TV Triggers

Yesterday I watched TV for two hours, from 7-9, and counted the number of ads.

There were 67 ads in total. 28% of those ads were about food. The next highest contender, ads about tv/movies, made up about 20% of ads.

What does this mean? That perhaps watching TV is not the best way to try and reduce behaviors. I’ve noticed on several occasions that TV ads about food make me feel less full and they make me want to have the taste of something in my mouth. I also tend to eat while I watch TV, or at least if I have to eat I will turn on the TV while I’m doing it. This might create an association in my mind of food with television, which will not help if I’m trying not to binge. However, there’s also the fact that TV is something to do to distract yourself.

It’s a mixed blessing. Maybe the solution is to read a book during the commercials. 

Sabotage

Yesterday my parents came home with half a cake. It was left over from my brother’s birthday celebration, and it was a large chocolate cake with peanut butter and chocolate icing.

Of course, since my Dad is a sugar addict, he started talking about the cake like it’s his child, and all I could do is glare at him while my mouth watered.

Mom opened the cake box and she presented it to me, with the tantalizing peanut butter icing rolling in waves down a rich chocolaty cake. Then she asked if I want to be excused.

Of course I couldn’t be excused! There was no way, after I heard that there was cake in the house, that I could resist, especially yesterday, when I’d already not been doing well with behaviors. As soon as I saw it I wanted some. I NEEDED some. I knew that I would throw it up, and I knew that I shouldn’t have a piece, since I’d been binging all day, but it’s so easy to fall quickly and so hard to stop yourself from falling. My mother served me right away, and I scarfed down my piece before my mind even had a chance to tear itself away from the thought of the flavors waterfalling into my stomach.

Ten minutes later, as I stood over the toilet retching, I was more angry than I’ve been in a long time. My mom knows that I don’t do well with desserts, and she knows that I asked her to remove most of the desserts from the house. And yet she STILL brought home that delicious devil. I felt betrayed, sabotaged, and like I was alone in my universe.

The fact is, even if my parents hadn’t brought home that cake, I was still not doing well with behaviors. Yes, they made it worse, but I’m doing bad enough on my own.  Is it fair to expect them to know not to let me know that there is dessert in the house? Is it fair to expect them to stop caring about it, to help me stop caring about it? Is it fair to hold them responsible for my purge? 

Rational Emotive Therapy

To me, this is the most useful type of therapy out there, at least for eating disorders. The point of the therapy is to have insights, and to dispute irrational thoughts and beliefs. In other words, you have arguments where you support and argue against your irrational belief, and then at the end you come to a conclusion. 
To do this type of thing with yourself you need to be open-minded and honest. The point of the therapy is to change your belief, so you can't give up halfway through when it seems like evidence for the belief outweighs evidence against it. You have to push yourself until you know you've explored ever nook and crevice of that thought, and presented yourself with all the evidence. 
The way I do it is I sit down at my computer and have a typed conversation with myself. I start out by pointing out my thought or belief (whether or not I believe it's rational or not) and then ask myself: why do you think that? From there, a conversation flows, where Therapist Emily questions Bulimic Emily's motives, desires, and evidence. This type of therapy is also really helpful in getting all your thoughts down, because it has to be so detailed. In that sense, it can be very therapeutic. 
The following is a very long example of this, but I will post the whole thing, so anyone who wants to can see how it can help break down destructive thoughts. 

Restricting makes me feel powerful and gives me a sense of motivation.

Why does it make you feel powerful?

Because I am in control of my urges. And my weight. Also, it means I won’t be sluggish from food or feel fat or anything. I feel thin and like I can handle things.

Why do you want to be in control of your urges?

Because losing control of them does not feel good. Also, my urges cause me to eat (at least the ones I’m trying to regulate) and gain weight. Also, focusing on controlling my urges distracts me from other things that I don’t like or can’t handle.

Such as?

Aspects of my personality that I don’t like, such as my apparent inability to make friends, and my social awkwardness, and my stupidity and stuff. Or things that I can’t handle like when it was Thanksgiving and everyone was starting to get anxious.

But you didn’t use restriction to feel in control then.

I did use restriction to be in control then. It was still less about handling things than it was about reducing my weight, which I focused on all the time. But consciously it wasn’t about trying not to deal with things.

No, you used food and throwing up to deal with that.

After that Thanksgiving, yes.

So your main reason for restricting was to lose weight?

Yes. The ultimate goal was to control my weight. It’s not about losing necessarily, I just wanted to exercise control to lose. But it was the control over it that I wanted.

Why did you want control it then?

So I could be in control of it. I like being in control of things, especially when I know I can control them well.

How do you know you can control your weight well?

Well, I have been able to go from 130 pounds to 115 pounds pretty well. I knew I could do it if I really tried. So then there was no excuse to fail.

So you wanted to lose weight to avoid failure?

Yes.

Why would failing to lose weight be failure?

Because I know that I CAN lose weight. So I should be able to.

But why even focus on that as a goal? If it’s not a goal, you can’t fail at it.

I thought that by losing weight I would become more attractive. Also, it gave me motivation to do things. It was my driving force. If I wasn’t restricting, I had no desire to do anything, and I gave up all endeavors pretty quickly.

So it looks like restricting makes you feel powerful because it motivates you to do things. You feel like you have control over your life, which makes you invest more in it.

Yes. It motivates me to care about myself. To exist.

Do other things motivate you to care about yourself?

Well, if I’m trying to impress someone. Like before I started dating my boyfriend, I wanted to impress every single boy I met because I wanted his attention. That motivated me to care. But in particular that motivated me to care about my WEIGHT. Mostly my weight, anyway. Nothing else really makes me care about myself. Sure, I do fun activities, but I don’t really care about myself. I just sort of enjoy life.

What happened to your motivation last time you stopped restricting?

When I was in Costa Rica and I was binging and purging every day, I had low motivation to do things. I made myself do them because it was part of the trip and I knew I would want to have the memories later, but I can recall being a little less motivated to care about myself during that period.

When you were in Costa Rica, you still wanted to do fun things.

Yes, I did. I did also want to rest more than I usually did. And I had no desire to shower, or try to contain my food intake, or brush my teeth, or write in my journal, or call my parents…

If you had done those things, how would you have felt?

Then I would have felt it was a waste of effort because I was getting fatter. I wasn’t taking care of myself in one way, so I couldn’t take care of myself in other ways.

What about when you started eating normally?

You mean on the meal plan? I still have motivation to do stuff. Not on the days I’m binging.

What you seem to be saying is that loss of motivation actually occurs when binging, not because of stopping restricting.

I guess. I mean, I’ve never really not-restricted without binging.

But if you did that, your motivation levels would be normal.

Yes.

And you would feel in control?

Only if I were losing weight.

What about maintaining?

If I was at a weight I liked then I would feel fine about maintaining. I did feel ok about maintaining towards the end of school when I was at 117. That was because I wasn’t binging, so I didn’t feel fat.

So you feel fine maintaining as long as you don’t feel fat or get too full.

Yes!

So you don’t care about losing weight, you just care about how full you feel.

Yes.

And feeling full makes you powerless.

Yes.

What will happen if you get too full?

I will gain weight.

Evidence?

I have gained 2 pounds in one sitting.

What about other times when you feel full? Do you always gain weight?

Immediately afterwards, yes.

Long term?

Not sure.

Why is gaining 2 pounds a bad thing?

Because if I can gain 2 pounds in one day, I don’t know how long that will go on for. I know I have a predisposition to be fat. And I refuse to let myself get that way. I know I can eat more than enough to become overweight.

And yet becoming overweight is not on that cons-of-recovery list.

Because I know it’s really unlikely for me to become overweight quickly. And because I know that I have the capacity to follow a healthy diet. One that isn’t restricting. And I think that by following the meal plan, and eating to when I’m full and not much after, I will not gain much weight. Five pounds at the most.

Will five pounds really hurt?

Not if they’re healthy five pounds that come on slowly.

Then you have nothing to gain by restricting! You can still exercise control over yourself by following the healthy meal plan, which will decrease the number of binges. And You said you still have motivation when you’re following the meal plan. You know that what you’re most afraid of: becoming fat, is not going to happen if you follow that healthy meal plan. So this con can be eliminated by following the healthy meal plan.

I’m still afraid of gaining weight. Any weight. But that’s a different con.

Outpatient Therapy

The type of treatment I enrolled in is called Intensive Outpatient Therapy. As part of this treatment, I eat dinner at the clinic 3 nights a week, and spend an hour on either side of dinner in group therapy with other girls who have eating disorders. One day out of those three, I get weighed and get my blood pressure taken. That same day I see a psychologist for about 45 minutes and we talk about whatever.

In the first group so far we’ve been over a couple of skills that supposedly help us step out of emotion states that could encourage us to engage in eating disordered behaviors. They’re all pretty easy stuff, and I think they could be useful. In another post I’ll talk about some of them.

During dinner, everyone has to follow their meal card. The meal card was prepared by the nutritionist at the beginning of treatment and for each meal you have to eat a certain amount of different types of food. At dinner, I have to eat three starchy things, which is a little bit distressing because in my book starchy foods aren’t healthy and I would rather substitute things like vegetables. Other people have to eat extra fats, or more starches, or more fruit. I’ll admit that I do try to prepare a meal with the least amount of calories possible while still following the plan, but I can’t get away with much less than 600.

After dinner, we have either a venting session or cognitive behavioral therapy. Cognitive behavioral therapy seeks to help us restructure our thoughts, so it could be really useful in shifting beliefs about body image, forbidden foods, and self-esteem. The venting sessions can be awkward, or they can be really useful. The most recent one was extremely useful for me, but for the first half of it conversation was very strained. I don’t think our particular group has formed much of a bond, or maybe we’re all just too self-conscious to talk. I know I am.

The other parts of treatment are keeping a food log and an eating-disorder behavior diary. I don’t know if anyone reads either of those, but they’re supposed to keep watch on how much of our required food we take in. In this type of therapy it would be really easy to lie on those self-reports, so I don’t know how effective those are, but I tell the truth on them, and I hope others do too.

The treatment only lasts 4-6 weeks, so I don’t know how effective it will be.

I just want people to know what kinds of things people do in this type of treatment, and that it’s not scary, and it’s not hard. 

What "Fat" Means

Lazy, ugly, stupid, worthless, undeserving of attention or love, can never attract a decent guy, seen as less successful, made fun of, even when people don’t realize it, embarrassment, greedy, eating habits judged, insulted, seen as causing their problems, judged when they can’t solve them, fat-shaming, pitied, criticized, no empathy