I am kidding myself

July 31, 2017

CN: eating disorder, dieting

I have had non-purging bulimia and binge eating disorder in the past. I had disordered eating for many years as a teenager but the overt eating disorder only emerged after a crash diet. This is a common story: strict restriction hugely increases your risk of binging simply due to the physiological response to starvation. I was in the psychiatric system for my bipolar disorder and the psychologist I was seeing did a detour and treated my eating disorder pretty successfully. The fact that strict dieting (i.e. restriction) causes binging which causes compensatory behaviour was drummed into me and while I didn’t really believe the link before, I do now.

I went on a diet for the last three months of last year and I lost 23lb. I told myself I would do it slowly and not trigger my eating disorder. I had norovirus twice in the last month and my weight dropped much faster than my planned 1lb a week. I started getting urges to binge which gradually got overwhelming. I thought I would ‘pause’ dieting and deal with the urges to binge. I did not. I binged and compulsively overate (discrete episodes of eating very large amounts very fast feeling very out of control over a background of generally eating much more than I wanted to). I put back on all the weight plus 15lb over the next six months. This coincided with other medication changes so perhaps there was more to it than simply the eating disorder. I read Fairburn’s Overcoming Binge Eating which is the gold standard in self-help. Eventually, I wasn’t binging anymore and my urges to binge pretty much disappeared so I felt the eating disorder had abated again.

When I weighed myself and found out how much weight I had put on, I was so shocked. I felt crushed. Yeah, it was an over-reaction as in the scheme of things it is not that massive a deal. It’s not a death in the family or a diagnosis of terminal illness. But still, I had this drive that I couldn’t be that weight. It was unacceptable.

So I went on a diet again and here I am. I have lost weight faster than I originally agreed with myself (red flag) and I feel triggered to cut my calorie intake right down (red flag). I log everything I eat in an app pretty obsessively (red flag) and feel reassured by how in control I am (hahahhaaa). The statistics say that when I stop this diet, there is a 65-90% chance that I am will put the weight back on and a 33% chance that if I do, I will end up heavier than I started. I feel a mixture of hopelessness and hope. There is so little chance that I will be at an acceptable weight (and for me, that is not ‘thin’ but simply a BMI below 30) permanently but there is that little thought that maybe I will manage it this time.

What am I doing? I am kidding myself.

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Insight, or I had a shower four days in a row

July 23, 2017

CN: self-harm

I had been ridiculously depressed since the New Year, possibly as a side effect of a drug I’m taking for a physical health condition, after a three month mixed state/mixed episode/dysphoric mania. As depressions go, and I am a connoisseur of twenty-five years, it was pretty grim. My world restricted down and down as I stopped doing things. One of the things I stopped doing was showering very often.

When I was a teenager and lived with my parents, the only room in the house with privacy, or a lock, was the bathroom and so that’s where I self-harmed. I self-harmed for around eighteen months before I told anyone about it and it was very lonely. I would go into the bathroom for a shower, cut myself (three one night, four the next, to make groups of seven, fuck yes, I might be mad) and then shower watching the red water run down my skin and swirl at my feet. This continued for a few years. So a shower equals self-harm for me. I haven’t self-harmed in years now but the association is still there. I feel like when I am in the shower I am prey for my intrusive negative thoughts (in English, that means bad thoughts that force their way into your mind) and it crushes my mood. A shower also takes a lot of energy when you don’t have many spoons. Showers, not a fan.

When I was last well, and that was over fifteen years ago, I showered every day. The above still bothered me but I had enough resilience to overcome them. My ‘good periods’ since I stopped working are to shower every other day. If I have a shower in the morning (haha, afternoon) then I spend the rest of the day saying “at least you’ve had a shower” to myself in relief.

At my worst, I just don’t shower. I think the longest I went was over two weeks but two or three showers a month during a bad spell of depression would be typical. My severe depressions last months at a time.

What the fuck has all the banal detail in my showering habits got to do with insight? I have had a shower every day for four days and feel like I could be okay with that. So? I genuinely can’t tell sometimes when I’m ill. That will sound completely ridiculous to someone who hasn’t had lack of insight. This symptom plus this symptom plus this symptom equals this mood. I think people experience it differently but, for me, when I’m depressed it isn’t that I am ill that all these things are happening to me but because I am stupid and lazy and these things should be happening and the universe is functioning as it should. It is fair and right and entirely deserved. When I am manic, I simply disagree that things are as bad as other people say. They are simply wrong. If I am feeling magnanimous then they are simply misinformed if well-intentioned. If I am feeling paranoid (and I would never use that word or recognise it as that at the time) then they are deliberately trying to curtail or hurt me. All these scenarios actually happen to people and have happened to me so why don’t they count now I’m supposedly “ill”?

Showering is a proxy for me. I like to think that I always try reasonably hard to have a shower so the amount of effort is pretty constant over time. It is the other factors that vary (i.e. my mood) and those that determine whether I actually have a shower. So if I am not showering then I am depressed. No, I am just rubbish and pathetic this time and in a few months I won’t look back and think “you were depressed” and this is simply cause and effect; it is real this time. It doesn’t completely convince me but I allow the possibility that it’s not real this time. That opening of the possibility gives me a space that I wouldn’t have had.

So maybe I am well now. I feel fine, calm and somewhat positive. I’m even wearing makeup (oh no that’s a red flag proxy) and going out to meet friends (I have this drive to socialise, oh no that’s another red flag proxy) and I find it hard to get to sleep despite my antipsychotic (oh no) and I don’t sleep long but wake up raring to get going (oh no). These are all such little things and none of them appear in the diagnostic criteria. I can’t trust myself to tell what my mood is directly as fine can mean depressed, normal or manic in retrospect. But I can feel smell the wind.