Special Treatment

Psychotherapy. This takes place in a private place and enables you to talk about yourself, relieving your anxieties and emotions in a bid to learn the basis of these sentiments without judgement. The exploration delves deep into the sub-conscious of your mind to uproot revelations- something we are rarely forthcoming to do without coaxing. People will seldom admit to needing help or finding comfort in someone else at the risk of seeming reliant on this source. Reluctance to expose ourselves to someone we barely know leaves you requiring to build a trusting relationship between you and your therapist before any rummaging can be made. This particular connection with a therapist can take months to construct, whereby until you feel ready, you will not fully disclose all the information by withholding the brunt of your angst and divulging the bare minimum. Therapy can be regarded as a relationship between you and the therapist, as they will become someone you feel you can trust so the sessions are often focused on an engagement with the therapist other than just plain old treatment. With most psychological issues, there is no single cure that will work reliably time and time again, unlike a physical pain which can disappear by popping a pill. A trained therapist must adapt their way of helping each individual via trial and error techniques, as no two patients are alike, finding benefits within the various treatments. What makes therapy so different for each case, is that no one person will be the same or will seek solace from a therapist for the same reason no matter how similar their background situations might be. Due to the slightly different approach each therapist undergoes with treatment, some patients will prefer to shift through different therapists, whilst other find it more useful to stick to the one they feel most at ease with. With each patient that undergoes treatment, a therapist will learn something new, as a successful recovery is achievable mostly by experimental practices. With Anorexia Nervosa, due to the diverse causes by which someone may develop the disorder, it is tricky to produce the correct method of treatment straight away. Rarely will a proposed treatment be effective on the first attempt, therefore reinforcing that there is no ‘quick-fix’ method to recovering from Anorexia.

Describing my experiences of the way my treatment has been handled is subjective, as some techniques that may not have worked for me, have undoubtedly worked for other patients. The rummage within the confines of my troubled mind as to what treatment I have so far found to be useful was this week’s personal task. I have been undergoing therapy since August 2010 after being referred to the Hertfordshire CommunityEating Disorder Service (CEDS) by my GP, meeting with a dietician and later my therapist who specialises in eating disorders once a week at my local hospital. The sheer location of the meetings creates an emphasis on the fact that I am suffering from an illness that I MUST recover from, as I have a tendency to downplay the gravity of my Anorexia to myself. The NHS endeavours to assess a patient as soon as possible after a referral and will initially commence by evaluating the nature and severity of the disorder. The first organised session within my treatment programme was with my dietician. I was thrilled at the idea of meeting her due to a presumption that she would create an extremely healthy and balanced diet for me, without apprehending that her aim would be weight regain. At first I followed her advice of eating cereal bars and nuts as snacks, which led me to maintain a steady weight. However, she then went on to encourage me to eat bread, cheese and chocolate- all the foods I had strived so hard to cut out. Succumbing to the thought of reintroducing them to my diet felt like a defeat to my Anorexia and so I began to resent her. I relapsed. After this I would do anything within my power to defy her by deliberately not undertaking most of the suggestions she made to increase my calorie intake. Once I knew how hard an attempt at recovery was, it left me reluctant to try and struggle through it again. Therefore, in the weekly weigh-ins, as she saw my weight continue to plummet, her disapproval was more of a personal insult in my eyes than what should have been a wakeup call. I have currently ceased meeting with her, as a dietician was not personally useful for me.

The next step for me involved my therapist who started me off on Cognitive Behavioural Therapy (CBT). This is a subtle motivational therapy technique used to challenge and eventually change the way someone perceives something (food in particular for Anorexia sufferers). It allows the sufferer to be in charge of their steps towards recovery with the therapist merely acting as a facilitator, therefore giving a semblance of some sort of independence and choice. CBT aims to connect your behaviour with how you feel as a consequence, by finding triggers to the Anorexic thoughts. It is important to enforce that CBT does not aim to find a blame for the disorder but simply to connect a certain action with a reason. It allows you to adapt anorexic thoughts into more positive and healthy ones but only when the sufferer is willing to accept the change, as there is still the idea that people are supposed to be unique and you therefore can’t change who they are. When I was asked to keep a diary of my thoughts by writing down how I felt and my behaviour in my day to day contests against my disorder, I did not realise that I was undergoing this method of therapy. I would recount how my mood and behaviour was affected after and whilst doing particular experiments. This is the sort of therapy that explores the facts focused on present cognitions and not inquiring into a patient’s past, as many sufferers are not prepared to bring up such memories. Through CBT my therapist and I discovered that my trigger was a feeling of failure due to the high expectations I had set for myself, so I am now conscious of not reverting to starvation when I am down. A particular memory where I was distinctly aware of being forced into a challenge was when my dietician asked me how I’d feel trying cheese. Irrationally believing cheese is an unnecessary food-type due to misleadingly seeing it as just a block of fat, I found the whole experience distressing and exhausting as ‘I felt she was pressurising me to have some’. I couldn’t and still can’t even think of simply picking up a piece of cheese with the intention of eating it no matter the size of the portion, rendering me to tears should I try and picture it; my Anorexia won’t allow me to.

Sometimes a sufferer will be asked to take photos of themselves in their underwear at different angles as part of their treatment. The reasoning behind this comes from the denial of how thin you have become as a result of your destructive behaviour. It is an inspirational help in order to make shifts in your actions, though these are always done at your own rate. I never personally took pictures of myself but the sight of my summer holiday pictures in my bikini were horrific enough for me to see how much my bones were protruding- I looked sickeningly skeletal. I always knew how skinny I had become and hated it but I had got used to seeing myself this way in the mirror. I was given a workbook to focus on outside of my therapy and within it were exercises to help me understand my Anorexia. It embarked me on the journey to recovery by prompting me into asking myself where I wanted to go and who I want to be. I had to challenge the way I perceived myself as a failure and that others did not see me in the same self-critical way I was. One such exercise I did not find useful and still do not accept, is the idea of externalising the Anorexia even though it has been known to work on other sufferers. It suggests that you name your Anorexia so as you can separate your own rational thoughts and behaviours from the spiky ones twisted by ‘Ana’ i.e. ‘It was Ana speaking’. I am unable to see how I can distinguish myself from the disorder, as I am Anorexic and it is essentially ME speaking. All the turbulent thoughts are occurring within my mind and so if I was thinking it then it must have all come from me! This makes mental disorders difficult to comprehend and was a factor that caused me immeasurable guilt; I brought Anorexia upon myself making my family and friends suffer in the process. I was thinking these thoughts. I was Anorexic. The importance of this exercise is to allow a sufferer to not punish themselves so harshly. Succumbing to Anorexia is NOT a deliberate act to cause others harm and it is vital to learn that you can take away the blame you inflict on yourself, as you have not intentionally done something wrong. Some people will feel that you are not feeding yourself purely to get at them; however the disorder leaves you so insular that you don’t even think of others in the process.  Eating is such a basic instinct that forcing starvation upon yourself is near impossible and so you can immediately eradicate any notion that it is a cry for attention.

With the mortality rate for Anorexia being the highest within mental diseases, there are facilities within hospitals where a sufferer can undergo attempts at recovery. I have fortunately never had the need to become an inpatient, having been on the verge during my relapse (days away from needing to be). I was allowed to continue recovery within the community, as it was deemed more beneficial for me. I distinctly remember in November 2011, that in every session with either my dietician or therapist, I was warned that I was on the brink of becoming an inpatient. I felt this was ridiculous. I did not see myself as needing such drastic action, as in my eyes I WAS eating and therefore felt it would not be necessary. They were all trying to get across to me that I was dangerously ill and that it was indeed a cause for concern. I begrudged my consultant who only monitored my physical health from afar and blamed my disorder on irrelevant factors within my life, which left me feeling like he did not know me and therefore he shouldn’t be allowed to pass judgement on my treatment. I did not connect with him, really believing that he was insisting on me becoming an inpatient without allowing me to fight against his belief. I now know that becoming an inpatient was a threat thrust upon me as an incentive for want to recovery. They knew I REALLY did not want to go and so in a way they were forcing recovery upon me. Scared into action, I was willing to make changes myself in the end after questioning whether it was worth staying at the depressed and desolate stage I was at or to move forward. It is a task that not many sufferers can do on a whim; therefore these people do require the aid of the hospital in their own recovery. My parents, having been strong enough to ask for help from my consultants, were able to act as adequate carers and motivators to me.  If a sufferer can manage to sustain weight restoration outside of the hospital environment then it is always encouraged that they should continue within the community, especially if they have a good surrounding support.

 There are many inpatient clinics around Britain who will treat their patients differently, but the main emphasis always lies equally with weight restoration and the psychological challenges.  What qualifies a sufferer with a requirement to become an inpatient depends on blood tests. Should the results come back abnormal, then the patient is at a very high risk of potential death and so they are referred to the various hospitals for a more hands-on specialised treatment. Like many, I believed that becoming an inpatient was purely based on the BMI of the sufferer, however I have been told that it has been known for individuals with a BMI as low as 9 to continue their recovery within the community, providing their blood tests were normal. In extreme cases the Mental Health Act must intervene and a sufferer will need to be sectioned within the Eating Disorder clinics. The adolescent service is however different to the adult one, whereby they don’t allow their patients to get to too low a BMI before referring them. A patient can spend several weeks or even months within the clinic and, whereas in the olden days they would keep you sectioned until you reached a healthy BMI of 20-25, they now ask the patient to set themselves a realistic target BMI ( it can be as low as 15, as for many what is deemed a healthy BMI is too much to bear for them) to achieve before they are allowed back out into the community.

In an inpatient facility, the ‘care package’ devised for each sufferer admitted is very personal and individual. The staff will create a meal plan which will always start off as small portions in order to avoid the risk of Refeeding Syndrome; this can be fatal. Refeeding Syndrome occurs upon the reintroduction of nutrition after a period of starvation or malnutrition, whereby the electrolytes in the body become unbalanced. There are different ways of feeding an emaciated patient with Intravenously (IV) or tube feeding being used the most extreme of cases, however an individual will be encouraged to eat via the normal method in order to regain normality. The initial portion will be thoroughly thought out according to the BMI of the patient and how long they have been at that particular weight for. They will gradually increase the portion according to the blood tests that are taken regularly to make sure the electrolytes within the body remain stable. Every meal will be monitored under scrutiny, with certain rules enforcing that they must finish their meals within a certain time. This can cause inpatient peer pressure, as the sufferers will all eat together pushing each other along. During their stay a patient will receive what are known as ‘privileges’ or ‘rewards’ if they manage to reach a certain weight. Such strict regulation is necessary, as a sufferer will have let the Anorexia spiral out of their control and so must lose their independence in order to accept recovery.

The final stage of recovery is known as relapse prevention, where you insure that the patient is ready to be reintroduced within a normal habitat with a minimal risk of immediately reverting back to weight loss. The staff are all well trained in noticing whether a patient will only eat in order to get out of the clinic then regressing back to Anorexia upon release. The patient must want to get better in order to get better. It has been scientifically proven that even if the patient remains at a lower weight than would be thought of as ‘healthy’, it is far more detrimental to the body if they are made to gain a lot of weight then immediately lose it again repeatedly causing exaggerated fluctuations in body weight and therefore electrolytes. This is where the idea of the patient setting their own achievable BMI goal has demonstrated a healthier and quicker recovery. The visitation of such facilities is sometimes used as a recovery method, as it is an eye-opener to sufferers that they do not want to end up there. These are not recommended however, until a sufferer is in a better mental state and further along in the road of recovery, as the mere sight of seeing someone thinner than you can ignite the competitive side of Anorexia.

My initial reason behind starting my blog was to raise an awareness and understanding in a somewhat judgemental and prejudiced society about Anorexia Nervosa. Providing an honest insider’s report for other sufferers and supporting them in the knowledge that they are not alone became my goal. What I did not count on was how it raised my own awareness about myself and how I have dealt with the disorder. In my eyes it has now become an essential part of my own recovery. In wanting to help others, I found that my readers were willing to help and support me by bestowing a tide of best wishes and positive feedback. The illness isolates you by making your world seem smaller in order to appear safer, yet in doing so I had unintentionally disregarded the virtue of human solidarity. It has touched me in the most remarkable way. Expressing myself in writing rather than talking out loud, has always come far easier to me, as I have time to reflect how much and in what way to expose my true self. Generally being a shy person, I have a fear of being judged negatively by others and therefore I feel that in writing I can justify myself far better than if I were to have to do it face to face. I find it far less embarrassing as it were. In therapy I honestly believed that I had finally been able to fully open up and relax in our sessions, yet I was stunned to find out that my therapist was still discovering some new findings within my texts. Upon my move to Newcastle later this year, I have impressed that a referral to another therapist would be essential for me. Continued weekly supervision and support would be necessary to prevent me from returning to ‘old habits’ to cope with the angst of an increased work load and pressure I stress upon myself; this having been the main reason behind my demise.  I am determined to never feel I must starve myself to cope. Overall, everyone close to me has been amazed at the transformation within me since I have begun writing a mere 2 months ago. I am more at ease, more willing to go out and socialise and most importantly to challenge myself in my recovery. I CAN see a joyous future. 

To access other very personal witness testimonies on recovery an Anorexia, click on the link below or on the side of this page- it makes a good read:

An Extra Treat