A couple of weeks ago, Sophie Boulton wrote an article for us on eating disorders. Reading this gave us a fresher look at what it means to have one of these issues in your life but managing it remains very difficult. So we asked her to follow this up with some of her favourite tips for managing such a condition.

Please feel free to add your own in the comments section.

1.  Eating a structure. 

   At the Priory this is something that they call the ‘structure’, meaning eating three meals and three snacks each day.  Often people struggling with an eating disorder do not eat three meals and snacks, and in today’s society a lot of people have disordered eating, I realised that not many people I knew ate in this way, but that it actually is just ‘normal eating’.  After speaking to the therapist M, who has worked in this field for almost 20 years she said she had not known anyone get better without doing this. She explained that there is a continuum of eating disorders; anorexia, bulimia, and binge eating disorder, and that for all people on this continuum eating the structure is important. For people who are restricting and needing to gain weight it is important to be eating three meals and snacks, and this becoming a routine, but also for people who are bulimic it helps to break the habit of restricting and then eating and purging. Also, by eating throughout the day it results in the body not being in starvation mode, so not storing the food because the body doesn’t know when it is next going to be fed. Often individuals binge because they have got to a point where they are so hungry that they start eating and can’t stop, a tip that they give in hospital is to not have masses of food in the house, and to stick to a set meal, so whether that is following a portion guideline, or buying a ready meal so that it is contained. Another important point is that if you relapse and skip breakfast, you can jump back on it at the next snack time, and this helps to not think I’ve ruined today, I’ll start again tomorrow, which often doesn’t happen. Personally, when I first heard about the structure it caused me to feel sick, anxious, and really stressed, and when even talking about foods that I felt ok about eating, it made me cry. I felt completely overwhelmed.  However, after roughly 15 months of sticking to eating my three meals and snacks it has now become my normal, after not eating for 3 hours I can tell that I am hungry, whereas previously my body had lost the ability to recognise hunger, or fullness. Another thing that surprised me is that by eating this much food my weight didn’t continue to rise exponentially. Something that I was convinced would happen, when actually I have maintained a weight within a 2-3kg range for almost a year.

2.  Recognising that food and weight are the symptom, not the problem.
    
   This again is something that I could not get my head around at all. All I thought about was food, everyone was talking about my weight, and how I needed to gain weight. All the emphasis was on getting me to eat, and to gain some weight. At the time, this was important because I was underweight, and my body was not coping very well at being a low weight; I was cold all the time, I couldn’t sleep, my period stopped for almost 2 years, and I did not have capacity to have a conversation that wasn’t about food. One day I realised that it wasn’t about what I had eaten, or my weight, it was about how I felt about myself, what I thought I deserved, and it was my immediate go to whenever something wasn’t ok. Being in recovery I have realised that I am still very worried about my weight, and what I eat, but it isn’t to the extent that it used to be. Now I am at a healthy weight there isn’t the focus on the need to gain weight, and I do wish I could lose some weight and be thinner, but the rationale behind that is if I am thinner I will feel better, If I am thinner I will give myself a break, If I am thinner then everything else will be ok.  Yet that is not true, when I was thinner I felt worse, I did not give myself a break at all, and everything wasn’t ok. Food and weight are important, particularly when you are underweight or overweight and it is affecting your health physically, but it is not the whole problem. Something that is so frustrating is often intervention is on a weight basis, and weight is not indicative of how unwell somebody is when having an eating disorder.

 

3.  Talking about it.
    
   The first time I spoke about my eating disorder aloud was really difficult, and I didn’t realise that my thoughts were abnormal, and it wasn’t ok to feel that guilty for eating a meal, and most people don’t want to go and run ten laps around the field because they ate a cookie.  It is still difficult but over time I have found people who I can talk to about it, and who through listening and talking have developed an understanding so can then support me. Talking about it leads to help, which is what the eating disorder does not want. When I have been at my most poorly I felt that I couldn’t speak, it wasn’t allowed to be spoken about and eating disorders thrive on secrecy. Even now, I have days when I find it difficult to talk, but I’ve come to realise that this is when my Eating disorder is being particularly loud and is trying to regain control. This is the time when you need to utilise your support the most.

 

4.  Seeking professional support. 

   
   I don’t know anyone who has gotten better without any support, and it is really vital to have professional support. Especially as eating disorders are co-morbid with many other mental health conditions, such as; anxiety and depression. However, something that is important to know is that professionals will not make you better. The only person who can make you better is you, and that is one of the most frustrating things about having an eating disorder I feel. There is no magic drug, you cannot have radiotherapy and be cured, you are the one who has to choose to ask for help, and ultimately not do the eating disordered behaviours every single day.  I received really brilliant support from CAMHS when I first was diagnosed with anorexia, but after being discharged and going into adult services there has not been much support. Going to the doctors is a great first step, usually they will check your weight and blood pressure, as well as do bloods. If it is appropriate there are often referrals made to more specialist services. I have been fortunate to have an eating disorder nurse, and psychologist whilst under CAMHS, but for the past 2 years I have not had any professional support for my eating disorder.  It doesn’t help that the NHS have had so many cuts made, there is less funding, few inpatient beds, and eating disorders are an epidemic that now cause a massive strain on the economy.

 

5.  Accepting the illness, and wanting to change. 

   A good metaphor of an eating disorder is an abusive partner. You are treated terribly, told you aren’t good enough, abused, and continue to stay in the relationship, often because you feel that you deserve it, and can’t see any other future for yourself. If you are lucky enough to break out of this relationship and think that you are free, well think again, it is like having constant missed calls, voice mails, apologies and that things will be different this time. Think about the good times and how much you need me, and how much I’ve been there for you. Strangely when things are difficult my eating disorder calls me back, makes me feel like I can be safe if I engage in the behaviours and that things will be ok.  For a long time I couldn’t see the negatives of having an eating disorder, and even when I could it wasn’t enough for me to change.  I didn’t even want to say the word anorexia, let alone anyone else label me with that.  Now I am starting to accept that it is an illness, and that I don’t want to be like this, and I want things to be different. For most people unless they reach this point, then it doesn’t matter how much support is offered, how many times they go into hospital or whether they have a cardiac arrest, they will not get better. Another thing; give yourself a break! It is really difficult to live with this every day, especially as food is something you cannot just avoid, unlike alcoholics who no longer touch a drop.

6.  Having something to focus on. 

   When I wasn’t very well my only focus was on weight, and losing weight and what I could and couldn’t eat. I couldn’t see the future.  An important goal for me was that I wanted to go to university, and be able to carry on with my A levels. The possibility that I would have to leave sixth form and go into hospital gave me a good kick up the bum, also knowing that I was affecting my chances of having children when I was older. Initially hearing you could affect your fertility is not that big of a deal, especially when you’re a teenager, not thinking about children and think you’re invincible. Luckily for me I have always really wanted to be a mom, and being healthy so that I could have babies in the future has been a big motivating factor for me. Having a goal that isn’t food or weight related is really important, and helpful to have something to aspire to. 
   

7.  Finding a healthy coping mechanism. 

   Ultimately an eating disorder is a coping mechanism, so it is crucial to find something which helps you to feel better in a healthy way. Writing was a mechanism that really helped me, often I would write and write until I didn’t know what else to say, or until my hand was sore and I had cramp. The Priory encourage writing also, it is a really good tool because it enables you to get it out, it is easier to write things down that to say them aloud. Writing is also great because it gives you some more capacity, you can come back to what you have written at a later date and be reflective. Having a distraction is useful, particularly after mealtimes or during times when you feel really anxious and like you need to engage in behaviours such as; purging, self-harming or exercising. Knitting, colouring, and organising were all great distractions for me. Now I am in a better place, I am able to use exercise, without it becoming obsessive, to help me deal with bad days. This improves my self-esteem, and allows me to focus on what my body can do, rather than how many calories I can burn off.

8.  Identifying Triggers. 

   Triggers are something that need to be spoken about, because even if someone is quite secure in their recovery there are still events, and emotions that can cause people to relapse. I have identified that for me when people I care about become unwell this is very triggering, and I use my eating disorder like a comfort blanket to help me cope. Another trigger is my depression, during times when my mood is lower I eat too much to make myself feel worse, because it is what I deserve, and I am shit anyway. By identifying these triggers, and telling people close to me what they are, it has helped me to have a bigger support network, and occasionally when I don’t notice that I am relapsing, they do.

9.  Having a team of people who love you and are supportive. 

   Having an eating disorder is really difficult, and so is watching someone you love having an eating disorder. It can cause arguments, conflicts, resentment, and not everyone can cope with it. Part of growing up is realising who your real friends are, and getting rid of the people who aren’t good for you.  I now only surround myself with people who love me, and support me no matter what, through my good and bad times.  During my illness, there were ‘friends’ who did not understand, who made me feel even worse, and believed that I was attention seeking. This fuelled my negative beliefs and caused me to isolate myself further, which was exactly what my eating disorder wanted. Sometimes you have to put yourself first, and only surround yourself with love and positivity as there is enough hate in the world.

10.  Throwing away old diaries, weight charts and ‘sick clothes’.
    
    This tip is not essential to managing an eating disorder, but for myself letting go of the old diaries which contained weights, food diaries, and horrible journal entries about myself was important. I am no longer a size 4/6, and those clothes hanging in my wardrobe are a reminder of my illness, and annoyingly instead of looking at how far I’ve come, I just see reminders of how I’m not as thin anymore, and not fitting in those clothes feels like a failure. So, the best thing to do is to get rid of them! Throw them away, take them to the charity shop, burn them, whatever is good for you. I have thrown away many clothes that I have negative associations with, any clothes that I will only wear when I am ‘thin’, and all the old diaries. It is hard but feels empowering, and like I am moving on. I would highly recommend people doing this, but only when you are ready.

    Bonus Tip – Give yourself a break!!!