Thinking about Body Image

The last two weeks at group have been focused on body image, which is particularly hard for me. I have always said that I don’t have low self-esteem. I have high self-hatred. That makes having any appreciation for my physical self incredibly difficult.

During week one, I was pretty furious, honestly. We watched a documentary about women’s body image called THE STRENGTH TO RESIST: Media’s Impact on Women and Girls. I fully recognize the impact media has on female body image. It’s terrible and real. But I have two major complaints about the movie:

1. There was not a single “obese” woman in the film. The lack of representation of real women and real bodies was really disheartening to me. The one woman who did talk about her “curves” was a professional boxer with arms like Mohammed Ali. I did not feel represented or understood at all by the creators of the movie. How can they possibly understand the emotions that I feel about my body when they do not experience what it is like to be in my body? Who knows what their body history is, but in that time, while make that movie, they were thin. And with thinness comes privilege.
2. The movie does not acknowledge the reality of fat-phobia/fat-bias. Not really. Yes, it acknowledges the existence, but it felt sugar coated in a “We are women, we are invincible” kind of way. I am working hard to do everything I can to stop my own judgment of people based on weight (including myself), and when I hear hate speech directed at people, I speak up. However, it is real. And my actions cannot change the world. There was a particular scene that really just pushed my buttons. Gale Dines, an AMAZING lecturer and associate professor of Sociology and Women’s Studies at Wheelock College in Boston, was speaking to a lecture hall of typical students. During her presentation she uses a lot of slides, mostly of models in various poses. She points out the inherent violence/racism/sexism/etc-ism in each. The audience listens intently, seeming to really appreciate everything that she is saying. And then she puts up a photograph of a woman, who by today’s medical standards would be considered morbidly obese. The woman is wearing a tiny blue bikini. And the audience breaks out in hysterical laughter. To the point where Dr. Dines has to change the slide before she can speak about how awful it is that this woman, no matter how comfortable she is with her own body is ridiculed for her size. THAT, my dear friends, is reality. Reality is that people pretend to not care. People pretend to not judge. People pretend to be truly and honestly interested in the horrors of media bias. And then they see a woman that doesn’t fit the standard that very same media has taught them is attractive, and they break out into laughter. I can’t even imagine what it would be like for the woman in the photo to be in that room when the fits of giggles began.

I will give the movie some credit because beyond the issues with weight bias, they also discussed the media’s representation of women of color. This was where the documentary hit the nail on the head about privilege. (I’m fully aware of my own white privilege, and try to keep that in mind when I get angry about any –ism that I am subjected to.)I will never fully comprehend the experience of a woman of color; I have a great appreciation of Jean Kilbourne’s attempt to shed some light on this media bias. Not trying to “unpack my invisible backpack” or anything here, just acknowledging the one good and direct thing that I saw in this movie.

This week, we talked a bit more about the movie, but it seems that my opinion didn’t change and the group leaders just weren’t all that interested in having a politically charged debate with me. I’m just not willing to swallow the “one person can change the world” pill that they want me to, at least not on this particular topic. I will be judged for my physical appearance. That is just the harsh truth of the society we live in. It sucks. And I do what I can to change myself, and I can try to change my own reactions to the rooms full of laughing college students, but I cannot make anyone else see things the way I want them to. That’s just life.

We moved on to a discussion about all of the things that we have put off or will not do because of our weight/body. My list is immeasurable. But the therapist said two very heavy and emotionally weighty things that made me start really thinking about it.

“The Eating Disorder will not give up until you’re dead.”

and

“What would life look like if this was it? What if you never lost another ounce?”

That second one scared the shit out of me. I cannot imagine being the size that I am for the rest of my life. None of the “future fantasies” that I dream about have ever had me in this body. I don’t know how to go about changing those images in my head.

I have always put off going to school, because I want to become a traditional midwife. I cannot imagine expecting anyone to respect anything I say about their physical health if it is obvious that my physical health is not visually excellent. I’m “obese” according to the medical industry, and I worry that working in a health related field, I should have my own health under control before I try to give advice to anyone else about their health.

So, in my ED controlled mind, never losing one more ounce means that I will never fulfill a lifelong dream of becoming a midwife. I will never catch babies. I will never get to watch the joyous look on a woman’s face when she holds her child to her chest for the first time and know that I was there to assist and witness her own personal miracle.

There are a million other things that I could list that I’m not doing until I lose weight (going to Europe, shopping at real stores instead of thrift stores, etc).

I’m trying so hard to find a way to wrap my mind around the fact that I may never ever be anything other than the size I am right now, but I cannot seem to accept it.

Balancing medical needs and emotional needs

I think the break that I took this last week from posting here really helped me get a little more perspective on things.  Did it shut up E.D?  No.  But it helped me remember that I have a voice and I can scream back if and when I need to.

This weekend has gone alright.  I’ve managed to only get on the scale once a day, which is huge for me.  I’ve managed to not obsess about food…much.  I did have a few moments when I questioned things, but I pushed through and ate anyway.  I just hate when I do all the right things but the scale still shows a gain.  I know at heart that I need to get my eating disorder under control before I’m going to be able to keep the weight loss going, but it’s frustrating and panicking when I know that my health depends so heavily on me losing weight. I also know that my metabolism is so screwed up from years of restricting, binging, purging, obsessive exercise, and popping pills that it is going to take some time for my body to truly understand what it is supposed to do with food.  And that because of that, I might see some gains.  Losing forty pounds in five months is still quite an accomplishment and even if I have to sit at a plateau or gain a few pounds back to get my metabolism straightened out, I’ve already made a huge improvement in my health.

I’ve been talking at group a lot lately about the endocrinologist that I see and how focused she is on weight loss.  The group has really been pushing me to get a second opinion and find an endo who really understands both the polycycstic ovarian disease AND the eating disorder.  But E.D. is loud and has been working on convincing me that they’re just jealous that I’ve lost weight and they haven’t.  Idiot.  E.D really can be a dick sometimes.

Today my heart is hurting

• The scale shows a four pound gain in something around 20 hours.
• The thought ran through my mind that shaving my head might make the scale drop a bit.
• If it had not rained most of the day yesterday, I would have spent an inordinate amount of time on my bike and the Wii Fit trying to burn off the food I ate.
• I engaged heavily in some fasting and restriction over the last few days and can’t seem to shake the fact that the morning after I gave in and allowed myself dinner, there was a four pound gain.

That is all that I have the energy for.

Wow that ED is a screamer!

It’s been a helluva week.  Damn, really it has been a hell of a month when it has come to me struggling with this damn eating disorder.  See, it’s been….well this month I’ve only managed to lose three pounds.  Three measly, miniscule little pounds.  (Hello, Mr. Ed.  Thanks for popping your head into this post.  Try to keep it to a minimum okay?)  So, I’ve been struggling.  A lot.  I can’t seem to focus on what it is that I need to do to stay healthy.  Today I’m struggling to even eat.  I’ve managed two cups of coffee this morning.  I tried to eat some toast but I gagged the minute it went into my mouth and I spit it out.

I’m still attending the groups every week, but ED screams constantly through those and for a good couple of hours after about how much bullshit they are feeding me.  And there have been a couple of instances when I can’t keep quiet and it slips out loud and wow does that cause for a kerfuffle.

Realizing just how loudly the ED voice was, I called and made a follow up appointment with my dietitian. I think I want to talk to her more in depth about formulating a meal plan that fits ALL of my medical needs, physical and emotional.

I just can’t seem to find that balance.  In order to get my hormones under control and help my body to function properly, I really need to lose weight.  But I don’t know how to do that without food completely and totally taking control.

Self-evaluation and self-approval

I received a fairly angry email this morning about the fact that I call this an eating disorder recovery blog and yet I keep track of my weight on a seperate tab.  First, I want to apologize to the reader that was offended by this.  That is in no way my intention.   I know that weight can be very triggering for women with ED.  I was hoping that by putting the weight tracking on a seperate tab that could only be reached by conscious decision, it would be okay.

Here’s the situation though.  I’m going to track my weight.  One of the problems that my personal experience with ED has caused is an incredibly messed up metabolism.  I have health problems due to my weight and I’m losing weight with medical supervision, as well as while working with my ED therapist and a nutritionist.

Okay.  So now that I’ve gotten that taken care of,  what I really wanted to write about today was the appointment that I had with my ED-therapist yesterday.  We were talking about the panic I was having over making sure everything was perfect this weekend for the barbecue that we were hosting and that everything is perfect for our upcoming camping trip. I was going to such an extreme that I was cleaning like a madwoman and going overboard with things as though I thought I was Martha Stewart. It’s not OCD related, because I’m really able to recognize when I’m having obsessive thoughts. It was totally anxiety about being perfect and not wanting anyone to judge me.  Throughout the session, I came to realize that it all makes sense.

I was born to a young teenager who gave me up for adoption to her older sister: Rejection

My adoptive mother became a heavy drug user and stopped taking care of me when I was just barely in junior high. I went to live with my grandmother.: Rejection.

When I hit my pesky teenage years, my grandmother decided she “couldn’t handle it” and sent me to live with my sister. : Rejection.

My sister and I fought continuously until she kicked me out when I was fifteen. I lived on the streets and bounced around among the friend’s houses until I met my first husband. : Rejection

Now of course, I’ve had amazing and wonderfully supportive people in my life as well, but for the most part the schema of my entire life has been rejection for things that I perceived as my fault. I wasn’t “good enough”, “special enough”, “important enough”, “pretty enough”. I just wasn’t enough. In my mind at least. Who knows what was actually happening, but I now have a very strongly held core belief that I am not enough.

Nearly every action I take in the day, is trying to prove that I’m enough and when I fail, as all human beings do, I fall apart.

So, I binge. Or I restrict. Or I obsess over clean cement in the backyard and a shiny Coleman cook stove.

I guess the next step is learning how to find that approval inside myself and not look so much for external validation.

disillusioned

I’ve had four appointments at the ED clinic in the last two weeks.  I know that I am really just a tiny sprout in the field of ED treatment, but I really am struggling with it.  I don’t feel like the therapist or the dietitian understand me and what I’m dealing with at all.  I feel as though there is a strong bias towards treating me for one disorder over another because of my size.  Now I know that certain disorders are diagnosed based on weight and I certainly do not fit those classifications, but neither B.E.D. or B.N. have weight as a diagnosis criteria.  I’m being treated for B.E.D.   So, I wanted to take a look at the diagnostic criteria for both and maybe try to wrap my head around why this is happening.

The DSM-IV criteria for Binge Eating Disorder does not exist.  As of the DSM-IV, BED is classified as Eating Disorder, Not Otherwise Specified.  The definition of BED is: (I’ve bolded the characteristics that fit my own disorder).

A. Recurrent episodes of binge eating.  An episode of binge eating is characterized by both of the following:

(1) eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is larger than most people would eat in a similar period of time under similar circumstances.

(2) a sense of lack of control over eating during the episode (i.e., feeling that one cannot stop eating or control what or how much one is eating)

B. The binge-eating episodes are associated with three (or more) ofthe following:

(1) eating much more rapidly than normal

(2) eating until feeling uncomfortably full

(3) eating large amounts of food when not feeling physically hungry

(4) eating alone because of being embarrassed by how much one is eating

(5) feeling disgusted with oneself, depressed, or very guilty after overeating

C. Marked distress regarding binge eating is present.

D. The binge eating occurs, on average, at least 2 days a week for 6 months.

E. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.

So, all of the criteria but one.  That seems logical.  But then I take a look at the criteria for Bulimia Nervosa.  (Again, bolding the criteria that fit my disorder).

A. Recurrent episodes of binge eating.  An episode of binge eating is characterized by both of the following:

(1) eating in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

(2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stopo eating or control what or how much one is eating)

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diruetics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

D.  Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Specify type:

Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diurectics or enemas.

Non-purging Type: during the current epsidoe of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretcis, or enemas.

It would seem, from those criteria, that though I do fit most of the criteria for B.E.D., I fit all of the criteria for Non-purging Bulimia Nervosa, which is in direct opposition to Criteria E of the B.E.D. diagnosis.

I just don’t seem to have the skills to explain this to the therapist and dietitian.  The advice I’ve been getting from both of them is starting to feel strangely like going to a Weight Watcher’s meeting.

“Eat mindfully.”

“Pay attention to your hunger scale so that you know when to stop.”

“Make sure you’re getting a fat, a protein, and a carb in every meal.”

From what I’ve gathered the treatment models are slightly different.

BED is generally treated with cognitive behavioral therapy, dialectic behavior therapy, or some other form of talk therapy to address the cause of the binging and addressing self-image, coping skills, and impulse control.  In essence learning how to control your eating and change the relationship you have with food.  Learning to control chaos. Though my particular clinic does not, the treatment sometimes even includes a weight loss program, such as Overeater’s Anonymous or Weight Watchers.  The treatment model for my particular program is here.

I don’t know a lot about the treatment model for Bulimia is more…all encompassing.  It recognizes the chaos of binging, but it also addresses the incredible amount of control that people with Bulimia feel when compensating for binging.

I’m feeling so…unheard.  I’m feeling so….well, I’m feeling like an oversized square peg being shoved into a round hole, because the hole is bigger and looks like I should fit in it.  I’m definitely feeling disiullusioned with the entire process.

Clogged plumbing

The title of this post is two fold.  First of all, our toilet has been severely clogged for the past week.  I’ve tried plunging and auguring the heck out of it over the past few days to no avail.  So, today I get to work on the fantastic DBT skill of building mastery.    I have definitely struggled in the past with feeling capable and proud of myself, so this is going to be a prime chance for me to let myself feel some pride.  It’s a hard concept for me to grasp, but I do actually feel proud of myself today for taking this on head on and not being terrified to try.  Trying alone is a big thing, and I am not doubting my ability to actually fix it.  BIG STEP.

The second aspect of the title is that, well, my own personal plumbing is clogged up.  Severely.  It’s been four days since I’ve been able to…..”flush” my system.  I took a chemical laxative earlier in the week, and prior to that it had been three days.   With all the new medications that I am on, I have no doubt that the constipation is caused by one of them, but who the hell knows which one.  I’m feelin’ incredibly bloated and uncomfortable.

Hello, Mr. ED,I understand that my constipation has put a hault to my weight loss.  I assure you it is temporary and that as soon as I get things worked out, my body will figure out what it needs to do to be healthy.    I appreciate you noticing that health concern for me, but please stop fixating on it, okay?  We’ve got this under control, my body and I, and we don’t need your negative nelly additude throwing a wrench into the business.  Thanks.

It’s all about control, right?

It seems as though the new medications are working.  I’m not sure if they’re all working or if just one or two of them is working fantastically, but things are going well whatever the situation.  My energy is fantastic.  I can exercise without draining myself.  My mood is really good.  I don’t need to nap during the day.  I’m eating three rounded meals a day and a snack.  I haven’t had the urge to binge even once.   AND I’ve lost six pounds this week!  SIX pounds!

I have my very first therapy appointment at The Melrose Institute tomorrow morning.  I’m a nervous about that.  I’ve been so therapized to death in my life, that it’s not the therapy that scares me.  So, I don’t know what it is about it that’s make me a bit scared.  I’m sure it has something to do with losing the control that my ED has always let me feel.  Or atleast that’s what therapy shoudl tell me.  Honestly, I don’t know how it has helped me feel in control.  But that’s the theory, right?

It’s time to find a new street

1
I walk down the street
There is a deep hole in the sidewalk
I fall in
I am lost..i am helpless
It isn’t my fault
It takes forever to find a way out

5
I walk down another street

Changing Pace

The decision to start this blog really was weighing on my mind for days now.  I’ve worried it to death truly.  That’s a change for me and definitely showing some growth, because usually…I would have obsessed the food, the calories, the exercise to death when I was starting something like this.  But this time, I’m really aware that there is something absolutely wrong about my relationship with food and weight, but mostly my body.  There is something deeply and completely dysfunctional about my relationship with my own body.

Initially, this was going to be a diet blog.  You know, talking about what I’ve eaten, what exercise I’ve done, how much weight I’ve lost.  And if it were to follow history, eventually whining and crying about how much weight I’m not losing and then slowly how much weight I’m putting back on, which would also turn into self-hatred and excessive blathering on about yet another failure.

After a lot of crying and talking to my therapist, Monday I went to my initial assessment at the Melrose Institute.   They have diagnosed me as having “eating disorder NOS (not otherwise specified).  I’m really not up for talking about the details of that right now, but suffice it to say that I am beginning to get some treatment to deal with these issues.  The doctor at Melrose is willing to let me continue seeking treatment from MN-COME, as long as I continue to see a dietician and maintain open communication with both clinic.

So, my plan at this point is to change the focus of my blog.  The focus is still “losing something”, but now perhaps I’ll try to look at it more as losing my self-hatred, my negative feels about food, the sense of control that my food problems have always given me.  And losing the fear that food will always control my life.