I’ve been trying to figure out what it is that bothers me about having them there.  I’ve looked up the nutrition facts a hundred times, so it’s not like I’m seeing the calorie count for the first time.  Plus, I still ordered the same thing (hey, I’m a creature of habit).  Still, I didn’t like the calories being there.  I have a couple of theories as to why…

1. Out of sight, out of mind – I know how many calories are in an asiago cheese bagel.  I know how many exchanges it counts for toward my meal plan.  However, I’m not really thinking about it when I order, because I order it all the time.  It’s a “safe” food for me.  The calorie reminder is not helpful — it makes me re-examine my choice.  I stop thinking “I’ve eaten this a dozen times and have been fine, therefore it’s still fine” and start thinking, “hmmm, you know, that is kind of a lot of calories for a bagel.”
2. Comparisons — When you put all the items in a list, I can’t help but compare the calories.  Somehow strawberry cream cheese doesn’t seem like such a good idea when I’m comparing it to the lower-cal plain cream cheese.  I start looking for the “best” choice.  There’s just something about lining them all up that enables me to do that.  It’s harder to choose the strawberry cream cheese when I have the calories of all the different kinds in front of me.
3. Ignorance is bliss — Okay, so I don’t know the calorie content of all the items on Panera’s menu–just the ones that I usually get.  I really had no idea what was in a Sierra Turkey Sandwich (I’m a vegetarian).  Let’s say that pigs flew and that I did order it one day, though.  I’d know that foccacia bread was higher-calorie than whole wheat bread, sure.  However, I wouldn’t know exactly how much of a difference it made.  If I did, there’s no way that I would ever get it.  I understand that this is probably the whole point of the new menus — to make consumers aware of what they’re ordering so that they can make educated decisions about sandwiches.  Well, educated / disordered.
4. Obsessing – I don’t really need any help (or encouragement) obsessing over food, calories, etc.  Seeing the calories while I’m ordering just puts me in the wrong mindset.  I’m thinking about calories instead of exchanges, for one.  And once that’s happened, it’s hard for me to figure out what I want.
5. Calories aren’t the end-all, be-all – It’s actually kind of interesting to me that Panera chose to just display calories.  Granted, that’s probably the most universal measure of food okayness, but these days the diet industry seems to be all about carbs and/or sugar.  So yeah, a blueberry bagel may have fewer calories than the power breakfast sandwich, but it doesn’t have nearly as much protein as fiber.  And sometimes, I actually consider those other factors.

As someone recovering from anorexia, I know I’m in the minority of Panera customers.  I don’t expect them to cater to individuals with eating disorders.  Do I think non-ED people will change their orders based on the new menus?  Probably for some, but I really don’t know.  I’d be curious to see how many people order the Sierra Turkey Foccacia Sandwich now.  Maybe having calories in menus isn’t that different from having nutrition labels on packaged foods.

First WHAT!? moment:

Participants were asked how the decision had been reached to avail of their various treatment options. Most participants had no involvement in any decisions pertaining to treatment.

WHAT? No way, I don’t believe that. I think there’s a BIG difference between treatment not being your idea and having “no involvement in any decisions pertaining to treatment.” I highly doubt that every person in this study was court ordered or dragged kicking and screaming into the treatment facility. Most of the people in the study were diagnosed in adolescence, so okay, maybe they HAD to go then… but the participants also all had “a lifetime history of AN.” As an adult, they CHOSE to get treatment. Even in Intervention (the TV series), you are given a choice — either get help or live a really difficult life where no one in your family will support you anymore. It probably doesn’t really feel like a choice, but it still IS one.

I know I’m fussing over semantics, but not taking ANY personal responsibility for your health / illness / treatment is a pet peeve of mine. I’ve had my fair share of anti-treatment periods, and can definitely separate the times I wanted help versus the times I didn’t, but the reality is that I DID show up for that doctor appointment. Maybe she “made” me go, but I could have immediately signed out. Staying in treatment is a decision.

Second WHAT!? moment:
(when talking about deciding factors for dropping out of treatment)

while for three participants (15%) the fear of weight gain was a major contributing factor to dropout.

Only 15% of patients would say that the fear of weight gain contributed to their decision to drop out / sign out of treatment? That’s just not honest. If everyone created a pros/cons list when considering quitting treatment, I bet that weight gain would be on 75% of their lists. Maybe it’s not in the top 3 reasons for leaving, but probably most patient’s top 10. Personally, I might not admit to my professionals that it’s a contributing factor, because I’d want to sound reasonable, rational, and believable (and definitely not want it to sound like a decision motivated by my eating disorder). Also, maybe I should clarify this is a list for dropping out of treatment — ending treatment because you’re ready or your team is ready to discharge you is different.

Anyway, I encourage everyone (who can get it) to read the article, and have a lot of other thoughts on it, but these few statements really stood out for me tonight.

While I’m not in a position where I have to calculate hours spent on a task, I was thinking about how the eating disorder would affect my focus factor.  It’s kind of scary (and pathetic) when you really think about how much of your time the eating disorder can consume.  Obsessing about your weight, what you’re going to eat, what you already ate (etc) is really distracting.

I tried to break down the components of my focus factor, and came up with the following pie chart:

Eating disorder-wise, this isn’t really current for me.  I’d say the numbers are accurate for when I’m struggling moderately — not at my best or my worst.  When you add it all up, I’m really only focused on work for 1/3rd of the time I should be working (this isn’t including the rest of the non-work day).

One time when I was struggling, I cut back my work hours to do day treatment.  I fussed about what a disaster it was going to be to not be getting work done.  I was afraid I’d be letting my coworkers done and hurting the overall quality of my team’s work.  As it turned out though, by getting more treatment I drastically reduced the amount of time I spent on all those ED thoughts and ended up being MORE productive.  Go figure.

My therapist still loves to bring it up, in some kind of “remember how you are actually more productive and successful when you make treatment a priority?” comment.  While it’s definitely true, I knew I shouldn’t have admitted it…

Anyway, while discussing Bob Forest, we decided that we wouldn’t want to have to hunt patients down when they left treatment AMA.  Do addiction counselors really do that?  It’s TV-rehab, so I’m guessing probably not, but I have no experience in this domain so I don’t really know.  I can’t say I’ve ever seen a psych professional ever go searching for a patient, though.  In fact, I’m pretty sure it would be viewed as inappropriate.  I’m trying really hard to envision the ED-version of Bob’s driving into the dessert to get Heidi back into treatment… but I’m having a hard time imagining my dietitian (or therapist, or anyone else) driving to my house (or local laundromat?) to make sure I didn’t skip lunch.  It would never (even in a million years) happen.

There are lots of things that professionals do in Celebrity Rehab which I’ve never heard of before:

1. Actually going out and finding patients that leave treatment AMA.
2. Having patients stay at your house for a night if they leave sober living.
3. Have your house re-decorated while you’re in treatment.
4. Going to the veterinarian with you if you have to put your dog down.
5. House calls (or hotel, in Seth’s case) to visit former patients and convince them to come back to treatment.
6. Setting up random activities to help patients find themselves (ballet lessons for Mary, a benefit concert with School of Rock for Mike)

Just to name a few.  Again, I know it’s VH1 and not exactly “real life,” but wow — where can I find a treatment center that will redecorate my house while I’m gone?

“A relationship doesn’t have to be romantic to fall into the “toxic” category, of course. Many friendships, mother-daughter, boss-employee, and waiter-eater relationships qualify. If someone is bringing you down consistently, chances are that your relationship with him is toxic.”

Hmm, sounds like something that I can connect to eating disorders! (Imagine!). I’ve heard that “the eating disorder is like a bad boyfriend.” I guess that in this context, referring to the eating disorder as “Ed” makes a lot of sense. The boyfriend analogy aside, the eating disorder does fall under the category of “toxic relationship.” Just look at how relevant the 10 steps are…

1. Step out of denial - I just wrote a whole post about eating disorders and denial. The article suggest asking yourself questions like, “Does the ED leave you feeling energized or drained? Do I want to spend time on the ED or do I feel like I have to? Do I look to the ED for a response that I never get?”
2. Keep a log of emotions – I’ve had a hundred food journal variations, but I think they all had a section for thoughts and feelings.
3. Identify the perks - The eating disorder is doing something for you… it serves a purpose (maladaptive as it may be). Maybe it’s something you’re good at, or it’s a distraction from everything else in your life, or maybe it numbs overwhelming feelings. There are pros of the eating disorder.
4. Fill the hole - EDs are coping skills. If you take it away, you have to find some other coping skill to rely on. (See my whole series on coping skills). Recovery might leave you with other holes… like free time that you previously spent obsessing over food/weight or that sense of accomplishment that you got when the number on the scale went down.
5. Surround yourself with positive friends - the article is right on with this one:
   

   “Lots of support and friends isn’t going to cut it. You need the right kind of friends – i.e. those working on their boundaries as hard as you are, who aren’t enmeshed in their fair share of toxic relationships and therefore become somewhat toxic themselves. The stuff is contagious.”

   Eating disorders are competitive. Dieting and disordered eating are prevalent in society. It’s easy to be triggered and important to be surrounded with “normal” eaters.

6. Drop a note to yourself – I was glad to see this on the list, just because it makes me feel a little less crazy. I write notes to myself all the time.
7. Bribe yourself - I knew a girl who did this. When she was tempted to binge, she’d take the money that she wanted to spend on that and purchase something else for herself (nothing big – like $10 to $15).
8. Heal the shame - I think that shame is HUGE in maintaining eating disorders. The article references “inner-child work,” which I know is helpful for a lot of people.
9. Repeat affirmations - I am not an affirmation person, but I may be the only one. However, I am a QUOTE person… and while not really the same as an affirmation, I think that they can kind of serve the same purpose – to cheer you up, keep you motivated, remind you of something important, etc.
10. Allow some rest - need I really elaborate?

So, while I don’t think I’ll be telling my friend that my eating disorder is just like his relationship with his girlfriend… it’s an interesting idea.

1. Feeling your feelings – good, bad, and everything in between
2. Your body adjusts to where it needs / wants to be (based on your own genetics)

Johanna supports these two ideas with a lot of great thoughts, so I definitely recommend that you read the post.  However, what really caught my eye was one of the comments:

My therapist told me yesterday that “people try to get out of their eating disorder by going into their eating disorder.” I slipped a little in the past two days. My therapist said, “You’re in the hole, but you’re trying to get out of the hole by going farther in the hole. You don’t climb out of a hole by going down. It’s like people are hoping so hard that if they just go farther into the hole, they’ll find a secret back door that will let them out more easily. The truth is, there is no back door. It’s a cul-de-sac. It’s painful to be in the hole, and it’s painful to come out of the hole. But there is only one way out. Up.”

Laura so eloquently articulated something that’s going to take me five paragraphs to describe.  Everyone has heard the phrase about things having to get worse before getting better.  However, it doesn’t say MAKE things worse so that they can get better.  It doesn’t exactly work like that.  I see a couple of different situations where people “try to get out of the eating disorder by going [further] into their eating disorder”:

1. Trying to replace one symptom with another
2. Not feeling “sick enough” to recover
3. Waiting to hit rock bottom
4. Trying to do recovery perfectly

To explain a little further…

Trying to replace one symptom with another
Replacing bingeing or purging with restricting is not recovery.  Replacing restricting with compulsive exercise is not recovery.  It’s tempting to say, “okay, I’m going to stop bingeing and eat only healthy food and lose weight.”  I think this just exacerbates the binge > purge > restrict cycle.  It seems unintuitive… but I think part of the recovery process is learning to forgive yourself when you do screw up.  It’s being a little more lenient with yourself… not stricter.

Not feeling “sick enough” to recover
I’ve blogged about this several times.  There’s the whole “if I were really sick, then I would recover” idea.  Or “if I just lose 5 lb., then I’ll feel ’sick enough’ and will feel justified in trying to eat more and get better.”  There is no “sick enough,” though.  Digging a deeper hole is not the answer to getting out!

Waiting to hit rock bottom
This is the “I’m still functioning, it’s not THAT bad” rationalization.  Or the “I’ve been worse before” idea.  There doesn’t have to be a rock bottom.  While true that some people have that moment when something really awful happens and makes them realize they are ruining their lives and have to change, I’d say those individuals are more the exception than the rule.  I’ve had “rock bottoms” (note the plurality), and sure, they motivated me to change.  However, the times that I really committed myself to recovery were not near those bottoms!  I’m very guilty of the “I’m a functioning person so I’m fine” excuse.  I have to stop and remind myself, “Why would I want to wait until I lose my job, ruin relationships, have a heart attack, etc.?  Can’t I just avoid that horrible bottom and work on getting better now?”

Trying to do recovery perfectly
I know so many people who want to keep “restarting recovery” so that they can “do it right this time.”  Restating seems to imply getting worse… so that you’re back at the starting line to try again.  I’ve done this over and over with eating and my fear of having a slow metabolism forever.  If I’m not following my meal plan, yet maintaining my weight, I am convinced that I screwed up in the recovery process somewhere and am condemned to a life of having to watch my weight because I’ll obviously gain eating a normal amount of calories.  And then, what’s the solution?  To lose weight, of course… so that I can try that again and follow my meal plan and trust the science of it all.  When you’re deep in the eating disorder, it seems to make a lot of sense.  But, looking at it from the outside… why would I think that doing worse would be the solution to getting better?

Laura summed this up so well: You don’t climb out of a hole by going down.

You as your own case manager
Originally Posted: 01/01/2009

I wish that all these guys were going to stay clean, I really do. I’ve just seen it so many times that I can tell when someone’s really willing to do whatever it takes and when someone’s willing to do what they think it should take. And it’s just not going to work like that, unfortunately.

–Shelly, Celebrity Rehab with Dr. Drew 2

Wanting to want to recover
Originally Posted: 06/12/2008

Motivation to change implies an intention–weak or strong–to change one’s behavior. However, AN patients may at the same time both wish to recover and be highly resistant to change their behavior. Therefore, we suggest that assessment of motivation in these patients should include not only their motivation to change, but also their different wishes to recover which do not necessarily imply a behavioral intention.

Dr. Drew should treat eating disorders
Originally Posted: 07/01/2008

There are a lot of components of addiction treatment that I believe in and think are important, and should be applied to eating disorders:

1. Recovery is a lifelong, daily process
2. Denial, and not necessarily that you have a problem, but that you need help
3. The importance of personal accountability
4. There’s no magic cure
5. The disorder should be taken as seriously as any potential fatal disease

Do not pass Go, Do not collect $200
Originally Posted: 12/09/2008

“I don’t want to play the rehab game anymore”

– Jeff Conaway, Celebrity Rehab 2

I think that recovery can feel like a game at first because it is so different from the rest of your life. It’s nice to have others care about your wellbeing and there’s something about treatment that gives you permission to take care of yourself. Plus, there is so much positive reinforcement (gold star for following your meal plan over the weekend!). All of this doesn’t sound so bad… and I do believe you can make progress — even with this mindset.

When does the game end? Personally, I think this is when the disorder starts to feel threatened. There is something scary about recovering, and suddenly it doesn’t sound like a great idea anymore.

“I’m not deflecting because I’m avoiding something deep. I’m deflecting because I’m avoiding something shallow.” – House, MD

One of my biggest treatment pet peeves is when professionals ask non-deep “deep” questions. For example:

1. What does it mean to feel?
2. How did it feel to be in that space?
3. How does it feel to be in this space now?
4. What does it mean for you to not be in that space anymore?
5. How do you experience that process?
6. What would it mean for there to be grey in your world?
7. How does it feel to have acknowledged that out loud?

Okay, depending on the situation, some of these questions could potentially be useful. However, I’ve had therapists who use them over and over and over again. “What does it mean to feel?” is probably my least favorite question of all. Maybe it SOUNDS deep and therapeutic, but there are really only two answers to this question:

1. It means that I have feelings
2. It means that I am allowed to have emotions and that it’s okay for me to recognize them and not judge them as being either “good” or “bad”but to just accept them as they are… and that emotions may be scary but I can work through them and get support to handle them… and that they are normal and a necessary part of human life and essential to enabling us to connect to other humans and form relationships….

My point is, your answer is either “this is a stupid question” or “I just had this revelation about the significance of feelings and everything else in my life.” And if your answer is the first, then it’s “But what else? What does it really mean?” This is where the House quote comes in. I’m not deflecting the question because I don’t want to address some deep underlying issue, but because it’s really not a deep question! And if you won’t accept “Um, it means that I have feelings” as an answer, then you are going to get whatever fictitious BS I can come up with off the top of my head. Plus, I’ll be frustrated and won’t want to intelligently answer your additional questions.

You can ask me what I’m feeling, what I felt at that time, how I feel about feeling that way, etc…. but I hate when it is reworded to sound like a deep question. “How does it feel to be in this space now?” is just “How do you feel?” with six extraneous words.

Wow, I swear I am not as bitter (or as difficult of a patient) as I sound in this post! I just don’t like shallow questions that are pretending to be deep.

Unfortunately, this doesn’t serve me too well in therapy.  I can have a great session and later that night not even remember half of what we talked about.  And on the same level, when I’m in session I don’t remember half of what I planned to say.

In an effort to make my time in therapy more useful, I’ve started to write things down.  Not quite journal, but write when I’m upset or just a couple of points I want to make sure that I let my therapist know.  If I’m afraid that I won’t bring up the issue in therapy, sometimes I’ll email them to her before my appointment.

That’s just one way that writing things down helps me in treatment.  Another is with my meal plan.  I know my meal plan backwards and forwards at this point, but one day I decided to pin it to pin it to my bulletin board above my desk.  This probably sounds silly, but it has made such a difference.  I am reminded all day that my meal plan and recovery are important.  When I’m in the middle of work I think “oh, I’ll eat that later” or “I am too busy right now,” but just having it written out and sitting in front of me helps me remember that treatment is important even when I’m not in my therapist’s office.

A third way is with affirmations.  Well, affirmations may not be the word that I’m looking for… but clips of little things that mean something to me.  For instance, also on my bulletin board is a fortune from a fortune cookie that says “Remember there are people who care deeply about you.”  I also have this paper on which my therapist wrote, “You can let go of your ED and still be validated” and “Never forget, but forgive and make yourself a better person.”  And then, sometimes I’ll print out pieces of funny or significant emails (from anyone in my life) and pin those up.  Yes, I have a very large bulletin board!

I need a written reminder for several reasons:

1. I’m a visual person
2. I twist things and second-guess myself and think “she didn’t mean it that way” or “I am reading into that too much.”
3. Being continually reminded helps me convince myself that it is true

Different types of therapy are helpful for different people, and I think that there is some trial-and-error involved in figuring out what works for you.  Personally, I highly recommend investing in a bulletin board.

Pros:

1. Adolescents can learn a lot from adults who often have been in treatment before and have some more insight into the disorder.
2. Adults are (hopefully) more mature and less competitive. Eating disorders in general are competitive… and I’ve just found that when you have a large group of ED high school females in a room, who are not necessarily in the best place, you could be in for a disaster. Sometimes just having a couple of older people in the room is enough to keep everyone from competing as much.
3. Adults can learn a lot from adolescents. They have a different perspective, and sometimes you need that.

Cons:

1. Being an adolescent and seeing adults in the group can cause some hopelessness that you’re never going to get better. It can give you the sense that people never really do get better and that you’re going to struggle with this the rest of your life.
2. As an adult, I often feel like a bad role model — especially if I’m having a hard time and an adolescent is doing well. I feel like as the older, “more mature” one, I should be responsible for setting the example.
3. Adolescents still live with their parents and (hopefully) their families are very involved in their treatment. I’m always a little jealous since my parents were pretty anti-treatment and didn’t (and still don’t) think that eating disorders are really problems. Sometimes interacting with others’ parents brings up stuff that you haven’t thought about recently (maybe that’s good, but it feels bad).
4. Adults and adolescents have different bodies, ideal weights, nutritional needs, etc. I know adults who have a really hard time being on the same meal plan as a 15-year old, with all the info they’ve heard about slowing metabolisms, muscle loss with age, etc.
5. Tiny, underweight adolescents are triggering. It’s hard to not compare yourself to someone who is 15.
6. Adolescents and adults are (obviously) at different stages in life. Sometimes it’s hard to relate to one another and certain sessions may not seem helpful for one group or the other.

This is just the start of a list — I’m sure there are 100 reasons. Personally, as an adolescent, I was really happy to be in treatment with older women. I really looked up to them and thought that they were so wise — they knew so much and had so much insight. There were a couple of people who I wanted to be like. There were also people who I did not want to be like, and it was motivating to me. I definitely told myself that I would NOT be one of those adults with an eating disorder. It wasn’t until I WAS an adult that I started feeling guilty about still struggling and/or being a bad example.