Identity and life goals

I had an appointment with my regular therapist yesterday.  It was hard.  Hell, when is therapy not hard for me lately?  I think I’ve finally broke through some walls that I had up and it’s making it easier for me to let go and be open and honest.  And at the core of it, open and honest is raw emotion.

We talked a lot about my frustration with the ED clinic and about how much of my identity is wrapped up in my physical appearance and weight.  I’m not sure if this is what feeds my eating disorder or if my eating disorder feeds the identity issues, but there certainly is a correlation there somewhere.

We talked a bit about my comparisons of my life to other people and judging myself based on that.  I have highly intelligent, highly educated and successful friends.  And I beat myself up regularly about the fact that I don’t have enough education, or that I don’t have a career.   She reminded me that during the time other people were going to college and developing careers,  I was learning to survive and teaching myself to live.

She generally doesn’t send me home with actually “homework”.  Usually it’s just something to think about or a phone call to make.  This time though, I have to come back next week with three goals that are completely related to me.  Not related to anything that I’m “supposed to be”.  No goals that compare me to what other 31 year olds are doing.  Three goals that are solely mine and are important to ME.

So, I’ve been using some software that I found that helps me create a “mind map“, which in turn is helping me to narrow down some of my actual wants/needs.  We’ll see what I can come up with.

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.

Feeling the frustration

I’m consumed with frustration and almost a feeling that this all just isn’t going to work. My brain working the way it does, I know that there has to be a deeper root to the frustration.

My heart has just felt so heavy since I left Melrose this morning. See, after the initial assessment, I also have to have an intake with a therapist, a dietitian, and a physical therapist. Today was my therapy assessment….

I actually had to walk away from this post on Monday night because I was so fiercly flustered.  I was wrapped up in the irrational part of my brain that refused to see anything but the negative.  After a day of reflection and relaxation, I’ve remembered that I can take what is helpful and leave what is not out of any situation.

I went into the therapy assessment thinking that she was going to tell me all the answers, that she’d have some sort of insite into who I am and who I want to be, and that she’d say some phrase or concept that would instantly make me have some faith in the process of ED recovery.  And she didn’t.  It broke my heart at the time, but my expectations were irrational.  I don’t need to have a sudden bright light of clarity.  I can walk through a fog of confusion and uncertainty for awhile and eventually it will fade.  It may be a slow fade, but it will happen.  .

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?

Nights like these…

I’ve been really inwardly focused the past few days.  And it makes it incredibly difficult to be effective in any other aspect of my life.  I’ve  been  trying to wrap my mind around the ED treatment center and the new medications.  I’m adjusting to the side effects of four new medications.  I’m trying to stay mindful.

It’s H.A.R.D.  I feel like my brain is being pulled constantly and I’m keep pulling it back.  From past experience, I know that this feeling of being torn in two directions will go away eventually.  For now, though, it’s here, it’s real, and it’s very, very difficult.

Compound this with “real life”.

I’m working very hard with my son’s school to develop his IEP (Individual Education Plan)  That’s equated to running to a million appointments for testing and evaluations.

My partner has thrown her back out and has been in an intense amount of pain pretty much constantly since Tuesday.  I don’t think I’ve ever seen her this miserable.  And yet, I have to force myself to help take care of her, because I just can’t seem to stay present and out of my own brain.

Time to dig through the toolbox and figure out which skills I can use to help me find some balance here.

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

The results are in

I had an appointment at MN-COME to follow up on my test results today. The verdict is in.  My testosterone was incredibly high.  My glucose is out of whack.  I had literally not a single drop of Vitamin D in my blood.  My vitamin B12 was very low as well.  So she added a shit load of medications to my already heavy  cocktail.
This is what my new medication regimen looks like:

Morning:

Phentermine 37.5 mg
B-12 15 mcg
Fish Oil 1200 mg
Aldactone 25 mg

Afternoon, just pre-dinner:

Fish Oil 1200 mg
Multi-vitamin
Lexapro 10 mg
Metformin 2000 mg
Aldactone 25 mg

Bedtime:

Valerian Root 450 mg
Melatonin 3 mg
Cymbalta 60 mgs
Klonopin .5 mg

There were no issues with my thyroid function.  There are a number of small cysts on the actual thyroid itself.  We’re going to keep an eye on those over the next six months or so.

Wow.  Supposedly all of this will work together to make me a happy, not “tired all the time”, able to process my food correctly, non-panic attack having individual.  It will also help the crazy hair growth on my chin and help me lose some weight.  And I might even have some energy again.  Between this and the eating disorder clinic dietitian helping me figure out the food stuff, I might have some semblance of a life ~!

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.

Not another “diet blog”

I really do not want this to become another one of the million “diet” blogs that are out there.  I don’t want it to be all about calories and “lifestyle change”.  But it probably will be.  The great thing is this time around, I’m doing it right.  I’m working with a fantastic doctor.  I’m keeping my  plans realistic and healthy.  I’m not starving myself.  I’m not exercising like a mad woman.  I’m eating healthy meals and snacks.  I’m aiming for 10,000 steps a day on my pedometer.  I’m trying to play around on the Wii Fit for a half an hour every night.

I went to MNCOME (The Minnesota Center for Obesity, Metabolism, and Endocrinology) last week for my initial consultation.  My primary care doctor is concerned about how hard it has been for me to maintain any sort of weight loss, and is starting to think that there is some sort of hormonal difficulty due to various weirdnesses in my body.  The appointment went incredibly well.  We scheduled all sorts of tests and appointments for the next couple of weeks, and I return to see the doctor again on the 20th to discuss the results and start moving on whatever course of action we decide to take.