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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by narcissistic_martyr on March 27, 2005, at 20:34:01
i am so tired of this... i'm 21 years old and have had an ED for almost ten years. Lately I feel i'm coming to the end of my rope. I'm 5'4" and currently around 84 lbs. Even though this isnt the lowest weight I've been at this height, I've been experiencing a lot of symptoms typically associated w/ anorexia... low bp, fatigue, depression, trouble concentrating. I've also been purging several times a day. Needless to say, all this has had a devestating impact on schoolwork, social life, and general well-being have all been compromised.
I know I need help, but I'm terrified of what, at this point, "help" will imply...namely, forced feeding/weight gain. i've been through hospital programs many times, and my experience has always been that they pack on the pounds so quckly that I come out feeling like a mishapen blob, completely dissociated from my physiognomy
Not sure what i'm looking to get out of this post... i know what i need to do (namely, "EAT"), but i've been stuck in this rut for so long, i dont know what to do...
Posted by Racer on March 28, 2005, at 1:19:16
In reply to Anorexic on the Edge, posted by narcissistic_martyr on March 27, 2005, at 20:34:01
Does your school have a student health center? Many times they will have a counselling service of some sort available, and that's my first recommendation. Second recommendation is, of course, a good nutritional counselor -- I go to one for my weekly spanking ;-O -- who will work with you to build your way up to normal amounts of food.
Horrible as it is, sometimes a quick weight gain is necessary, as long as you don't get hit with refeeding syndrome. As for the "blob" factor, that's all too real! Seems that most anorexics get hit with "visceral obesity" even before getting up to the normal weight range! How much does that suck? (In fact, it's triggered my current relapsing, after doing a bit better in recent weeks...)
I could offer you a ton of suggestions, like setting a timer for three minutes before you purge, so that you can see if you can resist the urge, but I don't know what to suggest beyond finding a therapist -- preferrably one who has experience with EDs or body image distortions.
I've never had IP treatment -- hell, I wasn't even formally diagnosed until the age of 40! -- so I can't speak to that. I will say, though, that nutritional counseling has helped a lot, and that psychotherapy is a very, very necessary adjunct to it. I was close to being able to follow my meal plan until the past week or so, but my body image issues are so strong that without therapy, I could not have made it even that far.
By the way, my OP NC has not tried to get me to eat anything like what I'm supposed to be eating for my size. She's set my meal plan for about half of that amount, so that I don't freak out. And my weight gain, although quite significant (and distressing) has been pretty much steady rather than rapid.
Hope that helps, somehow.
Posted by narcissistic_martyr on March 28, 2005, at 13:40:27
In reply to Re: Anorexic on the Edge, posted by Racer on March 28, 2005, at 1:19:16
Racer--
Indeed, my school has a health center, and i see the dr there for regular vitals checks and weigh-ins. I also see the school psych for meds (which do absolutely sh*t for my mood, but that's another story). There is also a dietrician who i've seen a couple times, but i didnt see much point to it since i already know so much about nutrition (it's just that i dont *use* this knowledge, or do so in a way that suits my ED). Also, as irrational as it may sound, since I'm not @ my lowest weight, I don't feel that I really "need" help...which is completely stupid, since when I was @ my lowest, I ended up in a hospital, where i constantly berated myself for not being able to "turn things around" before they reached a critical point. well, now here i am again, teetering @ the edge of another "critical point", and once again, I can't seem to turn things around...
Posted by Racer on March 29, 2005, at 13:11:29
In reply to Re: Anorexic on the Edge » Racer, posted by narcissistic_martyr on March 28, 2005, at 13:40:27
> Racer--
>
> Indeed, my school has a health center, and i see the dr there for regular vitals checks and weigh-ins.That's a good start, good for you for being proactive in keeping yourself going.
>I also see the school psych for meds (which do absolutely sh*t for my mood, but that's another story).
I'm guessing that the meds involved are likely SSRIs? They've been shown, in countless studies, to be basically worthless for anorexics. For one thing, you can't increase the amount of serotonin available by blocking its reuptake IF THERE'S NOT ENOUGH SEROTONIN IN THE FIRST PLACE! Serotonin production is dependent on supplies of the dietary precursor tryptophan. If you're not eating enough tryptophan sources, you're not going to get adequate benefits from any SSRIs because there's not enough serotonin to begin with.
So, you're right, medications of that sort aren't going to help. Unfortunately, SSRIs are about the only meds that are safe to give to an anorexic. Don't you feel better now? (Please -- don't jump off the bridge yet. I felt that way, too, when I read those studies. Cymbalta, a new dual action anti-depressant might help and should be safe. And, of course, nutritional rehabilitation will help.)
>There is also a dietrician who i've seen a couple times, but i didnt see much point to it since i already know so much about nutrition (it's just that i dont *use* this knowledge, or do so in a way that suits my ED).
You know, I thought so too, but I went so that I could tell everyone who urged me to go that they were wrong. Guess what? A good N who has experience with EDs is profoundly helpful. My N has taught me a lot of things about nutrition that I really didn't know, which surprised me a lot, but the most important thing she does is to help me apply that knowledge to my own situation. Every week, we go over what I've eaten, why I didn't meet my goals for the week (which, alas, is more usual than not), and what stops me. We also talk about ways to get me past my blocks about food. I urge you to try again with the N at your school, and see if maybe she can be helpful.
There's no question that it's hard to deal with the fear and guilt around eating. That's the nature of the beast. But just because something is hard doesn't mean it's impossible.
>Also, as irrational as it may sound, since I'm not @ my lowest weight, I don't feel that I really "need" help...which is completely stupid, since when I was @ my lowest, I ended up in a hospital, where i constantly berated myself for not being able to "turn things around" before they reached a critical point. well, now here i am again, teetering @ the edge of another "critical point", and once again, I can't seem to turn things around...
OK, if you can see all that, isn't it time to make a decision for yourself? You know that, when you were in crisis, you felt bad that you hadn't made more of an effort at a less critical point. You're at a less critical point, physically, but you don't think it's worth working on because you're not in a crisis? Hm...
Listen, I'm 41 years old, and I have been anorexic -- with periods of normal weight and semi-normal eating -- since my early teens. Trust me on this one: you do not want to end up like me. Hell, last autumn, during a bone density scan, I discovered that I had shrunk more than an inch in height! That was the most devastating physical finding for me, much more so than the actual bone loss.
I don't know what to suggest to you, besides what you already know. (For that matter, since you've already had some treatment, you probably know more than I do about it all. This is the first time I've received any treatment, and it's quite limited by the fact that none of the ED specialists in my area will take on an adult with AN.)
I hope that helps.
Posted by CareBear04 on March 31, 2005, at 14:19:23
In reply to Anorexic on the Edge, posted by narcissistic_martyr on March 27, 2005, at 20:34:01
hi there--
i can sympathize with your situation. i'm 22 and 5'5, and i've experienced the way life can fall apart when your eating goes down the toilet. my situation is a little different-- i've never had to be force fed, i don't purge, i'm not convinced i have an eating disorder, and though doctors in the hospital were set on the fact that i was an anorexic in denial, my outpatient doctors were not convinced. still, i've been very conscious of my weight since i was ten years old, and i have horrible body image so that i can see myself as fat even when i'm always underweight. i had a lot of health problems in the fall, and i was in the hospital twice. the second time, i was transferred to psych after my medical care and saw nutritionists galore to get my weight up. i had IV nutrients for awhile, and i actually would have welcomed a feeding tube because i had tears in my throat that made it so painful to swallow, but they wouldn't place the tube because it would cause more pain in my throat. for me, the most important factor in getting better has been being treated with respect and with the understanding that, while the problem may originate in the head or not, the physical implications of not eating are way serious and need to be addressed without regard to cause. when the nurses tried to pound it into my head that i was anorexic and needed to change my perceptions and sat next to me and watched me eat, i pushed food around my tray. it wasn't until the weekend attending almost took away my pass for sunday morning that someone finally got through to me. i was having huge blood pressure and pulse changes when going from lying to standing, and the dr basically said, "we're not doing this to punish you. it doesn't matter how this problem came about, what matters is that it's here now. it's just not safe or smart to be walking around with 50 point orthostatic changes." something finally made sense to me, and i ate and drank enough to get my pass the next day. but the most important thing, i think, was to get past the issue of who or what is at fault for the problem and to see that the physical complications are dangerous no matter how they came about. my psychiatrist and primary care doctor don't believe i'm anorexic, and over the past four months, they've focused not on getting into my head but just on practical improvements like getting my weight and blood pressure up and getting my electrolytes balanced. i think i appreciate this approach because it's not coercive or blame-assigning; we're all working together towards the same goal. i won't say that the weight gain has been easy. in the hospital, i gained about five pounds, and over four months, i've put on about ten more. i've had to stuff myself to being uncomfortable, and even if i know that i'm healthier and need the weight, i'm still really ambivalent about seeing the numbers go up. also, gaining 15 pounds is a huge deal, and i'm worried that i won't be able to stop the weight gain momentum and will end up not just feeling fat, but truly fat.in the hospitals, i've seen more nutritionists than i remember. they all say the same things and give me the same tips on increasing calories and gaining weight. like you, i don't really find that they help. they don't tell me anything i don't know already. what i would recommend-- what has helped me more than anything-- is to get referred to a physical therapist. i imagine that your strength has decreased as you've lost weight and that your muscles could use some building up. my weak muscles cost me a knee tear, and i didn't start PT until then, but i wish i'd started in the fall because it's been so helpful. my PT doesn't talk about weight at all; his focus is on increasing my strength and conditioning and building stronger muscles. my sessions actually make me feel good, and i come out smiling. if you're like me, with a big competetive streak, you'll find lots of exercises that push you to push yourself beyond your previous best and to do so safely with a trained pro watching you. after a month of PT, i have a lot more energy and focus, and i'm able to be a lot more active. before, i'd spend most of my days lying on the couch. when i'm more active, it feels more natural to eat more, and i don't feel it sitting in my stomach all day like when i'm lying down. and PT has helped me realize that the same muscles that will help my knee and help me be more functional also look good. it has shifted my ideal image from "skinny" to lean and toned. plus, muscles do things like increase your weight and help your circulation.
the problems you have from your eating are really serious. i still have really low blood pressure, and it causes lots of dizziness, and i've passed out on occasion. i've been lucky enough to come away with only a few scratches and bruises. luckily also, my kidneys, heart, and other organs haven't seemed to suffer from low BP as can be the case. most of all, i'm thankful not to have any permanent brain damage from brain shrinkage or lack of blood to the brain. the drs in the hospital threatened that it would happen. i don't know if it'll help, but i'll say to you what made a difference to me: "You're obviously a smart girl, so you can understand that it's just not smart or safe to walk around in your condition. Do you value your brain? because it's not getting enough oxygen or nutrients. do you take for granted that your heart will keep beating and that you'll keep standing? because those can stop at any time."
it's not your weight that i'm concerned about. it's the bad things that happen when your body stops being able to keep up with its demands. i've never had therapy for an eating disorder, so i can't say whether that'll help. my guess is that it's probably like the nutritionists telling you what you already know. though you've said that you're depressed, i assume you still want to live. i don't mean to threaten or scare you, but do think about the quality of life you'll have if you suffer brain or organ damage or if you're too tired to function up to your normal standards.
i'm sorry for babbling on. i just hope that you'll be able to adapt your demands on yourself and get your body treated to buy your mind some time to think over whether or what you want of life. i'm thinking of you.
Posted by maura on July 27, 2005, at 2:51:39
In reply to Anorexic on the Edge, posted by narcissistic_martyr on March 27, 2005, at 20:34:01
I can relate to these posts all too well. I have about a 10 year history with EDs, mostly AN. Over the past two years, I felt I recovered, I regained somewhat normal eating patterns, maintained a steady healthy weight, and most importantly, I stopped focusing on food intake in every respect, and became afraid of dieting.
I always recovered on my own, with no medical intervention. This time around, I've just experienced a severe weightloss (I went from about 125-130lbs to 100-105lbs over 4 or 5 months). I did not diet intentionally, nor was I at all concerned with my appearance or dietary restrictions, I was just very stressed out after a breakup with a significant other, and completely lost my appetite. At first I didn't notice the weightloss, or admit to its severity. I saw my doctor for a throat infection, when I was still at about 110lbs (I'm about 5'6 and a half) she didn't pay much attention to my throat, and fussed over my weight, and sent me off for bloodwork, cardiograms, etc. The results showed that everythign was still in tact, and so she left me alone. This was over 2 months ago, and now, I've lost another 10 pounds, despite wanting to regain my health. I am definitely not looking forward to the weightgain, and how awkward that will feel, but I know that I must do it.
In addition, I am a food and nutrition student. I am begin trained to treat and deal with poeple with these sorts of problems. I know what I have to do in terms of my mealplan, but I am very hesitant to go seek treatment. At the same time, I am uneasy about going back to school in september and being surrounded by future dietitians for most of my waking hours.
Similarly to narcissistic_martyr, this isn't the lowest weight I've been at, and so I don't feel I deserve to be treated. I feel a little bit ridiculous about the notion of treatment when there are others out there who are at far lower weights, with many more impairments. I do want to regain some weight, in order to avoid any harm to myself, but I want to be able to do it myself. But at the same time, I've been trying to do it on my own, and it's only been getting worse. At this moment, I am up, at 3 30 am, due to stomach pains and bloating from supper, which I ate about 4 hours ago. I know that refeeding is painful and slow, and so I doubt medical treatment is going to feel any better than this.
And I am trying to take care of helping myself, while also avoiding getting pre-occupied with food, since I have a fear of falling into old anoretic behaviours. I'm not sure whether involving medical professionals will only make this condition worse, by just stuffing me physically, or forcing me to keep too close tabs on my food. I don't want to become obsessive about food, but at the same time, I've lost my appetite. Hardly ever being hungry, and refusing to focus too much on my food intake, causes me to eat less than I should. Having a shrunken stomach also makes weightgain difficult. And so, when I get reminded of the need to eat, I force myself to eat as much as I possibly can, of a variety of foods.
THis isn't a diet, I am aware of the associated physiological problems, I am aware of beign underweight and needing a change..and even the weightloss itself, was not intentional, it was my body's reaction to stress. Is this still AN?
I know I should really go and at least see a psychologist, but I don't really know what it is that's stopping me, or scaring me out of it.
This is the end of the thread.
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