AtypicallyRecovering

Photo- mine.

OK, first of all, if you can get professional “in person” help, please do. Things have come a long way in the 44 years I’ve been getting help on and off- from straight up psych hospitals, to inpatient treatment (medical and residential), and outpatient. Back then, if you ate, you were better (and cut loose). No matter what kind of treatment you get, be sure to get a doctor on board, and especially a dietician. If you go through a program, those folks and therapists are part of the program.

There’s a much better understanding about the impact of restricting food and compensating (exercise, purging, skipping food, etc), and more intuitive ways to manage food, though I do think a food plan is helpful at first and can help ease the guilt of eating if someone else just puts it in front of you. I never had that kind of experience outpatient, and with inpatient, stuff just showed up whether or not I wanted it, which was appropriate for that level of care. MANY of the symptoms of anorexia, or any ongoing restriction, are the direct result of starvation and malnutrition. Many family members are recruited to supervise meals in the beginning. That’s a good thing, though terrifying. It will help things move along better in the early months. With improved nutrition, the eating disorder thought patterns and obsession reduced, though I know of one man whose entire family went into the food service business after surviving a concentration camp. https://psychiatry.duke.edu/blog/starvation-experiment

Refeeding syndrome is serious, and needs medical supervision to monitor specific chemicals/electrolytes via blood tests. Refeeding done wrong can be fatal, so get some help with that. It happens in any size body- I’m in a larger body, and my dietitian and ex-therapist both told me the same thing… no exercise, only up 10 minutes 3 x a day (laundry, trash, mail) unless getting food or using the bathroom. I’m still not allowed to exercise, over 3 years in. Mostly, I slept between things I had to eat, because my body was absolutely exhausted. If your prospective (or chosen) therapist doesn’t understand refeeding syndrome, find one who does if possible.

Look for the therapists’ online reviews. Google them. Check out their social media… in other words, vet the hell out of them. If there is anything questionable move on. Don’t get lulled into some disaster because you’re desperate. Try to get with someone in a group of therapists (online mental health sites that match therapists could be of use). If you find someone and things don’t work out, CHANGE therapists. They work for you- you are employing them. And that means you can fire them. I don’t mean for asking you to eat 2 grams of butter or an extra ounce of banana. I mean violating safety and ethical issues, and/or abusive or manipulative behavior. When I was first on disability, I must have ‘test-driven’ (meet-and-greet type appointment in person) about 4-5 therapists before finding one that was compatible.

Ask about how long they’ve been treating eating disorders, and what their philosophy is about eating disorder treatment. Do they support “all in”, or are they regimented ? Do they understand that size doesn’t matter, and someone who is overweight can have just as serious health complications as someone who is underweight? Even someone who is obese can have bradycardia, hypotension (low blood pressure), feel cold, have lanugo, be unable to sleep, pass out, etc. You are “sick enough” if you life is deteriorating because of your eating disorder. If al you think about is food and how to avoid weight gain, you have a problem. Especially for adults, primary care docs don’t get any education about adults with eating disorders. I’ve gone years with overt symptoms but because I’m ‘fluffy’, I was told to lose weight. NO problem ! Until it caused acute renal failure twice in the last 4 years.

If you have a therapist that micromanages every food imaginable, without the person having any risk factors for eating that food, find someone else. You should never feel guilt for eating what will get you well, and that will be different for everyone. Yeah, in the beginning, you’ll probably have to put up with some routines that can be very scary initially- but that’s to help get you out of acute starvation so your body can begin to heal from the damage caused by restriction.
The fear around this WILL decrease.

I was horrified when my ex-therapist asked me to eat 3 ounce of cheese ! WHAT? That was 3 servings in my mind- and cheese… that wasn’t safe at all to my head. But how can one designated serving size be what is right for every body out there? A child needs less, an adolescent needs a more, an larger frame adult needs more than a smaller frame (unless in weight restoration), active folks need more than couch potatoes, and someone who is overweight by xx pounds will be unable to lose weight unless they eat enough… that’s right. of us who have been chronic dieters and anorexic/atypical anorexic, and gained weight because of jacking our metabolism all to hell, need to eat more in a LOT of individual cases before our bodies feel ‘safe’ that food isn’t going to be scarce again. The body is designed for survival and keeping things as balanced as possible.

Does the therapist have set hours? What about what to do in an emergency situation if the therapist isn’t available ? Does this therapist travel a lot? Do they have other projects besides being a therapist? (I’d stay clear of them). Can you pay per session? Is payment funneled through an online wire transfer service? OR can you pay with a credit card (some recourse if things don’t work out)? Will your agreed upon appointments be set for a specific day and time, or is it more casual or unpredictable? You have to decide what you think is important. In the early months, consistency will be very important.

If you find information that isn’t positive about a prospective therapist, find another. There will always be critics, but if the majority of reviews are not good or there’ve been legal issues, that is a good indicator that you need someone else.