Anorexia nervosa

Taken from the DSM-5 lying in my room:

“There are three essential features of anorexia nervosa: persistent energy intake restriction; intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain; and a disturbance in self-perceived weight or shape. The individual maintains a body weight that is below a minimally normal level for age, sex, developmental trajectory, and physical health.”

******

As I sit here writing this post, I want to purge so bad. Why? Because I had breakfast and I feel full now. I can feel the disgust swirling in my abdomen, and my esophagus begging to let it all out. I’m not gagging, but very little is keeping me from having that happen. Rationally, I know my breakfast was a “normal” amount of food for any other person. However, that feeling of fullness is all I can think of. I want it gone. It means I’ve lost control. I want it gone NOW.

I highly doubt I’ll purge. I did it for the second time in my life last week and although I felt transiently relieved, I felt like an absolute failure. Why? Because purging means I ate, and eating means failure. The only thing that keeps me from purging is an obsessive and inexplicable fear of losing my teeth. Yes, just that. I don’t worry about electrolyte imbalances, my heart becoming weak, or even of dying….just of losing my teeth. And yet, the urge to do it right now is…all-encompassing. I can’t think of anything else.

And that’s precisely why I’m writing. I’m trying to just let the fullness pass and let it slowly turn into hunger so I can calm down. But I know that’s going to take a long-ass time. Fuck, I need to feel hungry NOW.

I feel like an absolute failure today because lately I’ve been having recurring dreams about food. The most mundane dreams have turned into nightmares. Dreams of various ice cream shops suddenly appearing close to my home. Dreams of almond flavored muffins, chocolate chip cookies, and brownies that take up all of my attention in spite of an old crush standing right beside me…him looking at me with disgust and rejecting me. Dreams about the textures of food, the richness of desserts. It’s always fucking sweets and desserts: my Achilles’ heel.

Hunger. Fullness. Those words define me. One meaning complete and utter control of everything within and around me, the other meaning absolute chaos. There’s no gray-zone here. From one second to the next, I can go from one to the other. It’s a delicate, unbalanced state that I must maintain to keep sanity (or else, the eating disordered voice in my head leads me to believe). In a same meal, from one bite to the next I can go from hunger, and thus control, to fullness, and utter failure. When I can feel that last bite that will keep me satisfyingly hungry coming closer and closer, I start asking myself: Is this the one? Is this the last bite? If I have another one will I feel full? At times, the internal debate is so confusing that I literally stop in my tracks and sit looking at my surroundings, unable to come up with a clear cut answer as the plate in front of me tortures me. Every second that goes by without an answer makes me feel incredibly desperate. When I finally do come up with an answer, the result is one of two: either I don’t take a bite and wonder whether another bite would have kept me just as hungry, or I take another bite, feel full, and know that the whole mission was in vain because I am now full and thus, fat.

Today is a bad day. It’s a really really bad day food-wise. I can feel the Anxiety taking a hold of me as Depression dozes off in a state of relative hibernation. Today, it’s Anorexia’s turn to torment me. But, unlike Depression, who is a constant enemy, Anorexia is at times a foe and at others a friend. I can see Depression for what it is, an ugly part of my life that I absolutely hate, but Anorexia….it fools me. It’s the backstabbing friend you can’t seem to be able to shake off because there’s just something about this friend that keeps me in one piece. But it’s a vicious cycle, that’s exactly what it wants me to believe. And I fall for it, day in and day out.

I didn’t have a problem when I was labeled with depression. I didn’t have the slightest issue when I was labeled with a borderline personality 3 years ago. However, last year, when G shoved the word anorexia right in my face, it felt like a personal attack. It came out of her mouth like a fishing rod, slowly and expertly trying to catch the neon-colored clown fish that was floating around her office since I first met her. She caught Depression on the first day, but Anorexia….it just kept dancing around the office in slimy calculated and strategic movements, avoiding her. But when she finally did try to hook the clown fish, it turned into a vicious shark, baring its teeth.

And it’s not the first time this happened to me. Back in 2011, my medical school’s psychologist had tried to hook the clown fish too, sometime after catching Depression. She was experienced, just not as technically savvy as G, and the clown fish just kept dancing around freely. But this time around, I wasn’t as lucky. G might have less experience in her career as a psychologist, but she was more deliberate in her fishing for the problem.

And I feel attacked. I feel attacked by both her and R. R is also more deliberate and calculating. G and R are both a good match for Anorexia. But fuck, I keep defending that backstabbing little clown fish and holding on to it for dear life. R told me a while ago that if things went downhill with food, she would ultimately have to take desperate measures such as contacting my parents. Instead of welcoming the threat of war and siding with her, I felt it an instant attack as I sat beside the enemy, arguments like But I’m over 21 years-old springing to mind.

I don’t know if there’s any way for people outside to actually understand what eating disorders encompass. For someone unfamiliar with the topic, all of this probably sounds like I’m in the throes of psychosis. For someone who jokingly throws around sentences like This diet isn’t working, I should just become anorexic!, none of this will make sense. People with anorexia (or, more appropriately: we) feel hunger, mostly know in a rational way that we are not fat, but still hate our bodies as they shrink. I live in constant fear of becoming fat, of gaining weight. And by weight I mean not 5 or 10 pounds, but a meager 0.1 pounds gets me anxious.

Hunger, meanwhile, is an addiction. I both hate it and love it. Let me repeat that: I hate feeling hunger. I absolutely hate that pang you feel in your abdomen because it reminds me time and time again that food is a basic necessity for life and that my body is begging for it. However, at the same time, I love feeling hunger. Why? Because feeling hungry means I’m not eating. It means I’m in control. It means only I can decide anything and everything that happens to me. And food being a basic necessity, wouldn’t a strong person be one that forgoes something so intricately tied to life?

The other day I told R I was fat. She kept quiet for a few seconds before incredulously responding: “You’re fat?” It took me aback, since R had never talked to me like that. But the way I perceived it was that she was simply trying to confront me, attack me, but not really caring about me, just checking off the responsibilities of her job as a psychiatrist. I responded: “Don’t even try. You’ll never convince me otherwise.” She smiled, and I went on to explain that I know I’m not fat, but whenever I look in a mirror all I see disgusts me and I feel fat. My BMI has been in the underweight range for 98% of my life, for chrissakes, of course you might not think I’m fat! But I digress. Only I know the truth.

And the triggers, oh the triggers. The other day I went out for dinner to a fancy restaurant with my parents and I had a soup as an appetizer, something very out of character for me since I actually hate soups. When I finished the soup my dad, who is obese, sat in disbelief and said, rather proudly, that he liked seeing me enjoying the soup and that it must mean the soup was delicious. And off it went inside my head like a broken fuse throwing sparks: DO NOT COMMENT ON WHAT I EAT OR DON’T EAT, HOW MUCH I EAT, WHEN I EAT OR WHATNOT!!!!! I kept quiet but instantly tensed up, looked around me and tried to control the nervous tic that always takes a hold of me when I am confronted with triggers of any kind. I ended up giving him the last mouthfuls of soup because I was absolutely disgusted with myself. And because triggers are like a ripple effect, I also became defiant and angry as I listened to the loud vulgar man that sat in the table next to us, who just so happened to remind me of The Ex and all the men I hate. Food and abuse, swirling in my head during dinner at a restaurant, aka: dinner with an audience. An audience that could see me for what I truly am: a fat dirty whore. How fun.

But that wasn’t the end of it, unfortunately. The main course was also a struggle because I didn’t want to eat but it was delicious. And in the end it was a complete disaster because I ate everything on my plate. In other words, I broke rule #1. I NEVER clean my plate or have second helpings. NEVER. Even if the last bite is just one tiny little bite, it must not be eaten, but rather left on the plate. It’s been like that since I was a child. But I ended up cleaning my plate because I didn’t want my dad to ask me for a bite. I want to protect him from his fatness, so I avoid being his enabler. In the end, I “protected” my dad from his fatness, but I became fat in the process by eating everything. Absolute and utter failure.

I remember thinking I was fat for the first time around 8 or 9 years old. At 11 years old I had a “phase” when I would skip lunch at school or have salads for lunch at home. What 11 year-old has salads for lunch??? Last year I gained 50 pounds and subsequently lost the 50 pounds all in a span of months, which was the first time in my life that I finally admitted to myself I had anorexia. At that time (September of last year) I decided I wanted to get better.

And yet, here I am again, thinking about food. I’ve told G and R before, but I don’t think I’ve been clear enough: I want to get better, I want to heal, but don’t make me gain weight. I am not willing to not control my eating, not at this stage in my life. Get rid of depression, get rid of anxiety, get rid of the BPD traits, just…..Don’t. Make. Me. Gain. Weight. I will not tolerate it. Of all my issues that is the only one I am not willing to address. I become tense and defensive just thinking about it.

My family doesn’t know. My parents have suspected something every now and then, but the only thing that keeps me safe and sound within my secretive little bubble is the simple fact that I have always been of small frame, regardless of whether or not I’ve been controlling my eating. My ex-childhood friend knows, because I told her last year, and I feel horrible for it, because it makes me feel like now she thinks: Oh right then, she’s actually fat. She’s just thin because she controls her food. I’m naturally thinner than her, then. Irrational, I know, but I have to be the thinnest one, thinner than her. And now that I blacklisted her, I cannot by any means be heavier than her because it means she’s above me…and she can’t be above me because it means a loss of control and power.

Sometimes I suspect my maternal grandmother was somehow eating disordered, and that it gives me a genetic propensity towards this thing called anorexia. She did, after all, eat very little, and constantly state that her set weight was 100 pounds, not more than that. And I’ve always suspected my sister, MM, had a bout with eating disordered behaviors during her adolescence.

Meanwhile, the mirror tempts me constantly. And even when I don’t have a mirror close to me, I find ways to body check. I touch my clavicles, my thighs, and “measure” my fatness by how much of my waist I can grab with both my hands. Only I know how much is too much and how much is relatively satisfying. Because, let’s face it, doesn’t matter how thin I get I will never be satisfied. I know that….rationally.

Don’t get me wrong, I don’t like living like this. I actually hate it. I hate thinking and dreaming about food. I want to go back to how I was as a little kid, just eating whatever I wanted without a care in the world. But I can’t. I must keep the status quo, because changing the status quo results in getting fat. I can’t trust my body to know how much it should weigh. I’d rather control my food at all times than give into the unknown and risk getting fat because of it.

It’s sad this existence. It truly is. It’s obsessive and depressing. And of all the patients I will deal with in the future, I know eating disordered patients will be the most difficult for me, if not impossible. And it really saddens me, because as long as I can’t work with eating disordered patients on the long-term I know it means I am still sick.

The ultimate goal would be, then, to become balanced, to recover, and to be able to work with people who are actively going through this. But I don’t know if I’m up for the challenge right now. Maybe tomorrow. But not today. I have two ways of looking at it: I am either being compassionate with myself by accepting that right now I’m in a bad place to work with eating disordered patients, or I can think that I am a failure because I can’t work with any and every mental health patient. I didn’t, after all, go into medicine to cherry-pick my patients.

Much like when I’m sitting in front of that plate of food deciding which is going to be my last bite, I really don’t know the answer. Fortunately, there seems to be some hope because I’m leaning toward the former.

I can’t give up damn it. If I just spent three hours writing this post just to let the urge to purge pass, then it means I still have some fight left within me.

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2 comments
  1. Thank you for sharing something so personal and deep. I think it’s insightful how you phrased anorexia as being especially dangerous because it can pose as your friend and your enemy, and I think that’s so true. It’s one of the reasons food is such an addiction, because we physically need it to survive.
    But I just want to let you know you are not a failure. You ate breakfast, and that is a victory! Don’t let that voice in your head tell you lies.
    I wish you the best on your journey through this. I know you’ll come out on top!

    Liked by 1 person

    • Hey there, I’m glad you could relate. And thank you so much for your comment, the part that most got to me was “But I just want to let you know you are not a failure. You ate breakfast, and that is a victory! Don’t let that voice in your head tell you lies.” I forget that what you say right there is *the* truth, so thank you so much for reminding me.

      Like

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