Sunday, 28 February 2016

Weekend update and my concerns about taking new medication

For the first time in a long time I feel hopeful, I feel happy and optimistic about the time ahead. I forgot about this feeling, I actually forgot what it was like to smile and feel good. How it felt to play music and it making me want to dance around my room. How the sunshine outside makes me smile rather than fuels and enhances my depression.


This weekend has been so much nicer for me, I am scared because I know this feeling won't last but it is the first time in a very long time, where I have felt more hopeful and like myself.

Depression and anorexia (in my opinion) go hand in hand. Just the biological implications of anorexia leads to a depressive state. My new private therapist, Z, even agrees that I am not suffering from depression, but the depression state is something I learnt from childhood. That I have adopted those feelings and internalised them. It is so refreshing to hear and it is so refreshing for once to be heard!


Even my new consultant on the day program, actually listens to what I am saying and takes this on board. One frustration I have had with my Eating Disorder Doctors is that they are always trying to review and change my medication but fail to acknowledge that I have an extremely low tolerance to sedatives, so they try me on a number of medications and guess what I can't function on them because I just end up so tired and in a zombie like state ,despite being on a low dose.  My new consultant has prescribed me some medication to try, it did make me exceptionally tired, but I stopped taking it. I was reassured that even though weight gain was a side affect of this medication that it wouldn't make me gain weight. I know from the past that what usually happens is that it will increase your appetite, hence you eat more and then gain weight. However, this is unlikely to happen to someone suffering with anorexia because they are so vigilant about what they eat. As I do not suffer from binging tendencies, my consultant said she wasn't worried about this potentially triggering a binge.

I was fine with this, hey it might even work in my favour because my appetite has been decreasing lately and I know this is down to my digestive system working hard to catch-up now that I have finally started fuelling my body again! However, after taking the medicine on Friday night I started doing some research, I found so many forums where people state that it isn't just the increased appetite that causes weight gain but it also suppresses their metabolism, now this really freaked me out! I already have a suppressed metabolism as it is! I eventually want to follow the MM guidelines and I know I am slowly being increased the minimum amount that I need to consume, I am not there yet.

Since I became so scared I have not taken the medication since. I hate being reliant on medication as it is, it frustrates me that I am taking the highest dose of anti-depressants as it is!


I am apprehensive about tomorrow's weigh in at the clinic, but a part of me is feeling so much lighter (wrong choice of words!) with regards to my feelings. My mood has lifted, I really hope it lasts because that endless feeling of hopelessness is too much to bear.

I am going to leave for my sister's house now and have some lunch there. Happy Sunday everyone!

  • What to do you think about taking medication while in recovery from anorexia?
  • What do you think about reading up about people's experiences with medication? Is it a good or bad idea?
  • What are you doing on this lovely Sunday?

Wednesday, 24 February 2016

We need to accept that pain is a part of life

The title of this blog posts is from the DBT group on Monday where we discussed Radical Acceptance Therapy. Today is an entry from my diary from Monday 22nd February...

It has been four weeks since I joined the day program, my intake has been increased by XXX calories and my weight by XXX.

Monday is weigh day and obviously I was expecting a gain considering my meal plan was increased last Thursday. J (the day program manager) said something which made me feel so much more comfortable with the weight gain and made me see it in a positive light. J said, this is much better then not having made any progress and she is right. If I had spent four weeks on the day unit and off sick from work and not gained or changed anything, I would be calling myself a failure. I would be so frustrated and angry with myself. I need to continue to focus on the positive aspects which are that I am now eating an appropriate amount of food and I am slowly, yes slowly despite what my head says, gaining weight.

I am restoring something that is already mine, rather than it being something in addition. So in the same if a friend borrowed £20 from me and then it pays it back. I am not £20 richer, I haven't acquired more money, it is replacing something that was already mine. This is why it is called weight restoring. Anorexia is the friend who keeps borrowing your money and doesn't want to give it back, but it doesn't just take your money, it takes your everything from you, it can make life not worth living and sometimes it will take your life too. I am not just restoring my weight, I am taking control of my life, my body and of myself.

I am willing this to try convince myself, maybe if I write it enough times, I might start to believe it? But will I ever believe it? Will I ever not want to retreat back into my little bubble of anorexia?


Saturday, 20 February 2016

Four weeks into the day program

Hi all,

I just completed my fourth week on the day program and wanted to provide an update on how my week/treatment has been going.

Therapy with A

I had a very difficult  conversation with my therapist A on Monday about terminating our therapy sessions. While I feel that it was incredibly supportive when I was distressed state and awaiting for more intensive support, I don't feel like we are getting anywhere. It feels like a bit of a dead end. I think as I am receiving this treatment via the NHS, and for that I am incredibly grateful, I find it difficult to say what I think does and does not work. So the fact that this isn't working is partly my responsibility. Plus being a notorious people pleaser does not help in this situation. So while I went into the session planning on making it our last session, I now have one scheduled in for Monday coming. I am not very good at this!

Ward Round

On Wednesday I was seen in ward round, where I received some very positive comments from my treatment team. Who said that are really happy with my progress and how much I am engaging in the program, which was so nice to hear. I did ask for some feedback, but I want to make sure that any changes they think I could make to progress my recovery that I can start doing! Overall it was quite positive. We spent the majority of the time discussing how one to one therapy could help me more. My consultant is concerned that unless we deal with the emotional issues of my eating disorder, that I will eventually return back to restricting and losing weight to help me cope with these feelings. While this may seem negative to others, I was grateful that professionals were acknowledging that it isn't just about the practical elements but I need more emotional support. They also mentioned that my weight gain had slowed down, after the horrors of the "massive" increase in the first week (my words no theirs), and that I would need to discuss increasing my meal plan in my dietetic appointment.

Dietitian appointment

So the next day I attended my dietitian appointment, where A informed me as I was not gaining sufficient weight to meet the minimum required amount for the program I would need a meal plan increase. We decided on increasing my breakfast, morning snack and afternoon snack. A said we would address my dinners next when we need to increase my meal plan again. I have found this quite anxiety provoking, I know it needs to be done. I am trying to push through the feelings. On Tuesday I had my first full on panic attack at lunch time, but I have definitely learnt how to manage my anxiety better. I still ate everything that was required and completed my lunch. Skipping my meal plan and not completing food does not seem like an option this time, I think my mind-set is in a much head space this time in recovery.

Private therapist

For those who are not familiar with the NHS, it is the UK's free healthcare service. So my therapist appointments have been provided by the NHS, but this means the length of support provided is limited. I am given 20 sessions, but this means that this will come to an end soon. Part of my relapse was not having sufficient support in place. I looked into a private therapist, but they can be incredibly expensive. However, I found a few who were reasonably priced, had a background in treating eating disorders and were within an appropriate distance for me to travel on a weekly basis even when I return to work. I attended my first therapy appointment with a new therapist, Z, I feel like the appointment went well and that there was a good connection, but I also know it is very hard to judge from just one session. However, I have gone to one session and know that it is definitely not going to work!


The red velvet muffin

As part of my treatment program, the Occupational Therapist, C, will take the patients every fortnight on an activity called snack, shop and cook. It is pretty self-explanatory, we have morning snack together in a local coffee establishment, do a food shop and then cook lunch together. The idea is to challenge yourself and learn to take responsibility for your own food.

We went for snack at an independent coffee shop which I have frequented before, they do great coffee and always use whole milk which I am all for! I knew on my new plan, a good cereal bar and whole milk latte would suffice, but instead with the support of C, I instead chose what I wanted. Not what was easy, but what I wanted. This is huge for me! The fact I willing chose something I would enjoy and was yes higher in calories, but why would I not choose something out of the lovely bakery section. I enjoy cake and chocolate and I refuse to not admit it to my fellow patients anymore! I know when I have been in treatment before I have felt ashamed for not picking the "healthy" options, but the way I see it, if I have to eat and gain weight I might as well have food enjoy. So I had a red velvet muffin and a white Americano. I didn't ask for lower fat milk in my coffee, I just had what I was given and do you know what it was the perfect, most delicious morning snack!

Not the actual muffin - credit goes too this website! It was not a situation where I could whip out my phone and take a picture. Although mine did have little sugar hearts on top!

So that has been my week. I am anxious about the weekend, especially with my larger meal plan, but feeling a lot more positive then I have last and this week, where my feelings have been hopefulness and low. I am now going to have a shower, get dressed and have morning snack!

I am wishing you all a very happy and lovely weekend :)

Saturday, 13 February 2016

"I am so OCD!"

Hi y'all,

I don't want to sit here and act like I am sort of expert in recovery and all things in mental health. I am just your average Joe or in this case Josephine, who is sharing their experience of recovering from an eating disorder. Like many who suffer with anorexia, I don't feel like I "deserve" this title, I continue to argue with myself that I am not anorexic. The word burns in my brain day after day, I remember for so long I couldn't even speak the word or associate myself with it, but more on that on a later date.

Something which has been on my mind recently is the popularisation of OCD. OCD, which many of you know stands for Obsessive Compulsive Disorder, has become more "popular" in the media, such as programs called Obsessive Compulsive Cleaners on Channel 4. While I am pleased that such a serious mental health issue is being recognised and awareness is being build in the general population, I worry about many people having the wrong understanding of what OCD is and sometimes flitter the word around in every day conversation without much thought. How many times have you heard, or even said the phrase, "I am so OCD". This is not to publically shame anyone, but hopefully re-educate some people to truly understand what the illness is around.

Some people refer to any form of routine or "quirk" as OCD, such as the way you like to write lists or need to double check that the car door is locked. However being organised does not make you OCD, neither does being clean or double checking things. I am not going to go into the symptoms or diagnostic criteria of OCD, but to be diagnosed with OCD you need to be obsessing about your behaviour for at least an hour a day, everyday.

And yes it does annoy me that this picture spells colour without the U, but this does not make me OCD!

However, if you do want to learn more about OCD, I would highly recommend reading the book "Am I normal yet?" by Holy Bourne. This is a truly amazing fictional story of a girl's experience of suffering and living with OCD; while trying to lead a normal teenage life; which I think we can all agree is hard transition as it is!

So why am I writing about this? People's frequent comments about their "OCD quirks" really grates on me. OCD is highly associated with other mental health issues, including eating disorders. However, please note that a symptom of low weight and malnutrition can cause obsessive behaviour (check out the Minnesota Starvation Study for more information). At both a low and health weight I have suffered with symptoms of obsessive behaviour, do I consider myself to have OCD? No. I do not think that it is fair to say that I have OCD to the people who are genuinely suffering from this mental health illness. Having routines and "quirks" does not mean you have OCD. Like with an eating disorder, weight and behaviours are symptoms rather than the problem itself. Being skinny does not mean you have anorexia and being a healthy weight does not mean you cannot suffer from an eating disorder.

Having a mental health problem means it interrupts with your daily activities and your ability to function in every day life. This will obviously vary in severity for different people, but does not make it any less serious (note to self, please look above at said belief about not having anorexia!).

My obsessive behaviour is closely linked to my eating disorder, but it does go wider than that. I will not go into specifics with regards to my eating disorder obsessions as I do not want to trigger anyone or give anyone ideas. I know that when another person with the illness says they do or think one way, I sometimes think well why don't I do that? Am I not ill enough because I don't do those behaviours? Anorexia is a competitive illness and it thrives on comparison.

However, my obsessive behaviour extends further than my eating disorder, I also have an issue with cleaning the house. Countless professionals have asked me "well how much time do you spend cleaning the house?". For me it is not about the number of hours I spend doing it, this can range from 10 minutest to hours, it is the anxiety which comes with it. It is cleaning before leaving the house for work, it is spending all day ruminating about what I need to clean and how I am going to clean it all day long, it is running out of work as soon as the time hits 5 pm because I need to go home and clean or refusing the invitations for social activities because I must go home and clean. Again I repeat, do I have OCD? No, but I do suffer with obsessive behaviour. I feel I have a slight insight to how someone with OCD may feel, if it impacts me on this level, I cant even imagine what someone with OCD goes through.

It is the overpowering compulsion of the behaviour which takes over their lives, in the same way as eating disorders. Many suffers say they feel controlled and have no choice but to do this behaviour, there is no sense of relief or accomplishment with finishing a task. Sounds extremely familiar to an eating disorder right? To say to someone with OCD "just stop cleaning", it is like saying to someone with an eating disorder "just learn to eat properly".

So next time you hear or say the phrase "I am SO OCD", take moment ad think about what this really means.

I know this issues extends to other mental health problems such as "I am so depressed today" and "feeling a bit schizo at the moment". I have to say I am guilty of this too, I am not proud of this behaviour, but I want to acknowledge and change tis.

I understand on the one hand it is about not taking life too seriously and having to watch every little word or sentence that you say, but where do we draw the line?

Sunday, 7 February 2016

Two weeks in (almost...)

This is how I felt earlier today, I wrote down my feelings and wanted to share...

I am contemplating whether recovery is worth it when life doesn't feel worth living. it's not so much that I want to do die but more s that it feels too hard to live. I started recovery (again) almost two weeks ago. Two weeks ago, I went to Enfield Town and enjoyed coffee with my sister while I told her how I scared I felt about starting the day program.

While it isn't about the weight, I would be lying if I said it didn't bother me. Yes I have read about million articles about rapid weight gain in the first few weeks of recovery and how this is water retention. Knowledge is power and I do feel better knowing this; but it doesn't mean I also do not feel like a complete and utter failure.

I remember this feeling from when I was weight restored. I felt so lonely and alone. I couldn't see the point in fighting each day to live a life of loneliness, depression and anxiety. This isn't about facing fear foods and weight gain, while bot of these need to be tackled, this is about something deep inside which finds this all too much. I have never fully recovered, whatever that means. The past few years I have lived in a half-way house with fun mirrors, where yes I looked normal, but would I eat hat extra biscuit offered to me at work? No. Would I eat outside of my allocated meal times? No.

I spent one and a half years post discharge from inpatient; lapsing, coping and functioning. Then I relapsed.

My greatest fear is the same as when I first started recovery; getting to a healthy weight and still feeling like this. It isn't just a fear though. It happened to me and no one listened until my weight started to drop. I didn't start restricting because I thought I was fat. I started cutting back on my food because the thoughts became so loud and unbearable that I couldn't take it anymore. I could not function. I was desperate for that sense of relief, until it was too late and I was trapped in the vicious cycle of anorexia.

So now what?

I am in recovery again. What will be different this time? Because at the moment it just feels the same...

My mood really plummeted today (unlike my weight lol. Too soon for jokes? Maybe). So instead I did something helpful, I went and had my nails done. Gel nails are my new addiction, I went for a purple plum colour. This isn't my image but it is this sort of colour

I battled with the thoughts that I should be saving money as I have currently taken sick leave from work. However, since I haven't been buying any new clothes and I have no social life to speak of at the moment, I thought I could splash out on this treat. I am not usually someone who has their nails done, I am terrible with keeping up with a polished anything, plus with my constant hand washing and anorexia the skin on my hands look terrible, but sometimes self-care is needed and do you know what that is okay.

I came home, had some lunch and then headed off to R's house, where I received lots of cuddles and had a nap.

Am I completely better? No, but I took the steps to try and look after myself. My mood hasn't been fixed but maybe I am learning how to look after myself better?

I guess time will tell...

Wednesday, 3 February 2016

Feelings of shame in eating disorders (and general mental health)

Yesterday in group we discussed shame in eating disorders and mental health in general. I am sure we have all head about the Time to Change campaign which aims to reduce the stigma around mental health. The day program brought to my attention the work of Brene Brown, a  research professor and author.

Brene talks a lot about shame in eating disorders and how we can only overcome it by talking about it. People can only support and understand our needs if we explain it o them. I very much believe it is hard to understand what it is like to have an eating disorder unless you are suffering from one. However, I do feel like someone with mental health issues have a better awareness of what it may be like even if they don't necessary "get it".

There are thousands of blog posts about what to say or not say with someone with an eating disorder (please note I think that these are very important and highly valuable to building the awareness of eating disorders and how to better support suffers). However, I think many of the readers are suffers themselves and/or carers, but not necessarily other individuals such as friends or co-workers. I am not saying these groups of people should or shouldn't be reading this information, as I know other people have lives or responsibilities that they need to focus on.

So what am I trying to say? I guess how do we build a sense of understanding to the people around us about eating disorders so they can better supports us and reduce the stigma around mental health. Brene says it's not necessarily speaking out to the world, but initially just choosing one or two trustworthy people in your life. If you do to have these people, them please make sure you are seeking support. The Beat website have an excellent number of resources and recommend some amazing forums and support groups in your local area.

Remember ,while discussing mental health problems are important, it shouldn't be at the detriment of your recovery!

You can find out more information about Brene Brown's views and approaches to how to tackle eating disorders here.

Tuesday, 2 February 2016

Group therapy - the good, the bad and the potential triggers

Today's blog post has been inspired by a topic we discussed in this morning's group on the day program. The Tuesday morning group Body Image, where we were discussing how we feel in groups situations which was a continuation from last week's session.

The discussion lead to talking about group settings and how changes can really affect the dynamics. Changes within a group setting causes me a lot of anxiety whether this be in a work or treatment setting. We currently have two places available on the day program and someone is currently being assess - I am trying to not this get to me because I found this distracted me when I was an inpatient and I am trying really hard to focus on myself. While I am dealing with these feelings better this time; the group's anxiety about someone leaving last week and the possibility of someone new joining and how this may change the dynamics. As it is a small group (maximum of six at any one time), changes can really impact how everyone feels. Obviously, I am fairly new in the group but the other patients have been amazing at welcoming me and making me feel part of them.

Something which the other patients highlighted to me, is that the greater anxiety we have about the changes in the group are higher than say at work; this is because in treatment you are expected to make yourself vulnerable and this can be extremely difficult. Especially as you are challenging yourself on a daily basis on the day program - you are implementing new meal plans and are expected to put on weight.

Group therapy plays a major role in eating disorder recovery, whether this be in as an inpatient, day patient or finding groups to attend as an outpatient (which I have done before). I wanted to discuss the pros and cons of group therapy and some of the approaches to take when attending therapy.

Pros of attending group therapy

  • Finding people you can relate to and understand what you are going through
Eating disorders (and mental health problems) can be isolating and lonely. As well as part of the eating disorder is isolating yourself from people round you, it can also often feel that no one really understands how you are feeling and what you are going through. While doctors and therapist can speak to you about how you are feeling - sometimes you just need an honest, down to earth conversation which makes you feel less alone and realise your behaviour is not only just you! When I was first admitted as an inpatient I remember a huge sense of relief when talking to other patients - I wasn't alone! Groups can give you the opportunity to meet people who you can relate too, while you may not be from the same background or be suffering from the same problem, there is a sense of unity in understanding amongst the group. When you start thinking "omg me too, I do that too!" it can feel like a weight has lifted off your shoulders. I met one of my closest friends in an inpatient setting and I quite honestly do not know what I would do without her support, I joke that she is like my AA buddy.

  • It provides a place for you to vent your feelings and difficulties
  • It can help with building a support network
  • It is a place to learn new coping mechanisms and learn from others' experiences
Now this last one is particularly important - people at the group might be able to give you insight into some of your feelings and behaviours. They even might be able to suggest different coping mechanisms and what may or may not have worked from them. Having professionals in your life is great, however, sometimes the best advice can come from someone who has been through it themselves. It can also be more reassuring, when a professional says to me "it gets easier" - I think hmm course it will, when a patient says that to me, it fills me with hope as they have directly experienced it.

Cons of group therapy
  • It can be triggering...enough said really!
  • Unfortunately not everyone will consider your feelings when talking about their issues.
  • Conflict - I think their is always the potential of conflict when you put a group of individual together where they are discussing quite sensitive topics and making themselves vulnerable.
  • Picking up unhelpful behaviours
This one can be particularly harmful - this is something I struggled with as an inpatient and found really hard to separate myself from.
  • Feeling judged by other patients
This can be difficult - the other day someone commented on us both eating a cheese sandwich and the extremely high fat content in it. Comments like this can be quite upsetting - so be prepared to have to rationalise the thoughts this may bring up. Plus cheese sandwiches rock :)
  • Comparisons - speaks for itself really.
  • Picking up negative feelings
When I was discharged from inpatient treatment my therapist recommended seeking out further support before my sessions ended. So I started attending an eating disorders group which I found online. I found the group impacted my mood - my sister even said she had noticed that when she picked me up from the group I was consistently in quite a low mood. I did not find it helpful or productive, while I do not think this was a reflection on the group, but more so the impact it was having on me. So this is one to watch out for! Not all groups will be for you!

So now we have discussed the good and bad - I wanted to highlight things to consider when joining in group therapy!

  • If this is a group you are choosing to attend i.e. it isn't forced as part of an inpatient treatment, then always attend more than once. One sessions is not enough to decide whether it is for you or not. Small changes in the people who are attending the group that day can have a huge impact on the dynamics - remember some individuals may not attend every session. Remember to give it a try!
  • Be open to trying new things even if you don't think they will work - as part of the day program I attended dramatherapy - now I was sceptical and not really looking forward to it, but do you know what I actually enjoyed it. It made me feel more connected to the other two individuals on the program and I felt like it was really helpful. You never know what is going to work but be willing to try everything at least once, it can't hurt right?
  • Be honest! It can be so hard to be vulnerable but if you are not honest people can't help you. I always find I would rather say "I don't feel comfortable discussing this" rather than making stuff up.
  • Stay away from numbers - I think this one is pretty self-explanatory.
  • Be considerate of other people's feelings.
  • Be willing to be challenged on your views and fears - remember recovery is not meant to be easy and will not always feel comfortable!
  • Last but most certainly not least, always consider how this is impacting your recovery! If it is an unhelpful environment leave it, if you are finding it is negatively impacting your recovery then remove yourself from the situation. You and your recovery is the most important thing and these situations sometimes you need to be selfish!

Sometimes it is important to attend treatment with blinkers on. Remember you need to focus on yourself and not to pay attention to unhelpful behaviour. Your recovery is about you and how you want to change. This time I have enterered treatment I have had a very different mentality, if someone makes a comment about cheese, that is their eating disorder impacting them, but I want to fight through this and not let their eating disorder thoughts become mine. It isn't an easy task, but it is important to enter these situations with an awareness and understanding that this will be a potentially triggering environment, look after yourself, self-care is important and hey it isn't for everyone. So what may work for one person, may not work for you, that isn't a reflection on you as a person, everyone responds to treatment different. Be kind to yourself :)