Friday facts: OCD 

Right now I’m writing this blog post about reducing obsessive compulsive behaviours because I’m doing it as we speak. I like repetitions and even numbers, that way I know I’m doing tasks correctly and being safe. My therapist asked me to see how I felt if I only checked once. No repetitions. 

Anxious. That’s how I feel. 

I suppose the theory behind exposure tasks is absolutely solid: the more you are in anxiety provoking scenarios the more of them you can tolerate. It seems so logically to simply wean off doing things that aren’t helpful to me, but let me tell you, it’s pretty damn hard when you actually do it. 

So far these are how I have managed my discomfort:

1. Leave the room. Being physically distant from where you tried out the different behaviour means you are less tempted to go back and “even out” afterwards 

2. Tell someone. Hearing from others that the fears are in your mind is a useful reassurance when you feel on edge

3. Accept anxiety. You’re uncomfortable, just like me right now! But that’s normal. Having feelings makes you human. Just let them be. 

Therapists being people

I had a session the other day, and while waiting beforehand someone I knew came in.
It was the low intensity therapist I saw before being put on the higher one. I was shocked that she remembered me after so many months!
And then it hit me: THE ONLY 2 therapists in that building today were my old one and my current one.
I know that therapists are professional and don’t blab about people, but as I left, I couldn’t help but think about what they would be saying about me. Do they talk? Do they like me?

What is therapy anyway?

I had therapy today and had some thought provoking, and emotionally challenging discussions. I have seen quite a few different people over the years: a youth counsellor, a support worker, an eating disorders nurse, a low intensity therapist, and now this high intensity therapist ( who is a clinical psychologist.)
My experiences with them have all been very different, and few of them have actually helped me to change my attitudes and behaviours. I guess the problem is that mental illness is totally different to medical ailments; instead of medication, rest or diagnostic tests, mental illness requires time to heal.
The whole world is always racing against time and money, and so I’ve no doubt that there are millions of people who, like me, have been through several short interventions, only to find that nothing changed.
For me, the hardest part of therapy is being honest. In that hour a week, I have to answer questions that spark deeply emotional reactions that are supported by negative beliefs I’ve had since childhood. There are many things about my illness- such as weight, self harm, and feelings of fear that are almost impossible for me to be talk about. My body tenses and my words become short. It’s like there is no explanation strong enough to describe what I feel. Obviously, it is vital that I’m able to overcome that difficulty in order to question my views and take a healthier approach, but it just made me think about the whole concept of therapy. I mean it is basically an optional hour of stress in a way!
I know that left to my own devices I would not be able to make positive progress, yet it is easy to feel stupid for not seeing why my views are warped without needing someone to show me. I know it isn’t normal to do the things I do, so why is it so hard to do anything about it on my own?
I don’t really know. All that I do know, is that therapy is incredibly useful. My therapist is kind and open for a laugh at times too. She is clearly very knowledgeable about the human mind and the effect it can have on our behaviour and self worth, and I am being exposed to many new techniques to change my current outlook on life. I’m grateful for her, but I’m also aware that it isn’t too long until the end of our sessions. Scary times.

To be in control there has to be no rules to break

My relationship with food and exercise is all about hyper awareness of everything. Everything is calculated and judged as good or bad accordingly.
If I feel I’ve over eaten then I would be obliged, based on my rules, to fast for a certain number of hours.
At some point, daily restriction makes me so desperate to eat that I “binge”- usually meaning a normal calorie level instead of my acceptable calorie allowance (again all this is determined by the rules).
So how the hell can the cycle be broken?! Surely if the rules are abandoned then the whole thing just flies out of control and I would eat anything and everything and become disgustingly obese … Or does it?
Therapy this week made me think that maybe if there are no rules, then no food is terrifying or off limits. Food would just what it is: food. Not a punishment or a reward; not an emotional numbing device; not the most important thing in my mind; just food.

IAPT therapy and eating disorders

I am currently being treated in the high intensity iapt service. I hadn’t heard much about the iapt thing until I got referred, and so I did some investigation into it online. Initially I was a little confused, as it seemed that Body Dysmorphic Disorder was as close to ed’s as iapt went. I was psyching myself up for some more pointless therapy.
But then I got there and was utterly surprised. My therapist is a clinical psychologist who has done the extra work to be a HI therapist. Therefore, her educational background is very broad in terms of the kind of psychological issues she has studied. Even so, I know that ed clients aren’t people that she works with regularly.
From personal experience I knew that an ed service probably wasn’t the way to go though. The waiting lists are long and the cases are usually prioritised by physical risk; I’m not dying so they would probably assess me and send me on my way.
Since starting my iapt cbt, I have found documents online about particular iapt services that do specifically say some ed clients are seen in their services. All I can say is that I’m so glad I took this option.
My therapist is warm, kind, organised and helpful. She has books about cbt in eating disorders and is giving me ed specific homework. She also recognises the need for medical input and so I am being monitored by a gp- like I would be in a ed service. She has created a formulation that merges my ed, anxiety, depression and self esteem into one, and has helped me through the hard parts of starting antidepressant medication.
I feel like she might be the person who can really help me 🙂
I’m also totally fascinated by therapists. I kinda find it hard to imagine them as people outside of work! It must be a really rewarding job, and I suppose their own life experiences probably make them better at understanding others.

Hungry for what?

In cbt today I learned that an ed sufferer has to be recovered for around a year before the bodies ‘full and hungry’ reflexes work properly again. No wonder I never know what to eat!

Today I have made a goal:
By Christmas I want to be able to sit and eat something, even if it is just one of everything, with my family.

From this moment onwards, I promise to commit to the tasks my therapist sets me. This week I have to eat breakfast, lunch, tea and one snack. No more , no less, no changes. I can’t trust myself, so I need to trust her and her plan.

Fortunately she is brilliant. Friendly, upbeat , informative and focused. She always has a plan for the session and she always asks me very directly about tricky things. For me that’s good , because given the opportunity to keep any suicidal thoughts or specific food things hidden, I will take it! I think that cbt therapists everywhere could learn from her. I just feel so comfortable talking to her, which makes me motivated to go back next week with so good efforts to report.

Night for now.

Cbt formulation and medication

So it’s been a while since I posted. I have so much to say that I have struggled to order anything that made any sense! So here goes:

Since my last post I’ve started on sertraline. I’ve always had this strong feeling about not taking tablets, but when I’ve started imagining my own death and thinking about ways one could die, I figured maybe the drugs are worth a shot. A bit up and down, but sometimes I am definitely feeling their positive effect.

I’m also starting to make some real progress with engaging with therapy. The thought of being weighed terrifies me so much that I’ve been discharged from treatment for lack of compliance in the past. Maybe it’s the drugs; maybe it’s me, but I’m suddenly understanding why they want me to have regular weight checks.

My cbt is taking place through the uk IAPT service. I know that usually it would just be an ed service, but because of my depression and anxiety, one of the iapt therapists has decided to see me and use an eating disorder formulation ( with additions for other issues). She is a lovely lady and I feel totally comfortable in being honest with her. I like that she will always be honest with me too – like if there’s an aspect of eating disorders that she is not 100% sure about. Most of the time though, I feel like she is helping me map my way through my thinking, and I’ve never felt so clear about how and why and when I do and think as I do.

Obviously, it is early days, and I self harmed two days ago, BUT I am beginning to have hope that I can change. Wow. That doesn’t even sound like me talking!

Sick of it.

I went to cbt today (which focuses on the anxious and depressive thoughts I have) and she wants me to have higher intensity treatment.
She also said “obviously in terms of how are you , bmi and what have you, you wouldn’t fit the ed service criteria.”
Well. Screw the system then.
Anyone who reads this and is from the UK can hopefully testify that the nhs system for eating disorders basically waits until you are on deaths door to help you. My parents and gp went to a lot of effort to get me seen by them back home, even though I had an underweight bmi, felt like crap and lost my periods. Although I know the system usually only allows for the most physically affected patients, her saying this has caused me to feel fat and disgusting.
Since September I have lost most of the weight I regained through my “rapid recovery” , which was in fact just my ed developing into bulimia.
I have so much more to say about how hurt and stressed out I am, but I just can’t find the words to say it. It’s been going on too long, I want to reach my weight goal and be done with it.(I’m well aware my last sentence basically screams disorder as in realistic terms I won’t ever be happy,)but whatever, I’m just sick of it all.

An epic day & a plan of action :)

Today I got my assessment marks at college and they have made me smile! My response to “you got the highest marks in the year” was “are you joking?!” I am so happy that my hard work has paid off, that my teachers like me, and that my psychological issues have not got in the way of either of those things.

After a tough day seeing a therapist yesterday, I am feeling mega positive after the surprisingly good news this afternoon! So, I have been thinking carefully recently about what I want to do about everything, and this is the plan:

-Reach the body measurements I have set myself, and then STOP. The weight I want to be is one that I have maintained on a healthy amount of calories before now, so I believe this goal is realistic.

-Accept the CBT appointment I’m waiting to receive in the post, and try to make the most of what I am offered. Become less anxious as a result.

-Continue to work hard in my studies, and do as much as I can to keep my ed stress outbursts to a minimum!

-Go to a youth ed group if I am eligible for the one I have in mind.

-Keep trying to accept that my eating disorder has to stop dominating my life if I want to have a healthier and happier life, but that I don’t have to abandon my ed label. My experiences and feelings will always be a part of me, because everything that happens is!

-Try to be more relaxed even when doing tasks that majorly trigger food stressing (such as getting food out in front of others.) 

Thanks to everyone for all the positive messages the last week or so. I always feel so supported when I know there are others who have ed’s who have been told they are fine, or who have had a tough time getting help/ getting help that’s actually useful, or who know how it feels to be trapped and not certain of what to do. I love that I’m not alone, and I think it is also good for me to be reminded that my problem is real & I do need to challenge it. Thanks… my blog is a very necessary outlet right now!

 

Anxious, positive and sad all at once…

So, I went for the awaited CBT assessment and I am going to get some for my anxiety, so I can hopefully go on to apply it to all the food stuff.

I am positive that getting some sort of help is now in the near future, but the whole thing did make me very anxious. I’m also annoyed by the fact that I mentioned how almost all my panic is about food, weight etc & she then felt it appropriate to say “you don’t have an eating disorder”

Although this was more a general statement than an accusation, I was hurt that she didn’t guess before I said that I did. It just made me feel like a not thin enough failure. I guess it is pretty dumb to dwell on that one point of conversation, but it all goes back to the fact that my ed feels like my protection, a piece of me… and above all, it is there every minute of every day in a very blatant fashion in my mind. All of a sudden I’ve realised that people only really see you from the outside. Of course, I take from this that I am not thin enough, and that I should be disgusted that my eating disorder is technically “atypical.”

Another mental argument I’ve also got going on is that I do have an eating disorder, so it’s ok and I don’t need to be freaking out…

Then there is the logical part of my brain that knows (very VERY deep down) that surely all of the above is insanity.

Will I ever get out of this? Am I even sure that I want to? Will getting thinner and people knowing more obviously about my ed really give me the twisted sense of justification I feel I need in order to give it all up? Would people even notice at all- I mean hardly anybody has noticed that I’ve never eaten at college infront of them (and we have been there 4 months)?

Everything is confusing. I am happy that some help appears to be on its way, but I’m worried that it won’t be right, or be enough help, or that I simply won’t be able to have a normal mentality.