.) The professional informs the patient or family that the ED is about control.

3.) The professional is not knowledgeable about recent science regarding the etiology of EDs.

4.) The professional emphasizes psychosocial causes of EDs (e.g., family dynamics, societal pressures, identity issues) while ignoring, discounting, or minimizing the genetic and biological underpinnings.

Red Flags re: Family

1.) The professional blames the parents (either subtly or overtly) for causing or contributing to the development of the patients ED.

2.) The professional advises the parents: Don’t be the food police.

3.) The professional does not keep parents of minor patients (< 18 years) fully informed and actively involved in their child’s treatment.

4.) The professional views parents with suspicion or keeps them at arms length, without reasonable cause.

Red Flags re: Treatment

1.) The professional is not knowledgeable about evidence-based treatment for EDs.

2.) The professional cannot, or does not, explain the treatment method she uses and / or the rationale behind it.

3.) The professional recommends or allows individual psychotherapy without ongoing nutritional restoration, weight restoration, and medical monitoring.

4.) The professional is very interested in exploring underlying issues in an acutely symptomatic patient.

5.) The professional insists on addressing the patient’s co-morbid conditions without also (either first or simultaneously) addressing the ED symptoms.

6.) The professional has never heard of Maudsley/ Family-Based Treatment (FBT), or has heard the term but knows nothing about it.

7.) The professional asserts that Maudsley/ FBT will not work for this particular patient, without giving a convincing explanation for this assertion.

8.) The professional blames the patient (either subtly or overtly) for having an ED.

9.) The professional advises parents to send their child or adolescent away to a residential treatment center without first trying Maudsley / FBT, unless it is clearly contraindicated.

Red Flags re: Recovery

1.) The professional asserts that the acutely ill patient has to want to eat or has to want to recover.

2.) The professional emphasizes the adolescent or young adult patient’s need for control and independence as more important than her recovery from ED.

3.) The professional sets or allows a target weight range based on population indices (e.g., BMI of 18.5) or percentiles (e.g., 50th percentile for age/height) without consideration of the individual patient’s build, weight history, or optimal weight.

4.) The professional declares the patient recovered based on weight alone, without regard for her behavior or mental state.

5.) The professional asserts that one never recovers from an eating disorder.

I found this article from Dr. Sarah Raven really interesting! Many of the above points go directly against traditional eating disorder treatment, and although I don’t agree with all of her ‘red flags’, I do think there is a certain (great) amount of validity in what she has to day. Of course, focusing on nutrition first (as opposed to finding a ‘cause’) and having family involved will NOT suit every case, especially in the instance of an abusive home or when an immediate family member/parent is also suffering an eating disorder/other mental health problems, but I do think the method of nutrition and weight restoration and then psychotherapy (if needed) would be far more effective in many cases. I’m in no way saying that causation should be ignored (I think insight as to cause can play a big part in the prevention of relapse), but rather that identifying a cause often has no impact whatsoever on motivation and will to get well. 

Life = blergh. 

But at the same time, it’s just so wonderful. 

After everything I have been through, and everything I have learnt, and all of the wisdom I have acquired; I still remain stuck*. One would think that acceptance and insight would lead to enrichment, but I am afraid that that is not the case. 

There is a part of me that wants something else. 

*in wonderland. 

Yikes! I clicked on the ‘text post’ (probably) obviously to post a text post but I really don’t know where to start. 

I’ve been feeling ok the past few weeks. Not great, but much much better. I have no idea whether it’s just the placebo effect or not, bit it feels like the medication is working. I’m not really having as many suicidal thoughts/ urges to self-harm and although I still feel very on-edge a lot of the time, I think I’ve been able to deal with my anxiety better. I feel a lot more relaxed. 

What hasn’t really improved is the anxiety around eating. I guess I feel cured now because I do eat and I’m not binging/purging really at all. So in many respects, I feel as if I’m all better. What isn’t so great though is the fact that I haven’t really been eating lunch. I don’t really know why. I just don’t feel like I need it, and if I make myself eat it, I just feel horrible. I guess in many ways my eating problems haven’t gone, they’ve just morphed into something different. A compromise. “You can eat, but only if you eat the same meal for breakfast, (sometimes)lunch and dinner”. I know this isn’t good, because I know that this sort of thinking is rigid, inflexible and disordered; it’s not going to help me build any new more positive neural pathways. If anything, giving into it is only strengthening the rigid neural pathways. I just can’t deviate from my ‘plan’, though. My psychiatrist said that it isn’t really a problem unless I think it’s a problem, and that I will start eating a wider variety of foods when I want to. The problem is, I don’t see myself ever really wanting to. Not because I want to stay ‘sick’ or ‘special’ (there’s nothing I want more than to be happy and ‘normal’), but because my brain just can’t process the concept. In my eyes (or my ed’s), I’m already committing enough of a sin by eating an ‘average’ sized breakfast and dinner. That alone causes me enough anxiety and self-hate. To eat a variety of foods is just so…messy and uncontrolled. I need that safety and predictability. 

Also, I need to have a talk with one of my best friends. She’s been in recovery for anorexia for roughly four years now. She’s been doing really well. She’s been very open with me about her illness throughout the time I’ve known her, and I know that I am at the top of her list when it comes to support people. She sees me as her closest friend, a sister almost. I know I need to tell her about my own issues. When I met her, I was still in the ‘oblivious’ stage in which I didn’t really recognise I had a problem. I know I need to tell her because her friendship means a lot to me, however I know that in doing so I am taking a risk because I know that she has cut ties with the people she knew from treatment because she finds it triggering to be around other people with eating disorders (recovering or otherwise). I think I’ve done ok with concealing my own struggles so far; she knows I’m vegan (which takes care of food restriction) and she thinks my weight changes have been due to anxiety. I guess that’s all true in some sense, but I can’t help but feel guilty because she doesn’t really know the ‘real’ me. I know that the longer I take to tell her, the more it will probably damage our relationship. Of course, I could just not tell her at all. That would probably be the most ideal, but there’s the issue of this one-sided friendship that doesn’t have a lot of future potential. : /

Wow. Loooong post. 

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I can’t for the life of me picture it. I know my psychiatrist is a *real* human and all, probably with a wife and kids and the whole shebang, but it’s hard to imagine him being able to have regular relationships with others without analysing them.
Perhaps they manufacture mental health professionals in factories and keep them in boxes when they aren’t practicing. That would make a lot more sense.

I also am hesitant to post this because I feel like all I do on here is whine and whinge, but I’m trying to employ the ‘my blog; I will post what I like’ stance because I guess that’s why I started writing here: to get things off my chest. 

I am so gosh darn tired of being so trapped. I am not in control of my life in any way, shape or form. It feels as if almost every waking thought is filtered through a screen of comparison, fear, guilt, anxiety and self-hate. 

I wish I could just fix things. I don’t want to be like this anymore. My rules and anxieties stop me from living a normal life. I would rather be a couple of kilos heavier and be happy and healthy than live like this every day of my life. I should be better by now, but the thoughts just won’t go away. I wish I could understand how this started and why I’m still so consumed. 

When I first started restricting what I ate, I had to idea it would escalate into this. I really wish I could have stopped myself.