Adults & Adolescents – In Treatment Together

I have mixed feelings about putting adolescents and adults together in treatment. I have been on both sides of the equation (treatment as an adolescent and treatment as an adult), and definitely have a stronger opinion about it now that I’m older.

Pros:

1. Adolescents can learn a lot from adults who often have been in treatment before and have some more insight into the disorder.
2. Adults are (hopefully) more mature and less competitive. Eating disorders in general are competitive… and I’ve just found that when you have a large group of ED high school females in a room, who are not necessarily in the best place, you could be in for a disaster. Sometimes just having a couple of older people in the room is enough to keep everyone from competing as much.
3. Adults can learn a lot from adolescents. They have a different perspective, and sometimes you need that.

Cons:

1. Being an adolescent and seeing adults in the group can cause some hopelessness that you’re never going to get better. It can give you the sense that people never really do get better and that you’re going to struggle with this the rest of your life.
2. As an adult, I often feel like a bad role model — especially if I’m having a hard time and an adolescent is doing well. I feel like as the older, “more mature” one, I should be responsible for setting the example.
3. Adolescents still live with their parents and (hopefully) their families are very involved in their treatment. I’m always a little jealous since my parents were pretty anti-treatment and didn’t (and still don’t) think that eating disorders are really problems. Sometimes interacting with others’ parents brings up stuff that you haven’t thought about recently (maybe that’s good, but it feels bad).
4. Adults and adolescents have different bodies, ideal weights, nutritional needs, etc. I know adults who have a really hard time being on the same meal plan as a 15-year old, with all the info they’ve heard about slowing metabolisms, muscle loss with age, etc.
5. Tiny, underweight adolescents are triggering. It’s hard to not compare yourself to someone who is 15.
6. Adolescents and adults are (obviously) at different stages in life. Sometimes it’s hard to relate to one another and certain sessions may not seem helpful for one group or the other.

This is just the start of a list — I’m sure there are 100 reasons. Personally, as an adolescent, I was really happy to be in treatment with older women. I really looked up to them and thought that they were so wise — they knew so much and had so much insight. There were a couple of people who I wanted to be like. There were also people who I did not want to be like, and it was motivating to me. I definitely told myself that I would NOT be one of those adults with an eating disorder. It wasn’t until I WAS an adult that I started feeling guilty about still struggling and/or being a bad example.

Not interested in your perception of “normal.”

This is nothing new, but everyone seems to be on some kind of diet.  Or, if they’re not “dieting,” then they are eating purely organic food, or only raw foods, or cutting out all white flour and sugar.  All of this leads me to ask myself — if this kind of eating is “healthy” or “okay” for the rest of the world, why isn’t it okay for me?

I think that the line between healthy and disordered is so fuzzy (grey territory, I’d say).  Eating organic is healthy.  Raw foods are healthy.  White flour and sugar are not the healthiest ingredients out there.  This is how everyone should be eating… right?  In ED treatment you’re taught that there are no “bad foods” — there’s that “everything in moderation” idea.  And while residential we definitely had cookies, sugar cereal, non-organic fruits and vegetables, non-whole-wheat pasta, etc.

Where’s the line between healthy and too healthy?  And if all these people can be so picky about food… obsessing over healthiness… what’s the big deal about my eating disorder?  If I ordered a salad sans croutons and dressing (which I would never do — I love croutons.), it would be eating disordered.  If my friend did the same, it would be healthy.  Why the double-standard?

My mom cooks primarily out of the Weight Watchers cookbook (note: no one in my family has ever done weight watchers nor has really needed to lose weight), because “it’s healthier.”  My fiance makes mac & cheese without any butter or milk because “it’s healthier.”  Both of these behaviors seem disordered to me (although my fiance does NOT have an ED.  At all.  My mother’s another story).

I spent so much time arguing with myself about this… and ultimately just had to give up and let the whole issue go.  I don’t know where the line is — because actually, the line moves, depending on the person, situation, and a hundred other variables.    And really, healthy/unhealthy labels aside, my vision of recovery includes sugar and white flour.  I’ll admit to owning the Mayo Clinic’s recipe book — but not Weight Watchers.  Even if Weight Watchers isn’t at all disordered and IS the healthier way of doing things — I don’t want it.  I plan on making mac & cheese correctly, eating carbs after 9pm, sometimes having more than one glass of wine, and eating the bread that they serve at restaurants… even if “normal” people without a history of an eating disorder insist it’s unhealthy!

One thing I love about eating disorder treatment is that the recovery ideal seems so livable (albeit slightly unbelievable and unattainable).  No diet food, no skipping meals, no overworking or over-stressing yourself, moderate exercise (aka: not 60+ minutes a day, every day), 8 hours of sleep, lots of support, time to take care of yourself, etc.  Maybe I could technically “recover” and still eat fat-free yogurt, get 5 hours of sleep a night, take on too much responsibility at work and never take a vacation — but do I really want to?  (No).

I don’t want to be so preoccupied with food, exercise, and weight forever.  If that’s the healthy, “normal” thing to do, then I’m aiming for a different normal — Renfrew-normal (or just ED recovery-normal, although that’s slightly more ambiguous).  It sounds like a much more enjoyable existence.

Not interested in your perception of "normal."

This is nothing new, but everyone seems to be on some kind of diet.  Or, if they’re not “dieting,” then they are eating purely organic food, or only raw foods, or cutting out all white flour and sugar.  All of this leads me to ask myself — if this kind of eating is “healthy” or “okay” for the rest of the world, why isn’t it okay for me?

I think that the line between healthy and disordered is so fuzzy (grey territory, I’d say).  Eating organic is healthy.  Raw foods are healthy.  White flour and sugar are not the healthiest ingredients out there.  This is how everyone should be eating… right?  In ED treatment you’re taught that there are no “bad foods” — there’s that “everything in moderation” idea.  And while residential we definitely had cookies, sugar cereal, non-organic fruits and vegetables, non-whole-wheat pasta, etc.

Where’s the line between healthy and too healthy?  And if all these people can be so picky about food… obsessing over healthiness… what’s the big deal about my eating disorder?  If I ordered a salad sans croutons and dressing (which I would never do — I love croutons.), it would be eating disordered.  If my friend did the same, it would be healthy.  Why the double-standard?

My mom cooks primarily out of the Weight Watchers cookbook (note: no one in my family has ever done weight watchers nor has really needed to lose weight), because “it’s healthier.”  My fiance makes mac & cheese without any butter or milk because “it’s healthier.”  Both of these behaviors seem disordered to me (although my fiance does NOT have an ED.  At all.  My mother’s another story).

I spent so much time arguing with myself about this… and ultimately just had to give up and let the whole issue go.  I don’t know where the line is — because actually, the line moves, depending on the person, situation, and a hundred other variables.    And really, healthy/unhealthy labels aside, my vision of recovery includes sugar and white flour.  I’ll admit to owning the Mayo Clinic’s recipe book — but not Weight Watchers.  Even if Weight Watchers isn’t at all disordered and IS the healthier way of doing things — I don’t want it.  I plan on making mac & cheese correctly, eating carbs after 9pm, sometimes having more than one glass of wine, and eating the bread that they serve at restaurants… even if “normal” people without a history of an eating disorder insist it’s unhealthy!

One thing I love about eating disorder treatment is that the recovery ideal seems so livable (albeit slightly unbelievable and unattainable).  No diet food, no skipping meals, no overworking or over-stressing yourself, moderate exercise (aka: not 60+ minutes a day, every day), 8 hours of sleep, lots of support, time to take care of yourself, etc.  Maybe I could technically “recover” and still eat fat-free yogurt, get 5 hours of sleep a night, take on too much responsibility at work and never take a vacation — but do I really want to?  (No).

I don’t want to be so preoccupied with food, exercise, and weight forever.  If that’s the healthy, “normal” thing to do, then I’m aiming for a different normal — Renfrew-normal (or just ED recovery-normal, although that’s slightly more ambiguous).  It sounds like a much more enjoyable existence.

Intuitive eating in eating disorders?

For the first 5 years of my treatment, I kept a food log. Yes, I have a record of everything that I ate for 5 years… which is now completely useless, but at the time I thought it was a helpful tool. I counted exchanges (rather than calories), drew pictures to illustrate my days, and wrote any feelings that came up during the day. My therapist and nutritionist would review it every week… which was also useful, since I am really bad about brining up things that aren’t bothering me at the moment (meaning, if Tuesday was an awful day but it’s now Friday, and things are okay…. I wouldn’t bring up Tuesday’s events).

Anyway, somewhere in the middle of college my nutritionist decided that eating disorder recovery was all about “intuitive eating,” and that meal plans and food logs were detrimental to treatment

For someone with an eating disorder, eating is not intuitive. Does eating a piece of pizza excuse restricting the rest of the day? I don’t think so, but my nutritionist felt that trying fear foods was more important than anything. I used to joke that I could eat nothing but a plate of spaghetti one day and my nutritionist would probably pat me on the back for eating scary pasta.

It’s been years since I kept a consistent food log, but I think it can be therapeutic because it helps you keep yourself accountable. I recently moved and changed my entire routine… and that’s stressful. Because eating for me is still not 100% intuitive, I rely on a lot of external factors. Queues from the people around me, usual eating patterns, my daily schedule, etc. When all of that is different, it’s hard to keep myself accountable. Plus, writing down all the food & body image thoughts/fears does a lot to lessen anxiety. It’s easier to be objective when everything is sitting on paper in front of me. (and much easier on my boyfriend — he doesn’t need to hear every time I’m having a freak-out about food/weight).

No dieting friends allowed

Half of Americans are dieting these days (not an official statistic) — and I can’t handle being around any of them. That rules out a lot of potential relationships! But really… I don’t handle being around dieting well. I don’t need anyone around me counting calories or skipping meals. Why? Because:

1. I’ve spent enough time in my life counting calories (and want those hours back!
2. It’s triggering
3. I feel guilty for eating more, weighing more, needing more, wanting more, thinking I deserve more, etc
4. Paranoia that I’m eating too much
5. I’m a little competitive

I’ve been extremely lucky to find very normal eaters for friends… relatively healthy eaters, but non-dieting friends. We get ice cream, go out for pizza, have snacks, etc. And this is all so so so helpful.

I visited family a couple of weekends ago, and my two younger sisters are dieting. I don’t think they have eating disorders (knocking on wood). One is out of college and the other is half-way through. Yes, I know that 1/3rd of women at Renfrew are now adults… but I’d like to think that they would have shown disordered behaviors by now were either of them prone to developing an ED.

My parents don’t discourage the dieting… actually I’d go so far as to say that they support it. You wouldn’t think this would be the case after having one daughter in and out of treatment facilities for most of high school… but I guess my parents never really did get involved with treatment. Anyway, when I told my mother that my boyfriend would be coming, she was excited to bake because “no one around here eats anymore.” Yes, this was going to be a problem…

The drive to my parent’s house was eight hours, and apparently my boyfriend does not like to stop for meals or snacks along the way. Notice that unless we were driving in the middle of the night (which we were not), this interferes with the “normal eating” model.

I realize that it’s probably normal for people to skip an occasional meal (I’ve talked about this before), but sometimes I feel like I should wear a sign: Warning: Do not approach if you do not eat 3 meals and a snack.

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