Wednesday, January 28, 2009


Self-awareness, especially on an emotional level, takes time and introspection for any human being to develop. It’s a constantly changing process, lasting throughout a person’s lifetime.
Some develop a deeper understanding of self than others for a variety of reasons. These reasons may include family dynamics while growing up, experiences with relationships, friendships, and social interactions, religious convictions (their parents’ or their own), or perfectionistic/obsessive personality types. These can be important factors in a person’s level of self-awareness. I also believe that there are some people who are more naturally tuned in, and able to understand themselves more fully on a higher level.
With an anorexic, the level of self-awareness that a person may have had before their disease, may become greatly narrowed. As the disease unfolds, and becomes more complex, many fears and doubts may begin forming in their mind. The anorexic identity broadens to include more aspects of life, while any former identity my slip away, or lie dormant. During the intense phases of the disease, true self-awareness isn’t possible. The inability to think rational clear thoughts is also a hindrance, due to the affects of starvation. In anorexia, self-awareness is usually limited to the most basic needs for survival, and even at that, becomes clouded in terms of physical well-being. Their awareness of self is contained to only who they are in their disease strictly on the outside, what they consider to be obvious to others. Self-criticism and the belief that they are never “good” enough goes hand in hand with the fear and isolation that is often exhibited. The awareness that they have at that point may only be that they are “bad”, “wrong”, “imperfect”, etc. They have no awareness of their true self.
I have found that true self-awareness involves accepting oneself, being confident of who you are, and motivation to keep moving forward. This requires honest evaluation of yourself, psychologically and emotionally, and reaching out for support and input from others. Imperfection is difficult for most people to accept in themselves, but the reality is that no one is perfect. It’s much more complex for an anorexic. Most of all, in the minds of anorexics, being imperfect causes great fear. It can indicate loss of control, being a failure or a “bad” person, and can bring on a sense of danger or impending doom. In their minds, their ability to be “perfect”, by their own standards, protects them in some way. In recovery from anorexia, breaking away from the obsessive mindset to begin to focus on thoughts, feelings and self-analysis is the hardest part.
The first step, weight restoration, can be in a way, the key to unlocking the rational and teachable part of the brain. Learning about oneself requires taking risks and a willingness to reveal parts of themselves which they have kept hidden for a very long time. It’s a process which requires time to begin to fit the pieces together, but which then, at a certain point, becomes more of an exciting discovery. Acceptance, as in the process of recovery as a whole, is necessary for continued progress.
My own self-awareness has drastically improved while in recovery. A major difference is that I can now accept my imperfections, or my humanness, as I prefer to refer to them, including physical qualities (weight, size, shape, etc.) as well as who I am inside, emotionally, psychologically and spiritually. I don’t consider myself as inadequate or mentally ill anymore. In addition, my definitions of “perfect” and “imperfect” have completely changed. I don’t believe anymore that there exists perfection, so therefore there can not be imperfection. Attempts at perfection will most likely lead to self-hatred, feelings of failure, and possibly unhealthy coping methods. As I have become aware of these things, and have begun to practice awareness and acceptance of self, I can realize that I can use this to go forward, to face my future, and to develop meaningful relationships with special people in my life; on all levels. I feel a new confidence in knowing who I am, and in my ability to contribute to relationships. I also know that I must continue to grow and change and always remain aware and open to who I am becoming.
Very similar to self-awareness, one’s concept of self is often based more on judgment and criticism and how they evaluate their own worth. It is directly related to a person’s level of self-esteem and respect for themselves. In the world of anorexia, worth may be based on accomplishments, level of perfectionism, self-denial, and control (of themselves and often the world around them), all of which are meant to be noticed by key people in their lives. In the anorexic mind, strength is exhibited by losing weight (no need for food), over-exercising, needing less sleep, higher accomplishments (grades, sports, etc.). This is their daily goal. Many determine their own worth solely on inner strength, outward accomplishments and self-control. Recovery involves acquiring an understanding and belief that worth is not earned, nor is it something that is developed. Worthiness is something that is realized along with the development of an identity outside of anorexia, the social skills to contribute to meaningful relationships, and the acceptance of who they are as a person. This requires taking risks, a commitment to examining who they are as a person, and patience. I believe that time is critical.
I now find strength in having true control over my disease, trusting my own decisions, and by refusing to use past coping skills.

Saturday, January 10, 2009

IDENTITY: “The set of behavioral or personal characteristics by which an individual is recognizable.”

The anorexic identity can be an enormous factor in the development and maintenance of the disease, and the reconstructive task of recovery.
Even before the onset of the anorexic disease process and the behaviors, there is often doubt and confusion about one’s identity. Several factors often add to the confusion of this matter, especially for women. Parental teaching and expectations, sometimes pertaining to gender roles in society, or religious teachings can cause conflict with regard to individual beliefs and life goals. Society’s influence and focus on outward beauty and physical perfection can trigger guilt and a decrease in self-esteem. In an over-controlled environment, the attempt to gain control becomes central. If one is taught how they ‘should’ be, what they ‘should’ believe, what goals they ‘should’ have for their life, and what is and isn’t acceptable, they can begin to look at all things in their life as ‘good’ or ‘bad’.
Interpretations of good and bad may vary, but being ‘good’ usually means people-pleasing, conflict avoidance, and emotional and physical self-control. Emotional self-control usually denies feelings and emotions, “protecting” one from pain. Physical self-control focuses on body perfection, which is displayed in society as the ultimate goal and success. With anorexia, in time, the need for control and the search for perfection evolves into restricting food, losing weight, exercising, and other forms of bodily control. The lack of clear identity and the obsessive nature of the disease, together presents a forum for isolation and protection from scrutiny or judgment.
When weight loss becomes obvious, the positive reactions from others strengthens the resolve and fuels the belief that this is good and acceptable, i.e. more “perfect”. Others may see this as self-control and strength, and an achievement beyond others’ ability. For the anorexic, there is pride in this, and she endeavors to continue to prove her worth and her strength by denying herself. When she is acceptable and successful in others’ eyes, she is “good”. To an anorexic, “bad” is synonymous with weakness, and can be applied to eating, weight gain, uncleanliness (germs), impulsivity, lack of self-control, displaying emotions, and allowing one’s self joy and pleasure. Sleep even becomes “bad”, because inactivity isn’t acceptable. For some, they believe that if their life isn’t difficult and painful, they aren’t working hard enough. In time, this identity strengthens as individuality diminishes, and they are unable to have a rational view of themselves. It becomes important to them in time that others notice the weight loss, even the decline physically, to uphold the identity.
There are numerous psychological factors involved in the maintenance of anorexia, and they may each take on their own personal identity. It’s terrifying for an anorexic to imagine letting go of that identity. Emptiness is perceived without it, along with loss and loneliness. There is desperation in thinking, “who am I without it?”, “how do I find out who I am?”, “will I like who I am?”, “will others like who I am?” etc. This is a process of discovery, and it can not be forced. But it can be encouraged by being willing to take risks in exploring one’s self, reaching out for support, and by challenging past beliefs. In my experience, after many years of maintaining the disease, and after not being successful in numerous attempts at recovery, I felt no pride or accomplishment in that identity. For years, that anorexic identity had been seen by everyone around me, but I felt shame and guilt for continuing to be sick. I hid my body, and pretended that I was fine. I wanted out of the prison I had built, and I wanted to adopt a new identity, yet fear had me immobilized, and I knew no way out.
As I began to recover, giving up that identity wasn’t so hard. As I said, it had become a source of shame for me. I desperately wanted something better for my life. Also, I didn’t return to the environment I had come from, so I didn’t have the same issues that others might have of people noticing and commenting on the physical changes they saw in me. I did however, feel great fear about what my identity would be without anorexia. I knew myself no other way. I can’t fully explain what the process has been like for me. I know that the first and most important issue that had to be addressed was weight restoration and maintenance. Normal brain function had to be restored. Weight stability, over time, has been the key to allowing myself to discover my true identity, and that continues. I feared at first that I would have to develop or create an identity, which seemed overwhelming, until I realized that I had an identity before anorexia, and that I still have it. It just took a lot of hard work to recover it and understand it.
Recovery, to me, is a process which requires repeated times of letting go and allowing yourself to become you. Actually, developing and maintaining an identity is a life-ling process, as we grow, change, live and learn. Life’s experiences, and how we deal with them, also influence who we are. At this point in recovery, I have learned a lot about who I am, and I am able to accept myself, flaws and all. I have become comfortable with my body size, and when I feel discomfort, I am aware that it is not about my body, but that something emotional is going on, and I’m not dealing with it adequately. Now that I know what maintaining a healthy weight has given me, I’m not willing to sacrifice that. Besides, my weight is no longer who I am.

Monday, January 5, 2009

More about Me

I am 53 years old. I was born in a small town in Southern IN in 1956. Third of four children, two older brothers, and one younger sister. Mother a homemaker, Father an independent businessman. Environment growing up was very black/white, right/wrong, and gender stereotypical. I led a very protected life. I basically developed a great fear of the “world”, and I see now, of becoming independent. I was “chubby” as a child, which translated to “fat’ as time went by, and was reminded of it often by my peers. My home was not an angry or abusive home, but little to no affection was shown, or emotions exhibited. I felt tremendous pressure to be “good” and not “rock the boat”. I never felt like I “met up” to anyone’s expectations or was “good enough”, and I was constantly trying to please everyone, yet hating everything I was doing.
In Jr. High, I remember on my birthday, two of my friends wrapped up a little brochure outlining the “Roman Meal” diet as my gift. I was crushed, and left to go home crying. After my Freshman year in HS, at age 13, I began to diet, after a dare my Father made to me about who could lose the most weight the quickest. I lost over 60 lbs. in three months, and also my periods, which I had only begun one year earlier. I loved the praise and positive comments from my peers about my “success”.
The rest of my HS years were a progression of isolation and continued dieting, adding exercise and the food rules and rituals began to become ingrained in my mind. I pretty much lost all contact with my former friends, and avoided social functions b/c they included eating. My parents were always onto me about eating, but they didn’t consider that it might be a sickness, but only stubbornness and rebellion. I was 16 when I began to date a young man who was “acceptable” to my parents, and we were married 2 months before my 18th birthday. I graduated HS mid-term, married in March, then went back for Commencement in May….a married woman!! It was 1974, and I was 17 years old…..every day scheduled…and every calorie counted in my head.
I maintained a low weight for several years during this phase, but was obsessed about everything I ate, and how I looked. Exercise began to take it’s control also. I tried to get pregnant, going through fertility treatments….strange how the doctors never said a word to me about my weight loss had affected my fertility. No luck. We applied to adopt, and in August of 1979 we adopted our first son, Matthew. I thought my life was perfect then. The years after that are a blur,except that I remember my weight began to drop. I also began OP therapy with a psychiatrist in Bloomington about two years after Matt was born. I was put on many different types of drugs over a few years’ period of time, but things never got any better. We also tried fertility treatments again, and I did conceive, but miscarried at 6 weeks. I will always believe that it was my fault b/c of my ED. Shortly after, I lost a lot more weight, and I ended up in Indpls.(2 hrs. away) in a Psych unit for 3 months. I continued OP therapy there, and we adopted our second son, Tim, 2 months after my release from the hospital. This was in May, and by Oct. I was very ill again, and readmitted to the same Psych unit for 3 more months. My Mother took care of my boys. After 3 more months I was released and again continued OP therapy. This was in 1985-86, and I started going down in weight again, but I refused to be hospitalized there again.
During the next year or so, I was in and out of our local hospital on IV feedings, etc. several times. Our local doctors had no clue how to help me. When I had subclavion ports inserted, they punctured my lung….I just felt like I deserved it. I felt like it was my entire fault. I felt terrible all the time. I had pain in my right abdomen that would not go away. I finally had stomach surgery in 1991 to re-route my stomach and small intestines. The surgeon told me that my mesenteric artery was being compressed, and that the surgery would also cure my anorexia. Recovery from the surgery was terrible. I could barely move for months. My eating disorder was no better. Over the next four years I just kept going downhill.
When Tim was 4 years old, we found out he had a seizure disorder….absence and photosensitive seizures. His seizures had held him back developmentally, so he was labeled “LD” in school, which was very hard for him. I was admitted to a treatment facility in Arizona in the Winter of 1995-96. Over all these years, I missed out on so much of my boys’ lives. I just couldn’t keep up with their activities, especially Matt’s, and I will always believe that it had a great affect on him…even now.
Tim and I were closer….he had a lot of trouble with coordination, so he didn’t play sports like Matt did, and was very socially avoidant. He was kind of my “sidekick”. He was always begging me to eat, and asking me to “get healthy”…which were the last words he ever spoke to me, two days before he was shot and killed at age 17, on June 7, 2001. It was in May of 2001 that I had returned to the treatment facility in Arizona. I was out of hope and didn’t know where to turn. I had done well for about a year after my first stay there, but I had manipulated things even then. I was on a feeding tube (NG) for 9 weeks during my first 3 month stay.
After my discharge the first time, I enrolled in Nursing School at a University about 1 ½ hours away from my home in 1997, against everyone’s wishes, but I was determined to do what I had always wanted to do. It was a struggle all the way. I was going downhill with my weight the entire two years, and had to make the drive back and forth four days a week to classes. I had five accidents during that time, and miraculously wasn’t injured in any of them. I was taking so many medications at that time, and also prescription “speed” to keep from falling asleep at the wheel….which did happen twice. My weight was very low, but I managed to pull through and get my degree….then immediately went to work back in my home town. In December of 2000, I collapsed at work, and was taken to the ER. I had developed strep pneumonia, was septic, and so depleted, they had to access a femoral line to take blood and administer fluids. I truly almost died. I was in ICU for 5 days, had blood transfusions (which I remember none of), and spent a total of 2 ½ weeks in the hospital. The entire time, I played all the games with my food, hiding it, flushing it, and just not eating.
I was in treatment in Arizona in June when Tim was killed. I tried going back to treatment 3 weeks after his funeral, but I just couldn’t deal with anything, so I went back home in August. Later, when talking to my former therapist there, he told me that they truly thought I would just go home and die. I wanted to. I pulled away from everyone….kept going to church, but the thoughts there had always been that if I had enough “faith”, I would not be sick. I was living in a fog. It was Sept. 2001, and I knew that I was headed for death if I didn’t find help. My family, including my husband, thought that I should be able to “just eat’, especially for Tim’s sake, but I knew that I couldn’t do it on my own, and I knew my body couldn’t take much more. I went to a therapist, and she said she wouldn’t work with me because of my physical state, but she recommended a treatment center near Toledo, OH. It was January 21, 2001 when I arrived at that facility to begin TRUE recovery.
I was in intensive day treatment for six months, and then continued regular OP therapy until about 3 years ago. I filed for divorce in Sept. 2002, and my family totally disowned me. Little did they know the complexities of it all. My husband had come for a few “family meetings” with my therapist and I, but it was obvious that he would not support my recovery into becoming a person of my own. It was such a hard decision, but it was the decision I had to make to save my life. I worked with a female therapist while in OP therapy…..she totally messed me up. She had me doing dangerous behaviors in the name of “freedom”, and in the end, betrayed me and lied to me, nearly destroying everything within me. She left the clinic soon after, and it took me several months of working with another brilliant psychologist to straighten out my thinking. I lived in my own apartment for about a year, and then bought a house about 8 miles away.
One great thing that I am so thankful I experienced was being allowed to house a total of six different young women in my home (at different times) who were moving on from intensive treatment and into their independent lives. It really taught me a lot about relationships, how to have fun, and how to let go of some of the perfectionistic expectations I had for myself and my life. Plus, I made some great life-long friendships. Up to this time, my recovery had been solid. It was about this time that my eating started to suffer and things were getting out of control…but I couldn’t ask for help.
I met my husband Dave in Feb. 2006, and it was soon that we knew we would get married. He has been my rock, and through him, I now know what "being in love" is really like!! I had emergency stomach surgery in May, 2006, for an intussusception, which really messed up my eating and my thinking, and then I allowed myself to get lost in wedding plans. We married in Sept. 2006, and I also had to have bilateral carpel tunnel surgery in November and December. So I was out of work for almost nine months. I lost nearly 25 pounds total after the first surgery, and over the next six months or so. I was in denial, and for some reason, just couldn’t force myself to be compliant with increasing my calories to gain back the weight. I was dishonest about it, which made me feel worse, and it took the loss of a very important person in my therapeutic life, and pretty much an ultimatum from the professionals at the facility that I have still been accountable to, to get me back on track. I have managed to gain up to the weight that is right for me to be stable and healthy. I feel more balanced than ever in my life. I also have noticed that in a spiritual sense, I am much more grounded and peaceful with my beliefs. The old ED part of me has truly died away and the healthy “me” has taken over…I know for good. For that I am very thankful. I am also much less anxious, and able to deal with uncertainty and other people’s issues, without taking them on as mine to “fix”.
My passion at this point in my life is to allow the love and care I feel for others to pour from my heart, and to do all that I can to promote true recovery to those around me who are suffering. I love the feeling of being alive!!!

Sunday, January 4, 2009

Physical/Psychological Effects of Starvation

The physical/psychological affects and consequences of an eating disorder are not well known, or rather, not considered as much as they should be in terms of affecting and impeding the affected person’s ability to process cognitively well enough for psychotherapy to be of any help.
The fact is, a person actively engaging in symptoms of anorexia or bulimia are in a state of starvation. Their body is starved, and just as important, their brain is starved. A person with bulimia may be at a near normal weight, but if the food they ingest isn’t being utilized by their body, it’s just the same as if they weren’t eating at all. If the amount of food ingested is being compensated for in any way, such as purging, exercising, or laxative abuse, the same result will occur. While a person is enveloped in the disease, it is not possible for them to grasp the reality of the harmful affects, short or long term, this can have on their bodies. This may be denial, lack of insight, or the absence of cognitive reasoning…an obvious effect of starvation.
I won't attempt to list or explain the effects that starvation itself can have on the body (please note the sidebar reference to Ancel Keys’ Starvation Study, and those results), or what, if any, are the differences in prognosis based on the length of time that a person has suffered from the disease. I do want to offer my interpretation of the emotional impact of certain physical effects of anorexia, and how they are also involved in the onset of the disease. It is common for a young girl, who is approaching puberty and pre-adolescence, to have fears about reaching womanhood, the obvious physical changes that occur in her body, and how that relates to her sexuality.
The attitude and expectations of society that are placed on a female can be confusing and can raise many questions and emotions that she may not be prepared to handle. If there are abuse issues, past or present, these can also increase those fears. The lack of knowledge, amount of parental involvement, and attitudes about gender roles all can have an affect on the way a young woman perceives her body. The consequences of anorexia; amenorrhea, lack of breast development, and an overall "little girl" or boyish appearance, can ‘protect’ her from the expectations of womanhood or adulthood in general. An anorexic, while trying to control her life and be seemingly independent, actually sets herself up for eventual loss of control and increasing dependence on others to "take care of" her. In some, this can lead to a learned helplessness, which involves manipulation of others around them.
There are many more possible physiological affects of long term starvation, some reversible and some not, that require both physical and psychological healing. As I recall my own experience, one of the most obvious things that I can see now, is how over the years, this disease slowly took it's toll on me. When my eating disorder began, my weight loss, and focusing my life on food and eating was an achievement. It energized me. I made it my life's purpose, and I was successful at it. I can't recall at what point, but in time, my attempt to run a household and raise my two adopted sons became exceedingly more difficult. I pushed myself to prove my strength and worth, both to myself and others, refusing to face reality, hoping I could change it. It took great effort to just get through the day. I could barely climb the stairs to my bedroom. We even at one point, discussed that it might become a necessity to put a chair lift on the stairs, or completely move to a one-story house. I became weaker and weaker, yet pushed myself harder all the time. I couldn't tell anyone how weak and sick I felt. I had been told many times that it was my own fault, and my choice, so I thought I deserved to feel that way.
After my first inpatient treatment in AZ, I did have more strength and hope, and that's when I made the decision to go to nursing school. I don't know how I made it through and graduated. I drove 3 hours a day to attend classes, I couldn't focus, and I was always exhausted. I felt that I had to prove myself, to myself and others. It was a miracle that I made it through school alive and earned my degree. I had five automobile accidents during that 2-year period. I fell asleep at the wheel three times, and just lost control the other times. I was never injured. The entire time I was in school my health continued to worsen. I lost weight slowly, but continuously, my anxiety was out of control, and I felt increasing pressure to set my goals higher for my nursing career. I could barely take a deep breath by that time. The pain was intense when I sat on any unpadded surface. I was bruised all the time from my bones protruding. It was excruciating to get into the bathtub. I pulled away from anyone's touch, for fear of pain, and their discovery of how bony I truly was. I was in misery, both physically and emotionally, but I was imprisoned by my disease. I had to push myself through each moment, always feeling like I would collapse at any time. I went to bed at night, wondering if I would wake up in the morning.
I don't know how I survived, except that my will to live somehow remained strong. It's painful for me to recall that time of my life, and all the experiences that I missed out on. I wish for others who are suffering, to see and believe the reality of where it can lead. I want them to experience the restoration of their bodies and what real strength feels like again. I will never forget, after being in true recovery for several months, how it felt to discover that I could actually run a few feet again! My legs were wobbly and still very weak. It was a very strange, but freeing feeling. At that point, I could finally envision myself being strong again. I found that I liked the feeling of strength as it began to return to my muscles. I finally felt hope that my life could actually change!!

Saturday, January 3, 2009


I would like to share some writing that I have done, relating to what I have experienced to be key factors in the development of, and the recovery from my anorexia. I will begin with Fear, because I consider it to be one of the strongest components of an eating disorder.
Anorexia is often accompanied by an underlying, constant fear, and is often maintained by the development of additional, more complex, irrational fears. The fears are often related to specific everyday occurrences, gradually becoming more focused on food issues, further distracting from the psychology of the process. The fears can be about many different issues and situations, and of course, are individualized with each person, but some are universal.

The anorexic focuses on fears of gaining weight, or rather, on the fears of not losing weight. Even a stable, low weight is frightening, because the goal is to continue to lose every day. They feel “bad”, a failure, lazy and depressed if that isn’t happening. Strong desperation may set in at this point. They have to make whatever changes it will take to be successful in losing weight. There exist fears about facing people, fears about revealing themselves to others (fear of judgment or rejection), fears that their plan for anorexic behaviors will somehow be interrupted, and they will be “trapped”. There is a very strong fear that someone will take their control away.
Fears of maturity (womanhood), a sexual self, adult responsibility, and that without their disease, no one will show care and concern are also common. These fears are often not realized by the person, until later in therapy, when they begin to develop more hindsight and self-awareness. A very general fear, which contains many components, is the fear of who they are as a person, whether they are “good” enough, or worthy for this life. The quest for weight loss is much more than just about weight control. It’s about running away from the pain in their lives….looking for the way to be a perfect, acceptable person…..and gaining control of a part of them that no one can take away.
In time, anorexics live with constant fear. Fear that someone will find out, when in reality, it’s obvious to everyone. They lose any sense of security, because they have to constantly keep their guard up to protect their behavior, and later on, when they realize that without help, death could be a reality. Some are never able to admit that fear, or they remain in denial. A fear of close relationships and disclosing certain parts of who they are, keeps them isolated and even more fearful. That fear of criticism, judgment and rejection is more powerful than anyone can imagine.
The process of weight restoration is long and hard. With every pound, there is fear that the weight gain will continue forever….fear that “they” are going to let them get “fat”…..and a lack of trust in terms of recommended “goal” weights, and daily calorie requirements. This is when the feelings start to emerge, and they may present as several different emotions. Feelings are very frightening when they have been turned off for a length of time. As the brain becomes more able to process and examine thoughts and feelings, the fears can actually greatly increase. Now there is more of a threat that without their anorexia, they are nothing. They have no concept of who they are, or what they want in life. Their identity has solely been being anorexic, and living each day in that pattern. There was no time or energy to develop anything past that. They feel like their only source of stability and safety is being taken away from them, and then what?
Understanding and admitting what changes are needed in their lives for them to recover is also frightening. Stating it, believing it, and doing it do not all happen at the same time. If one has anxiety issues, the fears are more intense at times, and often more irrational. The fears cause a great deal of hesitation and what seems like stubbornness, but it’s much more complex than that. Depending on a person’s age, and where they are in their life in terms of goals, schooling, career, and family dynamics, the fears will vary, and the way to deal with them vary to some degree too. I know I’m not a therapist, but I know for me, the only way I have been able to deal with my fears and move on, is by facing them, feeling the feelings, good or bad, and using the resources for support that I have around me.
I plan to share some of my own experiences soon about how I have tackled some of the fears explained above. Any input from others is welcome and appreciated.