What does Ed look like?

I know a lot of patients (and professionals) who refer to their eating disorder as “Ed” (E.D.).  I’ve always been a little wary of this… it feels weird to name a disorder that I’m struggling with.  It makes me feel like I have schizophrenia or DID or something.  However, in some ways it helps to thing of the eating disorder as a separate voice.  It helps me to separate what I want from what the eating disorder wants.

My dietitian once told me “don’t bring Ed to dinner – leave him at home.”  I have this vision of my sitting at a restaurant, with Ed at the end of the table with just a glass of water.  Very silly, I know… but for some reason that helps me.  Maybe it’s because I am separating the eating disorder from myself.

People with eating disorders are competitive — that’s (one) reason why you have to be careful who you put in groups together.  I have some friends who I really like, but feel competitive with or triggered by.  It’s easier for me to think of our two Ed’s fighting.  We brought them along with us and now they are arguing.

Okay, now it sounds like I have an invisible friend… and usually I don’t think of the eating disorder as “Ed” — but there are certain situations where it’s helpful for me.  But, my question is — what does your Ed look like?  Do you have a mental image of it?  I’m curious to hear how others envision it.  I’ll draw mine and post it in the next entry…

Anorexic Handwriting

anorexic handwriting: small, meticulous, and linear — font-like.

I’ve been told more than once that I have “anorexic handwriting.” Aside from the fact that this label is very non-PC, I never really put eating disorders and handwriting together. When I was inpatient, I remember this girl had really, REALLY tiny handwriting. We’re talking microscopic, get out your magnifying glass-tiny. I’ve had both a nutritionist and therapist refer to my handwriting as “anorexic.” How exactly are you supposed to respond to that, by the way? Um, thanks? I’m working on it? (I would like to note, though, that the girl I knew with teeny tiny writing has since recovered from anorexia and changed her handwriting–interesting, don’t you think?)

Googling “anorexic handwriting” is pretty much a waste of time (there is one scientific article on the subject, which I will admit I have not read)… but I did read up a bit on “graphotherapy.” I’d never heard of it myself, so to quickly explain (from The Complete Idiot’s Guide to Handwriting Analysis):

A specialized branch of graphology sometimes referred to as ‘graphotherapy’ is actually a form of handwriting remediation. It makes sense that if handwriting is a true reflection of one’s psyche and the result of accumulated experiences, that changes made deliberately to handwriting can help one change uncomfortable personality traits.

Some systems of graphotherapy require the client to make changes to bits and pieces of their handwriting. For instance, the client might be instructed to change his writing slant, raise his t-bars, or adjust his lower loops. While changing one’s t-crossings might not be a big deal, meddling with the lower zone is.

In effect, making changes directly to the handwriting is like ripping away the client’s defenses without replacing them with something more positive. This kind of graphotherapy can be very damaging.

….hmmm, interesting. Maybe I should go back and add this information to my, Who said therapy couldn’t hurt anyone? post.

Using a series of writing movement patterns can help the writer make changes from the inside out, rather than the band-aid effect of changing bits and pieces of handwriting. Some amazing results have been reported by graphologists working with clients to change what they view as undesirable traits.

In Tucson, Ron Laufer has received media attention for his work with anorexic and bulimic clients. These young women had tried numerous other treatment without success, but the graphotherapy exercises seemed to make the difference.

So, next thing you know, there will be ED graphotherapy group. Right between Equestrian therapy and psychodrama…

Anyway, if I had to connect EDs and handwriting….

1. Perfectionism — a common trait among individuals with eating disorders. Why wouldn’t this extend into handwriting?
2. OCD — again, common among those with anorexia.
3. Control — I hate to perpetuate the “eating disorders are about control” theory, but I could tie EDs, handwriting, and control together.
4. Obsession with being small — okay, a stretch, but small handwriting and small bodies… why not.

Personally, I’m a little neurotic about handwriting. I will erase and re-write words and sentences if I think something is messy or if I make a mistake. Sometimes I’ll start all over with a new piece of paper. Let’s say I’m writing a card… sometimes I’ll write three versions of it (with different spacing and/or colors) and then choose the version that I think is the best. A little OCDish, yes.

Also… the physical act of writing is therapeutic for me. Some days when I am so anxious about work and just cannot get started, I will sit there and write a copy of my to-do list. Heck, I’ll find a psych article online that I like and take notes. Just because focusing on the letters and the organization of the paper somehow helps my anxiety. So…. maybe I just have nice handwriting from so much practice.

Just something to think about..

(because I know you are now just DYING to see it — this is a clip from a food log of mine from… oh gosh, I don’t know, sophomore year of college?)

Art therapy for everyone

I am officially the LAST person to blog about this study, but my thoughts seem to be pointed in a different from the other posts that I’ve read.

The Psych Central article, “Half of Young Adults Have Mental Disorder,” states the following:

“A total of 45.8 percent of college students and 47.7 percent of young adults not in college met the criteria for at least one psychiatric disorder.

The most common disorders in college students were alcohol use disorders (20.4 percent) and personality disorders (17.7 percent), whereas those not in college most frequently met criteria for personality disorders (21.6 percent) and nicotine dependence (20.7 percent).”

Now personally, I don’t lump alcohol use disorders and nicotine dependence under the umbrella of psychiatric disorders. Definite health problems — yes. Addictions — sure.

I think that Health News explained these results much more accurately:

“The effects of today’s lifestyles are taking some telltale tolls on many, and most especially on young adults. A recent analysis of more than 5,000 young people between the ages 19 to 25 has revealed that almost 20 percent of young adults in America have psychiatrics disorders that interfere with their everyday lives. Furthermore, the percentages of young adults who are abusing alcohol or drugs are even higher.”

20% is still a pretty alarming statistic, especially since the study found that “less than 25 percent of these college-aged youngsters who suffer from mental problems actually seek treatment.”

Laura Collins blogs that “it is obviously NORMAL if half of young adults have mental disorders.” Personally, I feel that when a majority of individuals of a disorder, that it is time to redefine “disorder.” Think, what if we considered yo-yo-dieting a diagnosable eating disorder? It’s definitely unhealthy and probably stems from personal issues, cultural expectations, other mental health issues, etc. but is it a disorder?

My point is that maybe the baseline of “normal” needs to be adjusted. I guess that there are two ways that you could approach this… either say that the quality of “normal life” should be lower (aka: moderate depression, anxiety, and substance abuse being the norm) or that society as a whole should be healthier.

Making society healthier is clearly the harder option. However, the first option of just accepting a degree of mental illness as a fact of life, is pretty depressing.

I would never say that all of these mentally-ill college students shouldn’t receive help… but I think when percentages start to reach this magnitude you need to look at global changes rather than specific, individual treatment. It is impractical (and nonsensical) to try and setup each of these kids with a therapist, psychiatrist, group therapist, etc. Counseling centers are already overloaded — no way could they handle that.

There is a lot of talk about the stigma that surrounds mental illness and its corresponding treatment. I don’t think that you can wait for this to subside to make mental health treatment more available, though. It needs to work in the opposite direction — first make treatment more common and easily accessible.

I think that college kids are much more open to getting help than others realize. My school had “stress reduction” as a PE class — and it was ALWAYS full. It was probably one of the hardest classes at the University to get into. Why aren’t there five of them? Why isn’t there a stress reduction group at the counseling center? I guarantee you that if there were a pre-med support group, that it would be packed. The pre-med track is stressful and probably causes a lot of the anxiety, depression, insecurity, and whatever else that causes more significant mental illness.

Why aren’t there art therapy groups at Universities? I was in IOP during my freshman year and my two best friends would kid that they wanted to make up eating disorders so that they could go to art therapy, too. Why do you have to have a significant mental illness to go to art therapy? Everyone could come up with something to process.

The system is setup so that you have to be sick to get help. The mental illness stigma is encouraged by the barriers to treatment. Seriously, create a program of “supportive groups” — regular misc. process groups, art therapy, stress relief groups, career-centric groups, psychodrama, grief & loss therapy, relationship issues group — whatever! I swear that students will come. If you offer a little more support to everyone, then treatment will seem less weird and fewer people will reach the point of needing intensive help.

Do not pass Go, Do not collect $200

“I don’t want to play the rehab game anymore”

— Jeff Conaway, Celebrity Rehab 2

While I never thought I’d say this, on some level I can relate to Jeff (putting “treatment” or “recovery” in place of “rehab” in that statement). Treatment and/or recovery sound like a great idea–at least in theory. You go to therapy and talk about things that bother you. Get a dietitian’s input on what you’re eating. Relate to others with eating disorders in ED groups. Take a break from the other stressors in life to focus on yourself. Maybe draw some pictures in art therapy. Try yoga. Get medication that makes you feel better. Doesn’t sound too bad–right?

After some time, you hit a point where the “recovery game” isn’t so fun anymore. You are uncomfortable with your meal plan and with the weight that you are gaining. You don’t want to talk about certain things in individual therapy and the other people in group are triggering or frustrating. You’ve drawn the same picture in art therapy three weeks in a row. The new medications are making you drowsy, dizzy, irritable, etc. And most of all — You are missing things in your life that you want to be a part of.

I think that recovery can feel like a game at first because it is so different from the rest of your life. It’s nice to have others care about your wellbeing and there’s something about treatment that gives you permission to take care of yourself. Plus, there is so much positive reinforcement (gold star for following your meal plan over the weekend!). All of this doesn’t sound so bad… and I do believe you can make progress — even with this mindset.

When does the game end? Personally, I think this is when the disorder starts to feel threatened. There is something scary about recovering, and suddenly it doesn’t sound like a great idea anymore. I understand the panic that Jeff is experiencing.

However, because I do not struggle with a drug/alcohol addiction, it’s also easy for me to see that he has a long way to go in his recovery. His motivation to quit rehab is fueled by his addiction (and probably a lot of fear). It’s much harder for me to identify eating disordered thoughts. Treatment can be so tiresome–especially if it lasts for years. Jeff’s excuse for quitting is that he needs another back operation. I have plenty of excuses, too: I’m not underweight, I am so much better than before, I’m not getting anything out of therapy and need a break, I don’t think that therapy is the answer, there’s nothing that a dietitian can teach me (that I haven’t been told before), I have a life to get back to, etc.

I think that this is the point where you have to change your mindset and treat the ED as the life-threatening disorder that it is. Just going to appointments and sitting in groups isn’t going to make it go away — you are looking at necessary life changes. Your desire to quit is motivated by the eating disorder.

Treatment can feel like a never-ending game of Monopoly… and I don’t know about you, but Monopoly is not fun for me after the first couple of hours.

Some treatment could sink the Titanic

“I’m not going to rearrange the furniture on the deck of the Titanic.” — Rogers Morton

I think that during recovery, a lot of people get stuck rearranging deck chairs. While you’re spending all this time working on some trivial issue, your overall recovery progress is stagnant (at best).

Examples from my own history:
* Dozens of Dermatologist appointments during the height of my eating disorder (I’m sure my acne was caused mostly by nutrition issues). When asking my Dermatologist about the depression side-effect of Accutane (since I was already on antidepressants), she replied “oh no, it will actually help grey’s depression! she’ll have clearer skin so she’ll have higher self-esteem and therefore be less depressed.” … Really? And who cares about acne when my EKG is off?

* Spending months talking about how I was controlling food because my parents were too controlling of me. (not only do I think this is complete BS, but really… what were we waiting for? My accepting this as true and therefore then being able to move on and give myself permission to eat?

* Three months fighting with my nutritionist about eating a sandwich. She felt the sandwich was very symbolic of my motivation to recovery…. I felt (and still feel) like it was just a sandwich. I wasn’t eating more than 1000 calories at the time (obviously not a stellar recovery period)… who cares about the sandwich?

* Art therapy. Okay, lots of people participate in meaningful art therapy… but really, I was happy to just draw pictures and make stuff up about their significance. “My mother and I are wearing the same color because we compete with each other.” “My flower has no roots because I don’t feel like I know myself.”

My point: Great Feng Shui won’t keep your boat from sinking.

Therapists are like Starbucks Drinks

Choosing a therapist these days can be like ordering a drink from Starbucks:

I’ll have a grande CBT lite DBT Gestalt-free psychotherapy with two shots of psychoanalysis and breve IPT.

This image came to mind have after dinner with a friend last night. She’s been in therapy for several years, and has decided to switch to someone with “a little more of a CBT focus… who still integrates interpersonal therapy but spends less time talking about family.” Hmm… good luck with that search, Rach.

The reality of it is, there are so many types of therapy out there. Just to give you an idea of how many:

• Art therapy
• Cognitive-behavior therapy (CBT)
• Dialectical-behavior therapy (DBT)
• Exposure therapy
• Family therapy
• Gestalt therapy
• Group therapy
• Integrative psychotherapy
• Interpersonal therapy
• Hypno-therapy
• Marriage counseling
• Music therapy
• Narrative therapy
• Play therapy
• Psycho drama
• Psychoanalysis
• Psychodynamic psychotherapy
• Psychoeducation

… and on and on and on. Granted, some of these are much more common than others, and you could probably lump a lot of them together, but you see my point — what therapy is right for you?

No one therapy has been proven to be the best choice with eating disorders (especially anorexia), so your perception of recovery and ED etiology will be largely influenced by your first therapist. I think very few people have much information on all of the available types of treatment (not to mention the different kinds of therapists, psychiatrists, social workers, doctors, nutritionists, counselors, etc.). And even if they did… how do you know which therapy to try? And what exactly is the focus of therapy supposed to be? What is the interaction between you and your therapist supposed to be like? How are you supposed to feel when walking out of therapy?

There are so many beliefs in the psych field right now, that maybe you do need to customize your treatment like you would your Starbucks drink. And beyond that, maybe you’ll need to just around between types of treatment… not necessarily because you chose wrong in the first place (although that’s common), but because you have different needs at different times in your life and stages of your disorder.

Where this gets tricky, though, is with the concept of “bad therapy” — and if you’ve read my other posts, you’ll know that I believe that there is bad therapy. Maybe the kind of therapy that you gravitate towards is appealing is because it allows you to perpetuate your disorder or to ignore some issue. You can draw pictures forever in art therapy and never change any eating behaviors. Or, you can talk about your meal plan every single week with a nutritionist and never bring up a bad relationship that you’re in. So, I guess what I’m asking… is to what extent is therapy supposed to be comfortable? Is it no pain, no gain?

Any input would be appreciated…

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