Letter to Younger Self/ Person. (The Costs of Conforming to Societies’ “Ideal Body”)

Dear…

I’m so sorry you’re struggling with body image right now.

Sometimes being human & having a body can suck. 

And, I really wanted to tell you a few things I wish I knew when I first struggled with body image. 

1. It’s okay. There’s nothing you need to do/ or can do to “fix” your body. Your body is NOT the problem. 

          a) it’s how you are made to feel about your body that is the problem.

          b) No matter what you do to “fix” or change your body you won’t feel better because your body is not the issue. 

i) Think of a day where you had the best day at school perhaps. You probably felt really good in yourself that day & if you looked in the mirror that day you would have “liked what you saw”.

ii) Now, think of a really bad day. Maybe you fell out with your friends. Looking in that same mirror, you didn’t feel so good. NOTHING, in your body changed between the two reflections. But how YOU FELT ABOUT YOURSELF was different. That’s basically body image. It has nothing to do with your body. & so my darling changing your body is never the answer. 

AND what’s more it comes at so, so many costs. Costs my darling, I wish more than anything to spare you from. 

Here are some of the costs associated with trying to look like the “associated ideal appearance” 

1. It’s an illusion. The biggest lie you have even been sold. 

    a) Even if it is possible to reach, it NEVER lasts because of nature. We age, we get sick, we go through changes in lifecycles (puberty, pregnancy, menopause so many more). Bodies are supposed to change, age & not stay the same. 

BUT, 

 i) even if it is possible, getting there can be a dangerous pursuit. 

ii) it can lead you down a path of yo-yo dieting, disordered eating at best & at worst my path a miserable life of an eating disorder. Or dangerous disfiguring surgeries. 

iii) Your body image gets worse and worse because there’s “more” to “fix”, “more” to conform to, it’s never enough.  Your relationship with yourself, your body and food gets completely fractured. 

The psychological costs are astronomical. 

– Once you start you might feel good. (I’m not going to deny this) but that doesn’t last long, because here’s the thing, if you change something about your body & it’s not where your body is meant to be naturally, it WILL fight like hell to get to where it wants to be. Where it feels safe, where it can do all the amazing things that make you special. Your body doesn’t care about the fake “ideal”, it cares about you. 

BUT, hard truth, when your body goes back to  its own happy sweet spot you will NOT feel happy. You will feel like something is wrong, like a failure & then you’ll want to “fix” it again & so it goes on and on. You never really feel happy with your body.  But you see, if you’re following you don’t need to fix anything. Your body is and will never be the problem. 

What makes you special and the reason we love you, has NOTHING/ zilch/ nudda not one iota to do with the body you live in. Your earth suit. We love you for all the things that make you, you. 

Another cost, specifically of dieting; food is something that if diets didn’t exist- then it’s fun, it’s away to socialize, share memories with friends and family or fuel your body to allow it to do all the amazing things you do!

    a) But diets introduce morality to food. There’s NO morality, food just is. It cannot be “bad” or “good”. But, dieting corrupts your brain & teaches you to believe foods can be “bad” or need to be “earned” or avoided. NOT TRUE. ALL FOOD IS EQUAL. ALL FOOD HAS VALUE. 

     i) Dieting confuses your brain. It makes something that is simple become harder than quantum physics, introduces maths when there’s NO need. 

ii) the more you diet, if you “trip up” you feel you failed & few bad about yourself. You can’t win. It all results in you feeling worse about yourself. When you zone out.. none of these things are to be fixed or in our control to begin with. But they all lead  you to feel crappy.

Trying to “achieve” the “ideal” appearance:

Takes you away from what really matters, it draws your attention away from things you actually care about. It’s makes your life smaller. 

It isolates you and that can make you lonely. 

It makes you boring. (Participating in, talking about diets, plastic surgery, etc is really boring) 

It makes you less “you”, less authentic. 

It takes you away from your true values. 

It also robs you of the opportunity to really get to know yourself and discover all the wonderful possibilities life has to offer.  

And while you think you need to shrink yourself to fit in, the opposite is true. You have the right to take up space, unapologetically. To be bold, to create your own path in life, and to enjoy the freedom that comes with it.

The more you try to “fix” the more you fixate on the “problem”. The problem that’s not even there. But it magnifies and you see it get bigger. This makes you feel more negative about yourself. You obsess over it and this only makes you feel worse. 

This striving for the ideal- lends itself to you beginning to compare yourself to others. 

     A) You have NO idea what anyone else around you, on Instagram, TikTok, tv, at school is doing to “achieve” this “ideal”. They might be very unhappy, living with dangerous ED’s, disabilities you don’t know about, you don’t know. But when you compare yourself to them you feel “bad” not “good  enough”  because you don’t look like that. 

Again zone out. 

i) Most pictures you see on TV, instagram or ticktock aren’t real. They’re made up/ curated. If you saw the person in “normal” day to day no make up/ filters etc they wouldn’t likely look like that all the time.

ii) let’s come back to the “ideal” according to who. Every single person on this planet is different which is really cool if you think about it. What you like in someone/ or are attracted to might be very different to the “ideal” and that is very cool. You can be who you want, like who you want.

Now, this is not specific to you, but important to EVERYONE. Conforming to ideals makes it hard for everyone to have and exist in a body. 

Because,

It perpetuates the narrative that -ANYONE- outside of this “ideal” is a “problem” & needs to be fixed. This in turn fuels:

               -Racism

              – Ableism 

              – Fatphobia

              – Homophobia 

              -Transphobia

       ** we don’t want to continue this! ***

You see, NO one needs “fixing” to be good enough. 

When you think of your favourite person,

What’s the first thing you think of?  What is it about them you like?

I bet it has nothing to do with how they look. 

Now, I bet if the same person told you they “hated” their body/ how they looked,

You  would remind them of how much you love them and all the reasons why.

You my darling, are perfect as you are. You are loved for who you are and always will be. And deserve to take up space in the world, to be seen and heard.

Childless In 2023

We live in a parenthood obsessed society.

Phrases like “when are you going to have a child, do you have children, why don’t you have kids yet” are as normalized as talking about the weather.

They shouldn’t be. A few reasons why.

It’s 2023, we’re striving for a more inclusive progressive and accepting society.

Procreating is not our life’s purpose, although, it’s still a societal expectation and parenthood, specifically motherhood is held on a pedestal. Those who procreate have more “worth” than those who don’t.

At least, that is how those of us who do not can be made to feel, when asked these empty questions. We almost have to anticipate them. My husband tells me he has a default answer “no kids but a cat, moving on” well practiced and ready. Mine’s not quite so well oiled and still gets me anxious and often a fumbled answer.

For many, not having a child is a decision. One that should be readily accepted without judgement, question or stigma. But it’s not. Yet.

Or in my own case, it’s something I have had to come to terms with. One that my husband and I desperately wanted and yet one that one that isn’t to be.

I am fortunate that having a child has not been my only dream. It has been an incredibly painful experience and, I am grateful that I have so many other things in my life that give it meaning and purpose. I am a wife, a daughter, a doctor and many many other things.

One thing this experience has shown me, is just how damaging the rhetoric that parenthood is the only way one can find meaning and contribute.

It’s an isolating place to be in society that has this invisible hierarchy. I’ve found it hard to find where I fit. Something I’m still navigating. Even giving a voice to things that we find hard, is something I’m finding gives me a sense of place. Talking about my experience with an eating disorder, infertility pregnancy loss early menopause all things that society doesn’t like to talk about. There are many ways to find meaning without “motherhood”.

Those of us, childless by choice or not are silenced and invalidated by society.

Phrases like;

“You have no idea what it’s like unless you have a child, you don’t know tiredness without a child, you don’t know love without a child” I could go on and on in the ways people are invalidated.

No, we may not know the same tiredness, love, or fears. And*** you are missing the mark on so many levels.

You don’t, know their struggles, grief, tiredness with infertility or pregnancy loss.

The people you are making these flippant remarks to, may be dreaming of the opportunity of that tiredness, that love and you are pointing out, over and over to them what they are missing & perhaps will never have.

Where there is a place for you to freely voice your struggles and your fears around parenthood or tiredness there isn’t the same compassionate welcoming space for the childless. Their voices go unheard.

And so, think next time before you do this, please. Whilst your struggles are valid, so are the people who have to receive them.

The childless in society are the ones who often have to work so that you get to spend Christmas’, holidays with your children. They’re expected to.

From my own experience I’ve at times welcomed the escape of working these periods because they serve of a reminder of what has been missing.

Other times, when people tell me they are times for “children or family” this has hurt.

Who is to dictate what family is.

Families come in all shapes and sizes. My family happens to be my husband and my cat. My parents, sibling, nieces and nephews. They are all valid.

Just because a person doesn’t have a child, it does not mean we don’t deserve to spend with our families, so that you can have all the holidays. There is no hierarchy of worth with family.

And so if you have read this as someone new to the notion that asking questions about “when someone is going to have a child”. Or perhaps you are a parent and didn’t realize that telling someone without they “can’t possibly understand what it’s like”, I hope this has perhaps given you a new perspective, something to think about the next time you go to do this. Please stop yourself.

Thank you from the childless community.

A little quote..

Someone I love wrote this on a card. And it really resonated. Acts of kindness and encouragement can mean the world when you are struggling.

I wanted to share these words of encouragement because they are so powerful.

Your recovery must come first so that everything you love doesn’t come last. Be willing to be a beginner every single morning.

EDAW, Infertility, Pregnancy Loss

** I’m going to discuss eating disorders, infertility & pregnancy loss & so feel free to skip this post if you think this might be unhelpful for you. Reader discretion advised. ****

Standing perusing the new born baby clothes in a department store to pick a gift for my expectant friend. I feel my eyes welling up and a lump in my throat. This week would be the week my husband and I would have been expecting to welcome our own rainbow baby. Instead I’m choosing a gift for our friend’s baby, and the enormity of our grief hits me like a freight train once more. In the middle of a busy store. No warning.

My husband takes the present from me and hugs me.

I say to myself; “ It’s just a piece of clothing, ridiculous. Pull yourself together, I shouldn’t react like this”. I was not prepared for moments like this. I was done with this, right? moved on?

This moment felt so permanent, so raw. I wiped the tears from my face. Paid for the onesie and the next day went to visit my friends and pass on the gift.

No one talks about how many emotions one can feel all in the space of a few minutes when you have experienced either pregnancy loss, infertility and are surrounded by either pregnant friends or those with children. You can feel immensely happy for someone and consumed by sadness at the same time and a deep sense of no longer belonging in circles. So much confusion.

Pregnancy loss, miscarriage, ectopic and infertility are all difficult words to speak. People avoid the subject, skirt around the topic or mutter under their voices as if it’s a dirty word. Some people avoid you completely too. I’m sorry if this is your experience, you’re not alone, despite how it feels.

It’s Eating Disorder Awareness week. This weighs heavy on me, one of the topics I rarely see discussed in the ED community/ space is exactly this subject. Infertility, pregnancy loss or navigating pregnancy/postpartum in recovery. The latter I do not feel equipped to discuss because, I have not been there.

However, I have lived through the wrath of infertility and pregnancy loss with an eating disorder. Both, I believe should be spoken about more openly/freely in the space because eating disorders, infertility and loss all have isolation & grief in common. Sadly we are also not immune to these problems. There’s enough shame already and I feel called to open the discussion.

On top of the isolation these issues bring, & speaking from my own experience, they perpetuate the common hallmarks of guilt, shame, loneliness & body dissatisfaction eating disorders feed off. Another difficult and common denominator of these, is that society shies away from & stigmatises them. There’s not a safe space to openly discuss the experience of an eating disorder let alone the often complex complications such as infertility or loss that can be more common amongst our population. Considering 1 in 4 pregnancies end in miscarriage, that’s a lot of people even outside the ED community that are affected by loss and emotional distress.

Throughout the entire process I experienced intense body loathing. Every cycle failure this intensified. Every pregnancy announcement around me I felt more and more disconnected from myself and my peers.

This, I imagine for a person without an eating disorder is also a common experience. However for someone with an eating disorder, familiar with, the all encompassing viscous eating disorder voice, it was incapacitating. Infertility treatment in itself was incredibly hard, my body changed over night, my hormones reaped havoc with my mood, appetite.

The lack of control. Your body is not your own. Things change in an instant. One minute you’re pregnant, then you are not. The feelings of shortcomings were unbearable. “Why can’t you do this” “It’s your fault”, “you’re a failure” “You’re so broken” We’re all things I repeatedly said to myself.

Infertility, pregnancy loss are not a form of grief readily recognised or accepted by society. I found myself not knowing “what the process was”. How I “should” be. If I was “allowed” to feel what I felt.

Infertility, treatment, pregnancy losses all stirred up feelings of alienation from my body. It didn’t feel like a safe place to reside. I believe this is a common experience with many who go through this, however, personally with the history of an eating disorder it allowed a space to slip into a familiar self-deprecating/punishing state.

For me, a family, being a mum was a strong motivator for my eating disorder recovery. You hear the term “ remember your why” banded about in the recovery space a lot.

For me, the post-pregnancy loss, this term especially, alienated me from my own community for a time. I didn’t feel I belonged in any community and I’d temporarily lost my ‘why’, until, like always happens with recovery, I found new reasons to recover. But for a while, body positivity spaces, neutrality spaces really infuriated me. I needed to know this was okay, but there’s no one who talks about this! I’ve never seen it anyway. It’s ok to feel whatever you feel, there is no right or wrong. What you feel is worthy of compassion. COMPASSION is what I lacked for myself. Compassion is what society lacks at times. And so you need to learn to be compassionate to yourself and to find where it’s safe for you to get the support you need. For me it’s been talking to my husband and my therapist. A lot. It’s been in writing.

Connection is the other thing that humans need. Yet, experiences like this, where you not only feel disconnected from yourself but also with everyone around you, finding a way to remain connected is imperative to healing. Whether it’s online communities, podcasts, blogs, friends, family, therapy or whatever.

Eating disorders are complex entities. Whilst I can only speak from my own experience, I know there are certain themes many of us share. Numbing painful emotions can be one thing an eating disorder promises, at the expense of losing any emotion. However, in a body that no longer feels home and with such grief it’s hardly surprising many of us believe the false promises. Again connection, having people that remind us of our values and show us compassion is so helpful.

I wish, we lived in a society that recognised this grief and there was a space to acknowledge a persons loss and pain. No one should have to suffer the self loathing and loss in silence. Expecting these feelings as a given, and allowing room for them how we heal. Creating a safe space for discussions and environments for healing.

Your grief is real and you are worthy of help and support.

The way your experience affects your body matters, you matter.

Thinking of anyone experiencing complex body related grief especially during this EDAW.

These are my own experiences and opinions and whilst I want to make my posts relevant to as many people as possible it is impossible to do this in a single post.

Smoke ‘N’ Mirrors

I’ve never written a post whilst “in the thick of it” before. But one of my values is authenticity. We often forget our struggles when we come out the other side and often some of the biggest lessons are lost if not shared when we are truly at our most vulnerable. I’m out of alignment and stuck. That’s basically an eating disorder summed up.

The last few months have been hard. I let small ED things creep back in and before I knew I was back under anorexia’s grip. I didn’t think they were a big deal. Individually they probably weren’t but if like me, you have a history of an eating disorder, we have to be vigilant of these things because one slip can become a landslide before we even realise. It’s a lot easier to deal with when it’s small and early. My aim of this is to reach someone, perhaps you’ve noticed a couple of things slipping, shut this down before it becomes an uphill battle.

The best way I can truly describe being amidst a relapse of an eating disorder is “Smoke and Mirrors”. I could kind of see it happening, but the smoke just kept coming.

The eating disorder serves as an obscurer. It’s made it near impossible for me to accept/ see I am in a relapse, I have a problem, I need help or that I’m not making my eating disorder up. It confuses my brain on a daily basis. It will have me believe I’m fine when everything and everyone I care about tells me the contrary.

All of this is the smoke that has kept me in the grips of anorexia, it’s made me hard to “reach”. How do you solve a problem when someone doesn’t believe there’s one to be solved? It’s taking me time to figure this out. It can’t be unless I decided to trust the people telling me I’m on fire. Some days I believe it, other days I can’t see past the smoke.

This is the main reason for wanting to share this, because I forget this feeling when I get back on track and yet it’s a feeling I can guarantee anyone who’s lived an eating disorder has or will feel at some point. When this started a few months back, I didn’t talk about how things were slipping, instead I isolated and went to anorexia’s open arms. Anorexia and eating disorders thrive on this secrecy, isolation and vulnerability.

Talking might have pulled me out of this faster and so I urge you, if you can feel things slipping, don’t wait for it to get worse before you ask for help. “It’s no big deal” may well be a big deal. It gets harder to ask for help the longer you wait and the eating disorder will do anything to trick you into believing you have this “shit in control”.

It’s a scary and lonely place to sit in. When your brain doesn’t allow you to see through the smoke. Everyone around you might be trying to pour water over the fire, but you struggle to even feel the burn. Occasionally the smoke clears for a moment and you might get glimpses of the situation and it’s suffocating. Realistically it comes back to putting one foot in front of the other to pull yourself back out. Because I only I can pull myself out, just like only YOU can pull yourself out. BUT*** We don’t have to do it alone. Which is something I’m yet again grappling with.

My goals are to go back to basics.

What does that mean?

– Attempting acceptance and when it’s not there trying, to trust my support team because I sure can’t trust my brain right now. If people are telling you they are worried, try to listen to them even if the eating disorder doesn’t believe it. It may never believe it, but one thing I do know is, I can trust people that care about me.

– Try and be honest. There’s no point saying you ‘want’ to recover when you don’t, but that doesn’t mean we can’t commit to recovering or at least trying. It’s a very strange concept to explain to someone who has never lived an eating disorder, why on earth wouldn’t someone want to recover from something that was harming them. For me the work here is coming from “unpacking what my beliefs around what the eating disorder does for me“ It’s hard for me to say I want to recover when in the short term recovery makes me feel shit but I know that long term it’s short term pain for freedom.

Again being honest about what’s realistic for you to challenge now. Only you can really know this. Recovery is meant to feel hard. But I know if I over commit and I can’t meet that goal it only fuels the critical voice of anorexia. Everyone’s recovery is different. Your goals will be not be the same as the next person. Whilst we are at it, releasing comparison full stop.

– Going back to basics. Trying to re-establish the healthy routines.

– Trying to re-establish things like regular eating.

– Using tools that I have learned in treatment or that have helped me in the past- such as dialoguing (as much as I dislike this exercise) because I know it helps to bring my healthy self to the foreground. Dialoguing is something I have let slip, yet it’s a tool that has always helped me see my eating disorder thoughts and healthy self more clearly and allowed me to reinforce that healthy side of me in moments of difficulty. (For anyone who is unaware; dialoguing is an exercise where you write out eating disordered thoughts and counter them with your healthy self (non disordered brain) to try and separate yourself from your disordered thoughts and strengthen your healthy self, you should always end on a healthy self point)

– Connecting not isolating or withdrawing. For me this looks like: keeping appointments with my team, talking to friends and family and even writing this blog because it’s connecting with my authenticity. This is something that I’m finding hard right now because the eating disorder wants me to be quiet an secretive. I’m also having a tough time saying eating disorder or anorexia and so I’m being deliberate in using it. Calling it what it is. Connecting with reality, truth and people. All the things the eating disorder tries to stop me from doing.

So where am I going with this…

Am I motivated to recover at every waking minute at the moment HELL no, But I am COMMITTED to keep trying every day. You don’t have to want to recover. But first step is to meet yourself where you are and work with that.

Eating disorders will distort and hide the truth of your suffering from you. Making it hard to accept or see your reality.

But no matter where you find yourself, even in times of relapse it’s important to remind yourself you’re never starting at square one, even if you feel like you’re starting again. You’re starting with more knowledge and resilience than you did at the beginning. Recovery is not linear. It’s ok to not be ok.

https://www.eatingdisorderhope.com/recovery/self-help-tools-skills-tips

Three Years in Eating Disorder Recovery

Sat in the car with Ben driving me to my first ED therapy session was the scariest day of my life, but it was also the beginning of my life. Sounds dramatic, well it was.

I sobbed the entire way, I yelled at him when we got stuck in traffic and the prospect of missing this appointment. The extreme reaction came from utter terror that if I missed this appointment I might never be able to re-find the courage that was leading me there and fear of starting the hardest battle of my life.

I had been to therapy before, when I was 7 and struggling with OCD and again a couple of times as an adult but I’d never talked about the eating disorder.

I remember the room and the welcoming demeanour of my then therapist who went about my intake assessment, I recall the paper questionnaire she had me fill, (EDE-Q) exploring my relationship with food body and mood. Distinctly I remember the battle in my head about how honest to be.

The room was cold and it was pitch black outside and I’d rushed from work, because I didn’t feel I could attend this appointment in work hours. At the end of the session I remember telling the therapist “please don’t label me”

She replied with a sentence that changed my life. “You have anorexia, restrictive type”

I felt a rush of complex feelings, Shame, disgust, denial and most prominent RELIEF. Relief I might not have to do this anymore.

Relief that now it was out in the open I couldn’t completely deny it anymore. Although at that very moment in time there was no part of me that felt “ready to give this part of me up” I also knew I couldn’t keep it up either.

The weigh in, which would become a regular feature of our sessions following, made the ED scream. I wanted to leave and not return for my second session but the present but quiet healthy voice would make me show up.

And three years on, that quiet healthy voice is now the predominant voice and I’m grateful to her.

I went back 3 weeks later and started CBT-E. It was the toughest and still remains the hardest thing I’ve ever done, hands down. I affirm it saved my life, in every sense. But 3 years on from that first meeting I wanted to share some hard truths.

1. Recovery isn’t a quick process. When I wrote a blog last “year- two years in recovery”, a large part of me hoped and thought by now I’d be saying I was fully recovered. In some ways this black and white all or nothing thinking kept me stuck. It was putting an unnecessary pressure on myself. There’s not magic crossing line.

2. You don’t always have to want to recover in order to do it. I mean when I reflect on that first appointment I certainly didn’t, but I started it anyway. There are days now, where the constant of my eating disorder feels like an easier option than recovering. But when it comes down to it, I hated my life with an ED far more than in recovery. Recovery will also not be forever, whereas an ED would be or a race for death. I don’t want to die and so even on the days where the ED comes knocking it no longer has as much power.

3. My definition/expectations of recovery have changed with time. Like I said, I no longer have a self determined end date for recovery. Instead it’s a commitment I make to myself over and over, with the hope and expectation that one day I will confidently exclaim I am free.

4. Slips, lapses happen. I’d be completely disingenuous if I pretended recovery has been linear. I’ve probably had more slips in the last 12 months than the 12 months prior to that, but each slip/ lapse has given me much needed information and education. I’ve gotten to learn so much about myself and it’s been generally easier to pull myself out of each one. It’s shown me areas of recovery that require my attention and focus to move forward and prevent the same slips later.

5. Self compassion. As a typical ‘all or nothing’ thinker and perfectionist tendencies it’s been one of my biggest challenges to learn to be self forgiving, to show myself kindness and compassion particularly in moments of struggle. But eating disorders feed on this inability to be kind to ourselves and practicing these have been by far one of the most powerful tools I’ve found in my recovery. This includes learning to talk back to the negative critic with kinder & gentler affirmations. Often, accepting what the eating disorder tells me and countering those thoughts with a healthy alternative. This continues to be something I work on. My journal is full of dialogues between my healthy self and the eating disorder voice and I gain insights to recurring themes or things that are keeping me stuck.

6. There are many beautiful things in recovery. My husband recently sent me a text “do you know what I really love? That the real Nikki is almost fully back, despite the shit that goes on in your head, the goofy girl that’s always been there is coming back more and more”

I screen shot that text and in moments where the ED is screaming at me, I read it and use it to motivate me to make the right decision. Finding something that can help motivate you in tough moments can really help, whether it’s a post card or somewhere you want to visit, an affirmation or a text from a relative can often empower you to fight back.

Now here’s where I highlight once more, I don’t always like recovery but if I want to stay that “goofball” my husband, family and friends love, I have to fight that voice, sometimes many times in a day. And this lends me on to another recovery tid bit.

Connection. Connecting with others in recovery, connecting with those that have trodden the path before you and connecting to your why’s is like an eating disorder recovery essential survival kit.

Connecting with people who ‘get it’ has helped me more than I can express in a simple blog. But if it’s something you’ve been reluctant or afraid to do, please consider it. Talking to people who ‘get it’ often without having to say what “it” is, really helps in several fronts; feeling seen, not alone or crazy. Not to mention the unwritten support and etiquette that most people in recovery show each other (I.e automatically knowing what Info is harmful, like numbers etc) without having to ask someone not to share things likes diets etc that is normalised outside of the ED recovery community. This can also lead to a level of accountability the “wanting to set an good example or help others” can inadvertently push you forward.

7. Connecting to my why. If I was to share what my why was three years ago, it would be very different today. The only thing I knew then was I couldn’t live that way any longer. Now, my why remains dynamic but is also much broader. I’m no longer a one dimensional figure where my life revolves around food and exercise.

What has recovery taught you?

That’s it my reflections on the last three years in recovery, who knows what I’ll find in the next 12 months, but I know one thing I’m letting go of the pressure of setting myself a recovery deadline and I’m just going with it.

Navigating Work and Recovering From an Eating Disorder.

Might work be an area that requires your attention in ED recovery?

If I was to ask you what one of your most challenging situations in recovery has been, I expect a lot of you will answer, navigating recovery and work.

What is it about work that makes it difficult to remain in recovery or on course with your goals?

Taking time off from our jobs/ school or college may not be possible for everyone in ED recovery. It wasn’t for me personally. There are times, where I know not being at work would have been really beneficial to recovery. Taking time out is beyond the scope of this blog and very individual.

I want to share some reflections regarding the relationship my work has had in my own eating disorder with the hope this may help you.

Considering many of us spend more than half our adult lives at work, it may be we need to put extra “work” in to maintaining our health in our place of work. Finding a way that means the two are not in conflict is vital. Both living with an eating disorder and recovering can be very stressful, managing this with the stressors of work can compound this further. It’s exhausting.

Ideally a person who is in the early phases of recovery wouldn’t be worrying about their career when the main goal at this time is to stay alive, yet because of a plethora of reasons, such as financial worries, stigma, access to care this is the reality for many. Many jobs lack the flexibility that is so needed to make progress in recovery.

Recently, I moved city and role in a new hospital.

Before we moved I told myself , “this was going to be an amazing fresh start in terms of recovery”. Before I go any further, I still have this view but I’ve had to shift my expectations and time line.

I came here with the mindset; people here don’t know my past which means I can start a complete fresh, ‘I will eat with people, eat all the foods I’ve not been able to in previous jobs and I will break away from the ED disorder identity’.

** To be clear, I ’m not ashamed of my background or struggles and if asked I will elaborate, however I want to recover, and not being tied to this ED persona is important to me.

My goal is to not be seen as the person who is ‘weird’ around food, or left out of social engagements that involve eating. I’ve missed out on this for years and my goal is to heal this relationship. Making connection with others, is recovery to me. To get to that, this for me means taking smaller steps.

Okay, so fast forward 6 weeks into my new job. I’ve felt completely perplexed by why my intentions hadn’t come into full fruition.

Let’s break this down, why might be harder than anticipated?

1. Firstly, let’s bin the notion you can ‘out run’ an eating disorder. I believed for years I could move and leave my ED behind. Time after time I proved this wasn’t a thing. I moved half way across the globe and my eating disorder followed. And so, let me save you the wasted time: YOU CANNOT OUT RUN AN EATING DISORDER.

2. People spend a lot of time at work. Sometimes people are afraid to share their struggles for fears of; discrimination, stigma or bullying. I was and to a certain extent still am.

3. Work can be a trigger for many. I’m not for a second saying certain occupations cause an eating disorder, however I strongly believe in those of us with the vulnerability to developing an ED, certain jobs may perpetuate them. Having this knowledge may be an asset in preventing and helping people to recover, for both employees and your employer. For instance certain occupations attract particular personality traits. Working in fitness, fashion, catering may draw specific trait’s. Working in the food industry may both be motivated by an ED or exacerbate. Certain careers like professional sports, fashion, entertainment and healthcare reportedly have higher incidences of people with eating disorders. Doctors’s may be at risk through; perfectionism, hard working, people pleasers and combine that with a culture where it’s praised if people forgo breaks, being vulnerable and speaking out against struggle is seen as a weakness. The stress of looking after others, exams, career progression, missing social events, It’s a perfect storm for those of us with the ED vulnerability.

4. Neural pathways take time to develop and naturally take time to deconstruct and rebuild new pathways. If your ED mindset and behaviours are entangled with your job, then it doesn’t take a rocket scientist to get why it takes time to resolve. (Though it’s taken me until now to realise this for myself).

5. Culture and societal pressures, “diet culture, weight loss, fad diets” are almost seen as a way of workplace bonding. People can fear being ostracised by speaking against this or simply excluded if they try to protect themselves from these otherwise seemingly innocuous conversations.

6. In the same theme as above fearing social engagements that involve eating with others can feel like it’s thwarting making connection’s and perpetuate this spiral.

7. Work place canteens may serve as a barrier to some people, the lack of options coupled with social anxieties may add a layer of stress.

8. Time pressure, work related stress may exacerbate eating disorder thoughts and behaviours especially when eating disorders have been the maladaptive coping strategies for stress.

9. Work may reinforce self esteem issues. If a person’s eating disorder is entwined with poor self esteem, a person who feels negatively about themselves at work or has poor confidence it’s unsurprising this may manifest in their eating disorder’s.

10. Imposter syndrome may be both perpetuated by an eating disorder and in some ways recovery. This is a big one for me, as I battle the eating disorder it can cause a imbalance of energy. I become anxious my focus on recovery is thwarting my career progression. I feel added stress and pressure, which can become a trigger in itself. However if I am not focusing on recovery, my work performance slips at the cost of my obsession with food and numbers. My anxiety can make me worry about losing out on promotions or career progression. Yet despite having to expend this energy, it will never impact upon my work in the same detriment that living with an eating disorder can. Being patient and kind to yourself here, I feel is the key. Forgiving for what is.

Now we can see some of the ways our eating disorder might be entwined in our work schedule, we have given ourselves insight and a place to focus our recovery goals.

I personally feel like identifying this, is a milestone in my own recovery, but I also feel frustrated by the fact it’s something I have to consciously focus on. It’s another hurdle when so much I want to be able to say; I’m free. Free to focus on anything but recovery from anorexia. However, I also fully embrace this is part of my healing journey.

Though I don’t claim to have this figured out, these are some of the tools I’m using to help me navigate this part of my recovery:

1. Make realistic goals. I am very much a black and white, or all or nothing thinker. Recognising my thought processes around recovering in the workplace has served as a catalyst to make changes. It’s not a failure if you can’t challenge everything all at once.

2. Be honest with yourself and importantly your support team. Make use of help anywhere you can get it.

3. Set yourself goals and debrief if they need tweaking. For example my initial goals were to eat with people every day when I started here. When that wasn’t working I needed to go back to basics and work out what was serving as the barrier. If eating with others is something that causes you a lot of anxiety, perhaps starting with smaller challenges first and building up to this might be a good one. I’ve been working on challenges like; making eating regularly non negotiable, practising eating different foods and buying the occasional meal or snack from the canteen. Something I have never been able to do until now. As I’ve become more comfortable in doing this I’ve then aimed to eat with others on occasion. I might not be in a place to buy foods and eat with others everyday yet, but that’s okay! I’ve often brought my lunch in and then gone and sat with my new peers outside or in the canteen. My point here is, you don’t have to achieve everything at once, take a step back from striving for perfect. Perfection is an illusion. Start with what feels achievable right now. I was focusing on the end goal rather than where I am right now.

4. Perhaps find a colleague you feel comfortable with, someone you can eat with (they don’t have to know about your eating disorder). I used to eat with a colleague in my old job, because she had a “fuck it mentality’ around food she was a great role model ( and she didn’t know how much she was helping me)

5. If it’s an option, sharing your struggles with a co-worker or employer. This is very personal and not for all. However having people around who know about your ED may allow other ways you can be supported: making time for breaks or allowing you to attend appointments etc.

6. Boundaries, boundaries and boundaries. Whatever boundaries you need to protect your recovery, whether it’s removing yourself from triggering comments, or carving specific times in your day that align with recovery. Boundaries are like a recovery superpower.

How can you, as someone without an eating disorder help a co-worker?

It’s highly likely you work with someone struggling with their relationship with food and body. You may never know someone is struggling ( kind of the nature of an eating disorder).

But you can be a real ally in someone’s recovery by:

1. Being mindful of how you talk about food and bodies around others. Don’t be that person who encourages the cheap diet talk. Keep the diet talk out.

2. Don’t comment on others eating habits, an innocent comment such as “ I wish I could eat that, or is that all you’re having or you’re going to eat all that” might just be the comment that serves as a barrier to a person eating.

3. If someone turns down an invitation to join you in social eating, don’t stop inviting them on other occasions. When someone feels excluded or isn’t given the opportunity to participate it may perpetuate the cycle that they cannot join in or they have to keep isolated. Eating disorders are extremely isolating.

4. Be kind. Don’t judge someone.

5. If you think someone you work with may be suffering from an eating disorder, share your concern with them in a non judgemental manner ( this may depend on your relationship). They may not open up to you, but you may have given them encouragement to talk to someone they’re comfortable with. It’s not your responsibility to make someone recover ( no one can do that) and so often a person won’t need advice but a supportive ear.

6. Educate yourself about eating disorders, some of the most harmful comments come from ignorance rather than a place of malice.

7. Be a role model, show people it’s ok to show vulnerability, to talk. You’re vulnerability may be the gift a person needs to feel safe.

8. If you are an employer, you can make your workplace a safer, more inclusive environment. Providing mental health training, awareness to make the workplace inclusive and reject stigma surrounding mental health.

I expect if asked, a lot of you would join me in saying one of the biggest threats to you recovery is work. Right?

With that, it makes sense a lot of our recovery energy needs to be focused on creating balance where the two are not in conflict. Perhaps talking with your support team can help you create a more symbiotic relationship.

What else would help you at work?

Let’s Review the Evidence Behind the New Jab To be Available on the NHS, to “Defeat Obesity”

Disclaimer: these are my own opinions, personal interpretations and are for information purposes only, reader discretion advised.

On the 8th of February NICE (National Institute of Clinical Evidence) approved the use of semaglutide as a “weight loss” intervention. 

If you’ve been following me for a while, you’ll already know some of my likely thoughts on this. 

But, I wanted to look into the evidence behind this.

First of all, what is semaglutide?

This is an injection that has been used for diabetes, it essentially helps a person secrete more insulin. It is a glucagon-like peptide-1 analogue.  Simply, insulin is the hormone to lower blood sugar and insulin resistance or lack of insulin is the driving factor in diabetes. 

What’s all the hype about?

A clinical trial published in the New England Journal of medicine; the Obesity STEP 1 Study, https://www.nejm.org/doi/full/10.1056/NEJMoa2032183 

Once-weekly Semaglutide in Adults with “Overweight or Obesity” concluded semaglutide once weekly, plus lifestyle changes was associated with sustained weight loss.

What is NICE? this is an independent organisation that decides which drugs/ treatments are to be made available on the NHS.  The aim is to make care more equitable, provide evidence based care that is cost effective and safe. I’ll return to this shortly.

Back to the evidence:

The STEP 1 study aimed to investigate the effectiveness of semaglutide on weight loss in people who are defined by the BMI criteria as overweight.

Participants were eligible for the trial if:

  • They were 18 or over (pretty standard for most medical studies)
  • **with self reported unsuccessful attempts at weight loss efforts
  • A BMI of 30 or above
  • A BMI of 27 or above with “an existing weight related health problem” these included high blood pressure, high cholesterol, heart disease or sleep apnoea 
  • BMI >40 with Dexa scan prior

Participants were excluded (not eligible to participate in the trial) if:

  • they had a history of diabetes or pre diabetes
  • Had taken glucose (sugar) lowering medications 3 months before trial start
  • Treatment with similar medication to semaglutide 6 months prior
  • Had a history of depression (2 years) prior
  • Major psychiatric conditions defined as: schizophrenia or bipolar disorder
  • Previous suicidal ideation (1 month before trial), attempt (lifetime)
  • Alternative medicine supplement use 3 months prior
  • Pancreatitis 
  • Elevated markers of inflammation measured by raised calcitonin 
  • Genetic disorders in first degree relatives
  • Impaired renal (kidney) function
  • History of cancer (5 years)
  • Strokes, TIA, myocardial infarction (heart attack) 1 month prior
  • Pregnant, breast feeding or intending pregnancy 
  • Investigators’ opinion where something not covered by exclusions might interfere with participants safety or participation in the trial

So, what was the obesity START-1 trial?

A phase 3 randomised double blind, placebo-controlled trial. (what is that in English!?) 

Basically before an intervention or drug can be adopted it undergoes rigorous testing, the gold standard of evidence in medicine comes from good quality trials. Phases of trials indicate both information about the size and stage of the evidence. 

For most medications that make it into practice they’ve been through phases, at least phase 2 and ideally phase 3, which investigate their effect (phase 1 generally is small numbers looking at safety, phase 2 dosage before finally phase 3 the effectiveness compared to xyz). Double blind Randomised control trials mean neither the investigators or the participants know whether they are receiving the intervention (drug and In this case semaglutide) or the placebo (dummy drug). By conducting trials this way it avoids biased results (in theory).

This trial took place in 16 countries, 129 sites (a broad sample in theory). 1961 participants were included in the trial (again not small numbers)

Once enrolled participants were randomised (selected at random by a special software) to receive either semaglutide or placebo. 1306 participants were randomised to semaglutide vs 655 randomised to receive the placebo (this is a common method of trials where people are randomly allocated 2:1 fashion in the drug arm and placebo) although most trials participants are allocated 1:1.

They gave the participants the semaglutide or placebo weekly for 68 weeks as well as lifestyle interventions. After the 68 weeks participants had a 7 week period of no semaglutide, placebo or lifestyle intervention. 

Lifestyle changes prescribed to participants included 500-calorie daily deficit relative to activity, 150 minutes of physical activity a week and recording daily of both activity and intake. 

The main outcome measurements were achievement of 5% or more reduction in body weight  from baseline and percentage difference from baseline in body weight at week 68. Other secondary outcomes ( measurements that were not the central focus of the study) included: achievement of reduction of more than 10%, 15%of body weight from baseline, systolic blood pressure, cholesterol levels, HBA1c various functional questionnaire’s Including physical activity, quality of life.

What were the results?

At the 68 week weight check there was a -14.9%  change in body weight in the semaglutide group compared to -2.4% with the placebo.  This was statistically significant ( the chance that this would be demonstrated again under the same circumstances and not as a result of chance).  There were more reductions in weight in participants who received semaglutide than the placebo. The percentage reductions of 5%, 10, & 15% from baseline weight were all higher in the semaglutide group. However, although included in the results, reductions in cardiovascular metabolic risk factors such as HBA1c, cholesterol levels were not statistically different between those receiving semaglutide compared with placebo. Additionally more participants receiving semaglutide discontinued the treatment owing to adverse events (side effects) from the medication. The most common being gastrointestinal side effects including, nausea and diarrhoea. 

What were the results?

At the 68 week weight check there was a -14.9%  change in body weight in the semaglutide group compared to -2.4% with the placebo.  This was statistically significant ( the chance that this would be demonstrated again under the same circumstances and not as a result of chance).  There were more reductions in weight in participants who received semaglutide than the placebo. The percentage reductions of 5%, 10, & 15% from baseline weight were all higher in the semaglutide group. However, although included in the results reductions in cardiovascular metabolic risk factors such as HBA1c, cholesterol levels were not statistically different between those receiving semaglutide compared with placebo. Additionally more participants receiving semaglutide discontinued the treatment owing to adverse events (side effects) from the medication. The most common being gastrointestinal side effects including, nausea and diarrhoea. 

Here’s where I think it’s important to know how to understand where evidence from trials can be misleading. On the face of it, this looks like a wonder drug for obesity. ( I say this with a bitter taste in my mouth because that in itself is a stigmatising sentence). The whole pretence of this study is filled with weight stigma, it is medicalising fatness. From the inclusion criteria you can see many of the participants were included by being fat, but without any “co-existing fat associated” conditions. They were included simply based upon their BMI, which is an unhelpful assessment of health. If I believed what the media reports about this and I hadn’t have been fortunate enough to a understand that fat does not equate to unhealthy and second my medical training that enables me to appraise the findings of such research I would have been led to believe two things: all fat much be medically treated and this is an effective method in doing so.

And so lets look closer at the trial design itself:

Most trials that are considered refutable minimise biases (any factor that may make the results difficult to interpret or apply to a wide population).

Let’s delve a bit deeper into the participants included in the trial:

Both groups of participants were fairly well matched with respect to age, BMI, pre-existing problems, diabetic status, ethnicity and gender.  This sounds good at this point. But on a deeper look the participants in the trial were predominantly white female 1453 (73%) in both placebo and semaglutide group and 75% (1472) of the study population were white. 

When you have an imbalance like this, it already makes it difficult to interpret findings and apply them to non white or female populations. 

Another criticism I have with this trial, ( something to always look at when interpreting a paper is where did the funding for it come from?) This trial was funded by and designed by the drug company who make and sell the drug-  Novo Nordisk. That in itself  creates conflict of interest and potential biases. The randomisation was 2:1 this, although not uncommon in trials already results in unequal allocation and the potential for biases. Caution should be aired when reviewing confirmatory trials such as this. The trial was powered  to be able to demonstrate a difference with these numbers, but if the hypothesis is that the group receiving semaglutide are going to benefit more than placebo, then really the justification for recruiting in an uneven fashion is null and void.

The next consideration that is not documented in the trial, what happens when people discontinue the medication or life style modifications? This study promoted a restrictive diet- calorie restriction. We know from a plethora of research that >95% of people who participate in diets regain the weight they lost and more, within 3 years.  We do not know the long term changes in these participants. Additionally, the majority of the population within this trial were female and white and so I would be cautious to apply this to a wider population including non female or any other ethnicity. 

In conclusion;

I believe it is important to understand a few things before thinking about prescribing this weight loss intervention or seeking it. Fat does not equate unhealthy. Weight stigma and bias is unfortunately an inherent problem within healthcare and society and so there would be an obvious appeal to approve another drug to “fight obesity” . Being fat is not in itself a medical condition. The focus should be on addressing risk factors that are “associated with fat but are not proven causational” ,  and addressing those, for example cholesterol, high blood pressure and diabetes andit is likely more all of these are more nuanced than prescribing weight loss.

Prescribing weight loss seems like the easy solution. You’ll note, I personally do not adopt the terms, obese or overweight because these are both stigmatising and medicalising a size rather than an individual patient. 

I am not proposing to have a solution, but adopting a one size fits all approach does not seem to cut it. 

Further more, my intention was to highlight the evidence is not as black and white as you may hear and I’m imploring fellow health care professionals to entertain the notion that weight is not a reliable measurement of health in isolation. I encourage anyone who is not familiar with the Health at Every Size movement to educate themselves;https://asdah.org/health-at-every-size-haes-approach/. To not blanketly prescribe weight loss to patients in front of you. I am concerned, these medications have the capability to be abused, patients with eating disorders living in larger bodies are potentially at risk of being prescribed these rather than receive treatment for their eating disorders.  As a doctor it is our duty to do no harm, please consider this when you have a fat patient sat in front of you. 

https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

https://www.fatdoctor.co.uk

https://linktr.ee/marquisele

https://asdah.org/health-at-every-size-haes-approach/

https://www.health.harvard.edu/blog/when-dieting-doesnt-work-2020052519889#:~:text=According%20to%20a%20new%20study,the%20benefits%20are%20largely%20gone.&text=There%20were%20no%20major%20differences,between%20the%20various%20diet%20programs.

Bye Bye BMI…

https://www.change.org/-ByeByeBMI

If I was to ask you what someone with an eating disorder looks like, I imagine most of you just described; a teenage, cis gender, emaciated white female.

I don’t blame you. That’s the current societal and media depiction of an eating disorder. Hell, most medical professionals hold this image too.

However, that image you just described is the rarity. It is so far removed from the truth.

The truth is; only 6% of people suffering from an eating disorder are underweight according to BMI. (Which if you have been following me for any length you will know that; BMI is bullshit and secondly it was never intended for individual health status)

You can not look at someone and know if they have an eating disorder. Like I said in, 94% of cases the person is not underweight by medical definition.

Here’s the real kicker, many treatment’s for eating disorders discriminate based upon BMI. The diagnostic criteria, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes BMI as a marker of severity for Anorexia. Now with the figures I just gave you, you can begin to see why this is at best problematic and at worse a health crisis. Further more, this archaic diagnostic criteria separates “Anorexia and Atypical Anorexia” into seperate diagnoses, purely based on a BMI number.

People can be underweight at any weight. A weight is not a useful health determinant. Someone can been dangerously ill at any weight.

Remove BMI and Atypical anorexia becomes exactly what it is; ANOREXIA without the weight stigma and discrimination. The BMI is an excuse to not allocate sufficient funding and it NEEDs to change if people with eating disorders are going to get the help they need.

A person can be experiencing extreme adverse effects from an eating disorder, both physically and psychologically at ANY weight. The difference is again, the DISCRIMINATION a person who is not “medically underweight” experiences.

What’s terrifying is, many people who are very ill, are denied access to life saving treatment, because their BMI is not deemed to be “low enough” and what’s worse many are encouraged to lose weight before they can access help. This also perpetuates the common notion held by sufferers “I’m not sick enough”.

Let’s frame this in another way to really highlight how twisted this is. If someone walked into a doctors office with a tumour, they would not be told to go away and wait until it gets to XYZ size have help. No because that’s just mental. Eating disorders should be treated like the serious health issue that they are.

But the problem is how we view and understand eating disorders. We don’t recognize them for the life threatening illnesses they are. Doctors don’t recognise them and society doesn’t recognise them.

Eating disorders have the highest mortality of any psychiatric condition, second only to substance addiction. Yet 94% of sufferers are not getting the life saving help they need.

We need to do better at raising awareness, recognising them for what they are, severe mental illnesses. We need to improve access, education and funding. Change doesn’t happen over night.

With the current pandemic, eating disorders have soared. Yet the most common message globally is to “avoid the Covid weight gain, start xyz diet” This is not helping anyone, least of all those with an eating disorder.

At the bottom of this article I have included an online petition directed at the American Psychiatric Association (the body responsible for publishing the DSM-5) requesting they remove BMI from the diagnostic criteria of Anorexia. The aim of this to improve access to help for 94% of those with an eating disorder that are currently denied help based upon this outdate measurement.

So far, >1100 people have signed this, including some big names in the eating disorder treatment field. But before I can take this further I need more signatures.

Please sign this petition and share, so that things can change for the better. Nothing changes is nothing changes.

The link is below, as well as a link to my instagram so you can see what others have to say.

Bye Bye BMI petition: https://www.change.org/-ByeByeBMI

Follow the petition progress: https://www.google.co.nz/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwj-sJXF8Mb1AhUowzgGHX7LCsAQFnoECAIQAQ&url=https%3A%2F%2Fwww.instagram.com%2Fp%2FCUGlCKpBskk%2F%3Futm_medium%3Dtumblr&usg=AOvVaw2EpH5DSOE42kkcv_N5PHpH

Tabitha Farrar: https://youtu.be/SjDAsvj3igI

Is That “Before” Recovery Photo Actually Thinspiration? Don’t Be Fooled!

https://www.recoverywarriors.com/is-that-before-recovery-photo-actually-thinspiration-dont-be-fooled/

What is thinsporation? And how does it play into eating disorders? And is that “before” photo helpful, or actually harmful?
— Read on www.recoverywarriors.com/is-that-before-recovery-photo-actually-thinspiration-dont-be-fooled/

What’s up Doc?

What’s up Doc?

This is a slightly different post to my usual.

I want to talk about well-being amongst healthcare professionals.

The people that look after you when you are sick are humans too but it can be hard to view them as anything more than the doctor/ nurse/ psychologist in front of you. They have a life outside of the workplace, they have their own families, insecurities and problems.

Doctors, nurses, first responders & all members of the healthcare profession make huge sacrifices for their patients and do so willingly.

But who looks after them?

Mental health problems amongst medical personnel is at an all time high. If we don’t look after our healers they can’t look after you.

Yet, we are a profession that is notoriously bad at seeking help for ourselves. It’s a common theme of jokes “doctors/ nurses make the worst patients”. We provide diligence to our patients but it’s a hard pill for us to swallow when we need help ourselves.

What are some of the reasons behind the resistance for a healthcare worker to seek the same help they provide without a second thought?

A study published by the lancet offered several reasons for this.

An old fashioned and harmful rhetoric that still bleeds into the healthcare industry: “we don’t get sick, we treat the sick”. It’s hard for healthcare workers to accept they are not infallible and often this narrative alone prevents them from seeking help, often meaning problems are advanced by the time the do access care.

The well-being of doctors is becoming increasing challenged.

The medical field is an unusual one.

For most of us, we give up our twenties to dedicate ourselves to studying or long hours working as junior doctors. We are often forced to make difficult balances, missing out on important life events and socializing because of the restraints of the profession. It’s not uncommon to battle to get leave for major events such as weddings or funerals.

Often, we can’t just go home when our work day is supposed to finish because we are looking after someone in their moment of need. We stay late because we care.

But this can come at a cost.

Our contracts can mean constant changes, junior doctors move around every 4 months, sometimes this means transferring miles away from your loved ones. This can make things like registering with a general practitioner difficult.

Long shifts, antisocial hours, plugging gaps in rosters, studying for endless exams and extracurricular activities can take their toll both mentally and physically.

Often these are accompanied with limited access to healthy food or basic self care including rest, relaxation or exercise.

There is an undertone within the healthcare profession that being anything less than perfect 24/7 is failure. Fear of disclosure and the implications it may have on our license to practice I’m sure is a common barrier to seeking help.

Doctors have an increased rate of suicide compared with any other profession, high rates of mental illness, including depression, anxiety, burnout, imposter syndrome and substance abuse. But it doesn’t get talked about. It remains “taboo”.

The resources for help aren’t made readily accessible, the encouragement to seek help is virtually non existent. This needs to change as early as medical school training. This needs to be openly discussed and normalized. Otherwise the stigma stays and nothing changes.

Doctors are making life or death emotionally demanding decisions. This is what being a doctor is. But sometimes the weight of these decisions is enormous without resources to help.

The threat of litigation is real, the trauma of some of the decisions they face, with often no debrief or acknowledgement of the enormity of these decisions.

Burnout rates are increasing.

Dealing with uncertainty is something doctors become adept at, changes in rosters, no two days being the same.

Teamwork can be challenging when there is conflict between management and the frontline workers or finite resources.

It’s not uncommon to come across bullying and not enough is done to mitigate or reduce this.

If you are a healthcare professional what were the barriers you faced to seeking help? I’d love to hear your experiences

What do you think needs to happen to protect our community’s wellbeing? How can we do this?

There are some charities that exist but again they’re not widely known about. I’ll share some links below. If you know of other’s please share.

References:

Trigger Warnings…

Trigger Warnings

What are trigger warnings and do they work?

These are often at the beginning of an article or social media post, either labelled as; trigger warning “TW’, or content warning ‘CW’. Triggers have many different definitions. The discussion regarding their use is not straightforward or easy.

I’m keen to start a discussion about how we perceive them, use them or alternatives that we could implement.

This is a heavily nuanced subject and I do not claim to have all of the answers, in fact my experience and knowledge is finite.

However I wanted to explore this topic further after an Instagram post I shared about them sparked a few interesting DM’s. https://www.instagram.com/p/CUYQe2Mhae4/?utm_medium=copy_link

Before I get into my own views, lets discuss the origins of where “trigger warnings” for content originated.

Trigger warnings originate from trauma, PTSD content. They were specifically attached to protect people with a history of PTSD/ trauma from experiencing the negative effects of reliving the traumatic exposure and secondary response. “Being triggered” in any other setting is different to this. People with PTSD often cannot regulate their response to the trigger.

I do not have experience with PTSD and so I’m not equipped to be able to talk about all of the nuances associated with this. I can however talk about the use of “TW” outside of trauma & PTSD and the potential harm they cause.

Multiple studies have demonstrated TW used in any other context at best do not work and at worst can cause harm. Yet almost every post I come across in the eating disorder community comes with a “TW”. It’s almost as if a trigger warning absolves a person from any responsibility of what they are posting.

If you are consuming, participating and engaging with particular content on social media you have a level of personal responsibility.

What do I mean by this?

It is your choice to visit certain pages, hashtags and communities. You have the same choice to avoid or unfollow content that does not help you.

Additionally you have a degree of responsibility regarding content you share. If you feel it may be harmful, caveating it with a TW is not solving a problem. Before I share anything, I consider a few things; does this post have the possibility to harm, does it serve the community I want to be an ally to and how would I have perceived this when I was unwell?

There is also a big difference between being “triggered” and discomfort.

Unlike people with PTSD, most of us with eating disorders whether you like it or not can choose to be triggered by something.

People with PTSD find it difficult to self regulate/soothe when they come across a trigger and reminder of the traumatic event. It can have many physical, somatic effects such as dissociation, soiling, hyperventilation and these are not in their immediate control. Therefore trigger warnings applied to topics/scenes depicting graphic violence/ sexual assault may help. There’s also debate that avoidance of such can do harm to some people’s recovery but again I am not equipped to go into the nuances regarding these.

I know when I was deep in anorexia, I would seek content with “TW’s, my eating disorder wanted me to be triggered. A trigger warning did not deter my unwell brain. If anything they helped keep me stuck in the cycle. I chose to be triggered by them. Why?

Eating disorders by nature a incredibly competitive. When the eating disorder voice is the dominant voice it will go looking for anything that validates it and makes it “more successful”. I could have controlled my response to them, I could have avoided them all together, but I chose not too.

Trigger warnings do not prevent this. They are the problem.

Now I’m solid in recovery, if I see an post with ‘TW” I can view content without allowing myself to become “activated”. I will often choose not to open such posts depending on how I am feeling in myself. I take responsibility in what I engage with. This is self regulation. But let me lay this out there…the “TW’s” on content I used to seek when I was ill with anorexia would reinforce intrusive thoughts. Labelling content with a “TW” would often lead me to engage in things I wouldn’t other wise. It’s like when someone says “don’t think about the colour red” all you can think about is the colour red. TW’s don’t tell you to avoid the content but they may increase the intrusive thoughts too. There’s increasing literature to show that “TW’s” do not work and can result in increased anxiety (I’ll share some links below).

As I have referred to already there is a difference between “being triggered” and feeling uncomfortable (feeling our feelings). I can feel uncomfortable about something but still remain within my parasympathetic nervous system and not enter the fight or flight mode invoked by the sympathetic nervous system. Commonly posts will elicit feelings of grief because I resonate with them to a time when I was unwell. These feelings are healthy and transitory- they do not keep me stuck in a state of “activation or triggered into a trauma state”.

Again I’m not knowledgeable in all of the nuances regarding this. I wanted to start the discussion about how blanketly these warnings are being used and whether they are causing more harm than intended.

I’m not saying there is no role for TW’s, I am encouraging you to reflect on why you use them, is it truly to prepare an individual or to remove responsibility from what you share or engage with?

Do trigger warnings help you are they as useful as we think? Do they cause you more intrusive thoughts? I’d love to hear your opinions, either via the comments or email me.

A few published studies:

It’s OKAY to Talk About Suicide

It’s ok to talk about suicide. Suicide is not the solution.

CW discussion of suicide

Feeling suicidal is terrifying and if you have these thoughts please call the crisis line or someone you trust.

This is a difficult post to write, but it shouldn’t be. September is suicide awareness/prevention month. Really every day should be suicide prevention. For some reason, suicide continues to be a stigmatised, taboo subject.

Suicide is the second leading cause of death in young people aged 10-35. Yet it’s not talked about. Not nearly enough. 90% of people who die by suicide have suffered mental health symptoms. Marginalised communities have a 4-12x risk compared with the general population.

Anorexia is the most fatal of all mental health diagnoses, 1 in 5 anorexia deaths are from suicide.  27 people die everyday globally from eating disorders. Suicide is a large proportion of these. It shouldn’t be and doesn’t need to be.

We need to make society a safer place if we are going to reduce these stats, it starts with talking and normalising mental health.

When I was deepest in my eating disorder, I was haunted by thoughts of escaping, but this was not something I ever admitted, voiced. I was even asked many times by my team if I was depressed or had suicidal thoughts. The truth is, I wasn’t depressed, I felt hopeless, like there was never going to be anything else. The idea of living another day in this never-ending self-loathing, food obsessed brain was sometimes overwhelming. I used to say over and over in my mind- I wish I was dead. In those moments I believed it, I meant it.

The reason I want to share this, there were many times I felt like this when I was trapped in the ED. I felt so much shame for having these thoughts, I grew up in an environment that didn’t believe in mental health, I grew up believing suicide was selfish, cowardly or attention seeking. That’s so far from the truth.

Isolation was the worst part. I can hand on my heart say, it is none of the above. Suicide is a permanent solution to what I feel is a temporary problem and preventable with support.

Eating disorders are incredibly isolating. Not feeling I could talk about this added to the shame and perpetual cycle.  We often ask people “are you okay, how are you” but it’s an empty question. We don’t ask people how they really are, because as a society we are afraid of how to respond if someone was to really answer. Personally, I wouldn’t have wanted someone to have the answers. You can ask someone how they really are and not have to have the solution. You can offer support in many ways. Listening, not judging a person, advising they get professional help, letting them know their feelings are valid (even if you don’t truly understand). One of the biggest things is not perpetuate the rhetoric that suicide is selfish, cowardly or a choice. People who feel suicidal may be experiencing feelings of not wanting to be a burden, isolation, guilt. People who are feeling suicidal are living with pain and so many other horrible emotions. It is not selfish and making someone feel guilty or selfish is only going to fuel anguish and isolation. People are more likely to withdraw and not get the help they desperately NEED AND DESERVE.  Suicidal thoughts are a symptom and can be treated with help.

Raising mental health awareness, particularly in the healthcare profession is something I feel very strongly about. Healthcare professionals have higher rates than the general population of suicide. Female doctors are 2-4x at risk of ending their lives than the general population. It doesn’t surprise me, but it deeply saddens me. The medical profession is one of the worst for stigmatising mental health. It’s not a safe place to openly talk about mental health.  Not seeking help for our own mental health is a huge risk factor, that’s without all the other issues including making life or death decisions, giving up a large part of our own lives for the career and the fear of complaints. It’s not really surprising, is it?

Today, I started the first day of annual leave. Ben and I went for “afternoon tea” and as I sat there laughing at some of his silly jokes and we tasted the tiers, I felt grateful. I was so thankful that I could be sat here, laughing, and eating with ever increasing freedom. Not being trapped in an endless cycle of shame and torment. I would have called you a liar if you had have told me 12 months ago, I would be sat, relaxed and most of all HAPPY. I felt the happiest I have felt in, a long time. I’m so thankful to be alive, but I almost wasn’t. I never imagined this life for myself.

I don’t know why I am here and others are not so lucky. But I know this, I’m not prepared to continue the narrative that suicide is selfish, that mental health is not as important as physical health. Truly if mental health has the possibility to take a life, it’s about as serious as it can get and needs to be treated as such.

How can you recognise someone may be feeling suicidal?

Perhaps there will be no signs, but if you don’t ask someone how they are and mean it, it could be easy to miss.

  1. Isolation, withdrawing
  2. Expressing feelings of hopelessness, being a burden
  3. Talking about death, other self-harming behaviours
  4. Speaking negatively about themselves
  5. Talking about suicide
  6. Getting affairs in order, giving belongings away etc
  7. Access to means to harm oneself
  8. Mood changes
  9. Turning to substance abuse/ alcohol as a way of coping with feelings
  10. Drastic weight changes
  11. Appearing to have lost interest in things they would typically enjoy or life
  12. A sudden sense of calm, or appearing calm
  13. Ceasing regular medications

Risk factors for suicide;

  1. Prior history of suicide attempt/ self harm
  2. Depression, anxiety any mental health problem.
  3. Alcohol, substance dependence
  4. Bereavement
  5. Physical illness/ disability
  6. Knowing someone who has died from suicide
  7. Subject of violence
  8. Loss of self identity- loss of job, sexuality
  9. Major life events
  10. Relationship breakdown
  11. Financial worries
  12. Isolation.

What can we do?

  1. Making access to help easy, without stigma or judgement
  2. Don’t be afraid to ask someone, ask them how they are feeling in a safe space. It’s ok to ask about feeling suicidal. Let them know many people experience feeling suicidal and they’re not alone.
  3. If someone trusts you enough to confide in you, acknowledge this. “I’m glad you are telling me, you can tell me anything” “I am here”
  4. Be prepared to listen even if it’s difficult to hear and upsets you.
  5. Talking about suicide does not cause suicide but it may help prevent it.
  6. Listen to someone struggling. Don’t judge them, even if you disagree. Don’t attempt to fix their problems or dismiss them.
  7. Help someone find professional help, charities, organisations
  8. Small acts of kindness “saying hello to a stranger” you never know a simple hello may make someone feel noticed, loved.
  9. Actively seek help from mental health services for the person- call emergency services or crisis line if someone is clearly in danger.
  10. Offer them support by asking open questions like “you don’t seem your usual self, is there anything you want to talk about? Tell the person you’re concerned about them

If you are reading this and you can relate, are experiencing suicidal thoughts, you ARE NOT ALONE and YOU DESERVE TO LIVE. Please get help now.

It’s okay to talk about suicide. Start the narrative.

Help:

**these are my own experiences and are not professional/ medical opinion*

Lived Experience..in ED Recovery.

Lived experience is one of the most valuable assets to recovery.

You can read about eating disorders in as many text books as you like and on some level you will understand them. Cognitively you may get it, but unless you’ve walked in the path it’s difficult to “really get it”

When you have lived that experience, You get it on a whole other level. People in recovery “get it’ on a level that reaches them to their core.

This makes people with lived experience such important allies in a person’s recovery journey and can be crucial alongside treatment.

I will never be able to express the gratitude I feel for my therapist, I know she saved my life, literally. Therapy was huge in my starting recovery and breaking free from the ED. But the most transformative part in my own recovery has been through connecting with those who have lived it.

At all stages of my recovery lived experience has been influential and important in my own growth.

Reading blogs, listening to podcasts/vlogs and following pro-recovery accounts on social media has really assisted me in the process.

There’s a deep level of trust that develops, knowing that others who have fully recovered, or are in a strong place in recovery helps us to feel connected, validated and most importantly gives us HOPE.

I reflect on the times I listened to people like Jessica Flint, Tabitha Farrar, Mia Findley and Millie Thomas sharing their stories, their wisdom and experience and aspiring to reach many of the milestones in recovery. Believing through sheer faith in their stories that recovery IS POSSIBLE for everyone. Even in some of my darkest moments in the throes of the ED or difficult moments in recovery, trusting what those who have lived and come through the other side has felt comforting and at most motivating.

Connecting with others in recovery seemed terrifying to me when I first started. If I had have been offered group therapy or any form of treatment that meant connecting to others, I would have ran a mile. In fact, I did. I was so ashamed of my eating disorder and terrified my “sordid secret” would become common knowledge. But through listening to others, joining platforms or groups a lot of this shame began to disappear, because there was nothing in this community that was judged, hadn’t been felt, said or done before. I started to see I was NOT ALONE, that there were millions of us who have experienced eating disorders.

A common theme I began to understand was the level of shame we all suffered. The more I read stories, listened and talked the more the shame began to dissipate.

Things I felt I could never share with another living person, suddenly felt like no big deal in the recovery community. The nuances that we believe are so shameful and not to be brought out into the light of day, are everyday struggles we share and is part of non-judgemental wonderful conversations. They say shame is fuelled by secrecy, I believe this is so true.

Following other’s journeys enabled me to find my own voice. I refuse to be ashamed of something that has made me who I am and helping me to connect with my true self.

I used to say I wanted to recover to the person I was before the eating disorder. I no longer wish this, because recovery has made me someone else, someone bigger than I was ( pun intended), but the level of growth that comes from choosing to recover & surviving an eating disorder is such that I wouldn’t trade it for the world. I’m becoming more connected with myself with every recovery orientated decision and becoming aligned with who I want to be. I’m grateful to those who were brave enough to share their experiences, that motivated my own recovery and helped me keep faith.

People recovering from eating disorders have to do this in a world that still challenges many of the beliefs we have to unlearn and to be able to recover in this society is so hard. For some this society can be incredibly cruel and the more people who share their struggle, experience the better this will be one day, especially for those who cannot find their voice. Lived experience is becoming a much bigger part of recovery, with the ever increasing resources available, recovery coaches becoming mainstream and peer mentorships, this can only be a good thing alongside traditional recovery. These people have experienced the struggles, the up’s downs and navigated their way out and are so valuable in helping others do the same, with compassion and sensitivity that is as authentic as it can get.

I’ll share some resources that have been so imperative to my own recovery below.

  1. https://www.recoverywarriors.com/ From blogs, to podcasts and online community platforms such as the “Courage Club” this has been huge in my recovery. Jessica Flint is fully recovered from her eating disorder and has now founded a recovery community that has reached thousands of people in recovery. This has introduced me to some of the most incredible people I’ve ever met.
  2. https://www.instagram.com/lindseyhallwrites/?hl=en Lindsey Hall has herself recovered from anorexia and she shares incredible insights
  3. https://tabithafarrar.com/ Tabitha is a recovery coach, who has fully recovered from her eating disorder. She’s very direct in what she believes recovery is, but she has shared some amazing blogs, podcasts and now mostly posts video content on youtube. I followed her avidly when I first started recovery. She posts about things from “extreme hunger, weight gain, and neural rewiring”
  4. https://www.instagram.com/millietnz/?hl=en & https://podcasts.apple.com/au/podcast/end-eating-disorders/id1534539219 End Eating disorder recovery Podcast.
  5. https://www.beyondbodycoach.com/ Mia Findley- is an Australia based recovery coach, who has fully recovered. She posts videos and podcasts with her experiences.
  6. http://maintenancephase.com/ This is a great podcast that promotes HAES, diversity and is anti-diet
  7. https://www.instagram.com/drheatherirobundamd/?hl=en

Recovery Super Powers

Protecting your recovery can be like developing a super power. It’s also incredibly important when we are surrounded by potential triggers every where.

If we are in recovery from an eating disorder, we need to learn to reject diet culture, which is really difficult when it infiltrates every part of our society.

I recently came across a blog, where the author was promoting a weight loss regimen, whilst sharing their own ED Recovery.

 That tells me two things, firstly it is not something helpful to my recovery, secondly the writer very likely still holds a lot of internalised implicit biases around weight and fear of weight gain and unlikely recovered.

 The intention of this post is to highlight the importance of being aware of  the content you chose to follow and your motives behind it.

People have the right to write/ talk about whatever they like. However, it can be really damaging to a person who is trying to heal from an eating disorder to follow accounts like that. You have a choice regarding the content you chose to follow or not.

My thoughts are and they may be unpopular, YOU CANNOT recover from a restrictive eating disorder whilst still actively attempting to pursue a smaller body. Believe me you cannot. It took me long enough to come to terms with this. You might get the idea of “I could go on x diet, lose this much and I would be ok”. Take it from me you will not. It is a relapse waiting to happen. That is how my last real relapse happened. All it really tells you, if you get those thoughts there’s still work to be done on neural re-wiring. It gets easier. I get these thought from time to time, “If I could just lose X amount I will be happy” this is my eating disorder voice and one that I know cannot be trusted. A size, or shape will never change how I value myself, I am so much more than a measurement but this is not what my eating disorder believes, it will make me buy into the notion that my worth is solely based on a number. This is not happiness.

I cannot diet ever. ever. ever. Choosing to go on a diet when you have a history of an eating disorder is like saying a person who has recovered from substance or alcohol abuse can have the occasional drink. You would not say this. Dieting is our drug. We cannot safely dabble.

In recovery the focus should be on challenging our fear of weight gain, body image, learning about the health at every size movement. Dieting becomes less appealing. I’m not saying you won’t get those thoughts. However your brain will learn that you don’t place all of your value on a number and it’s not something we’re interested in. If the concept of Health at Every Size (HAES) is new to you, I encourage you to explore some of the resources I’ve shared at the bottom. However, a very brief summary of HAES; the basic premise supports people in implementing health practices for the purpose of overall well being rather than the focus on weight control. There are some key values to HAES, it encourages people to eat intuitively, accepting of body diversity shape and sizes and that health is about much more than weight. This is a very simplified explanation.

I do not believe a person can endorse weight loss and be fully recovered themselves, because the aim of eating disorder recovery is to unlearn your fear of weight gain, to rewire implicit fat bias/ fat phobia. Therefore by promoting weight-loss on an eating disorder recovery site is an oxymoron. It does not have a place in recovery. I personally do not follow accounts whereby the premise is promoting weight loss or any form of diet culture based content.

If you are trying to recover from dieting, disordered eating or an eating disorder it is your responsibility to not allow this to trigger you. Therefore avoiding unhelpful information such as “losing weight” in eating disorder recovery might be the easiest way.

My last real relapse came from thinking “I can safely diet”

How I deal with these thoughts now; I challenge myself with the following questions:

Why do you want to diet, what are you actually trying to do? What are you lacking in an area. (It’s usually self care and self compassion for me).

Why do you feel the need to change your body- can you learn to accept your body at any shape size and understand a number on the scale has no bearing to who you are as a person or your health?

But, I find sites like this are dangerous in the ED recovery community, they do not realise the potential harm they could have. This particular individual has a large following. Many of the followers suffer with binge eating and the blog is the last thing a person experiencing such should be taking notes from. Dieting no matter how you look at it is restriction. Restriction is no friend to bingeing in fact restriction causes bingeing.

I recently shared this checklist on my social media- it serves as a way to protect myself and maintain healthy boundaries.

Resources: