Eating disorders and OCD

Here's a concise article about the links between OCD and eating disorders, courtesy of Ed Bites (a site that you should definitely check out if you're interested in or curious about the science behind eating disorders).

Co-occuring EDs and OCD

Looking for support in recovery?

If you, or anyone you know, is looking for a support group (either for people in recovery or for their families and friends), an extensive list of organizations offering support groups is now on this website under "Recovery Support." There are dozens of such organizations around the world.

If there is an eating disorder recovery organization that you know of that isn't listed on the site, please let us know!

Don't let the macaroni burn down the house!

Hi all, Emily here. As some of you know, I was a panelist at last night's Faces of Recovery event in Guelph, Ontario. I've decided to share my talk with you, with the hopes that it can make some difference to people recovering from eating disorders.

The first thing you need to know about me is that I tend to think metaphorically, so please bear with me.

My eating disorder began in late elementary school, though I only realized that my weird eating habits were a disorder when I was in middle school. I was always very anxious, perfectionistic, and sensitive, so I’m not surprised when I look back at diary entries from just after I turned thirteen in which I was terrified that I was becoming anorexic. I first started trying, albeit halfheartedly, to get better when I was fourteen, but I didn’t receive any real treatment for years, and I struggled almost constantly until midway through university. In my second year of university, I was losing weight rapidly, feeling suicidal almost all the time, and pretty much too anxious to function. My roommates were so worried about me that they didn’t let me go anywhere by myself, and I was sliding downhill rapidly despite having more therapy appointments every week than I had classes.

When I came to Homewood at the end of 2007, I desperately wanted to feel better, but I was convinced that I couldn’t be helped. I was lonely and terrified and spent most of the first couple of weeks crying. But with the support of my family and several of my good friends, as well as my new friends and my roommate from Homewood, I began to turn around and fight with everything I had towards getting better.

As is typical of anyone recovering from an eating disorder, I had a lot of ups and downs while I was at Homewood and in the time after I went home. There were many, many times when I wanted to throw in the towel. As most of you know, living with an eating disorder, as painful as it is, can be easier than trying to recover from one. Going back to my summer job was hard, as was returning to university. And in the first few months, I realized one pattern I had in the way that I thought about my disorder and recovery. Every time something went wrong, whether it was doing poorly on an exam or having a conflict with a friend, I would think, “I’ll restrict just for now, because I have to in order to deal with this. And if anyone asks why I relapsed, well, it’s no wonder. Just look at what I’m dealing with.”

That was what I’d done for years – restricted just until exams were over, just until all of my friends were emotionally healthy, just until I found a job, just until spring came. 

Just until everything was perfect.

I realized that life doesn’t work that way – at the very least, my life doesn’t work that way. I doubt that yours works that way either. Maybe at some point, all of the stars will align and everything in my life will come together exactly the way that I want it to be – but I can’t wait for that point to start living. I realized that I needed to stop making excuses.

This brings me to my metaphor. In my first year of university, I lived in an apartment in residence with three other girls, a couple of whom kept our kitchen in a constant state of disgusting disaster. One night, I was the only one home and was cooking supper. As I watched the toaster oven to make sure that my toast wouldn’t get overdone, I heard a crackling noise behind me. I turned around to find some fairly substantial flames coming from my stove – a bit of macaroni had gotten stuck under the burner and had caught fire.

My first instinct was to run out of the apartment and scream for help. My first thought was, “well, if anyone asks why the building burned down, it’s not my fault. I haven’t made macaroni recently. It was someone else’s food stuck under the burner. No wonder there was a fire – my roommates are total slobs.”

Fortunately, common sense got the better of me. I turned around, ran back in, and stuck a lid over the flaming burner. The fire was out within seconds.

Two important things came from that day. The first is that I won an award in residence for being most likely to set off the fire alarm while cooking. The second thing was that years later, I came up with a highly metaphorical mantra that I now use all the time:

One piece of macaroni is no excuse for burning down the house.

In the eating disorder context, what I mean is this: Don’t let any little thing send you spiraling back into your disorder. A flaming stove is a sign that something was stuck under the burner. All I had to do is put a lid on the fire and remove the burned piece of food. It doesn’t mean that the house has to burn down – there are other options. It’s the same with my eating disorder: a slip is a sign that something is wrong. The macaroni under the burner represents whatever is causing the stress in my life. The house represents my life itself, my mental health. Whatever it is that I’m dealing with, no matter how troubling it is, it doesn’t mean that I need to relapse; it means that I need to fix the problem and take good care of myself.

Before getting treatment, I used to let any slip be an excuse to relapse. Now, I know two important things:

First: slips happen to all of us. They’re part of recovery. But knowing that they happen is not an excuse to relapse. A slip is a sign that something is wrong, just how a small kitchen fire is a sign that something flammable was left on the stove.

Second – please excuse the metaphor: you have to know the difference between a big fire and small fire, and when to call in the firefighters. Sometimes, a slip is more than a slip, and you really do need help. Just as one little piece of macaroni is no excuse for setting the building on fire, nor is thinking that you can fight a fire yourself when really you can’t. I’ve learned that I can’t do it all by myself all the time. Sometimes, I need to see my therapist more often, or I need to ask a friend to eat with me to help me stay accountable. I’ve learned that asking for help is much better than letting my whole life catch fire.

The past few years have really put this to the test. Two years after finishing the eating disorders program at Homewood, I finished university and went to grad school. For anyone who hasn’t been, grad school is just as stressful as the movies make it out to be. I was studying to be an elementary school teacher, so I had to balance my teaching placements, coursework, and earning money. I also sing in a professional choir, which often has a rather rigorous schedule.

Then, to add to all of this, I got hit by some things that are much bigger than my metaphorical little pieces of macaroni. Sticking with my kitchen fire metaphor, it would be more accurate to say that some sort of explosive was planted in my kitchen.

Midway through the first year of my Masters, my life began unraveling. The first thing that happened was I started constantly feeling sick. I lost a lot of weight without trying to, my heart rate was ridiculously fast, and I blacked out frequently. I caught infections from the kids far more often than any of my classmates did. I also had terrible insomnia; without taking sleeping pills, I would only sleep for an hour – if that – in a night. My doctor had no idea what was wrong with me. 

And then, in March, 2011, my roommate from Homewood died from her eating disorder.  The guilt, grief, and denial were too much for me to handle. Many, many times, I had slips with my recovery. Many times it occurred to me that if I blamed a relapse on Laura’s death, people would understand – and it almost happened.

But instead, I asked my friends for support, returned to using my meal plan, and started going to therapy and a support group again. I put a lot of my time and energy into taking care of myself, of my emotional and physical needs. I was not going to let even a giant thing like losing a friend be an excuse for returning to my eating disorder. 

Throughout the next year, while I was struggling to cope, my weird physical symptoms got worse and worse. I lost a lot of weight for no apparent reason, which was really triggering. Emotionally, I felt like I was about to fall off of a cliff – and I knew that it was not just because of grief.

I felt suicidal almost constantly, and my anxiety was through the roof. I couldn’t focus on my schoolwork, I had trouble getting out of bed, and I couldn’t talk or think properly. My mind and body seemed to be in overdrive, and I felt like I was going crazy. My friends became concerned, and last spring, one of them made me go to the hospital. I was diagnosed with hyperthyroidism, which causes all of the strange physical symptoms I’d been experiencing.

I spent most of last spring in the psych ward because I was really anxious and suicidal. The hospital was awful. Knowing that my thyroid disease only partly explained my psychiatric symptoms, the staff kept suggesting that I had all kinds of disorders that I knew I didn’t have. I hated living in a locked ward, and I was miserable – and I slipped many times, only to have friends tell me that they were not going to allow me to relapse.

And so I used my mantra: no excuses. Over and over again, I would repeat to myself, “don’t let the macaroni burn down the house. Don’t let the macaroni burn down the house.”

Later in the summer, I returned to Homewood for the anxiety and depression program. I was diagnosed with OCD – a diagnosis that I actually agreed with – and my psychiatrist there found medication that worked for me. Just like in the eating disorder program, this program was hard – really hard. I had to work through things that I didn’t even want to admit were real. At the same time, I was still in treatment for my thyroid disease – and one of the effects of the treatment was weight gain. While I’m doing much better with body image than I was five years ago, I still struggle with my body. So as you can probably imagine, the unintentional weight gain was really triggering. And many times, it crossed my mind that if I restricted, if I allowed my eating disorder to relapse, nobody would blame me. After all, I’d been through so much.

Once again, I had to remember that I wasn’t letting myself use anything as an excuse. What I’d been through this year was much bigger than my metaphorical piece of macaroni, but I still wasn’t going to let my house – my life – catch fire. 

What’s helped me in the years since finishing eating disorder treatment is a change in my attitude. Where I used to look for excuses to relapse, I now have a very different approach. Nothing, including losing my roommate, being diagnosed with a physical illness, experiencing extreme weight changes, or spending the spring and summer in the hospital, was a good excuse to return to my eating disorder. It’s the same for you. That voice in your head will try to find a reason to justify a relapse. Fight back against that voice. There are no excuses.

Teaching children about eating disorders

My story for teachers of what NOT to do

When I (the founder, Emily) was in middle school, my teachers did what they thought was appropriate to prevent their students from developing eating disorders. Several weeks in health class were devoted to the subject, and the health teacher told us almost everything that there was to know about anorexia, bulimia, and compulsive over-eating. We were given a long list of the medical signs and symptoms of eating disorders, and we were then shown several television clips and documentaries, each of them featuring an anorexic woman (here I must note that every time, the woman featured was white and in her twenties or late teens, and was severely ill). Many of these clips were from daytime television shows such as Oprah or Dr. Phil. In each instance, the woman on the video talked extensively about her eating disordered behaviour. We learned which foods she ate and which she avoided, how many calories she consumed, how she avoided eating, how she hid her disorder from her family and friends, and how much weight she lost.

For many topics in school, the more information the children learn, the better it is for them. This is not true with eating disorders. For myself and several of my adolescent classmates, our well-meaning teacher was inadvertently giving us classes on how to have an eating disorder. Many of us copied the behaviours that we saw in these videos, or "competed" with the women on the videos to try to lose more weight or eat less calories. These cautionary tales did nothing to prevent eating disorders - in fact, they may have made the problem worse.

Our teacher would then have some media literacy lessons; she'd explain over and over again how images in magazines were airbrushed and that real women didn't look like supermodels. Once she had determined that we all understood this, the topic of eating disorders was over - perhaps the teacher even considered us immune. The problem with this is that there is far more to eating disorders than wanting to look like fashion models or celebrities. While some adolescents develop disordered eating behaviours or clinical eating disorders because they want to look like the celebrities that they idolize, more widely accepted theories state that eating disorders are coping mechanisms and/or biological, brain-based illnesses. Children who understand that magazine images are airbrushed may still develop eating disorders.

I'm not saying to stop teaching media literacy. The "magazines are airbrushed" lesson is still important. The problem, however, is that people who learn that eating disorders come from copying celebrities tend to trivialize these life-threatening disorders and to think of people with eating disorders as being superficial or shallow. To make matters worse, the belief that eating disorders are all about fashion and appearances may prevent some people who are suffering from getting treatment.

That was how it happened with me. I had learned in school that people with eating disorders wanted to look like Hollywood icons, to fit into skinny jeans. At age fourteen, newly diagnosed with anorexia, I was ashamed to have my friends find out about my disorder because I was afraid that they would think I was stupid. I was not a fashionista; I was a perfectionistic high-achiever who wrote poetry and sang opera! I watched TV rarely, had never read a teen magazine, and pretty much boycotted all forms of popular culture. But I had learned that eating disorders were all about vanity. Recovery was a lonely experience because for the first few years I never reached out to my friends. I believe that I could have recovered sooner if I'd had the support of my peers - but I didn't tell them what I was going through, because I was afraid of being judged. Unfortunately, too many people believe that eating disorders are what happens when spoiled little girls go on diets - such ideas create stigma, and stigma makes recovery more difficult.

Teachers, please remember two things:
a) Don't give your students too much information about eating disorders! Adolescents who learn all about disordered behaviour may use this knowledge against themselves.
b) Don't focus on the outdated idea that eating disorders involve superficial girls who took their diets too far - this grossly misrepresents why people develop eating disorders, and it increases the stigma surrounding eating disorders.

So, what should you do? I'll write about what you actually SHOULD do soon!