27: Eating Disorder Treatment

I’ve now been in treatment for about a month. My first steps out the gate might be best described more as stumbles and falls, but every scrape I earn on the way down is a badge of honor that I hang proudly in my mental trophy room.

Why? Because each time I slip and fall, I learn something new and often profound about myself. And each time I get back up, I reenforce the fact that I can do this.

I have an eating disorder. And I’m gonna kick its butt!


[Content Warning: eating disorders, weight, food, restriction, bingeing, treatment]

It’s taken a lot (and I mean A LOT) of work to take my first steps in treatment. As I wrote in my first post about my eating disorder, I spent over a year in therapy after diagnosis of disordered eating before I finally felt ready to start treatment.

“I feel like I’m starting out across a tightrope, and I look down and there’s no net that I can see,”  I stated bluntly to my therapist.

“Sometimes I’m scared and I want to crouch down, grab the rope, and head back to safety. But everyone around me—friends in treatment and recovery, family, my husband, books I’m reading, my therapist—is assuring me that I am safe and there actually is a safety net below me. I just can’t see it yet. I just have to trust and keep going.”

A meme with a close-up of a pair of feet and legs of a person balanced on a tightrope. Text reads, "Eating disorder treatment feels like I'm starting out across a tightrope and there's no net that I can see. Sometimes I'm scared and want to head back to safety. Everyone is assuring me that I am safe and there actually is a net below me—I just can't see it yet. I just have to trust and keep going." The words keep going are bigger font.

And here’s the thing: no matter how many rational people you have in your court; no matter how logically you look at your eating at times, an eating disorder will try to whisper (sometimes shout) in your ear that those around you are wrong—that you are wrong. Learning to identify that voice takes a lot of work. It takes even more energy and trust to at least ignore that voice, if not fully defy it.

Some days I can laugh in its face and retort, “You are losing and you know it. That’s why you’re so loud. Shout away!” Other days I cower and bow to the voice, agreeing with it for a moment if only to gain some temporary peace.

And it’s strange… treatment is hard. It can be scary. It’s utterly exhausting. Yet so far, treatment has been far, far less scary than my enormous dread of seeking help was.

I spent so long dreading and fighting the thought of treatment, but a huge part of me feels relief at tackling something that I’ve struggled with for eighteen years. While it’s scary to admit I have an eating disorder, it’s also incredibly liberating. As I do the hard work of therapy, it’s often exhausting and sometimes overwhelming, but it also comes with an all-consuming relief that I can’t quite describe.

Initial Steps of My Treatment

1) Six Meals

I started a six meal a day routine, eating three small meals labeled merely as Meal 1, Meal 2, and Meal 3, and three small snacks a day. This is fairly common in treatment. One of the benefits can be reawakening hunger cues that a body has stopped sending for people who have restricted.

I went into the routine thinking it would be very easy, but also feeling like that was a lot of food to eat. (Interesting how an eating disorder will whisper conflicting information in your ear. Once you start to catch on to its little inconsistencies, it starts to lose its grip on you ever so slightly.)

Through this task, I realized that anorexia has played much more of a role in my life than I had realized, and that my bingeing was often a symptom of both conscious and subconscious restricting.

This was a huge revelation for me because: A) I had always thought of it in reverse, that my bingeing lead to restricting out of shame and B) I had the false assumption that someone has to be underweight to be anorexic. (That is NOT the case at all. Anyone of any size or shape can be diagnosed with anorexia.)

I printed out a chart when I realized how difficult it was to remember to eat and how hard it was to hold myself accountable for it. I worked out the math: I needed to eat something every 2-3 hours or so. The only problem? Seeing what I was eating on paper made me fixate too much on WHAT I was eating. But my fear—that I needed to change everything about my eating habits all at once—was unfounded.

My therapist reassured me that we were breaking things into manageable steps. “Right now, just focus on when you eat, not what. Addressing nutrition comes later!” I was so relieved because she was right—focusing on what I was eating in addition to starting this new routine that challenged 18 years of restricting and bingeing was too much. It was setting me up to crash and burn.

2) Talking to my doctor

Another victory came at a follow-up appointment with my primary care physician. This was not strictly part of my therapy, but I made it part of it because I trust my doctor.

Toward the end of my appointment, I had worked up my courage. “There is one more thing. Something I think you should be aware of as my GP.” I took a huge breath and continued.

“I’m in treatment for an eating disorder and I’ve begun a six small meals a day plan in order to return my hunger cues and manage my restricting and bingeing. So far it’s helped a lot to identify that I wasn’t eating as much as I thought I was which was leading to binge eating. So far it’s helped a lot with dizziness and hypoglycemia.”

I paused and finally looked at him.

“That’s great! Most people should be eating 4 to 5 small meals a day rather than the 3 we do. And if you ever want to try medication, there are some that can help with binge eating.”

I could almost hear my eating disorder groan at this response (it had hoped he would shoot me down and I’d have an excuse to stop treatment), but ultimately I was relieved.

“Thank you! I think treatment is going well so far, so I’ll wait on medication, but it’s good to know there are options. Also…” I paused again, looking down at the notes I had written for the appointment, “I… would like to stop being weighed. It’s very triggering for me; It makes me struggle with restricting more. And it’s hard to avoid seeing it on my charts.”

I held my breath the beat it took him to answer.

“Absolutely. No need to take your weight.”

Phew! Another ally in my court.

3) Challenging the voice of my eating disorder

I have made quite a lot of headway in this regard, but am finding it the most difficult part of treatment. For so long, there’s been this negative narrative in my head regarding food, weight, perfectionism, and control. Identifying that voice was an overwhelming experience as I wrote down all the terrible things that voice says to me.

The next step after learning to separate the eating disorder “voice” from my own has been a little harder. I’m now starting to “reply” to it with snark like “Gee, what a terrible suggestion. Thanks, but no thanks!”

And as a close friend of mine pointed out:  the more progress I make, the more my eating disorder is going to fight to survive. It knows it’s losing, and it will do anything to survive.

But joke’s on it—I’m stronger. And certainly sassier!

4) Journalling and continuing to read

I write notes in my journal about what my goals from therapy are and reminders of things to do and not do. That’s been essential to keeping on track and reminding myself it’s okay when I slip up. I also reflect on things I’ve learned in the books I am reading as part of treatment.

Journalling has also helped me to connect some dots on how my eating disorder controls a vast variety of things in my life. I’ve been astounded, for example, to realize how much my eating is tied to my perfectionism and anxiety, and in some ways, my OCD tendencies.

For example, my need to follow difficult tasks through until the bitter end no matter if I want to or not is slowly, ever so slowly budging. I recently had a small but mighty victory of “cheating” while reading one of my books and skipping over a section that was triggering to me. In the past, I would have slogged through that section to be “self-disciplined” (strange as that sounds) even when my mind and body were signaling “This is not what we need right now!”

Journalling also helped me to realize that binge-eating had been a way to stress-stim for me, and that without it I was much more anxious. It showed me that I needed to start stimming as self-care: coloring, squishing clay and silly putty, singing, flapping my hands, holding fluffy stuffed animals, etc.

I see these victories as tied to my treatment in a very real way, and I wouldn’t have noticed them without journalling. The journal also gives me a place to record moments I’d like to share in therapy, and a place to look back on to see how far I’ve already come.

I’ve got a long road ahead, but for now, I am so happy to look back and see how far I’ve already come.

A meme of a forest path with a blue square of text over it. Text reads, "I have an eating disorder. I began subconsciously using food to cope with sensory overload, to avoid meltdowns and shutdowns, and to find some sense of control in my life. As I start down my long path to recovery, I am reaching out to others to say "You are not alone." I have an eating disorder...and I'm going to kick its butt."
[Featured image description: A close-up of a pair of feet and legs of a person balanced on a tightrope. Text reads, “Eating Disorder Treatment: My First Steps. Seeking Sara.”]

25: I have an eating disorder.

Trigger and content warning: eating, food, weight, eating disorder, bingeing, restricting, treatment, recovery.

I have an eating disorder.

It’s taken me a full year to reach a place where I can say that sentence out loud, but now that I have, I feel a tiny piece of its hold on me slowly peeling away. I was diagnosed well over a year ago, but have only started the nitty-gritty of treatment very recently.

So why am I writing about it on my blog?

Well, for one thing, my blog is a place that I can go to write what I’m feeling and it helps me to process things in a constructive way. In a big way, this space has always and will always be for me. A big part of Seeking Sara is unraveling myself and finding out who I am inside. (Alexa, play the Mulan soundtrack!)

But I also want to be open about it because if it weren’t for people in my life being open about their own struggles, treatments, and roads to recovery (including potholes along the way), I never would have been brave enough to seek help. So another massive reason I am being open about this topic is in order to reach out to others to say, “You are not alone.”

The last big reason I am writing about my disordered eating on Seeking Sara is that it is not unrelated to being Autistic. I began subconsciously, (then more consciously, but to my deep shame and suffering) using food, bingeing, restricting, and overall disordered eating to cope with sensory overload, to avoid meltdowns and shutdowns, and to find some sense of control in my life.

Bingeing has become a type of self-harm stim to me. Restricting has become a way to control at least something in my life when I so frequently am overwhelmed by the world around me, not to mention my various health issues and disabilities. But these are not healthy or productive ways to cope. The fact that I can see that now is not a small baby step, but a giant, giant leap toward my long marathon run toward recovery.

One reason I avoided seeking help for so long is the uncanny ability eating disorders have to convince you that they are no big deal. Cycles of denial and acceptance are pretty much guaranteed companions during anyone’s treatment and recovery. I have no doubts that I will struggle back and forth for months–and probably years–to come, but now that I know that and accept that, it makes it easier to cope.

So how did I decide I really did have a problem I needed to address?

I’ve known for a long time, but the final tipping point was a journal assignment my therapist gave to me. The prompt was, “What is your relationship with food like? Write a letter as if it were a real person.” The two images below are my letter to food.

(If you are using a screen reader, please click the images. Alt-text is attached.)
An image of a purple notebook page with text on it. The date reads January 1, 2019. Above the date is a branch with red buds. Text reads, "Dear Food, We need to talk. My relationship with you has been unhealthy for 18 years. It's true that I can't live without you, but sometimes you make me feel like I can't live with you either. You are nourishment, energy, life, necessity. You are addictive, controlling, an unhealthy coping mechanism. I need you. I love you. I hate you. I hate that I need you. You provide me with escape... and yet I can't seem to escape you. The solace you provide is temporary and leaves behind regret, frustration, and a shame.
The second page of the letter reads, "Where you soothe, you also blister. You are a gulp of cool water laced with poison. We need to talk. We have 28 years to evaluate--18 of them troubled. You know I won't ever leave you, but things between us are about to change. I can't leave, but I can loosen your hold on me. I will no longer use you as a crutch that feeds me lies and self-hate. We need to talk. Sara." Beside Sara's name is a graphic of a pen. Under her name is a branch with blossoming red flowers.

Was I shocked by what I wrote? Extremely. What started out as a seemingly-silly therapy homework assignment that I was doing only grudgingly soon pulled emotions up from deep within me as the words cascaded onto the page. What I expected to be a few lines or bullet points in my journal turned into a chilling look at how I really felt. It captured the push-and-pull, back-and-forth, ebb-and-flow love/hate relationship that I’ve been running from since I was 10.

But, like I said: Denial and acceptance are at constant war within me. The next day, I was back to the complacent “I’m fine” attitude. But this time… I had something to look back on. I looked at that letter and felt those same feelings rising up in me again. And suddenly… I couldn’t turn back. I couldn’t go back to believing everything was fine…

But more importantly, I didn’t want to.

So what now?

Well, I’m diving in to treatment head-first with my therapist, continuing to journal (no matter how silly a prompt seems), talking with my loved ones who have eating disorders, doing seemingly small things like asking doctors not to tell me my weight, and reading lots.

I’m cycling back and forth between two books:

The simple yellow cover of Body Respect: What conventional health books get wrong, leave out, and just plain fail to understand about weight. By Linda Bacon and Lucy Aphramor.

1) Body Respect by Linda Bacon, PhD and Lucy Aphramor, PhD and RD (Amazon link here).

The pretty yet simple white cover of Life Without Ed: How one woman declared independence from her eating disorder and how you can too. By Jenni Schaefer.

2) The 10th anniversary edition of Life Without Ed by Jenni Shaefer (Amazon link here).

Cycling between the two has been invaluable to me so far. Body Respect challenges our views of weight, fatness, calorie counting, dieting and more, while Life Without Ed shows me that I am not alone, shows me recovery is possible, and teaches me very practical techniques that I can use.

Getting to Know the Enemy

One of the most important things I have learned from Life Without Ed so far is the concept of naming my eating disorder. By doing this, I can begin to separate out thoughts and impulses that are genuinely mine and which are from the eating disordered part of my brain. It also gives me something to roll my eyes at and tell to go away!

One exercise I did once I named my disorder was to write down all the things it says to me. Once again, what I thought was kind of a silly activity turned into me easily writing a page and a half of terrible things that it says to me–and has done for 18 years. That was another eye-opening moment for me and one that will stick with me throughout treatment and well past recovery.

So there you have it. I have an eating disorder.

But I’m not terrified like I have been for years. I feel anxious. Sometimes I feel powerless. Sometimes I feel like I can’t do it. Occasionally I still feel denial. But now I know how to recognize these feelings and thoughts as products of my eating disorder, not myself.

I have an eating disorder… and I’m going to kick its butt.

A meme with a photograph of a sunny path through the woods. Text reads, "I have an eating disorder. I began subconsciously using food to cope with sensory overload, to avoid meltdowns and shutdowns, and to find some sense of control in my life. As I start down my long path to recovery, I am reaching out to others to say "You are not alone."I have an eating disorder...and I'm going to kick its butt."

[Featured image, image description: A photograph of a sunny path in the woods with shadows from the trees stretching across it. Text reads “Starting Down My Path to Recovery. Seeking Sara.”]

Yenn’s Autism Show: Sara Earhart

I recently had the awesome opportunity to be interviewed by Yenn Purkis–Autistic author, blogger, presenter, and advocate. Their podcast is called The Yenn Purkis Autism Show (Formerly known as Jeanette’s Autism Show at the time of recording.)

In this episode, we chatted about blogging, the Autistic community, identity, and more!

Click the link or picture below to be redirected to the podcast! Both open in a new tab. (WordPress isn’t allowing me to embed the podcast here for whatever reason.)

The interview: https://jeanettepurkis.podbean.com/e/jeanettes-autism-show-sara-earhart/

A screenshot image of the podcast player showing Sara's interview. The title reads

Yenn’s links:

Podcast channel: https://jeanettepurkis.podbean.com
Facebook: https://www.facebook.com/jeanettepurkisbooks/
Blog: https://yennpurkis.home.blog/
Website: www.jeanettepurkis.com
Twitter: @yennpurkis

We hope you’ll enjoy!

[Featured image description: On the lefthand side is a picture of Sara in front of Niagara Falls. Sara has sunglasses on top of her blue hair, noise-cancelling headphones around her neck, and a plushie duck in her hands. On the right is a blue box with the words “Podcast Interview. Talking about Autistic identity and community, blogging, gender, and more! The Yenn Purkis Autism Show: Sara Earhart” A small drawing of Yenn is pictured in black and white. They have their eyes closed and are smiling widely while holding a framed picture of their apartment.]

22: Depression

If at any point this post triggers you in any way, please please do not feel obliged to continue to the end. Feel free to put it aside and come back later. Feel free to put it aside indefinitely. That’s ok! Don’t feel like you have to read it at all if it will not be in your best interest. [Trigger and content warning: this post deals with severe depression and suicidal ideation.] Crisis numbers are listed at the end of the post.

Take care of you. You are important. You matter. You are enough.

I’m beginning to feel safe and myself enough to tackle what I’ve been going through recently. I’ve had to take several steps back from writing to take care of myself, but now I think I need to write about it so I can move on.


I’m just now coming out from behind a wall of clouds. I’m not “out of the woods” quite yet, but I can now see the edge of the forest and know that I can make it there.

About a month ago, my doctor started me on a new medication. I was really excited to be taking it, as it can help with a lot of symptoms I experience from a chronic illness. The first week or so, everything was fine and I was feeling optimistic and ready for the exciting changes. The second week, I noticed I was having strange bouts of moodiness and mood swings. I noted the change in my psychotherapy session and my therapist immediately questioned my new medication as it can affect hormones. We decided to keep an eye on it and see where things went…

By week three, there was an abrupt and terrifying change in my mental state. I began to experience sudden bouts of extreme, deep depression and suicidal ideation (thoughts about death and/or suicide without intention or a plan). It was especially bizarre because I’d experienced clinical depressed before as a teenager; I went through a period of time when I was about 13 or 14 when I never thought I’d feel happy again. But I haven’t been truly, clinically depressed for 15 years and this depression was so, so vastly different.

I experienced what I described to the alarmed nurse over the phone as “these bouts that feel like clouds coming in front of the sun, then pulling away again.” Darkness and utter hopelessness, followed by moments of clearheaded certainty that something was very, very off in my brain. I’d be tackled with soul-crushing, agonizing, deep sadness and hopelessness followed by “normal” brain functioning where I would reel from the shock of being so devastatingly knocked off my feet. Needless to say, the nurse called me back immediately with instructions from my doctor to stop the medication and either go to the ER or call 9-1-1 if I was in any danger. Because I was in direct communication with my therapist, in a safe location, and knew the difference between suicidal ideation and intent, I was able to remain out of the hospital until I could visit my doctor’s office with an emergency walk-in appointment.

There were several things that set this experience apart from the clinical depression I experienced as a child:
  1. This has been a strange in-and-out depression that slams me to the ground at the most unexpected times. As a teen, I experienced a numbing, near-constant depression. As I mentioned before, this has been vastly different. The episodes have been tapering off in frequency and intensity in this last week, but will probably continue for at least another week or so until the medicine is completely out of my system.
  2. The fear that this isn’t medicine-based at all, but me spontaneously going from pretty darn mentally healthy to devastatingly unhealthy in the space of a few weeks. Despite my therapist, the nurse on the phone, my doctor, the physician’s assistant I saw for the emergency follow-up appointment, and my husband all telling me it’s the medicine, it’s been an exercise in extreme trust in both myself and others that this is not me, but the medicine.
  3. The fact that I have little to no control over it. Of course, as a teen I couldn’t “control” my depression either. But with this medicine-induced depression, my therapist noted that it’s not situation-induced or even chemical imbalance-induced. I have to sit this out and wait; my normal coping mechanisms and strategies don’t work and don’t “speed it up” because it’s the medicine in my system causing it, not my brain. My therapist has encouraged me to allow myself to feel: “Stop trying to go around, under, or over it. You’re going to have to go through it.”

It’s been one hell of a ride so far. I’m fortunate to have an excellent therapist and empathetic doctor and an even more incredible husband to help me through a really disturbing few weeks of my life. My friends have been there for me, my Twitter followers and friends have showered positive gifs and silly pictures on me, my parents have video-chatted with me. With their support, it comes down to me being patient and riding this out.

This experience forced me to confront some really scary things from my childhood depression, but ultimately, I’m choosing to see this as a productive (not necessarily “positive”) experience. “HOW?” you ask?

Through this, I was forced to face the fact that one of my greatest fears in life is being depressed again. Of being in a place where I thought about suicide and couldn’t remember ever being happy. Through facing this fear (albeit against my will) I’ve realized that even if I face depression again, it will never be the same as it was as a teen. I am not a child anymore.

I’ve always said that anyone who truly wants to return to childhood isn’t remembering it accurately. I’m not saying I had a bad childhood. But children lack autonomy and control; they lack understanding of many things outside of their control. Their brains are not fully developed. They can’t always communicate what they are feeling and that they need help. They don’t know just how many options for help and treatment are out there.

Additionally, the nature of this coming-and-going depression has forced me to look a phenomenon straight in the face and stare at it unwaveringly. It’s a strange thing when you’re truly depressed: sometimes you literally can’t remember the feeling of happiness. Despite logically knowing it can’t be true, you can’t remember ever being happy. It’s your brain chemistry tricking you. The same is true when you’re not depressed: you truly can’t fully remember what it’s like to be in that bizarre mindset where everything is hopeless and nothing positive. Your brain doesn’t always reflect reality.

That’s part of why I’m writing this post. To remember.

I want to remember because I want to recall that–when I feel like this–it’s my brain that’s changing, not reality. In reality, there are so many people out there to help: therapists, psychologists, psychiatrists, doctors, nurses, specialists, spouses, partners, friends, family, colleagues, internet friends, strangers… There are always options: seeking help, calling a hotline, going to see a doctor, going on medication, in my case: going off a medication, trying a different medicine, seeing a therapist, crowdfunding money to afford to seek services, going to the ER, being hospitalized, talking to friends, reaching out to a loved on, dropping some responsibilities, taking care of only what you have to, focusing on the basics, seeing a psychiatrist, moving back in with family… the list goes on and on. There are limitless possibilities, but my brain can’t see them when I’m blinded by fear.

But now, if I ever experience depression again–be it situational, longterm, clinical, medicine or hormone-induced, or otherwise triggered–I can look back at this post and have hope that those clouds will clear and I will be okay.


USA

Lists of international suicide hotlines:

If you have trouble reaching out, cannot find a number, or have an unsatisfactory call experience, please do not give up. There is help; there are options. Try a different number, go to the closest emergency room, or call 9-1-1 (or your country’s emergency number).

 

[image description: A dark, cloudy day in Japan. The photo overlooks a small city with many buildings. Off in the distance, rolling mountain ranges cover the horizon. Bright rays of sun are shining through the dark clouds.]