The Weight of Recovery

It’s been seven months since I started proper treatment for my eating disorder, following eight months on waiting lists and an assessment period. Apparently, I have one more routine therapy session left next month, which is meant to wrap up the educational and therapeutic side of things. I’m feeling a bit overwhelmed by it all, so I thought I’d attempt my own version of a review.

Initially, I was refused support because of the complexity of my issues, not because I lacked them. The reasoning was that I was showing traits of all three main eating disorders, and they were concerned that treatment targeting one might worsen another. I was deflated by this, but my wellbeing practitioner contacted them and arranged for an extended assessment to see whether there was a way to help me find some balance and control.

The eating disorder practitioner, who is a registered mental health nurse, is absolutely lovely. I feel we’ve built a good rapport, and she often gives me positive feedback about how dedicated I am to getting better, particularly how organised I am with all the paperwork.

I’m on the ‘OSFED’ (Other Specified Feeding or Eating Disorder) pathway, as I don’t fit neatly into any one box and my issues aren’t currently life-threatening. I’m essentially in the middle of a Venn diagram, still with significant traits of an eating disorder, just not a straightforward one. They also initially mentioned ‘ARFID’ (Avoidant/Restrictive Food Intake Disorder), although that seems to have been forgotten about in favour of the other issues. As with most things in my life, it’s complicated.

I’m not sure what happens after my routine therapy sessions are over. I don’t feel better; if anything, some of my behaviours are worse than when I started. Perhaps that proves their original concern, that treatment could make certain things worse. I also feel like, by following their advice, I’ve gained weight much faster than I would have done without any support at all, which has been particularly difficult for me.

My personal goal in seeking support was to maintain a stable weight and to find some sense of control and balance with food. Their goal, however, has been different: to ensure I meet my nutritional needs, avoid restriction, and ultimately learn to accept my body as it is.

We’ve done a lot of psychological work around my eating disorder, including:

• Avoiding weighing myself.
• Keeping a food diary to help put my eating patterns into perspective.
• Exploring where my body image issues began and how they developed.
• Looking at my reasons to change, in the hope of creating some motivation.
• Thinking about how I see my future.
• Writing two letters to a hypothetical friend: one where I have an eating disorder, and one where I don’t.
• Looking at triggers for bingeing, such as episodes of anxiety or depression.
• Learning about the vicious cycle of bingeing and restriction.
• Identifying quick distractions for cravings, alongside urge surfing.
• Learning about the food pyramid and nutritional balance.
• Challenging the idea that certain foods are inherently “bad”, and that it’s important to enjoy treats every so often.
• Doing behavioural experiments to test my beliefs in cognitions.
• Completing an extensive chain analysis to identify where harmful patterns could be interrupted.
• Looking at relapse warning signs and identifying what a good, okay, or bad scenario might look like.
• Exploring other ways to feel a sense of achievement in life.

I was also offered mirror therapy to help with my body dysmorphia, but I just couldn’t face it. The thought of staring at myself for an hour and trying to find kind things to say felt overwhelming. I think I’d struggle too much with the self-compassion aspect; it feels uncomfortably close to self-indulgence.

Alongside the psychological work, we’ve also covered the biological and neurobiological side:

• The science behind eating disorders, including genetic factors, gene-environment interaction, and the different types of binge eating.
• The physical health risks, including effects on the heart, bones, gastrointestinal system and hormones.
• The life-threatening dangers of purging and laxative misuse.
• Starvation syndrome, including the Minnesota Starvation Experiment, and how restriction can trigger bingeing.
• Nutritional needs and why the body often won’t feel satisfied until those are met.
• Using a hunger scale to identify biological hunger and fullness.
• Learning that something I’ve always wondered about is a real concept: set point theory, which is the idea that your body has a natural weight range it tends to return to.

I was encouraged to create a support network with trusted people, such as my mum or Craig. I even had to identify their “support animal” based on the type of help they might offer. Ultimately, though, I realised I didn’t have the confidence to actually ask anyone for help, so I went through it alone. I’m not sure I’d want to feel under surveillance either, with people monitoring what I was or wasn’t eating.

The work has been hard. Really hard. Trying to deep-dive into all these deeply personal topics and somehow find meaningful answers. I’m often stumped, grasping at straws and hoping I’m saying the “right” thing. I worry that I bore the practitioner to tears when I waffle, go off on tangents, or sit in silence for ages trying to think of an answer.

It’s all well and good understanding your difficulties in theory, but actually applying what you’ve learned is the hard part. When I’ve followed the advice but still find myself seeking out sweets like they’re crack-cocaine, what am I supposed to do? The obvious answer is to distract myself until the craving passes, surfing the urge, but that isn’t always possible. And sometimes I simply don’t have the willpower, or I don’t want to resist. In those moments, I just don’t care, and I give in immediately.

I was hoping to come out of this process able to eat normally. Three meals a day without thinking about calories. To be able to have one biscuit from the packet and feel completely satisfied, without finishing the lot. I wanted my eating habits to be “normal”, my physical health to improve, and ideally to feel at peace with my body. None of those goals have been met. It’s hard not to conclude that I’ve somehow failed. That I haven’t worked hard enough, even though I know there probably isn’t any miracle cure.

I hope I won’t simply be discharged once the routine sessions are over. I don’t want to hear “We’re just a phone call away if you need us”, and that be the end of it. There’s no way I’d ever have the confidence to ask for more help, beyond my fair share. I’d suffer in silence rather than risk being a nuisance, especially when I know my situation is probably considered low priority compared to others.

Some kind of check-in every few months feels like a fair compromise: enough to make sure I haven’t slipped too far in either direction, and a chance to talk through anything new that’s come up. Because right now, I’m finding myself turning to fasting more often as a way of counteracting the weight gain, even though I know how harmful that can be in the long run.

Seven months in, I understand myself better than I did at the start, but understanding hasn’t translated into recovery in the way I’d hoped. I’ve learned the science, the psychology, the warning signs and the coping strategies, yet I still feel like I’m standing in the same place, just with more awareness of how I got here. Maybe that’s still progress, even if it doesn’t feel like it. I’m not where I want to be, and I’m scared of what happens when the structured support ends, but I suppose the truth is that recovery was never going to be something that could be applied like a software patch. Right now, all I can do is keep trying to find some middle ground between giving up and carrying on.