goodbye july

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yet another month draws to a close. it seems inconceivable to me that it’s 1 august tomorrow and yet, when i think back to this time last year, i barely recognise myself. it was last summer that the ptsd really kicked in, fuelled by a combination of an incredibly stressful project at work and the final decision of the cps not to prosecute my rapist. the anxiety, nightmares, flashbacks and constant intrusive thoughts were killing me.

this year, i’m in a very different place and whilst the last few weeks have been rough for a variety of reasons, i do also feel like i’m beginning to make some tentative steps forward. some events which i feared would trigger a reawkening of the ptsd symptoms didn’t (or at least, they didn’t as much as i was expecting). and a lot of work with my psychiatrist has meant that i understand far more about myself and the root cause(s) of my long history of eating disorders than i ever have before. of course, that doesn’t mean that the issues are resolved overnight but knowledge is, as ever, power. i can start to recognise the behaviours (both in myself and in others) that i find particularly hard to deal with and, in time, i hope i’ll be able to implement strategies to handle these better.

there’s no time like the present to start though and i think august is going to be a particularly testing month. there’s a long list of social/family occasions over the next couple of weeks, all of which, obviously, involve food. and then we’re on holiday for two weeks with my parents and every aspect of my life (and in particular, what i eat and how i look) will be under scrutiny. not to mention that i’ll have to relinquish control over what and when i eat.

i don’t know how (or indeed if) i’m going to cope really. in the past i would have defaulted to my usual unhealthy coping mechanisms (last summer copious amounts of wine and self-harm featured prominently) but i don’t want that to be the case this year. and so i have the rest of today to come up with some better alternatives…

be that self which one truly is

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there has been a lot written on eating disorders and the role of self-identity both in terms of the part they play in the diseases themselves and in recovery (for example, here, here and here). anorexia (and other eating disorders but i will use anorexia for short hand) is so all-consuming that it doesn’t leave much time for anything else whether that’s family/friends/work or whatever else it is you do for fun. that, combined with the body dysmorphia that often accompanies anorexia, makes it hard to work out where the eating disorder stops and where you start. as i’ve got waded further into recovery, i’ve been made to challenge the core beliefs that i have about myself and my identity.

many of these core beliefs have their roots in my childhood. growing up, i was always the fat, lazy, academic child, more interested in reading a book than running around the garden. in contrast, my brother was skinny, excelled at sports and could never sit still. i was a fussy eater and mealtimes often became a battleground between my and my mother; often i’d sit there in tears being forced to eat something that i didn’t want to eat. my brother would eat pretty much anything. we had our roles in the family narrative and i’ve been trapped in mine ever since.

and so, when someone says how fit i am or how think i am or how healthy my diet is, i can’t believe them (and just typing out those things makes me feel uncomfortable and i’ve already deleted this paragraph several times because they are so far from the truth). even when i’m being told these things by a medical professional, the bullying voice in my head just shouts louder than them. the disordered behaviours which feed off that skewed sense of my identity also perpetuate the cycle, continually punishing that chubby 10 year old for not being good enough.

as a result, i often end up feeling disassociated from myself; like my sense of identity and the ground on which i’m standing is constantly shifting. there’s nothing tangible that i can cling to other than the restrictive behaviours which have structured my life for so long. all of which are a response to what i believe i (still) need to change about myself. actually, it’s probably more accurate to say that it’s not so much what i believe i need to change about myself but what i believe other people want me to change about myself. because my need for external validation is strong.

on the way home from an appointment with my psychiatrist yesterday, i realised that the main emotion i feel at the moment is fear. and one the things that i’m most frightened about is learning who i actually am when you strip away the anorexia.

{title quotation attributed to søren kierkegaard}

on ivf and eating disorders

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i write this on the ‘other side’ of our first cycle of ivf. everything went well – far better than i had any right to hope for – but it still ended up with a negative pregnancy test last weekend and, after a slightly delay while all the progesterone worked its way out of my system, the appearance of my period yesterday. the constant and gruelling nature of ivf hasn’t really left much time for anything else recently. we’ll try again in a few months (probably) but it’s bloody hard. it’s bloody hard for anyone. it’s really bloody hard when you’ve got an eating disorder.

i feel that i should start by saying that i don’t think my eating disorder is the cause of our infertility. everything is as good as it can be with me and i responded very well to the various drugs. when we started trying to conceive (a long time ago now), i was probably the healthiest and happiest i’d been for a long time. the eating disorder was definitely in remission and my relationship was food was fairly uncomplicated; it continued that way for a good 18 months (the fact that it got more complicated again is nothing really to do with the infertility). lots of people who have/have had eating disorders conceive naturally. some people who have/have had eating disorders need some help. it’s the luck of the draw really. (i should also add that i’ve also only ever had relatively short periods of amenorrhea in the past too).

for someone with such a litany of mental health diagnoses to their name, i’m actually pretty laid back about the big things in life and so i didn’t feel like the ivf process, in itself, phased me much at the time. with the benefit of hindsight though, i can see that there were some elements that i really struggled with and which were directly related to the eating disorder.

for a start, ivf treatment is predicated on you (and by you, i mean the woman) being at a normal bmi. when you’re trying to get away from measuring your self worth by your bmi (and when a lot of eating disorder treatment is based on you falling to a certain bmi), this can be hard. some people may have happily been in recovery for years and suddenly find themselves needing to drop weight, often pretty quickly. for others, like me, it means putting on weight. i basically binged myself into a healthy bmi. it did not help my mental state at all.

once you cross that first hurdle of actually being eligible for ivf, you have to face the fact that lots of people are going to see you with very few clothes on. of course, they’re all medical professionals and they see hundreds of vaginas a day but that doesn’t change the fact that you have to wander round in a flimsy hospital gown or lie on your back, legs akimbo, with five or six people staring intently at your naked body. in some ways, i found this part the easiest to dealt with (partly because i was always a bit more worried about triggering my ptsd but mainly because quite a lot of the procedures require a (very) full bladder and i normally had to concentrate all my energy on not wetting myself). but the fact remains that i am far from happy with my body and far from happy about having people see it. (side note: i was also self-conscious because of scarring from self-harm but that was generally ignored by everyone much to my relief). added to this is the fact that the hormones and all the follicles that grow inside you often lead to bloating (and weight gain) and you have a recipe for feeling shit about yourself.

clearly, for the ivf to work, you need to be eating three meals a day and eating a relatively healthy diet (there are also some other dietary suggestions they make – like lots of protein and full fat milk – which i tried to follow as much as i could). on the whole, i managed to eat regularly because i was so worried that my failure to eat would be the reason that the cycle didn’t work. it was, it goes without saying, hard particularly as you are advised to limit exercise both before and after transfer.

what i struggled with the most though was that the regime of drugs i was on required that i eat at certain times. there were some drugs that i had to take with food in the morning, some which i had to take on an empty stomach (ie at least two hours after eating) and some which i couldn’t eat for at least an hour afterwards. i had to take those latter two drugs three times a day. there are simply not enough hours in the day. so i was having to desperately force myself to eat or not to eat at certain times and i spent all day consumed with the thoughts about when/what i would next be eating. controlling my food intake is so deeply ingrained as a coping mechanism (particularly in times of stress) that to have it controlled by something else was, frankly, unbearable and it was also somewhat unexpected.

if this had resulted in a positive pregnancy test, i’d probably have a very different view. it will surprise nobody (least of all my psychiatrist) that i’ve stopped eating very much since we found out that the cycle failed. i was only really embracing recovery (to the extent that i did) for the sake of a future pregnancy and although this is certainly not the end for us, it seems that much further away now. my eating disorder is absolutely loving it.

obviously though, i need to be at a healthy weight for another cycle and i can’t cope with the idea of not giving the embryos that we have in the freezer the best possible chance of life. but there’s part of me that’s terrified of doing it all again (possibly with the same outcome) and so losing weight seems to be the best option. and so, yet again, i feel like i’m stuck in the middle of a war zone.

i know that we are incredibly lucky to have access to ivf treatment and, in particular, that we ended up with a fair number of high quality embryos so the odds are in our favour.  i certainly don’t take it for granted at all. when/if we go again though, i can only hope that, in the end, it’s all worth it.