I don’t think that cutting food up changes the calories.  I don’t pick things apart because it makes me eat more slowly.  I don’t think that eating food with a fork makes it safe.  For some reason, though, being able to do the food ritual makes that food manageable.  It’s a nervous energy.  Not picking the food apart KILLS me (well, or so it feels).  I just feel so driven to do it.

So, my question is — where do you draw the line between ED food ritual and obsessive compulsive behavior?  Of course the two diagnoses cross paths, but not everyone with food rituals has OCD (and vice versa).  Is it a food ritual if you think the action makes the food safe or unsafe?  Or if you think that somehow it affects whether or not you gain weight?  Or is it only an OCD behavior if you have other OCD behaviors (checking, counting, etc.)?  Can you be diagnosed with OCD if you only have food rituals?  Is that enough of an obsession/compulsion?  And, if your food rituals are more of an OCD issue than an eating disorder issue, do you approach treatment for that differently?

I’d love to hear your thoughts on this!

Today’s rant was inspired by this article on BDD (Body Dysmorphic Disorder) treatment… or really, lack-thereof. I find the suggestion of Prozac + psychotherapy a little depressing, and for a couple of reasons:

1. Prozac has not been proven to be effective for patients under 85% IBW.
2. Only half the people treated in the trial were even helped by Prozac.
3. I’ve been on Prozac and had psychotherapy!

Unfortunately I don’t have any clever suggestions for treating BDD. I’ve never found a body image group to be particularly helpful. The only thing that has helped me is weight maintenance. Even if you can’t stand your weight, maintaining feels a lot better than gaining. I feel too heavy no matter what my weight is. But… there is some relief in being able to wake up and put on the same pair of jeans that you did last week. Somehow being able to cognitively rationalize that I did not gain 10 lbs over night puts my mind at ease, just a little bit…

I don’t really see BDD being an aggressively-pursued area of research in the near future… but wow do I wish something revolutionary would be unearthed.

What are your views on mental health blogging? If you have a blog, why did you start writing it?

I wrote this in her comments (in case it sounds familiar), but I think that mental health blogging is valuable for several reasons:

1. It can provide a healthy outlet for dealing with feelings surrounding your own struggles with mental illness.
2. It’s comforting to know that “you’re not alone”–there are other people out there struggling with the same things as you. Often another person can articulate something that you’ve been trying to explain/identify/put your finger on for a long time.
3. Community support and wisdom. There is a lot of collective and experience within the mental health blogging community.
4. It provides a unique inside look at otherwise poorly understood mental illnesses. How many people really understand how you view/experience the world with a disorder? How does the media affect you? What do you think about current research? What has/hasn’t been helpful for you treatment-wise? There is so much information that only someone who has struggled with mental illness can provide.
5. You can challenge others… challenge them in their recovery, or to look at something from another perspective, or to break through their denial about a problem. Mental health blogs make you think and examine your own reactions

Why did I start Grey Thinking? Well, for all of the reasons above–plus a couple more:

1. I have a lot of opinions on new research, eating disorders in the media, approaches to treatment, etc. My friends were getting tired of listening to my philosophical views of “what is wrong with the DSM-IV,” etc.
2. I have a psychology degree, an eating disorder history, an endless interest in mental health, and web design experience. I felt that this was a good way to combine my personal struggles, knowledge, and interests.
3. Not that I am objective, but I think that having dealt with an eating disorder I have a different perspective of eating disorders in the media, treatment approaches, popular theory, etc.
4. There are not enough mental health blogs out there

Therapists response: Yes that is disordered because you should be able to have the bread on the table. If you are intuitively eating, you should be able to eat a piece of bread if you want it, or leave the basket alone if you don’t. That’s “normal.”

My thoughts: No, that’s not disordered–that is taking active steps to avoid a potentially bad situation. By asking for the bread to be taken away, you are taking care of yourself. You are acknowledging that the bread will tempt you to binge and instead of giving in to that urge you are saying “no thank you.”

I don’t think that recovery is about being 100% “normal”… but rather more like 95%. If you’ve struggled with anorexia in the past, then no, maybe joining Weight Watchers will never be okay. Sure, you should be able to stop losing when it’s appropriate… but why take the risk? Think about alcoholism–if you’re in recovery, should you meet your friends at a bar for an evening? Yes, you should be able to refrain from drinking… but again, why set yourself up for disaster?

To use a non health-related example, let’s think about money. People design budgets so that they don’t overspend. Maybe you should be able to have all of your money in the same place (we’re not considering investment returns here), but most people need that kind of structure. A little planning can go a long way.

So what are your thoughts? Where do you draw the line between healthy and disordered?