Weight gain and physical/mental health

[Atonement]

Hey, everyone.

I know I’ve posted about this before, and I hope I’m not repeating myself, but I need to talk to someone and make some decisions.

When I left my parent’s house for college in 2012, I was probably about 145. When I started my school program in August 2014, I weighed about 165 pounds. Now, 2 months after graduating, I’m up to 193. I thought that things would stabilize for me after I graduated, started working and got rid of all the stress, but I’ve been working for a month now and I’ve gained 4 pounds since graduating.

So, basically, I’ve gained almost 30 pounds in the last year and a half, and 50 lbs in the last 4 years.

I’m really starting to become concerned about the rising numbers. Every time I reach a new weight, I think “Oh, this is OK, just as long as you don’t gain any more.” But, the fact is, my weight is steadily increasing and I feel like I have absolutely no control over it. It’s already been somewhat difficult to find clothes that fit, and I just have this overwhelming terror that I can NOT allow myself to get to 200.

I’ve done myfitness pal twice over the last 5 years or so, and both times it resulted in me having a major meltdown and then binging and gaining back more weight than I originally started with in a quick period of time. I started weight watchers this morning and I’m already terrified that it’s going to happen again, and if I should even risk it. I’m already feeling the sadness, deprivation and obsession with everything I put in my mouth that comes with dieting for me.

I know that binging is probably the biggest problem for me. I think I eat pretty normally/healthily for my main meals, but desserts are my downfall. One cupcake is never enough for me. Once I have one cupcake, there is very little that can stop me from eating the whole pan. Once I have one slice of pie, I can’t resist having a second or a third. I rarely stop until I'm borderline nauseous.I always want more. But just not having any at all makes me MISERABLE.

While I don’t think I can claim to do an amazing job on my body positivity, I’m really not that concerned with whether or not other people find me attractive. But at the same time I don’t think I can bear to be any heavier. I’ve already had to mostly stop wearing pants because my thighs are so full that they all give me cameltoe. And I’m ashamed of the double chin that is becoming more and more pronounced. My favorite rings that I like to wear every day when I’m not working are becoming more difficult to put on and take off.

Also, I’ve been working with a lot of cardiac patients recently, and also found out that one of my grandparents had congestive heart failure. Those are miserable diseases to live with, and I don’t want to end up like that.

I don’t mind being heavier than is stylish or recommended, but I don’t like the idea that I haven’t got any control and that I might end up being 300 or 400 pounds in 10 years.

On one hand, I know dieting is probably a bad idea for me but I’m getting desperate. I came really close to ordering some appetite suppressants online that my friend told me worked, and literally the only thing that stopped me is when I read that they might make me fail a drug test at work. I’ve even been tempted to make myself vomit, and then only thing stopping me is all the serious health complications I know this can cause.

I don’t have anyone that I can talk to about this. I know my friends will either fall in the camp of “weight is just a number”, “holy crap, you really do need to lose weight before you get diabetes/heart disease/ ect.” or “Let’s sit here and berate ourselves together, yoyo diet and accomplish nothing physically or emotionally”. I'm also kind of ashamed of both being concerned about my weight (As I like to project an image of self confidence and body positivity) and for not being able to manage it.

I sort of brought it up to my best friend the other day and she said that one of the things she admired about me was that I allowed myself to enjoy food without constantly complaining about my weight like all of her other friends. And I really DO try to stay positive and value myself at any size, but I’m just scared right now.

What should I do?

[Heather]

I am so sorry to hear you struggling.

Before anything else, the very first thing I would strongly suggest is talking to a healthcare provider. For one, I am hearing some of what sounds like disordered eating (the binging paired with restricting, the temptation to purge, and how all of this feels for you emotionally and seems related to your feelings, the secretiveness, the concerns about what you project to others), and you also clearly have general health concerns. If there are any health issues here that need to be addressed, and then advised on by a healthcare provider, you really want to tackle that first. And if what's going on here is an ED if any stripe, you really can't DIY it: that's something where per both physical and mental health, someone needs to call in the pros. What you weigh in numbers is unlikely a big health issue, but disordered eating, whatever the scale says, is always a major health issue and concern with that is very much warranted.

FYI, as I really hope Weight Watchers told you today - per being ethical - it is *never* advisable for someone with any kind of eating disorder to enter a dieting program. In fact, it can be very emotionally dangerous, and often only enables the disorder instead of helping. It sounds like you have already experienced the kind of negative impact that can have on that behavior and the hard feelings that are part of it. I would strongly suggest you do not do programs like that until you see a healthcare provider - ideally, for both physical and mental health - and are honest with them the way you have been here, and then only if they say it is safe for you (which they likely would not, based on what you are reporting here). Chances are, ED treatment is what an attentive and educated provider will suggest instead.

[Atonement]

Yeah, honestly I was thinking along the same lines myself.

I actually mentioned to a therapist about a year ago that I thought I might have BED, but the following week I was really mindful about not overeating and with all the other things I was discussing with her, it just all got forgotten.

As far as health issues go, I think I'm mostly OK now. My cholesterol was a little above the desired range last time I had it checked (June 2014), and I think it'd be a safe guess that it's a little worse now. But, I know from my more recent health screenings with my job that my blood sugar and blood pressure are still great. I'm more worried about what my health will be like in 10 or 20 years than I am concerned about my health now.

I guess also my concern about seeing healthcare providers is that in general the medical community seems to rest too firmly in the whole fat=bad camp. I'm really worried that if I just bring it up to a primary care doctor they'll just tell me to go on a diet or send me to a nutritionist. And that's not the problem. I know which foods are fattening, which foods aren't and what I need for a recommended diet. But knowing and being able to do are 2 very different things.

All Weight Watchers asked me was if I had an active diagnosis of bulimia, which I don't. But yeah, I'm thinking signing up was probably an impulsive decision and that it might not have been the best idea. Thankfully I only signed up for a month, and I used a work discount so I only spent about $8.

I'm the meantime, I think the best thing to do is to try and go back to the HAES approach and just try to be mindful of my satiety cues and try not to binge. But this never reals seems to last too long for me, so I think I probably do need to look towards healthcare.

So, do you think I should be discussing this with a mental health provider or a primary care doctor?

Thanks!

[Heather]

So, healthcare providers who assess people for eating disorders are not the same as general providers. I hear you focused on fatphobia (which is certainly for real, very much including with some of the medical community) and on your weight, or what foods you should or shouldn't be eating, but to be honest, I think that is your focus - and a potential ED - talking here.

A healthcare provider who hears about the feelings and behaviors you are describing here is much more likely to focus on those than on your weight, since things like binging - and you now making clear you have felt on the edge of purging - present serious health risks all by themselves, and not just long term, but now. EDs are truly dangerous to your health - physical and mental - in many ways, in both the long and short term. Too, if they are filled in like I am with a lot of your family history, that will be helpful. You have dealt with a lot of denial of the abuse in your family, with control, with heavy criticism: these kinds of things growing up are strongly associated with eating disorders.

HAES is the stuff, agreed, but it is going to be very hard to focus on doing what your body tells you to do if you have any ED stuff in the mix, because that stuff basically is going to be so much louder in your head than your body signals about hunger. Really, ED behaviors and ways of thinking basically teach you to ignore how you physically feel, especially where food and hunger is involved. I suspect that hasn't stuck for you for this reason.

My best advice - and this is also coming from me as someone who simply cares about you and your whole well-being: you've been in our community a long time now, and I value you a lot - is to pick either a GP or a mental health provider, based on what you have the most access too and the most comfort with, but make clear that what you are looking for from an appointment is an evaluation for a possible eating disorder. You can ask, when you are doing that, if that is something the provider has the education and training to do. If you want help looking for someone like that, or even ED care near you, please let me know: I would be glad to help as I can with either.

[Atonement]

Thank you, Heather.

I really appreciate you saying that! If I remember correctly, my first post here was probably around 8 years ago, and I've been reading articles off and on for at least 10. You've been a huge help to me over those years, and while I still have some things to work on, I've come a long way. I don't know if things would've turned out the same way without you! You have been a very good mentor and friend.

I think I'm going to go for this through the mental health route, as I feel that's most likely both the root of the problem and the aspect of my health that is most damaged by it at this point. With my current insurance and the fact that I like in a metropolitan area now, I think I should have about the same level of access to both. It's been a while since I've seen a therapist (I had a few visits over the summer and 2 in October, but I had issues with timing and access while I was still in school), and I had been debating whether or not I needed to continue. As far as overall coping with life and interpersonal stuff, I think I'm better than I've ever been right now. That's probably one of the reasons this particular thing has come to the front of my mind now- I finally have the time and energy to address it.

I'm going to look through my insurance to see what's available, but if I end up needing help I'll let you know.

[Heather]

I was trying to remember, when talking with my partner about you yesterday (and just voicing my bummerful feelings that someone I know to be so phenomenal and so motivated has just had such a hard time in so many ways), how long it had been, and had estimated around ten years. Amazing! I'm so glad I/we have been of help: I really think you're fantastic.

I agree that it's possible that you generally feeling better about you than you have in the past may make this all a very ripe moment. Often what's under behaviours and feelings like this is someone's biggest, hardest and scariest stuff, so it makes sense that when they don't feel very strong, they don't feel all that able to address or explore it.

If you want help figuring out some screening questions for a new therapist, give a shout. Just knowing what I know about you, your family, how it went with that one therapist, I can think of a few things I'd suggest asking about, but they may also be things you'd bring to the table yourself already. Too, if you'd like any suggestions with reading per EDs/disordered eating, let me know, I'm happy to suggest some.

[Sunshine]

Hello,

man, I am so, so sorry to hear about anybody currently having to deal with this kind of stuff. You have my sympathy and my respect.

If it would help you at all to just swap experiences about living with an ED and maybe vent a little, you can give me a shout. I've had these beasts on my heals for half my life now. Can't give you any good advice on how to get rid of them except for what Heather suggested - I also believe mental healthcare is the best approach and dieting of any kind is usually counterproductive.

If you have or had any unpleasant experiences around all this with doctors, nurses, nutritionists, etc., I hope you won't let that discourage you from continuing to seek out expert help. I hope you find somebody you can work with soon, and in the meanwhile, like I said, if you want to just talk, let me know.

Hang in there!

[Heather]

(Sunshine: I so appreciate you and all the peer support you offer people in our community!)

[Atonement]

Thank you both!

I just got home from work not long ago, and since I go in again tomorrow, I'll probably begin my searching tomorrow afternoon (I do an 8 hour shift instead of a 12, so I should have more time)

Actually, I'd love to hear the suggestions you have for questions. Sometimes I feel like there's so much history bumping around in my head that you might have a more concise idea of my history than I do. I'm actually really impressed that you often remember details that I've forgotten or overlooked.

Sunshine, I would like to talk about it. I think it would be really helpful.

One concern I have (and I know this won't be a problem if I find a good provider) is that BED seems to be kind of glossed over and treated as less of a real thing than anorexia and bulimia. Also, I guess the idea makes me nervous because I know that eating disorders in general are SUPER hard to beat.

You know, I have never actually had and of my healthcare providers make any comments or suggest I lose weight. My concern about that comes from the fact that I actually am a nurse, and I know exactly what we're taught to believe. Nursing school (And I assume med school) REALLY emphasizes the fat=bad concept. I honestly don't think I ever made it through a lecture where obesity WASN'T blamed for pretty much every single disease in existence.

While I'm fairly certain that what I was taught regarding that wasn't the whole story, it's really hard not to internalize these messages when they're being presented to you as cold, hard fact.

I actually feel a lot better now that I've shifted my focus away from dieting. I stopped logging food pretty much immediately after my first post and have had a few cookies since. The idea of working with a counselor/therapist feels a lot more comfortable to me than dieting.

[Heather]

Much to the chargin of people who have been hideous to me in my life, I have a pretty excellent memory. (Mind, aging is making it less excellent, but that's mostly impacting remembering things like where I put my keys and what day it is more than the important stuff, a pattern that will hopefully hold!)

I'm glad to hear that just feeling some support around this here is having a positive impact. I'm less glad to hear about your experiences in nursing school with fatphobia. I'm not sure it's sound to assume med school students -- or nursing school students everywhere -- are getting that same approach and information, though, if that's something that helps to know. I think that a lot of what people are hearing in nursing school, med school or clinical work environments is often very regional, for one, and depends a LOT on how current the education teachers at those schools (and staff at those clinical settings) is, as well as how current things like textbooks are. I suspect strongly that in places like Texas, or say, Ohio, fatphobia and the blaming of weight on health issues is probably bigger than it is in areas that a) are just more progressive and current all around, and b) where issues like adult onset diabetes and heart disease are less epidemic (for lack of a better word), of you get me.

Knowing what I know about you and the impression I get about what does and doesn't work for you, and what has and hasn't kind of given you more challenges and struggles versus making things easier for you, I'd suggest screening questions/discussions like:
• If a therapist feels they are educated and qualified to work with someone with a possible ED, most likely BED (though I would also be clear about how you feel you have been teetering on the edge of bulimic behaviours, such as the desire to purge, even though you have kept yourself from following through). I would ask them, relatedly, if they feel they have any bias around size: I think it's important for your own sense of trust and emotional safety (as well as just important, period), that you have someone without that bias, who you can hear make clear they feel they don't, and if and where they do, they can be aware of it and keep it out of your therapy.

• What their experience is working with people who have grown up in emotionally abusive families where that abuse has been (and still is, I think?) denied and diminished. I would also mention your mother's ongoing pattern of body-shaming with you, as I think it's clear that has had a lot of negative impact, and is a big part of your family picture in terms of your experience being in your family (body-shaming, controlling or policing from mothers is also one of the top things associated with eating disorders).

• How they feel they are about boundaries: as I recall, one of the issues with your last therapist was that their boundaries weren't so great, and there came a point where you weren't very confident in how well they were serving you, but you didn't feel like you could move on from them, which was probably about them not being great with their own boundaries.

• I think it's important you be very clear about what YOU are looking for and want from therapy. One thing is an evaluation for disordered eating, but what else? What are you looking to get from therapy for yourself? What do you want, and what do you feel motivated to start working on/through?

• As with any therapist screening, I'd also just ask them to talk about how they typically work with a patient: what kinds of therapy do they typically prefer and use? What are they looking for when it comes to YOUR participation?

[Sunshine]

Hello Atonement,

if you want to talk, I'm very willing to listen!

I can't really offer much advice. I am not an expert on any of this. All I can do is just tell you how eating disorders have affected me and my life and what I personally have found works well for me and what doesn't. I have found it useful in the past to hear / read about other people's experiences, so why don't I just tell you my story to get the conversation going.

This will probably be long... sorry about that.

I never really had the chance to develop a healthy relationship with food. When I was very little, a doctor (who, I am sure, really was trying to help and meant well) convinced my parents that my behavioral problems were linked to various food intolerances, and I was put on an extremely restrictive diet. My childhood was all about checking packages and thinking and double checking before putting something in my mouth. (It didn't help that they told me I had "allergies", and little me actually thought I could die if I accidentally ate the wrong thing).

Around the time I hit puberty, a different healthcare provider decided that the "allergies" were "healed". I went from a very limited range of foods to everything and was totally overwhelmed (and, in the beginning, overjoyed) by the sudden abundance around me. I had craved food all my life, and now it was all there and I really couldn't handle it. Add the hormonal changes during that life stage and I was basically always eating. It seemed as if I could never get enough. I never felt full, I just ate and ate and stuffed until I felt sick. Of course I became pretty pudgy really fast. Now, unfortunately, if there is one thing basically everyone in my family agrees on, it is that fat is BAD. Literally everyone I am related to in some way makes or used to make fun of fat people regularly. Nobody in the family pointed a finger directly at me, but still, I soon felt really ashamed of myself. Plus in school, I was bullied anyway and now my weight just gave the other kids something extra to be mean about. Soon, I felt completely ugly, disgusting and unlovable. Add the fact that I fell hopelessly in love with someone who did not feel the same way about me, and that I managed to convince myself that if I weren't so unattractive and flabby, this would change, and you've got yourself a pretty miserable picture.

I tried to lose weight. Oh my god, how I tried. I learned everything I could about nutrition - by the time I was 18, I think I knew more caloric values by heart than history dates. I was always dieting, and always failing. Actually, the more I tried to restrict my eating, the more desperate the urge to eat became and eventually I would always break down and binge, often at night, when I would just sneak down to our refrigerator and eat every single bit of food we had in the house. I could not control this. I felt like an addict, and my "drug" was everywhere and I couldn't avoid it or go cold turkey, because hey, you can't go without food altogether. (Healthy way of thinking, huh. Comparing food to drugs. I would never use this comparison now. But when I was younger, this was the way I thought).

I was very unhappy. I do not have a very sturdy body by nature and looking at old photos the other day, it struck me that I looked like someone on high doses of cortisone: Big round torso, round face and thin little arms and legs sticking out of me as if I was some kind of bug. Considering how I was constantly stressed out from one cause or another, I would not be the least bit surprised if my cortisol levels really were on a permanent high.

I began to throw up regularly, or rather to willingly regurgitate my food after a meal and spit it into the toilet. I did this for years and as a result, I now have really bad teeth. (I still have not had the courage to give my dentist an honest answer as to why my mouth looks as if I used acid mouthwash. Maybe some day.) This did not lead to significant weight loss either, so I decided it wasn't worth it and did it less and less, but the binging continued. For years, my thoughts when not actively employed otherwise revolved only around food: Tallying up how much I had eaten, how much I could still have that day based on my newest whacky weight loss plan, fantasizing about having a banquet or about just grabbing my tummy folds and cutting them off. And many other very unhealthy thoughts. I was a mess.

Of course I knew that I was a mess and I really wanted to do something about that. What I should have of course done is find a therapist. I did not, for various reasons. But I had a good GP and access to a lot of information and research. And my life got better in other ways: I left school, I earned my own money for a few years then went to university and I met someone who eventually became my boyfriend and then something more than that, who liked me just the way I was, bug-body and all.

I really, really wanted to be productive at work and in my studies and have a chance at a healthy relationship. So I had to try and somehow get better. First of all, I managed to admit to myself that I have an eating disorder in the first place. That was a huge step. Then I admitted to my partner that I have an eating disorder. I said, to him and to myself, that this is a chronic condition which won't disappear any time soon and that I have to somehow find a way to live with it.

Then, I decided that I needed to reduce the amount of pressure I put on myself. It was pointless to try and control my eating habits, because my food intake was really seriously beyond my control and everything I had learned in the meantime about how hunger and appetite and eating behavior works lead me to the conclusion that it is absolutely stupid and unrealistic to expect this to be any different. I stopped dieting. I threw away all the calorie tables and I got rid of the scale. I let myself just eat whatever I felt like whenever I felt like it, and when I got terrified that I was going to die of obesity-related diseases, I said to myself, listen girl, it's better to die fat than to live in misery.

With all the energy I wasn't wasting on fretting about food and eating, I tried to do good things for my body and my health. My weight might be beyond my control, but there are other things to consider, health-wise, that aren't. I began to exercise. At first I went swimming, because that's really gentle on the joints and I like water. Besides, it was good for me to walk around in my bathing suit and practice not giving a shit about what people thought. I had learned to dance earlier (that was the first step in the right direction, looking back) and I took that up again. Finally, I started running. I thought I would never be able to do this, but I am, and it does amazing things for me in so many ways. With all this, I took (and take) care that I wasn't being ambitious or competitive about it. I exercised only on my own or with people whom I trusted and liked and I focused on feeling good inside my body and appreciating what it can do rather than on any kind of athletic achievement.

Through exercising, I began to get a feel for my body other than "this big flabby thing I am stuck in that always makes demands". I began to practice what I guess you'd call mindfulness, paying a lot of attention to how my body works, what it feels like, what makes it feel good, what makes it feel bad, cold, fatigued, etc. When I ate, I tried to take note what the food tastes like, what texture it has and I tried to get a feeling for whether my body really wanted this particular food right now, not trying to control my eating, more like listening to my body as if it were somebody else whom I was trying to take the best possible care of.

I am now 31 (and beginning to feel old, but that's okay, really. Feels like even less pressure somehow. I find myself saying to myself "I am too old for this shit", and it feels wonderful). Contrary to what I thought would happen, I am not dramatically overweight. Left to itself, after a certain adjustment period (years, not months) my body seems to have found a size that is right for me and staid there. It's not a size approved of by the fashion industry, but it isn't a huge health risk either. I have learned to feel hunger and fullness. I stop eating when I need to because my body tells me that it has had enough, and being able to feel that is so awesome and so unexpected still - I thought it would never happen. There's an opened bar of chocolate in my house right now that I haven't finished since Monday. Wow. How did that happen. And I know it's there and I do not have any kind of urge to go and finish it right now, because my body knows that it can have as much chocolate it wants any time it wants it and there's no need to cram.

I don't think I'm pretty, but I don't hate my looks either. I am pretty much at peace with my body, tummy rolls and stretch marks and varicose veins and insect limbs and all. Contrary to what advertisements and magazines suggest, none of these things really has any kind of negative impact on my life.

I'm not 100% okay. I still go way overboard shopping for food and I stuff my fridge and my larder with more than I need, then stuff goes bad and I throw it away and that's so horrible and wrong and wasteful. But at least it doesn't take a detour through my digestive system any more before it goes to waste. And I am working on better shopping habits.


Wow, that was long. Sorry... Basically I guess what it boils down to is that I don't do well with don'ts and I do better with dos, like do exercise and do eat good food and do listen your body and do try to love yourself. That kind of stuff.

Hope you are successful in finding a therapist or doctor who can help you! I am looking into options to finally get therapy myself and I should have done so much sooner, but it's complicated where I am.

[Atonement]

Thank you for sharing your story, Sunshine! I found it helpful to read. I don't really have any more comments or questions at the moment, but if I think of something, I will post again.

I'm having a little trouble finding a provider with my insurance- On the explanation of benefits, it says that behavioral health services are covered and lists a copay. However, when I used their provider search tool, nothing comes up. This makes absolutely no sense because my employer (Which has their own insurance company) is local to this area, so anything in network should be here. I think what I'll need to do is make a list of potential providers and call the insurance company on Friday when I'm off.

[Stephanie]

Making the list is a good idea. As well, a lot of companies can give you assistance in their end with finding providers with your zip code when their services aren't working for you. In the meantime, it's especially important you're finding time for things that really just make you feel good, even if just for short periods. Whatever that means, taking a walk or a bath, drawing or writing, workouts or dance, etc.

[Atonement]

Well, I finally got around to making calls today. Finding a provider through my insurance was really hard because of bizarrely non-user friendly search methods.

I called probably about a dozen offices today and only one answered. She's looking into my insurance now and is supposed to be giving me a call back later today.

I have to admit something though. Since we talked, I've had a couple days where I would've had the opportunity to start calling around but I kept putting it off.

I think a lot of this is kind of around fear, too. It's funny because I have had overall positive experiences with therapists and am usually the first one to recommend going to them to my friends/family.

But this topic is so, so much more loaded for me than any of the other issues I've discussed with a therapist. Today I decided to examine the reasons why.

1) I'm ashamed about it. When I've seen therapists for other reasons, I get a lot of positive feedback because despite all of the setbacks I've had, I've gone to good schools and been relatively successful, I make generally good life choices, and I've never smoked, drank excessively or abused drugs. My weight is the one thing that I have NOT been able to control, and even though I know it isn't, I sort of feel like its my fault and I know many other people see it that way

2) Because of all that, I'm pretty afraid of judgment. It's not something I can even usually express to my friends/family because I think it's important to be body positive and generally try really hard to project that image. Also, I don't want to hear their diet recommendations, ect.

3) A huge part of me is legitimately concerned they're going to lecture me on willpower, put me on a diet and make me stop eating things I enjoy.

I was feeling kind of badly again today during a conference. Some of the new scrubs that I just bought about a month and a half ago don't fit comfortably anymore, so wearing them is kind of a constant reminder of the issue, especially when I'm sitting around listening to lectures all day. And I can't really rush out to replace them since they're kind of expensive.

But, I was able to make an appointment for next Monday. So, hopefully it will go well.

[Heather]

Do you want any of our feedback on any of this, or do you just want to have put this out there, as it stands, for its own value and sake?

[Atonement]

A bit of both. As a general rule, I always like feedback. I usually don't really feel like I've "told" something unless I get a chance to discuss.

[Carmen]

Hi Atonement,

I'm sure Heather may chime in here as well but I am glad you made an appointment and It's really awesome you were able to identify and map out of the possible contributors to your fear. To address your first fear, as it seems like you know, this is not your fault and any therapist that may make you feel that way is a not a good therapist. It is totally understandable that an aspect of your life that you don't have control over feels so scary but it is clear that you have been doing a great job being aware of yourself, taking care of yourself and reaching out for support which is what matters. As with making you feel like its your fault, any therapist that makes you feel judged, questions your willpower, or puts you on a silly diet is not a good therapist - using Heather's questions to help you discern a good therapist for yourself should help avoid this potential problem. As with friends and family, it sounds like you who know who can't or isn't very good at supporting you; however, is this something you want to be able to express to any friends and/or family? Is there anyone that you do feel like you can talk to about all this without feeling judged or like they are just handing out diet recommendations? Or maybe we can help you brainstorm ways of talking about this with the people around you right now if it is something you want to express but are not sure how.
How are you feeling about the time between now and the appointment on monday? These next few days may be an especially good time to make sure you are practicing self-care

[Heather]

I'll work backwards with this, then. (And duly noted! I just know that sometimes we'll write something out and just having it out there has a value by itself, and sometimes we don't really want others to weigh in, so I just wanted to check. But now I know that about you, specifically, moving forward, so note taken. )

A therapist is a MENTAL healthcare provider. Let me say that a different way for emphasis: their expertise and their job is about mental health.

Advising someone to diet, when that is done, is and should be ONLY about PHYSICAL health, because when dieting (and how) is advisable, it's about physical health, and doing it in a way likely to benefit your health, rather than create problems. Now: therapists who work with people who have any kind of eating disorder often work in tandem with that person with nutritionists (also physical healthcare providers), and with those who know full freaking well that advising someone who does or even may have an ED is about the worst advice of ever. But when they do work with them, they'll refer their patient to their nutritionist to talk with them about how to eat, just like their nutritionist would ideally refer that person to their therapist to talk about feelings and behaviours. And that's why they work with them, because how and what to eat is outside the domain of mental healthcare, as it has physical health impacts.

So. You're looking into therapy around and for disordered eating. No therapist should be telling anyone to diet, period, -- or to what to eat, in any way -- because that's not their domain, but if a therapist you were consulting to see about an ED told you to diet, you could know that person was quite possibly the worst therapist on earth, and that you should vamoose immediately, because they just plain suck, to the point they may be endangering your health and that of anyone else they advise that way.

But realistically? It's just not going to happen that when making appointments with therapists you are screening for ED help from the front, they're going to advise you to diet, or use words like "willpower" around food, the exact kind of language that only tends to support and enable disordered eating. That isn't going to happen because most are ethical and give a lot of you-know-what's about supporting people's mental health, not making it worse, and even for those who aren't so passionate, because most care about keeping their license. A therapist telling a patient to diet or what to eat would be acting well outside the bounds of their practice.

If it helps to hear about something analogous, one of the things I see my current therapist for, and that we talk about a lot, are the emotional aspects of my having chronic illness. The EMOTIONAL aspects. That means that she might, for example, talk with me about how to let go of the idea that I rocked so hard when I was more well and I suck now, or she might give me help and support dealing with the emotional ups and downs of an illness where I'll start to regain abilities after a flare-up and get all optimistic, and then feel slapped down utterly when I get another flareup and lose all that for the gazillionth time. What would not, however, be appropriate for her to do, would be to suggest, say a different medication, or some kind of supplement for my illness, to ask if I had looked into <insert name of maybe other illness I might have everyone is talking about right now here> or to otherwise try and do what a healthcare provider whose job is my physical health is qualified to do that she isn't, because she's my mental health provider. Make sense?

Per judgment: that's really another thing where if a therapist was doling that out, they'd be being a lousy therapist. A big part of being a therapist is avoiding that at all costs, and both gaining and exercising the skills NOT to judge a patient. But I think bringing up how big a fear of judgment is to you will be helpful in your screening process.

It's not surprising to me that you talked about both shame and control, as those usually tend to be the big starring roles in any kind of disordered eating and other similar issues (like addiction, for instance). But I think it's very helpful that you also mentioned an association between them that could take a while even *in* therapy to get to , and that's that, for you, there's a big, epic value attached to the idea of control. In other words, it sounds to me like you clearly think control is a massive virtue -- and lack of it, a vice -- so anywhere where you don't or can't have it makes you less virtuous, or just plain lesser all around.

That's not what everyone thinks, mind, but it seems pretty clear to me that you do, so I'd keep that in your pocket to bring to these screening visits. It's important, because that's going to be the kind of thing where you have something else to talk with a prospective therapist about and ask them how they'd work with you with that so you can get a sense of it what they suggest sounds like a fit to you or not.

All that said, I'm thinking that maybe what might make you feel better about this is kind of setting a few things up -- a self-care plan AND a plan when it comes to getting any needed emotional support, namely -- before any of these appointments so that you can go into them feeling less worried about what might happen. It can feel a lot scarier, I think, with any of this, if we're not just worried that we'll be upset, but we're worried we won't be able to handle it when we do, so that upset will be giant and debilitating rather than just momentarily upsetting. If that sounds good to you, I'm happy to help you brainstorm that.

(P.S. Brainstorm that tomorrow, mind: I have been battling a sinus infection all day that has made me much less smart than I can be, so this last post used up all the brain cells I'd saved up for a couple hours now. Thus, it'll probably be a few more before I have any to work with again. )

By the way, I don't know about you, but even in very supportive communities I find it very hard to say that I'm just plain scared and have put something important off out of fear. In my experience, that takes a lot of courage, so mad props from me for being so honest about that.

[Heather]

And another thing! (See, told you my head was fuzzy!)

I just wanted to tell you, Atonement, that I think so much of you. You've had so many challenges and struggles, but that you keep working to advocate for yourself, feel the way about yourself that really matches the amazing person you are, and work towards the kind of life you want is all stuff I hope you feel really proud of yourself for, because it certainly makes me feel very proud to know you. I admire you!

[Atonement]

Thank you both for responding!

Carmen,

At this point, I don't think I really want to talk to any of my friends/family about this. Maybe at some point, but I'm not quite ready.

I do have one friend that I might eventually talk to about this, one who has NEVER tried to offer diets and is always very body positive. The only thing is, the idea of an Eating Disorder is a pretty loaded topic for me, and I think I want to be in a little better place with it before I talk to anyone in person besides my future therapist. Also, another down side to sharing with this friend is that she is very busy with school and we don't really get to communicate frequently, so she wouldn't be a consistent support person, just someone I could tell eventually.

Honestly, I don't see myself telling anyone else. Out of my other close friends (who I will list separately)
Friend 1) We have more of a lighthearted relationship and don't talk about serious stuff. Also, I would feel weird because she's a lot younger
Friend 2) Does not respond well when conversations get darker. I've mentioned a few things about my past to her before and I can tell it makes her uncomfortable
Friend 3) Complains about her own weight even though she's my height and 60 pounds less than me, which makes me feel worse
Friend 4) Constantly Yo-yo diets, and I'm not entirely sure she keeps secrets

My mom is also out of the question for now. I suspect that she might also have BED, and although she has been on the heavier side ever since she had kids, she has said a lot more stable over the years than I have. She knows she isn't allowed to make comments about my weight and she respects that, but body positivity is a foreign concept to her, and she has no problem voicing her opinions about how people like, say, Mariah Carey have "gotten huge" despite the fact that they're smaller than I have ever been.

As far as the time between now and the first appointment goes, I honestly wish it were a little closer. But, I'm not off during business hours again this week, so it was the best we can do. Also, I feel good about the fact that they were quick to answer the phone and get back with me. I liked my last therapist a lot, but I had to access her through the student health clinic so she was pretty much inaccessible for huge spreads of time. So having an office that I can get a decently prompt appointment at is a huge plus.

Heather,

What you said actually made me feel a lot better. I guess I still think of the mental health world as a lot more entwined with the physical health world than it is.

That also brought up another question. We learned a little bit about eating disorders in psych, but mostly learned about anorexia and bulimia. From what I took away from that, the goals of treatment were that for anorexia, we get the patient to stop underrating so that they aren't undernourished. And that for bulimia, we get the patient to stop throwing up so that they don't have electrolyte imbalances, acid problems, ext.

It occurs to be that the way we learned about these disorders are probably VERY different from the way the mental health world thinks about them. All our goals were tied to physical outcomes, but I have a feeling this would be different.

So, what would my goal with this treatment be? On the surface, it would be to stop binging. But, what would that accomplish? In my fantasy world, I'd love for this to be able to make me melt off 50 pounds. However, I don't think this is a realistic or healthy goal given the situation. Do you think it could at least stabilize my weight? Or is the purpose of the therapy just for me to accept that I'm just going to keep blowing up like a balloon? (That last part was mostly sarcasm, but I do sort of feel that way)

This is all kind of new territory. In school they always told us about how entwined mental health and physical health were, but in the end the "important part" of the lecture was always preventing people from physically hurting themselves or others. But I guess I have to enter this learning that the physical things aren't ALWAYS the most important.

Sorry, this was super long. I really appreciate all the time you both have taken.

Heather, I just read your last message and I REALLY want to thank you. Sometimes, with the passage of time, I tend to minimize all the things that went on in my past. But you always help me snap out of that and appreciate that I really have come a long way. You're a person I HUGELY admire, so having your admiration back is an honor.

[Heather]

Aw, yay!

Let me gather you some reading suggestions, including links, to fill you in some common, current therapeutic frameworks, aims and methods when it comes to disordered eating (which are almost always more about working with and through your feelings, with the ultimate aim to change those feelings in a word, and less about behavioural aims like how much or little someone eats) in the morning.

IOW, the purpose isn't about what you weigh: it's about working with and through the feelings and other circumstances that drive the behaviours of disordered eating so a person can know them, accept them, and learn to manage them in ways that are healthier, including emotionally.

I'll just nab you some basic reading material about all of this so you're assuming less, and able to just know -- and thus, consider in what you choose for yourself -- more.

[Sunshine]

Atonement, I just want to give you a huge high five for putting so much effort into finding a therapist! I know how scary and discouraging that can be, and I think you are amazing for only putting it off for a few days.

Like Heather has already said, a good therapist won't judge you. And a good doctor won't judge you either. I know some do it all the time and unfortunately, your fears there are far from unreasonable, but even where your physical health is concerned, damning and shaming people does not help one bit and it's also unprofessional. Besides, there isn't really anything to judge you for. Did you wake up one day and go, "hey, lets develop an eating disorder!"? I think not.

Side note: as a nurse, you are exposed to several big risk factors for weight / eating problems, such as high stress levels and shift work. I admire everyone who takes on that kind of job and I have a special respect for nurses. (I cannot believe you have to buy your owns scrubs, btw. I mean, of course I believe you, but I think it's wrong). You must be an amazing person.

[Atonement]

Well, I ended up telling my mom this morning.

She was supportive, but I still kind of wish she didn't. She was quick to try to equate it to her financial issues (after my dad stopped controlling her spending, she built up a LOT of credit card debt and might end up bankrupt soon. She's calmed down some but still lives WAY outside of her means). She was all "I would never judge you", but I have a feeling this might come back to bite me in the butt the next time I talk to her about being financially responsible. I kind of wish I had kept my mouth shut.

I don't know, maybe she's right and it's ME that is being unsupportive. But I don't think these are really the same thing.

I don't really want you guys to get the wrong idea about my mom, though. We have a pretty close relationship and she is really supportive of me in a lot of ways. But we are also VERY different people.

She has a long history of making bad decisions and staying in relationships with people that have major red flags. She has a boyfriend now that she breaks up with about every other month. Every time they break up, she tells me that this time it's "for good" and says that she thinks he was showing signs of being controlling or abusive. They she gets back together with him, says she "acted too quickly and didn't give him a chance", and then I'm supposed to be all welcoming and supportive again. This has happened I believe 6 times in the last year.

I worry about her because in between breakups she will talk about how she wants to quit her job and move to the middle of nowhere with him in another state after my youngest sister graduates in a couple years, so obviously I feel I have a good reason to be concerned.

However, she has told me a lot that I'm judgmental. So, I could totally see her saying "I don't judge you about your eating disorder but you judge be about the way I live my life."

I kind of just wish I'd kept it too myself. She's really busy and distractible though, so chances are if I just don't mention it again she'll forget about it. But still, I think saying something made me feel worse and less safe than I did before.

Another concern I'm having is, what if I go there on Monday and they evaluate me and say, "No, you don't have an eating disorder", and it turns out this is all something I've made up to enable myself? Honestly, it doesn't seem very likely, but it does cross my mind.

[Redskies]

Hi Atonement,

I'm glad your mom was alright when you told her, though of course I'm sorry you're feeling unsafe about her knowing. If it helps any to remember, your mom can't do anything about your eating, your probable eating disorder, any treatment you seek for it, or anything you do about it. I know that things people - especially parents - say can be very hurtful and damaging and feel like they have a lot of power, but I think it helps to remember that the person themself has no control over what you actually do.

It was pretty sucky of her to take the conversation to her own troubles and not give you proper space and time. It's not okay when people do that, and you deserve better.

I hear your fear, and I agree it's very unlikely that'd actually happen. And even then, I think it'd mean that the person you were seeing was jaw-droppingly bad at their job. If it helps any, I think the things you're afraid of - that a practitioner might say you don't have an eating disorder, or might tell you to diet - are reflections of some of the things you yourself most fear could be true: that you should simply just be doing better with this and have more control, and that it might be your fault. They're not reflections of an actual truth. I really do understand feeling that way and fearing that it might be true, because as you said yourself, there are so very many messages like that in the world around us about food, eating, and body size, with a lot of judgement and nastiness. But it's one of the things that the world has latched onto to have bigotry and judgement around, and it's no more true or relevant than bigotry or judgement about illness, disability, orientation, gender, race, or any of the other things the world can be crap at.

It's a big deal and very brave to go to see somebody if you're afraid that it might result in finding out those things are true after all. It won't, because they're not - but that doesn't usually make it any easier or any less brave!

[Atonement]

Thank you, Redskies.

I might have been overreacting a little, I guess. Chances are if I want to drop the subject with her, it will drop. If I don't want to talk with her about this again, it is pretty unlikely.

But I guess it did bring up some underlying anger that I do have at my mom.

I felt like I was being a little bit detached from the past, so I decided to read through a lot of my posts on the old boards. I had kind of been going through a phase where I started to minimize the stuff that went on when I was still living at home, but reading through those reminded me that I definitely wasn't "making a big deal out of nothing".

On one hand, I don't blame her. She's been through a lot of crap in her life, and she doesn't believe in facing her demons. She believes in distracting herself and ignoring problems until they either go away or (more frequently) snowball to the point where they're out of anyone's control. I guess in some ways, that's what life made her.

But If she had faced them, things could have been SO different. I might not have these problems in the first place, and my siblings wouldn't have their respective problems. When my dad was still an issue, everything revolved around him and his whims. Now everything is about her. It's weird because I still think of us as really close. And maybe this is just me being paranoid and vulnerable, but a part of me is so sure she's going to abandon us for this guy as soon as she's no longer legally responsible for my sister, consequences be damned. And when I'm feeling kind of down like this, I think about just "ghosting" her, since I feel like it's going to happen anyway. But, I don't really want to do that.

I'm really glad this appointment is getting sooner. One thing that I'm unsure about, though, is that they told me that the first day will be me meeting with the doctor's (She's a psychologist) assistant and answering questions for her. I've never done it like this before, and it seems a little impersonal. I've always met with my therapist from the very beginning, so with this method I feel like I'm going to have to do the whole thing twice. Also, I'm not looking forward to having to open up to more than one person. But, she had really good reviews, and unlike the others her office actually answered their phone and called me back.