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.

Imagining non-ed life.

I have recently come to the end of a short period of CBT and now have another wait for the next step of it. I suppose I have progressed a little, but the difference is pretty tiny. I can now eat in front of a few more people than I could before.. and that’s it. I’m not eating any differently, I’m exercising more compulsively. and I am just as preoccupied with my body and calories as ever.

On a more positive note, I do know I get to continue my training where I am already next year, which is a MASSIVE bit of good news! But now this is definite, my parents are pressuring me to get longer lasting therapy there (before, my excuse has been “what’s the point if I end up moving again in the summer?”) I am not against recovery, but the idea of having that first appointment all over again just fills me with dread. I can’t count the different people I have seen on one hand anymore, and I am frankly bored of waiting/ being optimistic about whoever the new person is/ relaying the entire saga of it all to yet another person.

Being perfectionistic as I am, I feel like it would be inadequate to accept help until they tell me I’m anorexic. As I now live in a different part of the uk to where I was diagnosed and treated before, my ed wants the same justification it had initially. I know it is irrational and dumb to think like that, but I can’t argue myself out of it. I know that the eating disorder will never reach “the bottom” and so it is pointless to tell myself I will try to recover when a certain set of circumstances arises. The circumstances will constantly keep changing, I will keep pushing back the idea of letting go, I will keep feeling like this, and all because it is scary and stressful to change.

In spite of all that, I imagine sitting with one of my present housemates in our future house (just the two of us next year woop woop!) and eating. I fantasise about planning nice meals together, cooking together, eating yummy things… but I am thin in all of those mental images.

I don’t have a bloody clue what I want. I want to feel and eat normally, but I would rather be dead than look normal and chubby and horrible.

Reading that back I am ashamed of sounding so vain. I know that it seems like it is all about my body, but really I know it is just control. I don’t want to be or feel out of control…

 

1/2 way mark.

Today is half way through my Easter break, but the last day of being at my parents house. I’m glad to be going tomorrow in a way, as I can get back to normality and get myself ready for the coming term.

It also means it is a year since I was in the middle of my first bulimic episode. Looking back on it I would say that anorexia is easier, as I’m much less anxious on a day to day basis and cry a bit less each day than I did at that point. Of course it goes without saying that things are by no means simple now either, but the time has allowed me to take a new perspective on this time last year.

When the binges and purging (usually a combination of laxatives and excessive exercise as I could rarely find an opportunity to be sick without being heard) began, I was totally and utterly ashamed. I have never been so embarrassed about anything in my life. I was having fortnightly gp appointments, which I cancelled for 4 months straight as I came to the belief that my eating disorder was gone and I had became fat and disgusting.

I have rarely felt as alone as I did during that time.

When I finally went back to the doctors I admitted to everything and felt huge relief that I had a) gone back without fainting with anxiety in the waiting room! and b) that I still had an eating disorder (sad but true.) The issue was that I badly wanted my anorexia back, so I lied to the ed professionals about what I was doing.

Although that phase was deifnitely bulimic, I believe that I was a reaction to the anorexia rather than a standalone illness if that makes sense. Occassioanlly I have a few days where it flips again, but I now know that that’s my body fighting against starvation.

Another year has passed. Another year which I have spent being eating disordered and largely unhappy. Maybe in another year I will be in a better place.

In response to all your kind words… :)

Thanks to everyone who has taken the time to write comments on my posts- especially in the last couple of weeks. A lot of uncertainty in my general life has led me to feel a need to take even more control over my eating disoder. In some ways this is good because it has made me think long and hard about recovery; it has also made me realise that whatever the outcome of my upcoming therapy appointment, it will be a long wait (as usual) until anything drastic changes to what I’m currently having therapy-wise.

I have reached the conclusion that if you aren’t getting better, you are getting worse in some way. Every day that I allow my disorder to continue I’m making it a little more engrained in my behaviour and thinking. But the thing is I know I am not ready to change everything- maybe I never will be, but I hope to build the courage to jump in anyway! While I work relentlessly to be able to do x,y,z that my ed stops me doing now, I am counteracting that with creating stricter exercise and food plans.

After all the supportive comments I have made a decision:

I am not going to try too hard to do anything in either a positive or negative direction. If I try to recover in an unstructured way I will end up in a horrific bulimic phase like I did when my therapy stopped in the past. On the other hand, I don’t want to encourage myself to get sicker. If that happens anyway, then it will be a more gradual thing, which is more manageable (in my head.) If I am really honest with myself, things have been going on a gradual downer for a very, very long time, and as this  is unlikely to change, so I don’t need to pressure myself more than I already do in order to be sick enough to get treatment.

When the assessment for ed specific help comes around I will simply go in and be open about what has happened. Plus, I know how long the wait is for this kind of thing so I’m likely to be worse than I presently am by that point anyway.

I do believe I have the determination and self awareness to overcome my illness. I do believe that I can one day reach a place in my life where I can wake up and not be dominated by negativity about my body and food. I do believe that getting to that will be incredibly difficult, but when the chance to have more intense therapy than I presently have comes I will be able to do it. I believe that nobody can do this alone and so I will not expect that of myself- I will do what I can to be as positive as possible until the wait is over.

My blog is about being truthful and as nice as it would be for me to post all about how much I want to recover and how I’m going to wake up tomorrow and fight it, that would be a lie. For once I am proud of my ability to be both realistic and have a sense of optmism: I can’t fix it this second, but when I have access to the help required I can and will get better.

I wish I knew what is going to happen..

So.. this week I have had some really exciting news (woo) and some pretty crappy news too. The therapist I’m seeing has said that part of her job is to do what is best for me, and apparently that might be referring me back to the ed specific service.. except that ISN’T better for me. They will be different people, in a different city to where I went to that service before AND my experience with them there was rubbish. I have always been the type who would cry as opposed to feel rage, but one person there flipped that on its head. Never in my whole life have I physically want to cause someone else pain- until I met one of the people I saw there. She made me literally want to scream and break everything in sight. Of course, that wasn’t an option, so I have pushed these feelings of absolute anger to the back of my mind.

I waited ages to be seen, got turned away, got worse, went back a year later, got 7 weeks of help and then got told to go it alone. I’m not even back in that service yet and I already feel like I must be not sick enough, not thin enough for them to want to help me.

I feel inadequate, again, just like I did before. I know deep down that my disorder is very much affecting my life and I would like and need to have a normal life. But I just cannot get over this hurdle of not feeling like it would be justified to change- especially when the ed service has limited time and could turn me away, essentially labelling me not severe enough for them. That is the last thing I need right now. If that were to happen, then I would continue into this ed, depressed, anxious cycle even more, and that is not something that needs encouraging.

I want to be thinner AND better at the same time. And the latter of those might only happen if I do the former thing first. The health system is basically asking me to get worse so I’m able to get what I need to get better.

Who the hell designed that?

 

You know you have a messed up mind when a bit of you wants to be in hospital.

I know more than one person who has been hospitalised because of their eating disorder. For one of those people the inpatient time was only 2 weeks long. I don’t know what happened to initiate them going into hospital, but I just keep thinking that a fortnight is really not long at all, so maybe I would feel better if that happened to me…

I feel like an absolute idiot for even having the tiniest wish to go into hospital, but I can’t deny that it is there, and so I am writing to get it out. 

I have thought about this for a long time, and on days when I feel very low, having the validation of my disorder by being in hospital seems so appealing. Realistically speaking, I don’t want my life to be put on hold,.yet sometimes that is what I want more than anything else in the world. Sometimes everything just feels too much and I sit in a heap on the floor unable to do anything.

The “dream” would be to be fully eating disordered and function normally- obviously not an option- so when my issues are really getting in the way of my life, I feel like if I could finally hit the bottom of my ed then I could come back out of it and get on with being normal… The thing is, there is no bottom. There is always I way I feel I could be sicker, thinner, more depressed etc. There will always be somebody worse than me.

I guess part of my current worry, is that I am in a relatively new environment, full of people that mostly do not understand anything about any kind of mental,illness at all, and so it feels necessary and like it would be an “achievement” to prove to them that I really do have an eating disorder. 

Right now I am also waiting for one very, very important letter, which will probably determine what I’m doing for the next few years. I know that I will get this just before the end of the month. With that in mind, my focus is on hoping that it will say what I want to, so that I can relax knowing that my future is sorted out for a while. 

Once I read that letter (and if it is the outcome I hope for) then I will feel like I don’t need to keep holding things together, as I have been for the last months. If that pressure is relieved then I can relax a little.

The day I get that letter is also the day that I go home for Easter- busy time hey!? I have quite a long holiday and all I can think about is getting noticeably thinner for the new term.

Reading this all back just makes me feel silly. I know how bad it is to think like this, but right now there is so much pressure in my life that I can’t stop it. I WANT it there. I WANT to be eating disordered. I can’t let go of it now because it is the only thing I am holding on to.

If I get good news in that letter AND I lose lots over Easter, then I will tell my therapist I need the more intensive treatment option. Sorry to anyone who is reading all this non-nonsensical babbling, but hey, I wrote this to be a place to figure things out, and I have: I am as messed up as ever, I wish I weren’t, but right now I feel that I need and want to be. however much I want to get on with being normal.

Holding things in.

After a class of clawing at my body and wishing it wasn’t so disgusting, I had to take myself off alone so nobody saw me get upset. Sometimes I think it is bad that I hold things in from people, but who would understand me if I said things like “I can’t stop thinking about food, I love it, I want to eat, but I am disgusted by my body. I can’t eat, I don’t want to eat, I want everything to stop being difficult”?!?!

Anyway, writing therapy seems to have helped me to hold it vaguely together today (2 whole pages of scribbling my feelings in the changing room!) 

I wish I could eat the things I crave, but right now I know I cannot cope with how I would feel if I were to actually do that. At the same time, the thought of eating more makes me feel sick. As usual I am confused by my own mind..