Tag Archives: doctors

Treatment and Support Options for Eating Disorder Recovery

support

Recovery will be the best choice you have ever made for yourself. You will be choosing life over death. You will be choosing health over sickness. You will be choosing happiness over misery. However, recovery can be daunting. It can be terrifying and extremely difficult and immensely challenging. It can bring with it feelings of anger, guilt, sadness, shame, anxiety, and pain. It can leave open wounds that you were trying to cover by using your eating disorder as a band aid. It can uncover truths and experiences and memories you were trying to suppress. Because of this, it is important that you use all opportunities given to you in the form of professional support. This can be harder in countries where you have to pay for all professional help and do not have the NHS, but it is still possible to find help and support even if you are strapped for cash.

In this post I am going to go over some of the treatment and support options that you might want to consider.

Inpatient/hospital 
Inpatient treatment would be provided in a hospital setting. The main aim of inpatient is to medically stabilise the patient and get them back to a healthier weight, before discharging them. In most cases they would be discharged to a residential setting for continued care.

Residential
People using these services reside at a live-in facility where they are provided with care at all times. This means that they are under constant medical supervision and monitoring of both physical and mental health. Treatment programs within residential facilities are usually very structured, and they provide an environment in which the client can focus solely on physical and psychological healing with a great deal of support from their treatment team.

Intensive Outpatient (IOP)
Intensive outpatient is suited to those who need more professional support than outpatient treatment but still need flexibility to continue their education or job. IOP Programs generally run at suitable times for the participant, ranging from 2-5 days a week. Treatment usually includes therapy, nutrition consultation, topic focused groups, and/or family support groups.

Outpatient
Outpatient is much less restrictive than inpatient, and is good for those who have a job or are attending school or any other form of education. It is also an option for those who do not have the insurance to cover higher levels of care, but still really need a moderate level of support to aid their recovery. Those in outpatient programs may see a therapist, nutritionist, and other recovery professionals around 2-3 times per week.

Therapy
For those who don’t want to consider inpatient, outpatient, or residential, or who cannot get a placement for any reason (and that will be the majority of those with eating disorders), there are many options where therapy are concerned: Cognitive Behavioral Therapy (CBT), Medical Nutrition Therapy, Dialectical Behavioral Therapy (DBT), Acceptance and Commitment Therapy (ACT),  Art Therapy, Dance Movement Therapy, Equine Therapy, Exposure and Response Prevention Therapy (ERP), Family Therapy, Interpersonal Psychotherapy (IPT), Cognitive Analytic Therapy (CAT), The Maudsley Method (also knows as Family-Based Treatment), and Mindfulness-Based Cognitive Therapy (you can find out more about these therapy methods here, here, here, and here).

For those who cannot afford therapy and are in education, see if your school, college, or university has counsellors on site that may be able to provide you with free support. You may also be able to find therapists at reduced costs who have been fully trained but have not clocked up sufficient hours yet.

Support Groups
If you cannot afford any therapy, cannot get any using the NHS, and are not in education or have none in your educational institution, check out if there are any support groups near you that you can utilise.

If you cannot find a therapist or support group, you could ask the NEDA Navigator service to help you find support in your area – wherever you are from – or just to vent to and get some support from. (Beat also have a HelpFinder).

Doctors
If you can, do make sure you are seeing your doctor regularly, or at least semi-regularly, to get updates on your health. Again, I know this can be a money issue for a lot of you, but it is really important that you know where you are where your health is concerned. Doctors can also help you find support groups, and give you referrals for therapy, inpatient, or outpatient programs.

Helplines
If you are struggling to find any support, do know that there are many helplines available. There is NEDA’s information and referral helpline (there is also a Click to Chat option so you can instant message if you would prefer to do it that way), there is BEAT’s 1-2-1 Chat Online service, BEAT’s online services, and BEAT’s helplines.

Forums
I would advise being careful with forums, as they can often lead to triggering discussions, but if you are going to visit forums (and they can provide invaluable help and support) I would advise BEAT’s forums, NEDA’s forums, or the forums on Your Eatopia (the latter has a tiny fee but I would say it is really worth it – personally it helped me more than anything during my time in recovery).

Self Help
There are self help options such as books on certain therapies (like CBT workbooks), anorexia and bulimia workbooks, other eating disorder workbooks, online resources etc that can help you work through your issues with the help of workbook exercises, challenges, and reflection.

I hope that if you struggling and don’t know which way to turn, this comprehensive list enables you to find help and support during your recovering from your eating disorder.

If I have missed any that are important, do let me know!

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Men Get Eating Disorders Too

eating-disorder-mirror-drawing

Eating disorders are stereotypically seen as an illness that young, white, females develop. Whilst this is obviously an outdated myth and anyone of all ages, genders, and races can experiencing eating disorders, there are still a huge amount of people ignorant to the fact that many men suffer from eating disorders too and it is just as serious when men suffer from them as when women do.

Studies suggest that eating disorders are on the rise in men. However, it is also theorised that this may be because eating disorders in men are becoming less stigmatised and more men are coming forward and seeking help and treatment for their illness. Out of those with eating disorders, it is reported around 10% of sufferers are male, although again, these statistics are unreliable due to the fact that so many men do not come forward for treatment, and a recent study on a large university campus found that the female-to-male ratio of positive screens for eating disorder symptoms was 3-to-1 (Eisenburg, Nicklett, Roeder, & Kirz, 2011). As it says on the website MGEDT:

“Conflicting and poor quality data is one of the biggest problems in pinning down the full extent of eating disorders in the UK and indeed the world. According to Beat information from the Department of Health only shows how many individuals received inpatient treatment. This only captures only a very small percentage of cases, since as much as 50 per cent of treatment is provided by private clinics and only the most severely ill will receive inpatient care.”

Through large scale surveys it was found that in the past thirty years, male body image concerns have increased severely, with 15% to 43% of men being dissatisfied with their bodies; rates that are comparable to those found in women (Garner, 1997; Goldfield, Blouin, & Woodside, 2006; Schooler & Ward, 2006). In adolescent and college samples, between 28% and 68% of males of normal weights saw themselves as underweight and reported that they had a desire to increase their muscle mass through dieting and strength training (McCabe & Ricciardelli, 2004; McCreary & Sadava, 2001).  (Statistics and sources taken from the NEDA site)

So why do boys and men get eating disorders? Just like with girls and women, the reasons are vast and complex. Bullying, abuse, dieting, feeling pressured whilst engaging in sport, having a career that demands thinness (such as modelling or acting), and diet culture can all be a catalyst in the develop of an eating disorder in men (and these are just a tiny selection of the things that can trigger an eating disorder). It is also shown that the media is having an effect too, and that exposure to male body ideals are causing men to compare themselves to these ideals and this is positively correlated with the drive for muscularity in men. The fact that we are living in a society that still places importance on gender roles and traditional masculine ideals means that males have negative attitudes towards seeking psychological help. In addition to that, we are not identifying eating disorders in boys and men:

“Doctors are reportedly less likely to make a diagnosis of eating disorders in males than females. Other adults who work with young people and parents also may be less likely to suspect an eating disorder in boys, thereby delaying detection and treatment. A study of 135 males hospitalized with an eating disorder noted that the males with bulimia felt ashamed of having a stereotypically “female” disorder, which might explain their delay in seeking treatment. Binge eating disorder may go unrecognized in males because an overeating male is less likely to provoke attention than an overeating female.  This inferior image, among other things, contributes to the reality that 1 in 10 cases of eating disorders involve males. Particularly, for the disorder anorexia, up to one in four children referred to an eating disorders professional is a boy.” (ANAD)

Even though the stigma may be dissipating, it’s still there, as illustrated by the experiences I have been hearing about. One male wrote to my blog to tell me that his doctor told him he could not have anorexia because he could not experience amenorrhoea as he had no menstrual cycle to lose. Another man told me his doctor thrust a leaflet about eating disorders into his hands and offered no other information or support. It is extremely worrying to hear that even professionals are dealing with males with eating disorders in a way that is so dismissive and also shockingly ill-informed.

Men also find it extremely hard to talk to other people about it, because of the sense of shame they may experience in relation to having an eating disorder, and again, this is down to stigma in our society. They are afraid of being judged, and they are afraid of the negative reactions of friends who might laugh it off and dismiss it or make fun of them for suffering from an eating disorder, because it is still to some extent seen as a “girl’s illness”.

Eating disorders can also be harder to spot in some men because it is more likely for women to have dramatic weightloss, whereas in men their eating disorders can expressed through “bulking up” and hitting the gym, which is not seen as particularly suspect in a society so keen on advocating exercise and showing male body “ideals”. as lean and muscular.  It is important to note that if an individual is taking performance-enhancing supplements in their attempt to become more muscular and then engages in weight lifting, they are at increased risk of suffering a heart attack or stroke.

It is of paramount importance that we recognise eating disorders in boys and men as much as we recognise them in girls and women. It is of paramount importance that we start treating them just as seriously and it is of paramount importance that we continue to reduce the stigma surrounding males and eating disorders so that those suffering will come forward for help and support, from their doctors, from their friends, and from their families.

MinnieMaud: Is It the Only Way to Recover from a Restrictive Eating Disorder?

your eatopia

I have had quite a few people ask me if I believe that MinnieMaud is the only method of recovery that will result in remission. The answer to that question is not simple, so I have gone ahead and written over three thousand words on the topic.

MinnieMaud (MM) is the name of a recovery method with guidelines constructed by Gwyneth Olwyn, on her site Your Eatopia. Whilst MM has received much criticism, and is seen by some as controversial, many inpatient and outpatient facilities do enforce methods alike to MM, such as similar calorie requirements, and remaining sedentary. Other people find that they end up recovering in a way much like MM without having ever heard of that particular recovery method (for example Caroline, from The Fuck It Diet), and I would argue that that is because this type of recovery is normal and natural for the body.

As I see it, the main goals are:

– To eat minimums, and respond to any additional hunger and cravings
– To not engage in exercise
– To eat whatever you want, whenever you want
– To not weigh yourself (be blind-weighed if needed)
– To accept your body, and anyone else’s body, at whatever size it is naturally, and not try to control your weight, as your body does that for you (weight set point theory)

To the present me, these aren’t particularly controversial ideas, but with diet culture being so prominent in our society, I can see why some find it hard to accept, and in the past, I myself was one of those people doing furious amounts of further research and questioning what I read when I first came across Your Eatopia. I looked all over the internet. I asked other people about it. I relentlessly emailed Gwyneth about my doubts (and she always took the time to reply). I didn’t agree with all of it (and arguably I still don’t agree with some of the content of her blog posts), but I knew deep down that so much of the information was making sense to me. A lot of the posts were talking about things I had experienced during recovery and up until that point had had no idea what it was that was happening to my body. Reading the articles gave me a great deal of relief in finally having a logical explanation for the processes that my body was going through. So much of it clicked into place for me, and in hindsight seemed obvious.

I believe that during recovery it is crucial to eat “minimums”. When it comes to these “minimums”, I find it so important that people should follow them because if you let there be a grey area during recovery, it will be easier for the eating disorder to wedge its way into those cracks and convince you that you require less calories than other people (and less, and less, until you realise you have relapsed). It is necessary for everyone to stick to the “minimums” for at least most of their recovery journey, until they are stable and responsible enough to listen intuitively to their hunger. When this happens, things are slightly different, as appetites naturally vary from person to person. For example, my hunger generally leads me to on average 2800 calories, whereas someone else’s hunger may lead them to on average 3200 calories, and someone else may find themselves eating on average 2900. For older people, calorie requirements are often a bit lower (this is also taken into account with the “minimums”). Gwyn says that minimums are for life, and I interpret that to mean around minimums are for life, leaving room for natural variation. Eating minimums during the recovery process and then eating a slightly lower amount intuitively will not result in more than needed weight gain, as your body will burn off excess calories, or use them for the essential repair of the body. In fact, you are almost certain to experience extreme hunger at some point during recovery, and it is pivotal that you respond to it.

As for exercise, in recovery it is just as crucial not to engage in it as it is to eat minimums. To me this seems extremely obvious now (hindsight is 20/20 after all), but apparently not so to some professionals, and more understandably, those in recovery. If you have a broken leg, you would rest it until it was healed. To walk on it would not only prevent the healing of it, but it would make it much worse. This also applies to a damaged body. Not only that, but physical activity is a massively used and abused technique of the eating disorder’s to burn calories and exercise control (excuse the pun). The eating disorder is also an expert at convincing you during recovery (a vulnerable time) that exercise is healthy and needed, and that you can use it in a responsible way. It is very easy to fall into the trap of denial when it comes to this topic, and this was my biggest issue when it came to my own recovery journey. Just like calorie requirements, in remission it is different. In remission you are in a place where you can make an informed choice to engage in exercise or not, but you should always be extremely aware that you are walking a fine line, and it does make relapse more likely. If you feel you are stable and responsible enough to handle exercise without any problems, then it is your decision to go ahead, but also your job to always remain vigilant and to address and resolve any thoughts or behaviours that could pop up as soon as they do (if they do).

In recovery, I believe that no food should be the enemy, and if it is, this just accentuates an unhealthy relationship with food. I do not believe that there should be any forbidden foods, and I do not believe a distinction should be made between “good” and “bad” foods. I believe that all food is good food, and I also do not subscribe to labelling foods as “healthy” or “unhealthy”. I believe that if we stop associating foods with emotions and morality, we will be able to listen to our bodies and remain healthy by responding to it. From a personal point of view, that is working extremely well. During the beginning of recovery I was very hungry, and I also craved a lot of “unhealthy” food. Looking back, that seems perfectly rational: my body was starved and in need of a high amount of energy, and it also needed foods that it had been restricted from. “Unhealthy” foods not only provide lots of energy, but are rich in fats, carbs, and sugar, which were what my body had been restricted from for a very long time. As my body healed, my cravings and hunger settled down. As someone who is now fully recovered and does not see food as being a matter of morality or emotion, I listen and respond to my body and find that it leads me to a balanced diet. Sometimes I crave cheese. Sometimes I crave bread. Sometimes I crave cereal. Sometimes I crave ice cream. Sometimes I crave apples. Sometimes I crave broccoli. Sometimes I crave chocolate. Sometimes I crave bacon. Ectetera etcetera. I crave a variety of foods, at a variety of times. I trust my body fully to lead me to what I need to eat, and it seems to be working very well in leading me to eat a varied and balanced diet.

Not weighing yourself in recovery seems to me to be the most obvious one of all. So many people with eating disorders attach such great significance to the number that the association is not reversible, and so to weigh oneself opens oneself up to a massive trigger every single time one hops on the scales. The scale is something that does not need to exist in your life. It is an object infused with so many negative emotions that I would highly advise you to take a hammer to it in your garden (it seems to be quite therapeutic for some). However, you may need to be weighed for health reasons. I suggest being blind-weighed by your doctor, or by a partner/friend/family member. They could give you a thumbs up for progress, a neutral thumb for no change, and a thumbs down for weight loss. This gives you an idea of where you are and what you need to change or continue doing without giving you the specific number which is not going to help you in any shape or form.

Lastly, we come to accepting your body, and other people’s bodies, at whatever weight they are at naturally. People come in all different shapes and sizes, and that is the way of the world. Each body has its own weight range – its set point – at which it is at its healthiest and happiest, and each individual is different. To be healthy, and to be happy, you have to let your body gain to whatever that weight is. To try and control it and maintain a weight that is not your set point would be to restrict and to focus on intake all day every day (and that is not being recovered). Our weight is not as in our control as we think it is, or would like it to be. It is our bodies that decide what weight we should be, and we can either accept that or spend our entire lives fighting it (which many people tragically do). Some people are naturally slim. Some people are naturally voluptuous. Some people are naturally chubby. Some people are naturally muscular. Some people are pear-shaped, some are an hourglass, some are an apple shape, and some are other various fruit/veg/inanimate object shapes (still finding these nicknames for body shapes slightly odd). You should never judge or ridicule someone for their body’s weight, shape, or size, and neither should you do that to your own body. Body acceptance, for both ourselves and others, is an extremely important step that needs to be made by everyone in our society. I don’t think people can recover without finding it within themselves to make peace with their body. I don’t expect people to love their bodies (I certainly don’t love mine) but to accept it and move on from hating it and berating it and focusing on it is a crucial part of recovery.

There you have my in-depth opinions and reasoning for why I believe that the key points of MM are needed for recovery.

Do I believe that you can fully recover without those things? No. I do think that you can make a great deal of progress using other methods of recovery. For the first six months of my recovery I adopted the “eating healthy and exercising” method. It helped me a great deal: I was eating enough and eating a far more varied diet, which brought me back from being very, very sick, to being sick. What I noticed from those six months was a vast improvement in the functioning of my brain. Before, my cognitive abilities were impaired, I had severe brain fog, my moods were horrendous, and the only word I can really describe my state at the time is “insane”. I was not behaving in a rational way, and I was not able to think straight. I was not able to make logical decisions, and my brain was just not working correctly at all. Eating an adequate amount really helped with that, and I was able to regain my cognitive abilities, and some of my former self. However, I was far from recovered and I knew that, but I didn’t know how to move forward until I came across FYourED, which then led me to Your Eatopia. I read the information and advice given out there, which gave me a way to continue moving forwards on my journey to living an ED-free life. I don’t think continuing to focus on intake (whether calories or macros, or even just food types without being so specific) and exercising during the recovery process will ever lead to a full recovery, because there are still so many rules and restrictions, which the ED both creates and thrives on. Whilst people without the genetic predisposition to develop an eating disorder are able to try diets, go through phases of exercise frequently to try and lose weight, and engage in acts and thoughts pressed upon us by our diet culture, those with restrictive eating disorders do not have the luxury of doing so, as it will most likely cause a relapse at some point. I believe that to attain a full recovery, diet culture must be tossed out in the trash as well as your ED.

Without the help and encouragement from the wonderful community on the forums on Your Eatopia, and without my own determination to fully recover from my eating disorder, and without the extremely extensive and valuable support network that I have in my life, I don’t think I would have been able to recover, especially not using MM. Most of it was down to being so resolute in my decision not to go back to where I had been, but I had the privilege of having a family that tried as hard as possible to provide me with support when I needed it, but also left me to recover how I saw best without question (and this was the most important part for me). I also had the privilege of my many fantastic friends who all were rooting for me, who stuck by me throughout the entire journey, and who also let me rant and vent whenever I needed to. I also have friends with eating disorders and met other friends through recovery who were also recovering, who were invaluable to me, as we walked the journey to freedom together, and propped each other up when it was needed. I also had a partner throughout the first six months of recovery, who was essential in providing motivation, and in some ways built the foundation of my journey. Our relationship, in both its triumphs and failures, became one of my main inspirations and was always a reminder to keep on moving forwards, so that I may never repeat the mistakes I made again.

This meant that I had something that so many people lack in recovery: a strong support network. and a normal life to go back to once I reached remission. Some people do not have that to look forward to. Some people do not have the support of others. This can mean that recovery is a hell of a lot harder, and sometimes that can mean that the guidelines of MM are unattainable at this point in their lives. It can mean that they are not ready to embark on that journey, which is incredibly difficult and requires a sometimes overwhelming amount of dedication that some people are not able to give right now. It can mean that the anxiety and guilt that comes with recovery is too overbearing without having people close by to help with those negative emotions and experiences. Some people do not feel strong enough to oppose diet culture and the people who subscribe to it. All of these are valid reasons for not wanting to follow MM or a similar method, or not wanting to choose recovery at all (although I would still encourage you to try, because you have no idea how strong and courageous you actually are when the ED constantly tries to overpower you).

I am also aware that some people use the guidelines as just that: guidelines, and I think that is okay too if you feel confident in doing so (although I will always condone following them pretty rigidly as that is the stance I have chosen to take as I am so aware of that “grey area” that I talked about earlier).

In conclusion, I agree with the MM guidelines, and I agree with the general ideas and opinions that Gwyneth is trying to get across. However, I do not agree with everything Gwyneth writes about, and there are lots of things that she says on Your Eatopia that I am unsure of because I have not done further research on them. I prefer not to identify with MM as a singular recovery method (although it seems I have become one of the key spokespersons for MM, on Tumblr at least). This is because I would like to move away a little from just the specific recovery method and would prefer to take on an approach more like Caroline (The Fuck It Diet), where I am not just talking about the recovery method, but also a way of life. However, the two need to still be separated as recovery is more black and white whereas remission has room for experimentation. I also think that those general ideas are for anyone, anywhere, not just those with eating disorders, and as I said, a way of life. It means that I am stuck between being black and white (MM-style) for those who are in recovery from restricting eating disorders, and my own opinions about being less rigid but still vigilant in remission, and also being an advocate for the general guidelines as a way of life for those without eating disorders as well.

I believe that the guidelines at the beginning of this post are needed to reach a full recovery. The label of “MinnieMaud” does not have to be slapped on it, but I personally found my way through Your Eatopia, and through “MinnieMaud”. It provided me with a way to regain my life, and I know it has saved countless others. So whether you recovered by finding those guidelines through Your Eatopia, or whether those guidelines just happened to you throughout your recovery process because you recognised they were part of recovery, I believe they are of paramount importance to reaching remission.

A Word on Doctors

Smiling successful team of doctors.

When it comes to doctors, we often accept their word as fact. We see them as a source of knowledge and truth. In reality, they are people, like you and I – just with a lot more knowledge, education, and experience in the medical field. Doctors are to be used as a tool for your recovery: one tool amongst many. They are not the be all and end all of your recovery. They can provide a diagnosis and help treat some of the physical damages that are the result of your eating disorder. They can give you referrals for therapists and inpatient facilities. They can monitor your progress during the initial stages of refeeding, to make sure that you are not at risk of re-feeding syndrome, and are gaining weight. They can talk to you about different methods of treatment. They can help and support you, but that help and support can be limited.

Doctors are professionals. They have studied for a long time, gotten numerous qualifications, and extensive training. However, that does not mean that they are always right. Doctors make mistakes. They also don’t know everything, and of course, science is always changing and finding new evidence that points in different directions. Science may be factual, but a lot of the time when human beings uncover evidence, we haven’t gotten the whole picture, and so time and time again we find new evidence that points to something else. We can never know anything for certain. So when it comes to eating disorders, not only is there barely any research on the subject in comparison to other medical topics, but there is barely any research on recovery methods, and doctors need to know a lot more before they can hand out any concrete advice. No one really knows what is successful and what is not. In fact, most treatment methods advocated by professionals have poor success rates. Eating disorder recovery is, at best, trial and error.

In addition to that, it is common knowledge that doctors in general are pretty good for physical ailments, but not so good when it comes to mental health. Individual doctors have their own judgements, opinions, and viewpoints that interfere with the way they give out medical advice, not to mention the lack of training on the subject of mental health. This means that doctors are lacking both information, training, and personal experience – which doesn’t really build a strong case for them when they hand out medical advice for eating disorders recovery. They don’t actually know what is best for people in recovery a lot of the time. Consult your doctor, listen to what they have to say, and make your own decisions based on what you think is best for you. If you follow your doctors advice and it isn’t working, it’s time to try out something new. This could mean seeing a new doctor. It could mean trying out a new recovery method.

There are so many reports of people being treated by their doctors in ways that have triggered them, caused them to relapse, harmed their recovery efforts, and given them the wrong information, that what they say surrounding this topic needs to be taken with a pinch of salt. This doesn’t mean that you should ignore everything that your doctor has to say, but it does mean being aware that doctors are just people. They do the best they can with people suffering from eating disorders, but when it comes down it, they don’t have a lot to go on. This also means that with some doctors, what they suggest will depend on their own ideas about the illness. You can go from one doctor to the next and get completely different recommendations for eating disorder recovery. They also are people that live in our society too – a society in which diet culture thrives. Their advice can be useful, but it doesn’t mean it is always right.

This also applies to other professionals, such as therapists, dieticians, nutritionists, and anyone else that you may come across on your recovery journey. It’s not all doom and gloom: I have stumbled upon, read about, and talked to other people about professionals that have given them terrible advice, but I and many others have also had experiences with wonderful professionals that have been incredibly helpful, supportive, and informative, and have done a lot for people on their journey to remission.