Cooking and Grocery Shopping In Recovery

I recently saw an article of tips and tricks about grocery shopping when you have an eating disorder. Of course I clicked on the link, but I was surprised to find that almost everything on the list was exactly the opposite of how I prefer to approach food.

People’s strategies for recovery are as widely varied as they themselves are, and different people find different approaches to meal planning, shopping, and cooking helpful. So I thought I might throw out some of what’s helped me become more comfortable with the process of getting food from the store to inside my belly in the hope that others might find something useful in it.

I’d also love to hear other people’s tactics. The more we can share with each other what’s helped us, the less alone and confused anyone has to feel. So here are my strategies for the actual shopping and cooking processes while in recovery.

1. Plan ahead. I never ever go into a store without a list of everything that I need, and I try very hard not to buy anything that isn’t on the list (unless I look at it and realize I meant to put it on the list). This helps me to feel less out of control while I’m in the store, it ensures that my grocery trips take less time, and it means I can focus on crossing things off of the list instead of on all the food around me.
2. Buy in bulk. Some people really don’t like this one, and I understand. There are times that it’s overwhelming to me to have too much food in my house. But I really prefer to have fewer trips to the store, and so I buy lots of frozen veggies, grains that don’t go bad, and other things that can last me up to a month so I don’t have to venture back to the store for as long as possible. Again, your mileage may vary on this one, and if you feel really overwhelmed with having too much at once then it can be really helpful to start with a smaller store rather than a Cub or a Rainbow.
3. Produce and other things that go bad: approach with care. For a long time I wouldn’t buy anything that would go bad because it felt like too much pressure to eat it right this instant. If you have worries about things going bad then it’s actually possible to buy mostly long term things (frozen is your friend). My strategy has been to slowly introduce more perishables. I started with milk (because I need it for my mac and cheese) and have now worked up to such amazing buys as spinach. You don’t have to get a lot of any of these, or even a wide variety of perishables. You can make your basic diet one that doesn’t spoil and add on fresh things for more nutrients as you feel comfortable.
4. Recipes aren’t necessary but they can be helpful to come up with fast and easy things. You in no way need to follow recipes exactly, especially if there are more ingredients than you want to deal with. I recommend doing some brainstorming before going to the store for things that will be as easy and fast as possible. I find the longer I have to commit to cooking, the less likely I am to get my meals in.
5. Cooking in bulk can be great! I love to make extra pasta or rice so that I have a couple additional meals and don’t have to worry about cooking for a few days. Decreases stress, increases ease.
6. Eat things that taste good to you. I don’t buy frozen meals even though in many ways they would seem ideal for me. I don’t like how they taste. Instead I try to get things that I want to eat because that will increase my motivation to cook them and put them in my stomach.
7. With that said, also be aware of things that feel too anxiety provoking. I try not to have chips around too much because I eat them mindlessly and it causes me a lot of stress. That doesn’t mean cutting those foods out entirely, but rather being careful around them so that you can eat them with minimal stress (I only buy one bag of chips at my monthly grocery run so that I don’t feel overwhelmed).
8. If you’re going to go grocery shopping with someone else, communicate how you shop and what they can do to support you. There are lots of people out there who like to wander and browse in the grocery store, so don’t assume that everyone wants a list or can be in and out quickly.
9. I prefer to buy things that are not pre-portioned so that I can decide how much I am hungry for.
10. Eat before you go! Shopping when hungry means everything will look good and it can get overwhelming really fast. I also try to build in some downtime post shopping trips so that I can calm any stress that might have built up.
11. I prefer to have a few standbys for cooking that are as easy as possible and feel completely possible no matter how bad of a day I’m having. I always keep those around. For me it’s ramen noodles, mac and cheese, and chic’n nuggets.
12. I also try to make my cooking in general simple. I like to do variations on the same theme. Most of my food comes in the form of grain+veg+sauce all mixed together. That means I only have to figure out three choices for any given meal, but also allows me all kinds of different flavors.
13. When adding new things, don’t try to do too much at once. I never have enough protein in my diet, so I’ve been working on that, but I don’t try to do many things at once. This week I added protein smoothies to my diet. A few months ago I started adding fake meats to my basic meal template. One at a time is easier to keep track of, less stressful, easier to adjust if it starts stressing you out, and easier to grow accustomed to.
14. There is no need to be a perfectionist. For a long time I didn’t want to cook because I didn’t feel confident about it and I hate not being perfect. But my food doesn’t have to turn out like the food on Iron Chef. It just has to turn out like something I want to eat. It can be ugly, I can make mistakes, and I can experiment without being some kind of failure.
15. Spend money on food. I know that sounds privileged and stupid, but it’s an important shift of mindset for many people with eating disorders. For a long time I refused to budget any money for food because I didn’t see it as a necessity. But eating becomes much easier if you like the way your food tastes and if you can buy things that you enjoy, which means putting food as high on your budget priorities can go a long way. This is also part of why I allow myself to eat out more often than I probably should. My health is worth the money.

That’s what works for me at least. I hope some of it is helpful, and remember: if these things don’t sound useful for you then you don’t need to do them. Do what works for you.

 

Recovery In a World of Triggers

It’s extremely common for people with eating disorders to relapse at least once after feeling as if they’re in recovery or on their way to recovery. Some stats put relapse rates as high as 80%, although with more research on good treatment and long term support for people with a history of eating disorders, it’s likely that the number will go down. But unlike lots of other mental health problems, eating disorders live in a place where the bad behaviors are often praised, and triggers are basically everywhere all the time.

It’s astounding to me that anyone manages to recover at all. I’ve been doing fairly well for about six months, but the longer I spend away from the eating disorder, the more I realize how many unhealthy messages there are all around me. I recently had a conversation in which someone who was well aware of my eating disordered history and who brands themself a skeptic and scientifically literature person suggested that a diet of 1200 calories was an appropriate form of weight loss. Almost every day I hear people talking about how unhealthy it is to eat sugar or carbs or gluten or really anything. No matter how many times I try to remind myself that what’s important is eating food that tastes good to me and eating enough food that I feel full, I am constantly and every day reminded that being hyper aware of diet seems to be synonymous with health.

And yes, there is good evidence that being at a mid range weight, not eating tons o sugar, and getting decent exercise are good for you. The problem is how to interpret that statement when your brain is built for all or nothing thinking and perfectionism, for guilt tripping you and punishing you. How do you find any sort of middle ground between “I am allowed to eat what I want” and “I should try to eat in a healthy manner”? This to me is what makes eating disorder recovery so hard. There is no cold turkey to eating disorders because food is always going to be part of your life, which means at least a few times a day you’ll be thinking about the thing that ruled your mind for so long.

In addition, there’s tons of conflicting information out there about what’s healthy. Even for someone who doesn’t have an eating disorder, sorting through the morass of studies and recommendations can be incredibly difficult, and reading about diet studies can be extremely triggering for someone with a history of an eating disorder. That means most of us just want someone to tell us what’s right, what’s ok. No one can and no one will, so instead we’re surrounded with a thousand different messages and left reeling about what is or isn’t appropriate food behavior.

The unknowing is almost more triggering than the obviously pro-skinniness, pro-dieting messages. The deep uncertainty about whether or not your weight is too high or too low, your diet is too unhealthy or too many calories or too few calories, or not enough veggies, that gets into your mind until you just want the clear rules again. Unlike nearly any other mental health problem, eating disorders circulate around something that’s considered completely acceptable to comment on publicly: food. And it’s a conversation that everyone wants to have, so no matter how you try to avoid it, you have a coworker who says “Oh I’ll be bad and have a cupcake” or a family member who says “I’m down 15 pounds!” in a tone of pride. Each time you try to retrain your mind to erase the disordered messages that say “skinnier is better”, someone else comes along and nonchalantly dismantles your hard work.

Perhaps worse is the fact that many people seem to believe that choosing a “this works for me” approach is unacceptable when it comes to eating. You must be doing what is the most healthy, backed up by evidence, best diet ever or you’re not healthy at all. That means that for someone who has an eating disorder and might have to take some shortcuts (like: if I feel hungry for x food I let myself eat x food so that I get enough calories), their (perfectly logical and healthy) choices are derided as illogical and unhealthy. Some of us know that we engage in unhealthy behaviors and have to accept that to get food in our bodies at all. Some of us need to ignore some of the research to convince ourselves that eating more than 1200 calories a day is necessary. Some of us need to be irrational in order to be healthy, and that’s ok.

On top of all of that, you carry your biggest trigger around with you every day: your body. The changes that happen in your body, even if they’re completely natural, are extremely noticeable to a brain that’s used to nitpicking every ounce of fat. The weirdest things will set you off. I found yesterday that I couldn’t fit into a pair of shoes that had been in my closet since last fall, and that my ring size appears to have changed. These are tiny little reminders that I’m moving into uncharted territory, things to be feared.

All of this is to say that I understand why the relapse rates of eating disorders are so high. I hate blaming diet culture for eating disorders, since a mental illness is not just a diet, but it is true that all the conflicting and horrible information about healthy eating has serious impacts on people trying to bring their eating back to a reasonable middle ground. The good news is that there are people who have managed to recover and stay healthy. The good news is that we’re allowed to set boundaries, remove ourselves from conversations filled with diet talk, block the hell out of triggering websites and ads. The good news is that we’re entitled to our own health and well being, no matter what anyone else says about the appropriate way to eat.

Memory Loss and Recovery

There are lots of side effects to extreme calorie restriction, widely documented among people with eating disorders. They include memory loss, fatigue, loss of concentration, emotional dysregulation, heart problems, and many others. One of the symptoms that I experienced most acutely while I was in the midst of my eating disorder was memory loss. In my freshman year of college, I was trying to study for a Latin final. I spent hours looking over the same passages, trying to remember exactly what they meant, but when the test came I only scraped out a B (which was not normal for me).

The incompetent feeling that comes with not being able to remember anything doesn’t help when it comes to treating yourself better and feeling worthy. Unfortunately, not all of these side effects disappear the moment that you start to increase your caloric intake again. Even if your body starts to look and feel healthier again, there are some lasting impacts, most particularly fatigue (does it ever go away? Please say it goes away) and difficulties with focus and memory.

One of the skills that lots of therapists and therapy techniques promote is building mastery. The idea is that if you learn how to do something relatively well, you start to feel more confident of yourself. That radiates across lots of different aspects of your life, and especially if you work to become better at things on a regular basis, your mood will probably improve across the board. From my personal experience, I’ve found it a very helpful skill, especially when I can take the time to recognize that I’ve become good or competent at something. The feeling of realizing I know how to do something without any help or instruction is basically the best, and it’s a big part of what keeps me going on a daily basis. I start to know who I am a little more, I start to understand that I don’t need someone else to tell me if I’m doing alright, but that I know myself because I can see that I am capable.

The problem is that my brain is hazy and my body is tired. I was learning a new process for work today, but no matter how hard I tried to concentrate, my eyes kept slipping in and out of focus, and I would miss sentences, jumping back into the explanation and desperately trying to backfill the information I had missed. I felt like a failure. I wrote a blog post last week in which I completely forgot to add citations, the whole thing sliding out of my fingers in a blur without any real realization of what I was doing. And then there are the days that I fight with myself about exercise and movement, trying to get my body up and out the door to go to the climbing gym or for a run. I know I won’t get better if I don’t do it, but my eyes can barely stay open. It seems as if I can’t learn anything, I can’t remember anything. I swear I did this before, but what did I do?

Trying to build your life and identity into something that feels like self after an eating disorder is hard enough. It becomes even harder when your mind and body don’t cooperate to let you learn and grow, establish your abilities, and feel able of taking on the world. Failure is one of the fastest ways to set off depression, anxiety, or perfectionistic tendencies, all of which are quick ways to trigger a relapse into eating disordered behaviors. All of that means that the disorder itself is set up to keep you from getting better: you’re less competent after you’ve starved yourself, so you convince yourself that you’re incompetent, a failure, a loser, you don’t deserve food, and so you refuse to eat further. It’s vicious, and even when you start to get out of the cycle it takes time for your brain and body to catch up in the recovery process.

I suppose this all should serve as a reminder that certain skills need to be used with care until you reach a more stable state. Relying on external successes might not be the most important factor in building up an identity and self confidence at the beginning of recovery. It’s also a reminder that mastering a skill has to come in the context of where we’re starting and the resources we have available. For me right now, running 3 miles is a success. For lots of other people, or if I were healthier, that might be almost nothing. But at this moment, it is building a skill that I didn’t have before, and that still counts as growing and learning.

All of it still counts, no matter how much harder it is now.

You Can’t Turn Off An Eating Disordered Brain

Massive trigger warning for eating disorders

For about the past nine months I’ve been feeling pretty good when it comes to my body and my food intake. I still have a few hangups, mostly surrounding times when I should eat, but overall I was getting a decent number of calories and feeling fairly energized. I had stopped thinking about what my body looked like every day, and I had even stopped adding up the totals of what I had eaten each day to try to decide if I was allowed another item (or if I needed to go work out).

It was a massive relief to not have those scripts playing in my head anymore. But recently, somewhat out of nowhere, they’ve started to play again.

I have a lot more tools available to me now. I have more friends to ask for help, a better idea of what I want out of my life and why an eating disorder isn’t compatible with that, a fuzzy kitten to distract me, and a variety of strategies about what makes me feel good in the moment, but none of these things have managed to turn off the voices or the accompanying anxiety. They are enormously helpful when I need to choose a better behavior than restriction, purging, or overexercise, but no matter how often I try to ignore the bad suggestions my brain keeps giving me, it comes back louder.

This is what a lot of people refer to when they say that you never really recover from an eating disorder. The disordered brain will linger on and on and on. And while outsiders might suggest distracting yourself or challenging the thoughts, what they don’t understand is how incessant it is. When you wake up in the morning you wonder about what you’ll eat that day and think about whether yesterday was a “good” day (ran a calorie deficit). You go to put on clothes and are left with the quandary of what fits and what doesn’t, what you can convince your brain is acceptable. You go outside and now it’s the comparison game, who’s smaller than you are, who will see you as acceptable, does everyone see how big you are or do they care?

It goes on endlessly. You cannot turn it off (or at least no one has figured out the magic switch yet except constantly choosing a different behavior and working to focus on something else).

What no one tells you about jerkbrains, whether they’re eating disordered or OCD or depressed or anxious is that they will exhaust you. They don’t tell you that the worst part isn’t the full on meltdowns, but the normal days where you thought you were ok but instead have to spend half of your energy fighting with yourself.

It’s discouraging. While it is realistic to know that someone with a disorder that is highly linked to genetics will probably always have to be on the lookout against a recurrence of symptoms, it makes life feel like a neverending Sisyphean endeavor, even moreso than it might for someone who just has to get out of bed and drag themselves to the office each morning.

Even writing this feels like a repeat of things that I’ve said far too many times. It certainly puts more importance into the question of whether genetics are destiny. But pushing against all of the woe and angst and “determinism means it just doesn’t matter!” is the fact that I know I have changed. The eating disordered brain remains, but there is something in there or in me that can adjust. I make different choices, and the lows come further and further apart. I hate inspiration porn, especially when it comes to mental health, so I have to admit that I have no idea if there’s a relapse in my future or what it means for the quality of my life that self hatred is an essential ingredient of every day. But I am also done with wallowing in the unhappiness, so I also have to say that I have hope. There is the possibility of joy.

No, This Is Not How To Raise Awareness

Ugh. Ugh ugh ugh. Eating disorder coverage has been getting better in the past few years. I’ve seen stories covering orthorexia, binge eating disorder, bulimia, and EDNOS, as well as some that include the oh so shocking fact that eating disorders don’t just happen to people who are skinny, and sometimes they’re not motivated by weight loss, dieting, or models.

So I was deeply unhappy to see this art series that purports to draw attention to eating disorders but is exclusively composed of skeletal Disney figures. Sure, it’s great that it includes men and women of color, but there is such a small percentage of people with eating disorders who actually look like that, whose BMIs have dropped down into the “you need to be hospitalized” realm that I can’t help but feel that it just limits our perception. Beyond that, it perpetuates the horrible, horrible idea that you can diagnose a mental illness by seeing how skinny someone is.

Newsflash: eating disorders are not defined by someone’s weight. Weight is actually one of the smallest components of diagnosis (there are lots of other criteria! And lots of different disorders! Some of which include NO weight component!)

It is not outreach or advocacy to continue to portray eating disorders in stereotyped ways. This is not helpful.

For real information on what eating disorders are and what they’re like, try NEDA, Science of Eating Disorders, or just check out my back log of blogs tagged with “eating disorders”.

Cross Cultural Eating Disorders

It’s commonly held knowledge that eating disorders are a Western phenomenon. They came about because of beauty standards, small models, and photoshopping. They’re on the rise! Panic! It’s an epidemic!

Only this isn’t necessarily supported by a hard look at the data. One of the problems with assessing whether or not eating disorders exist in other cultures is that the diagnostics for the disorders were developed in the US and Western Europe, leading to a focus on the presentations that we tend to see in those places. As an example, one of the diagnostic criteria for anorexia is “Intense fear of gaining weight or becoming fat, even though you’re underweight.” While this is the motivation for many people to refuse food, it is not true of everyone who displays many of the symptoms of anorexia, and may simply have different motivation.

There are a few different sources of data that contradict the idea that eating disorders are culturally bound or that they are caused by Western beauty ideals. We can look at history or we can look to minorities or other countries that may not have been wholly influenced by Western concepts.

Historically, we have strong evidence that people have been choosing to starve themselves for hundreds of years. The book Fasting Saints and Anorexic Girls traces the history of self starvation from the earliest records through to the first recognition of eating disorders as psychiatric conditions. While the book suggests that these are distinct phenomena because in the past few people have practiced self starvation due to a fear of fatness, behaviorally it shows many parallels.

One particular group of individuals that have similar behaviors to modern patients with eating disorders are religious fasters. These tended to be young women who had little control over their lives in many ways and who chose to abstain from food for extreme periods of time in order to be morally better by ignoring their bodies and focusing on their spirits.

The book includes some quotes from people who chose to restrict their food intake in times past, and concerns about morality, space, selfhood, and perfection come up again and again, just as they do in current conversations about eating disorders. Many of the experiences are couched in religious terms, but the underlying fears (“I am not good enough”, “there is something wrong with my body”, “I need to be better”, “I don’t want this life”) could just as easily be pulled from a study of eating disordered patients today.

Individuals throughout history have chosen to abstain from food, often falling into something like depression and priding themselves on their ability to go without for long periods of time. Their motivations have changed as their social milieu has changed, going from religious, to entertainment, to aesthetic. However many of the sentiments that these individuals express ring similar across time and space.

“It’s like I never knew what self-respect was all about until now. The thinner I get, the better I feel . . . I’m proud of my stoic, Spartan existence. It reminds me of the lives of the saints and martyrs I used to read about when I was a child . . . This has become the most important thing I’ve ever done.” This kind of quote could easily be from a religious faster or a modern individual with anorexia.

Over at Science of Eating Disorders, Tetyana posits “Religious and spiritual reasons are not the only factors that could be contributing to AN in non-Western countries (or Western countries before the ‘thin ideal’). Personally, it would seem to be, that anorexics in those times, would just attribute their desire for weight loss to those reasons much like today it is often attributes to a fear of being fat. But, both of those could just be post hoc rationalizations on the part of the sufferer, to make sense of their otherwise perplexing desire to restrict their intake and lose weight. That’s my feeling.”

I’ve written elsewhere about how restricting food made me feel powerful, godly. I often imagined that my body was not subject to the same requirements that others were. Only the weak needed food, but I decided my morality, my meaning, and my body for myself.

“Comparable to the ascetic practices in the history of Christianity are the fasting practices in the Chinese Daoist tradition (Eskildsen, 1998). These practices sought to transform the body as a means of gaining immortality…  The history of Chinese thought thus suggests that, in certain traditions at least, the emaciated body has been highly valued and pursued in a manner highly reminiscent of Western observances.”

But in addition to historical examples, we can also look at current cases of eating disorders in non-Western countries. It’s a common trope that these are rare, and when they do appear they are evidence of growing Western influence in the country. The problem with that assumption is that many individuals who might be diagnosed with an eating disorder but lack fatphobia are not given the diagnosis. The unthinking assertion that the rise of eating disorders correlates to increased Western influence doesn’t look at the lived experiences of individuals in non-Western countries.

Again, from Science of Eating Disorders:

“For example, one study found that in British Asian girls, dietary restraint was correlated with traditional (rather than Western) values (Hill & Bhatti, 1995). This finding was supported in a study by Mumford and colleagues (1991) who essentially found the same correlation. On a Caribbean Island, with little Western media, Hoek et al (1998) found that the prevalence of AN was comparable to Western countries and a study by Apter et al (1994) showed that a group of village Muslim women (with minimal exposure to Western values) had eating pathology scores that were indistinguishable from patients with AN.”

Many of the patients quoted in this article don’t talk about a strong desire for thinness or weight loss, but point to their bodies as the site for other struggles in their lives, particularly around control and selfhood.

“… food restriction arose from a sense of powerlessness in the family context, it is possible that the patient experienced her emaciation as egosyntonic, with her low body weight consonant with the goal of not wanting “to ‘give in’ to her family, especially her mother, who forced her to eat even when she was not in a mood to.”

Again, these individuals exhibit many of the same behaviors as individuals diagnosed with eating disorders in the Western world, but don’t show the obsession with thinness or fatphobia that we assume is an essential part of an eating disorder.

An eating disorder is a coping mechanism that allows an individual to survive extremely difficult situations or feelings. Physically, it has effects that make it easier to live through strong emotions: it numbs out painful things, it leaves you sleepy and sedated, and it also provides a kind of high that makes you feel accomplished and safe. These are biological results. They are the same no matter where you are or when you’re living. And they are effective at helping someone survive a difficult situation no matter what kind of difficult situation that is: it could be not living up to religious expectations or not fitting into a beauty ideal.

And so I am continually dismayed at ridiculous articles like this that seem to think eating disorders are not only limited to the West, but also limited to young, naive, shallow teen girls who can’t figure out how to do basic things like feed themselves. Diagnosis, demographics, and etiology are complex and confusing. If you don’t know a little something about mental health, don’t write about it.

Embodiment

Eating disorders are about bodies. Duh. They’re about fat and losing weight and body image and skinny models and photoshop. Wait, what? That’s not right. Eating disorders are about the experience of being in a body, the limitations and lack of control that being embodied necessitates. Much better. I’ve been wanting to write about this article at Science of EDs on embodiment for quite some time, but I haven’t known exactly what to contribute beyond “yeah, that!” The article looks at a study of embodiment in which participants rated how much they experienced their body externally, through the feedback and sight of others, through objective measures, or through physical ways of controlling their bodies. Unsurprisingly, high scores on these measures were correlated with eating disorders.

When I read this, I felt a resonance with these experiences and questions: yes, what drove my eating disorder was a feeling of discomfort with having a body, an inability to imagine how my “self” fit into that body, a confusion about how my body actually fit into people’s conceptions of me, and a kind of certainty that the only time I really was in my body was when I was doing something to it or with it. But embodiment has always meant more than that to me. Having a body means you will die. That’s a pretty basic fact at this point in time (although there is the potential that through technology we will change it). Having a body also comes with a variety of limitations: you can only be doing one thing at a time, be in one place at a time, you are bounded by temporality and space. Even if you’re a highly capable person who can probably accomplish nearly anything they try, your embodied nature says that you can only try a limited number of things.

Bodies, and particularly bodily functions (like eating) are a constant reminder of these facts. For much of my life, I have not been able to stand being present in my own body (aware of my senses, my location, my body) because it was so limited. Some people are able to accept these limitations without struggle. Some people don’t find that being in a body is a constant reminder of their miniscule nature in the entirety of reality. But many of the people that I have met who also have eating disorders are the kinds of people who have been told their whole lives that they can do whatever they put their mind to, that they can do so at a high level of accomplishment, and that they can change the world. The perfectionism that this breeds hates limits, even ones that are utterly reasonable (like not being able to live forever).

Some people have certainly wondered why those with a high drive for control and perfection choose their bodies as the realm on which to enact their personal battles. The experience of embodiment as mortality and limitation gives a good window into this connection. It might seem that the whole world is not within our control, but the most basic level at which we have no control is the fact that we are embodied, our bodies do things we don’t want them to, we can get sick and die, and having a physical presence inherently limits the ways that we can affect the world.

It’s quite possible that few other people with eating disorders are consciously aware of hating their body because it represents the fact that they cannot do everything they’ve been told they could; I cannot cure cancer and reconstruct Proto Indo-European and become a bestselling author and be a feminist/atheist activist and play taiko for a living and learn neuroscience and solve the problem of consciousness and star in an amazing TV show. I have to pick and choose, and knowing that I am giving up on some potential opportunity is painful. But even if others don’t consciously recognize that the reason they can’t do all this is because they are physical beings, on some level I suspect they feel it: it comes out in the guttural anger at the body and at the failings of the body, it comes out in the unrealistic expectations of perfection in every way, it comes out in the unnaturally high achievements and the insistence that slack is for other people.

Embodiment might be at the heart of all eating disorders, but not because of bad body image or a struggle to reconcile self-image with the perception of others. Somewhere in there, all of us want to be little gods, capable of anything. Bodies will always remind us that we never can be.

 

Food As An Emotional Modifier

Some people eat when they’re in a bad mood. Most people, actually. Comfort food is a well known concept and we all have foods that are associated with home, safety, and good feelings. Some people don’t eat anything at all when they’re in a bad mood. Oftentimes depression can come with loss of appetite, and restrictive eating disorders are the extreme of “I feel bad I won’t eat”. Human beings use food to adjust and react to their moods.

For the most part this is considered unhealthy. Emotional eating is often at the heart of eating disorders, and many dieticians find that working with their clients to come to a healthy place with their emotions leads to a stabilization of diet. (FIND LINK) When we call someone an emotional eater, we don’t mean it as a compliment. Our thoughts/feelings are supposed to be radically separate from our bodies, and it’s unhealthy to seek out a physical solution to an emotional problem.

Except for the times when it’s not. Recently, I’ve started to try to regulate my emotions using food. “EATING DISORDER!” I hear you cry (or so I assume, I always cry out in distress when reading blogs). Well, not exactly. I’ve been trying to regulate my emotions using food by eating on a regular schedule, listening to what my body is craving, and eating until I am full. In addition to regular mealtimes, I’ve also been trying to notice when I’m getting cranky, anxious, sad, or otherwise unstable in some fashion and whether it has any correlation to how long it’s been since I’ve eaten. Guess what? It often does. I’m low energy and low happiness first thing in the morning, and I hit a low in the afternoon before dinner. Guess what these two time periods have in common? It’s been a while since I’ve eaten anything and I’m probably low on calories. Not having enough calories will make anyone more emotionally vulnerable.

Secret knowledge dropping time: our emotions are highly dependent on our bodies. Being tired, hungry, thirsty, cold, or sick will affect how you process what’s going on around you and what your reaction to the world is. Not all of these are things we can adjust immediately. If I’m having a bad day at work I can’t simply take a nap and feel more rested and thus stable. But I can go grab a snack or put on an extra sweater. I can use my body in a positive manner to influence how I’m feeling.

More often than not, things that are unhealthy for us are that way because they are extreme in some fashion. This doesn’t apply to anything (please do not go take moderate doses of arsenic), but for many things, we can use them positively if we understand how they actually interact with our bodies and minds. Exercise is another great example of this: too much or too little can throw us out of whack, but a moderate amount of exercise on a regular basis, and strategically applied exercise during times of stress can do wonders.

I don’t necessarily promote the view of the body that sees it as a machine (I think we’re far more integrated into our bodies than we will ever be with machines), but it can be a helpful metaphor when thinking of how to modulate your emotions. What kinds of things might this machine need to function better? Have I been getting too much or too little of any of the necessities? How can I make a small change right now to bring things back into balance. It’s not magic, but it is certainly a helpful framework for in the moment actions.

Dieting: A Gateway Drug to Eating Disorders

I probably read too much about eating disorders. Whenever an article related to them pops across my Facebook feed or shows up on Twitter, I click. And there’s a frustrating element of these articles that has begun to grate on me more and more. Every single time someone writes about eating disorders, they have to bring up those “terrifying statistics” about dieting and body dissatisfaction in girls and women. In one article I read last night, the author even went so far as to suggest that “dieting is a gateway drug to eating disorders”.

Now these are of course important concerns. Dieting isn’t a particularly healthy practice most of the time. Women thinking that they should or must be thin is not exactly an ideal state. But where I run into problems is this: a diet is not an eating disorder. Dieting does not lead to developing an eating disorder because an eating disorder is not just an extreme version of a diet or a choice or a lifestyle change. It is a disease. You can’t catch the eating disorders from a diet.

So what is the relationship between diets and eating disorders? Why do people keep throwing into the same sentences as if everyone knows the clear link between them? I can’t help but come from my own perspective and my first thought is that diets and eating disorders belong nowhere near each other. I have never in my life been on a diet. Up until my eating disorder came bearing down full force I had never even imagined restricting my food intake. And when my eating disorder happened, it was never anything like a diet. There may have been a couple of weeks during which I wasn’t aware that I was making destructive choices, but it became quite clear quite quickly.

I get the feeling that I’m not the typical case and that many people experiment with dieting before they fall into a full blown eating disorder. But it is the case that there are many, many people who diet and never develop and eating disorder, and I am evidence that the opposite can be true as well. The deep link that most people seem to assume between the two can be questioned.

And then there’s the evidence. Do we have any evidence that dieting leads to eating disorders, or even that dieting can predict eating disorders? There is evidence that those who diet are about six times more likely to develop eating disorders. We don’t however know whether those who are already predisposed to having an eating disorder are more likely to diet, or whether diets lead to eating disorders. The vast majority of dieters never develop an eating disorder, so there is no certain way to determine whether an increase in dieting will lead to an increase in eating disorders.

“Recent research indicates that 50-80% of the risk of developing AN is genetic (Kaye, 2007).  Patients with AN typically demonstrate high levels of anxiety, harm avoidance, and behavioral inhibition (Shaw et al. 1997) – all traits which are heavily influenced by genetics (Cloninger, 1986, 1987, 1988).  Perfectionism, obsessionality, and cognitive rigidity, which are also highly heritable, have been identified as risk factors for AN (Kaye et al., 2009).  Most patients with AN have exhibited one or more of these traits since early childhood, long before the development of an eating disorder.  These traits tend to be exacerbated during bouts of malnutrition and persist long after recovery, albeit to a lesser degree (Kaye, 2007).” Source

There are chemical changes in the brain when we deprive ourselves of food and for those who have the predisposition for an eating disorder, a diet can be the moment that flips the switch as it were. So while there is a relationship between diets and eating disorders, an increase in dieting does not necessarily imply that there will be an increase in eating disorders (unless there were a whole lot of predisposed people running around who never hit any level of nutrition deprivation or stressful circumstances that would have precipitated the illness). It is possible that an increase in dieting would trigger an illness in those with a smaller predisposition, but that’s all speculation.

So we have evidence that dieting does correlate with eating disorders. We have no evidence that it causes eating disorders. There are however many problems with talking about dieting as if it caused eating disorders (beyond the fact that it’s probably not accurate). Especially when the connection is drawn in a sloppy fashion, it implies that eating disorders are on a spectrum with diets and that one can slip from one into the other with ease. The further implication is that eating disorders are a choice, obscuring the reality of the genetic components of eating disorders, as well as the psychosocial aspects (which tend to be less about diet culture and more about individual stresses in someone’s life).

But perhaps worse is that it gives the picture that everyone who has an eating disorder is a chronic dieter, the kind of person who is always belittling themselves, or obsessed with their looks. This leads to the distinct possibility that people won’t get proper diagnosis, treatment, or support. It continues the love/hate relationship with eating disorders that our culture has in which the anorexic does what everyone else does but just does it better, so if you aren’t a model/fashionista/weight obsessed salad eater, you don’t have an eating disorder. And that’s a problem.

I’m not saying that we shouldn’t recognize that diets can predict eating disorders, but it’s not as if that’s not already in common parlance. Let’s spend some time focusing on the things no one thinks of, like a rape, or a bad breakup, or a bad family situation, or any other form of trauma that can easily precipitate a mental illness. Let’s get over the idea that an eating disorder is a part of diet culture, because it’s something else altogether and we know that.

 

The Role of Exercise in Eating Disorder Recovery

For people with depression, anxiety, or really any form of mental illness, a common refrain from well-meaning friends and acquaintances is often “well just exercise. That will help you feel better”. It’s true that there is good evidence that regular exercise can improve mental health (although there are many problems with simply prescribing exercise). However trying to incorporate exercise into a recovery and treatment regime becomes infinitely more complex in the context of an eating disorder. Over exercise is often a symptom of eating disorders, and for many people trying to recover it’s also a trigger for other self-destructive behaviors.

Because exercise is an important element both in healthy weight maintenance and improving mental health, but is also a triggering and potentially dangerous activity for someone with a history of overexercise, people in treatment for eating disorders must walk a delicate tight rope when it comes to their exercise regimes. This has been a particular struggle for me, and I’ve been looking for ways to bring exercise into my treatment in a positive fashion.

There are a few techniques that I’ve had some success with, but if anyone has more suggestions, please share in the comments. The first way that I’ve found to improve my relationship with exercise is to stop using the word exercise to refer to movement. This opens the way for all kinds of “exercise” that don’t involve going to the gym and using equipment that loudly announces your calories burned to you every time you look down. I swing dance and I rock climb and sometimes I just throw dance parties in my room and sometimes I try to just go for walks or have squirt gun fights with my friends. The more that I can find things that I enjoy which also happen peripherally to involve movement, the better.

The reason I try to use this technique is because the moment my brain is convinced that I am “exercising”, it becomes convinced that I need to hit certain markers of acceptability: burn a certain number of calories, exercise for a certain period of time, stick to a certain regime. If I don’t use the label “exercise” to describe what I’m doing, but rather focus on “fun activity, preferably with friends”, I get a lot more mileage out of the activity and don’t fall into a negative spiral that tells me I am not acceptably fit. Looking for activities that fit this mold also lets me double dip on my activities: not only do I exercise but I also find some depression fighting positive activities, and potentially social time as well.

Something else that has worked well for me is to accept that sometimes a complete break from exercise is necessary. I find exercise extremely helpful with anxiety and don’t like leaving it entirely behind (especially as I’ve been pretty active my whole life). However when I’m compulsively exercising every day, it can be much harder to try to slowly lower the amount of exercise that I’m doing while still doing some. In many ways it’s easier to simply say that I can’t be responsible about my exercising at this moment in time and I need to take some time off. This has the added benefit of giving me LOTS of extra time to do other positive things with my day.

There are a lot of ways that cutting exercise out of  your life for a time can backfire. How do you deal with all the anxiety you worked off before? How do you accept loss of muscle mass or increase in fat? How and when do you begin to add exercise back in without swinging immediately into over exercise mode again? Especially if you’re doing this while you’re trying to increase your caloric intake, it can take a serious toll on your emotions and your motivation to continue treatment. Unfortunately, this is one of those places I don’t have the answers: I’m struggling to find ways to begin incorporating exercise again without it becoming unhealthy.

One helpful way to deal with feeling guilty about not exercising or feeling extremely compelled to started exercising again is to find some friends who aren’t big on exercise. This doesn’t mean you have to dump your friends who are extremely fit, but there are people out there who aren’t particularly interested in physical fitness and are perfectly happy with their lives. I am a big proponent of distract until you’re in a healthier place, and finding people who will encourage you to do other types of fun and interesting things, model other versions of healthiness and happiness, and generally not bring up exercise as something you have to do is a great way to build a life that doesn’t circulate around exercise.

The final, and perhaps most difficult thing to do if you’re working on overexercise is to make sure that you’re not paying any money for exercise. What I mean by that is if you’re paying for a gym membership or classes or a personal trainer: stop. I’ve found that when I’m shelling out money I feel obligated to “get my money’s worth”. You can always go to the local rec center and swim some laps or go for a run or a bike ride. But those ongoing expenses are a constant pressure to get to the gym and make it worth it and I’ve found that pressure nearly unbearable.

Of course all of these are just suggestions that I have found helpful, and won’t work for everyone. I’d love to hear other suggestions in comments, especially from those who have found an exercise regime that works for them.