ED Ptsd & eating disorders

[presentjoy]

Since I was little, my weight-height was charted by the dr. as underweight. I was always told it wasn't a concern, because I've always been that way, aside from the regular baby fat. So when I started into the mental health system at 15, it wasn't a hard sell to any of the people that no, I didn't have an ED I was just underweight. The teen girls who were in the psych ward with me (it was also an ED clinic) with anorexia, I didn't relate with them. As in, I would encounter a few of them in the bathroom. One was checking her collar bones to see if they stuck out enough. I felt empathy for them, but recognized that their way of thinking wasn't in me. I never calorie restricted. I love eating.

I got teased throughout school because I was so skinny "it was gross". This was a source of shame for me. I think even the word anorexic was used as a slur toward me. I can feel like people hate me because I'm skinny, or are looking at that even when no one is saying a word.

When I started seeing psychs again in grad school, I'd get the same questions about whether I have an ED. I am always able to stave off the line of inquiry -- I have been skinny my whole life, I eat as much as my husband at a meal, I don't believe I'm fat, etc etc.

I continue that story, because it's basically true. I don't believe I have an eating disorder. I can't eat dairy because of a bad reaction when I do, but other than that I eat, and lots. However when I get depressed, or so symptomatic that I can't function well, it's a bit of a vicious spiral where I can't eat well so I start on this path of decline where I am so hungry I can't figure out what to make. I can also become very crabby, unable to make decisions, stuff that's probably just very common with low blood sugar. I start to get very weak and even more depressed, and longing for someone to take care of me. If I'm depressed enough the thoughts that I'd rather disappear come into play.

I can restrict food sometimes as a form of self-harm, or wanting to disappear. But other than that, I don't think I have an issue with body image (aside from feeling ashamed of how skinny I am). I was admitted to hospital (trauma/dissociative disorders ward) and when they weighed me at admission, I was shocked at how little I weighed. I had plunged to the double digits, which I hadn't seen in a long long long time. I hesitate to mention this on this thread. Sorry. It just saddened me. I don't own a scale, and don't plan to. But again, the questions, which I successfully was able to avert. I probably don't meet any clinical criteria for an ED. Honestly, I've never looked at the criteria.

Mainly, I believe that I probably don't absorb nutrition well. I have IBS symptoms. I think food just goes through me without being used efficiently. So I'm probably malnourished even if I don't eat well. Gut bacteria is shown to be highly involved with this, and yet, just like eating, the regular consumption of pro-biotics or vitamins is also beyond me. (Again I feel like apologizing here).

There are certain things I just don't do -- I don't keep a mood diary, a food diary, a thought journal, or do any record keeping of things like that because I am concerned about becoming too obsessed with record keeping (OCD runs on my mother's side). Like if I am gonig to record my moods, I need to record my sleep patterns. Which isn't just how many hours but what time to what time. And quality. And I'd probably want a dream diary. I think you get the idea. I know I have the potential for this pattern. So I just can't do those things. If I paid attention to calories, I know it'd start by wanting to get more calories.

What I want, is to eat well and regularly, 6 times a day, and go do resistance training to get my weight up and my bones strong. I feel so weak much of the time. Growing up, and now, I tend to wear really baggy clothing to hide my frame because I feel embarrassed. Someone I hadn't seen in a while commented on how skinny I looked, and while they probably meant it as a way of expressing concern, I just felt embarrassed, and kind of angry about it. People don't comment on when someone gains weight, so lay off my weight too. Why is commenting on *anyone's* weight acceptable? It's NOT. :(

Anyway. I have concern that I have an ED at this point, but I don't think I do, but I don't know, but maybe because I want to disappear I do? Sorry if this post is not appropriate or in the wrong place. I just didn't feel it needed its own topic.

Thanks for reading

 

[71nothing]

I saw the nutritionist today. I spent a long time being lectured about things that I already know.

- you're damaging your metabolism
- you're stripping your body of muscle
- you can't continue on this way
- you really should be eating .....

As I calmly made it clear that I was aware of all those things her tone would soften and she would try to understand. I believe, however, that she really didn't understand the OCD and the food phobias. She didn't understand how I could have all this knowledge and want to change it but be unable to eat. She didn't understand how equal the need to be rid of this and the need to continue with it and have that control are.

Then the dreaded words...
- you cannot lose any more weight. Not another pound.

As if I can or will just stop.

Then the words that brought both relief and terror:
- I'm referring you to a program that specializes in eating disorders. I will contact your primary care doctor to be sure you follow up. Here is the number. You should call them today.

Needless to say, I didn't get up the courage to call them today. I want very strongly both to have an appointment ASAP and run away from this all as fast as I can. Shove this secret eating issue I have back under the surface where I have complete control. I guess it's too late for that.

 

[Abstract]

Obviously not an ED N then 71. But maybe that is OK as she is referring you on. I know you can't be happy with that but it is the right thing.

I started seeing things as what my ED thought and what I thought. It sounds like your ED wants to have a temper tantrum and run screaming but that you desperately want the help and may be relieved.

There is something to be gained from this other than the obvious (the referral). You have the facts as unwelcome and unsavoury as they are.

Hugs if that is OK. I am sure this is very frightening. It is the right thing though. Try just to take one step after the other.

 

[Abstract]

I have concern that I have an ED at this point,

Present joy, the above enables me to say a few things. I am cautious as it seems you have been very misunderstood and felt badly because it and because of the ED issue.

ED's are not as cuts dn dried as one may think.

It doesn't have to be about "looking like a model" to start. That is a huge misconception. For a huge amount of ED sufferers there is no aspiration involved. Only self punishment, feeling that they do not deserve to take up space in the world, a need to disappear and shrink their emotions and an addiction to starving, binging, purging or exercise. That and I a huge problem with needs in general. Most with some sort of on-off cycle and some either constantly attempting to fill them and others totally rejecting them.

It also doesn't have to be about weight as such and can be about metaphorical and real space which you mention.

I am really reluctant to mention this (because of the others reading this thread) as I don't think mentioning calories or food lists is ever healthy for anyone with an ED but do you know how many calories you consume and did they totally control your eating when you in the ED facility? I would be interested to know if your view of your eating is accurate and how you react when you are required to eat when you don't want to and want to "disappear".

One more question to consider: do you like feeling empty or hungry at all and can you identify and are you aware of hunger? If you are underweight you will be hungry a lot. The IBS would be irrelevant as regardless you are not getting enough nutrition.

PS. I realised I didn't say what I wanted to directly enough. You said you did not feel you had much in common with the AN patients. I think what can confuse the issue is they spent their time wanting to talk about calories and fat. That doesn't have to be part of an ED. There can be a lot of shame about being a low weight but an addiction to starving and need to not be seen/to take up less space or a problem with meeting ones needs (such as nutrition).

There are also words and phrases that you use than hint at you possibly hiding some of what you were experiencing from the professionals you came in contact with. ?

 

[presentjoy]

Thank you, Abstract. I really appreciate your response here. If it seems better to take it to a different thread, maybe we can do that. I will answer a few things here for now.

I am really reluctant to mention this (because of the others reading this thread) as I don't think mentioning calories or food lists is ever healthy for anyone with an ED but do you know how many calories you consume and did they totally control your eating when you in the ED facility? I would be interested to know if your view of your eating is accurate and how you react when you are required to eat when you don't want to and want to "disappear".

I don't remember my eating being controlled at the hospital when I was 15. However, in my last inpatient stay, a big issue came up. I have a dairy intolerance now, bigtime, and trying to get that accommodated in the meals was very difficult. One girl hoarded much of the soy milk. Many of the regular meals it was unclear about their dairy content -- I can't just say "no milk/cream/cheese" -- it has to be "no whey/casein/dry milk powder" as well. I react to basically any dairy content.

So when I did intake at the hospital I mentioned the dairy problem. I had support around that, but somehow I wasn't getting meal accommodations. They gave me the gluten free meal options (??) -- so I was trying to, on a case by case basis, figure out what I could eat. I had a hard time planning in advance to maybe get special specific meals ordered, like egg salad wrap instead of the predetermined meal. Even then, I started to feel mistrustful of what had dairy because nothing had full on ingredient list. I started not eating. I would try, but it was hard. I started becoming weaker, but at the same time, I got outside privileges and so took a walk. It was more vigorous than I expected. By the end of it I was feeling very weak. We had a meal where I specifically ordered it with no dairy (pasta). I ate a lot, but this was after not eating much. I started choking during the meal. Other patients said I turned beet red. I basically was in respiratory distress (I had come in with a respiratory issue). Anyway after this a nutritionist actually came to talk to me, and so towards the end of my stay I was able to get *vegan* meals, which solved the problem and I was eating again.

I'm not sure if the entire process of getting to a point of restricting that much in the hospital was a kind of diversion, or part of a broader attempt on my part to keep being sick and not get out of the hospital (complicated, story for another place).

One more question to consider: do you like feeling empty or hungry at all and can you identify and are you aware of hunger? If you are underweight you will be hungry a lot. The IBS would be irrelevant as regardless you are not getting enough nutrition.

I think the feeling of hunger is a very tricky feeling. I don't recognize it sometimes, or I ignore it. Ignoring hunger can be a kind of self-harm for me. I mean, there are times I don't recognize it. But I would say sometimes I like it, in the sense that it is something I can *feel*. If I am staying home and not doing much of anything, this kind of works. However, of course if I'm hungry, low blood sugar, cranky, not thinking well, I run into problems if I'm not alone. Cognitive problems. I didn't think of this much. I just know sometimes when I get really reactive, I know I need to eat, and when I do I feel better.

PS. I realised I didn't say what I wanted to directly enough. You said you did not feel you had much in common with the AN patients. I think what can confuse the issue is they spent their time wanting to talk about calories and fat. That doesn't have to be part of an ED. There can be a lot of shame about being a low weight but an addiction to starving and need to not be seen/to take up less space or a problem with meeting ones needs (such as nutrition).

I have more general problems of self care, and food falls into that. I am not sure if I'm addicted to starving. I know I can feel a desire to take up less space sometimes.

There are also words and phrases that you use than hint at you possibly hiding some of what you were experiencing from the professionals you came in contact with. ?

Well, it's always just been really easy to alleviate/deflect questions and concerns about my weight with things like "believe me, I eat a ton, it's my metabolism". And to some extent, I'm not lying. I also have a resistance to imagining myself as having an ED because it's "one more thing on the list". I don't want to seek out disorders. But this may lay within the realm of, well, kind of being in denial that maybe this is a real issue for me. It only was really clicking when I read about other people here talking about wanting to take up less space, disappear, be invisible. In the context of trauma, it makes more sense to me. And not a hard leap to link how I struggle with food as a part of that.

Do you think I should make my own thread on this? I don't know if this is warranted (honestly I felt like I didn't want to be attention seeking around this)

 

[71nothing]

Thank you so much for your input Abstract. You seem so knowledgable and I appreciate it.

I started seeing things as what my ED thought and what I thought. It sounds like your ED wants to have a temper tantrum and run screaming but that you desperately want the help and may be relieved.

What a great way to illustrate it. This is how my therapist refers to my OCD as well so it makes perfect sense to me.

 

[Kintsugi]

However when I get depressed, or so symptomatic that I can't function well, it's a bit of a vicious spiral where I can't eat well so I start on this path of decline where I am so hungry I can't figure out what to make. I can also become very crabby, unable to make decisions, stuff that's probably just very common with low blood sugar.

PJ, that is definitely for me very common with low blood sugar. Sometimes I'm so hungry and my blood sugar is so low that as I feel my fine and eventually gross motor skills leaving me, I'm walking in circles in the kitchen with racing thoughts of "So hungry, have to eat," but I am so disoriented that I can't even focus on feeding myself. My SO has come to see and learn these patterns. I'll often start to cry as I try desperately to spread some peanut butter on bread. It's the blood sugar but also, for me I think, part of the accompanying helplessness and sense that I can't even properly do something as basic as feed myself. The worst part for me is that when my blood sugar is that low, once I put food in my mouth I have to really force it down. It seems so counter-intuitive, because I'm obviously completely desperate, but chewing and swallowing seem ridiculously foreign, and the food feels so weird and tasteless in that moment of total bodily weakness. Bizarre.

For me, the sticking point of these horrendous episodes is: how did my blood sugar get this low that day to begin with?

Someone I hadn't seen in a while commented on how skinny I looked, and while they probably meant it as a way of expressing concern, I just felt embarrassed, and kind of angry about it. People don't comment on when someone gains weight, so lay off my weight too. Why is commenting on *anyone's* weight acceptable? It's NOT. :(

This is utterly unacceptable. I never understand this myself. You do not comment on weight changes in others like this! No matter the direction! Besides, even telling a recovering anorexic "You look healthy" can be totally disastrous!

Anyway. I have concern that I have an ED at this point, but I don't think I do, but I don't know, but maybe because I want to disappear I do? Sorry if this post is not appropriate or in the wrong place. I just didn't feel it needed its own topic.

I'd look into the criteria... I didn't think I had an ED when I did. I thought that to be anorexic meant I didn't eat at all. I didn't realize eating 300 calories a day as classed as anorexic. I think <800 is also called undereating.

Also, I don't know others' experience with this, but the BMI chart can be a total load of BS depending on your body type. I have a very large chest and wide hips, and my ED taught me that they just don't go away no matter how bony I get. But I'm very short. So the BMI chart puts me at a just normal weight at just 105 lbs. When I finally started getting comments about looking emaciated, I was about 118. On the BMI scale that puts me at 20.9 (normal weight 18.5>24.9). If I were to guess where that would put me I would have guessed about 19 maybe. But double Ds... So it's not always accurate for body type. My SO on the other hand is in the anorexic range but, though he could certainly put on some weight, he really just has a swimmer's body--lean and muscular.

Thesis statement: feeling healthy can be more important than a stupid chart. I know people who aim to be 18.5 on the chart when that weight would be ludicrous. I also know people who are a 17 and aren't starving.

 

[presentjoy]

It's the blood sugar but also, for me I think, part of the accompanying helplessness and sense that I can't even properly do something as basic as feed myself.

This. Yes. I feel like I'm swinging back and forth between being able to and completely helpless. Ramen noodles at least are easy and give me sodium. I started learning how to put stuff in it to make it healthier, but in a pinch, wheat noodles with flavour packet does it.

It's totally unacceptable to comment on weight, at all. I know. Having grown up with bullying that was dismissed as "oh, they're just jealous". As if just because it's a "good" thing I'm being bullied and teased about, that's okay then?? #@$% that.

I am scared to count my calories. I honestly think it's more than I'd estimate, although some days I probably undereat. I'm just not sure. So maybe a typical day when I don't eat a lot, might look like:

Decaf, with some almond milk first thing. I wait a while before eating. (sometimes nothing else before noon) Mostly I just get distracted.
Breakfast alternates between 2 eggs and bacon, and maybe like, yogurt and fruit/granola
Lunch either doesn't happen, or if it does, it's maybe light. A wrap with tuna maybe. Soup. Sometimes an entire can of tuna (last night's dinner). Or an Amy's dairy free Mac & Cheese
Dinner. A burrito with rice and beans, plain greek yogurt for sour cream, salsa, and chopped up avocado. Or spaghetti with some protein. Or fish with a veggie and rice.

I mean, sometimes I miss breakfast, or don't eat til 3pm. Those are the worst days. Sometimes I eat a really crappy dinner and go to bed hungry. Other times, I eat as much as J.

Aside from this stress time (when BMI was <16), I'm usually around 16-17. I realize how little that means.
I wish I had more muscle. I feel weak most of the time. :(

 

[Abstract]

Presentjoy,
I personally think its fine to discuss it here regardless. If you want to of course. This thread seems to have turned into a general accumulation of information about a wide range of eating issues. It might help someone else to hear slightly different presentations of restrictive eating. It would also be fine to start a thread about it too.

I have to say I was deliberating about if it is likely to be an ED or not and then I read the below BMI of 16 and my heart dropped. When it comes to whether it needs to treated or not I actually don't think it matters if it is a classic ED or not as it is not at all safe to continue at anywhere near the weight you are. From what you list as well it is obvious you are under-eating and by a large amount. And that isn't even taking into consideration your low body weight.

You may not realise this but it can take as much as 4000 calories a day to put weight on when someone has been in the anorexic weight range - which you are.

I also know people who are a 17 and aren't starving

I just want to comment on this quickly. I agree with a lot of what Missantisunshine said and I believe I know what she was meaning in all but don't agree with this part. BMI is fallible but where it falls short tends to be the other way around where someone can be verging on underweight in the middle end of the so called healthy range or even close to the top end. There are some situations that result in the person seeming to be overweight and yet being very healthy. That includes bone structure, muscle mass and body shape. I also cannot count the amount of people in that sort of range (lets say under 19) that have sworn up and down that they don't have an issue and then later it has come out that they do (that is not all aimed at you Presentjoy).

When it comes to the low end though unless we are talking about the Asian population such Chinese/Japanese (who are more what the 18.5 to 20 BMI range is aimed at) we tend to need to be 20 or over to be healthy, minimum.

I am both shocked that no medical professional has ever taken this up and shocked by the treatment you received inpatient. They sound totally incompetent and these people were treating ED's! :wideeyed:

I don't know if you have an ED or not but I do think your eating issues need to be treated. My guess is that you could be eating on average under 600 calories a day from what you say. Anything under 1400 is considered starvation mode and eating 1600 is problematic. Most woman will need to be eating 2000 + calories a day. If you do have a fast metabolism at a guess you would need to be eating about 4 times what you are presently and after you had restored the weight as it can take a lot of calories to put it on.

I am sorry to mention calories. I don't usually do so when I speak about eating issues as I don't think its helpful and I know you say you avoid doing so. It just seems to me that you maybe need to have a bit of a reality check (with the limited info available to me) and I mean that in a kind way.

A lot of times people don't always know all of how they feel about the weight they are or the way they feel about the amount they eat until it changes. In other words I think what will be really telling is how you would feel after eating 2000 calories every day for a week and how you would feel after you put on 10 kg's. For me all sorts of things popped up and I know that is the case for many people.

I hope I haven't upset you. Someone is going to boot me off this thread sometime. ;) I just have such compassion for anyone dealing with this stuff.

Is your whole family very slight?

 

[Kintsugi]

@presentjoy
Just a thought if you would like to boost your caloric intake/weight. The Alternative Baking Company makes dairy-free cookies that are something like 450 calories each. I used to eat them as lunch when I worked as a rock climbing instructor and had limited time (we sold them). They are amazingly tasty, and if you'd like a fairly effortless way to add, say, 450-900 calories to your daily diet over time, although they aren't super nutritious they are dairy free and contain minimum BS ingredients (sounds like you are health-conscious as well). Plus, there's about 6 grams of protein per cookie (the peanut butter ones may have more), so it's an excellent snack for those with low blood sugar because it has sugar, protein, and carbs.

Didn't mean to be so involved. Just wanna help. I'ma stop hijacking the thread now. >.<
Edit: I also used to keep them in my car for emergency blood sugar crashes.

 

[Kintsugi]

Sorry this is a new post but it feels very different. I didn't even think to post here as I was writing the above yet obsessing in the back of my mind about these thoughts.

Today I ate a banana and about three quarters of a cup of tomato soup I made from scratch yesterday. Then my mother brought home my ultimate trump comfort, the ultimate weapon against appetite loss: Annie's Mac and cheese.

I ate the whole box.

This is actually pretty typical of me. Sometimes I won't eat anything at all in a day but a box of EZmac. But tonight I found myself looking at the package afterward, studying the servings and calories. 700 calories.

Now, if I think it out, it's really not that terrible. Let's say the soup and banana together were 350 calories. That's under eating. I had a small serving of ice cream for dessert, so if that was another 300 calories, we're talking what? The 1400-1500 range most likely?

Why does being home make me crazy about this crap? WTH? Ridiculous. I haven't felt like this in years.

 

[presentjoy]

I didn't feel like you were hijacking the thread. What you said, @MissAntiSunshine was helpful. So was @Abstract -- yeah, it's scary and I feel all kinds of swirling emotions but I duno. The ED clinic that was in the teen crisis unit when I was 15, was back in the 90s. The latest hospital stay had no ED clinic there. Although I have no idea how they were working with people who did have an ED.

My GP, for what it's worth, talked to me about upping my intake, including making shakes out of avocados and things. But no treatment recommendation. I have no idea how to incorporate, into my mind that is, additional treatment for ED as I feel already loaded down with crap I have to address. I feel so messed up.

But there's something to trying to address this, and improve my functioning and health, that could aid in the other work I'm trying to do.

MAS - man I wish I could eat a whole box of M&C. I know that wasn't your point, but I am so wishing I could eat dairy. I feel like I could spike my intake hugely, if I could just eat all the dairy. :sour:
(PS since I think I still can't post links, google eating disorders and gut microbiome)