“Body image is the last to come.” What does that even mean?

Throughout all of my eating disorder-specific treatment I’ve always been told that “body image is the last to come.” In other words, you can recover physically and stop all/most behaviors, but the body image distortions may persist for many years. I was talking to a therapist about this about a year ago and she said to me, “Well, even though you’re not fully recovered yet, you must notice some improvement in the body image stuff.” I was in a particularly bad mood that day so I quickly responded with, “Actually no, there’s been no improvement whatsoever. I still despise my body just as much as I did at 12 years old, even more probably.” Haha.

I probably really did hate my body on that particular day, because my feelings about my body are often heavily influenced by my mood in general. However, part of the reason I was so quick to respond like that likely had something to do with my weird need to never let go of that part of my eating disorder. This is hard to explain to most people. Basically, I fear that if I ever stop hating my body (or even admit to hating it less), that I’ll start loosening up my “control” by way of allowing myself to eat more. This, I fear, will lead to me becoming less and less rigid about food which will then lead to me getting bigger and bigger, perhaps so gradually that I fail to notice until it’s “too late.” I’m speaking in present tense because as pathetic as it sounds, I do still have this fear at times, although I can usually see how irrational it is far faster and easier than I could before.

I’ve said before that loving or even liking your body should not be a prerequisite for recovery. I may not “hate” my body as much as I once did, but I still don’t like it and I would feel pretty discouraged if I thought I needed to in order to make any further progress. I realize now though that the body image aspect of eating disorders and recovery encompasses a lot more than liking or not liking your body.

Before I go on I should note that while body image issues affect most people with eating disorders, they don’t affect everyone to the same degree or some people even at all. The latest edition of the DSM tweaked the criteria for anorexia because it is now accepted that some people who exhibit all of the other criteria do not experience body image distortions or a drive to lose weight and become thinner. For a lot of these people, their eating disordered behaviors may be purely OCD-driven.

That said, the majority of people with EDs do experience at least some body image-related symptoms which may include body distortions (sometimes even warranting a co-occurring diagnosis of Body Dysmorphia), or frequent “body checking” or measuring behaviors. I experienced all of these at some point. While my distortions were never as severe as some people’s (i.e., I never thought I looked legitimately overweight when I was at my lowest weights), I still had trouble seeing that I was ever as thin as other people said I was, and I always saw myself as “chubby” at weights that were considered normal/healthy. Rarely was my eating disorder about fearing that I’d actually become overweight; it was more about always feeling the need to be thinner and never being satisfied no matter how low I got. I also believed that others were somehow judging my level of self-control, success, or worthiness based on my weight. Because I was always comparing myself to my lowest (and/or anyone who I thought happened to weigh less than me at the time), I assumed everyone else was as well. Like, shit… surely that person I ran into the other day noticed I was a good 6 lbs. higher than I was the last time she saw me, so she must be thinking I’ve become super lazy and relaxed in my eating and is judging me for that.

In terms of body checking and measuring, I’m kind of a professional. I was “body checking” long before I even knew what it was, even before my eating disorder fully took over. I was involved in competitive gymnastics for most of my childhood up until the age of 13, so I was naturally more aware of my body than a lot of kids my age. I would stand in front of a mirror for hours in a leotard observing the space between my thighs, the degree to which my stomach stuck out past my hip bones, the circumference of my upper arms, etc. This soon progressed to performing very specific “body checks” throughout the day at school, on the bus or in the car, at home, or in bed. My most common checks included wrapping my left hand around specific points on my right arm, wrapping both hands around each of my upper thighs, and feeling the bones on the tops of my shoulders and my chest to make sure they were still as prominent as the last time I checked (likely earlier that day). I also went through long stretches of time when I would keep daily records of various body part measurements (e.g., the circumferences of various points on my arms/legs, my waist, hips, chest, neck, etc.).

It’s been a fairly recent discovery of mine that many of these body image-related symptoms have actually gotten better. While in the depths of my disorder I was intensely focused on my body and all the hatred I had for it. I would spend entire therapy sessions whining about how disgusting and gross I was. I would be told “fat is not a feeling” and to dig deeper and talk about the real issues and half the time that just made me angrier, because in those moments I couldn’t see past the body stuff. Other times I would be up all night studying years worth of weight and body measurement records, driving myself insane. Why did XX weight correspond to a measurement of X in 2008 but not in 2010? Why were certain measurements getting smaller without my weight going down, or vice-versa? Even 1-2 years ago I remember complaining to my dietician (who is more like a therapist to me) about how distracting my body checking was during the day, so much that someone had even noticed me doing some of these weird things so frequently at work and asked, “uh… what are you doing?” Wow, how awkward. You mean not everyone wraps their hand around their arm about 10 times an hour?

For many years, I corresponded almost daily with my dietitian through email. It started out as checking in each night about how my day had gone with food and behaviors, but it quickly morphed into more casual sharing and venting. I recently looked back on some of the emails from 3-5 years ago and was reminded just how body-focused these emails were for a very long time. I was complaining about how my weight was up two-tenths of a pound that day, or how I couldn’t focus in class because I was so fixated on how swollen my face or legs were. At one point she told me she wasn’t going to reply to any more of my emails where I referred to myself as fat, gross, or disgusting, so I pulled up good old thesaurus.com and expanded my vocabulary. I was now corpulent, rotund and roly-poly.

Over the past year or so, I’ve gradually relied less and less on these body-checks or emails. In fact, I can’t remember the last time I actually sent an email to my dietitian that was even about my “gross” body. I still write about my body troubles but rarely do I refer to my body as gross or disgusting anymore. Does this mean I like my body? Hell no, but I do pretty well at least tolerating it now. Most of my emails and in-person sessions these days are not even about my body. They’re about deeper issues, stuff at work, my future, relationships with friends/family, etc.

For most of my life I’ve been constantly striving for something “better” than what I currently have. In terms of my body, this usually meant setting lower and lower weight loss goals without even stopping to consider that maybe I didn’t need or even want that. I used to say, “If I’m not losing, I’m gaining” which makes NO sense (what happened to maintaining?) but it was my way of ensuring I never became content. I used to have so many rules and rituals that I had to follow exactly. If I didn’t, I’d lose control and become lazy, fat, gross, unsuccessful, etc. I’m finally starting to see that all hell may actually not break lose if I don’t follow all of these rules and rituals to the letter. I let myself have a few drinks last weekend without majorly restricting or compensating before and after, which is pretty much unheard of for me. I also ate a few things that I normally would never allow myself to eat (without proper “compensation”) and guess what? I’m still alive, no fatter than I was last week. It’s like some kind of miracle.

I’m always telling people that in order to make any progress in recovery you must find other things in life to focus on. I cannot stress this enough right now. I’ve only been able to let go of some of my body obsessions and compulsions because I started replacing them with other more meaningful things– dedication to my job/career, writing in this very blog, cultivating new relationships, and letting people in more than ever before. It all sounds so cheesy, I know, but it’s the most useful piece of “advice” I can offer anyone.

Now because I wrote this, I’m sure I’ll have a moment or two next week when I’ll be saying to myself, “WTF Becca? Nothing has changed. This body is not ok and you must do x, y, and z to fix it.” This happens whenever I start to acknowledge my progress because as strange as it sounds, it’s often really scary to get better.

When people used to tell me that “body image is the last to come” I would get really depressed. What was the point of putting any effort into recovery if I was still destined to hate my body for the next undetermined number of years? These days this thought actually gives me hope. I may still not like my body, and even struggle to tolerate it some days, but I also have proof that I can lessen the impact it all has on me by bringing new and better things into my life.

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Everyone needs something: How my love for psychology, research, statistics, and more helped me hang on in desperate times

I recently learned that I’ll be advancing to an exciting new role at work effective July 1st. I’ll be taking the lead on some existing projects and also transitioning into some new areas. In preparation for my new role, my supervisor and I have been reflecting back on my past two years with the agency. This led me to start reflecting back on my entire professional/academic journey that ultimately led me here. It’s been anything but a linear path, and I’ve recently come to realize that it’s been my passion for academics/learning that has carried me through the past 15 or so years.

As I mentioned in my last blog post, I entered college as a psychology major with every intention of going the clinical route. My ultimate goal was to become a therapist who would work with eating disordered clients. It seemed like the most natural career choice for me given that so much of my life at that point (and so much of it after, little did I know) had been shaped by my own experiences in therapy. I wanted to “give back” and help others like myself. I had the perfect little timeline mapped out where I would graduate from my college’s special 5-year combined bachelor’s/master’s program and then after a couple years of working I would apply to doctoral programs in Clinical Psychology. By my late twenties I would be Dr. Becca, happily managing my own successful private practice specializing in eating disorders and contributing valuable research to the field on the side.

That would have been really nice. Unfortunately (or actually, somewhat fortunately, I now realize), that did not end up happening. My eating disorder remained an unrelenting force over the next 10+ years which greatly altered my perfect little timeline.

Luckily for me I soon realized that clinical work in the field of eating disorders was not for me, and I shifted my focus entirely to research. While this initially restored a little of my hope (I could still help others indirectly by publishing groundbreaking research) I still came up against more and more challenges as the years progressed. I picked up several new behaviors during my freshman year that complicated and intensified my eating disorder. I was having trouble staying on top of my schoolwork because I was constantly exhausted and depressed and I quickly alienated myself from every friend I thought I made.

I had an especially rough junior year. A string of rather traumatic events that began on my 21st birthday led me to start questioning my future and why I even bothered going to school anymore. This was also the start of my longest succession of revolving door treatment stays. When I came back to school from a leave in the spring of 2006 I was denied the opportunity to return to on-campus housing, thus forcing me to move back home. I tried commuting for a while, but the nearly 2-hour drive was extremely inconvenient. More often than not I ended up taking spontaneous detours along the way to engage in various eating disorder “activities.” All my former college friends were getting ready to graduate and there I was pulled off on the side of the road trying to convince myself to go to class instead of doing “that thing” that I absolutely hated but could not stop doing.

Several interrupted semesters and hospitalizations later I finally swallowed my pride and transferred to the college 20 minutes from my home. This felt like a huge step down for me. This school wasn’t as highly ranked as my first school and although I was less than a year shy of graduating when I transferred, I had to re-take a bunch of classes that didn’t transfer which prolonged my schooling even more. (Note: I soon realized that rankings are not the be all and end all and I honestly think I got a better education at the lesser ranked school…).

One of the class sequences I had to re-take was the entire psychological statistics and research methods sequence (so like, four semesters worth of classes, because for whatever reason the A’s I got in those classes at my first school meant nothing). The psychology department at this school was very small, and I ended up having the same professor for most of these classes, the notorious Dr. N. Nobody liked Dr. N right off the bat. She was tough and blunt. She did not subscribe to the “there’s no such thing as a stupid question” theory. If a student asked what she thought was a stupid question, she would stare at said student with disbelief for what felt like an eternity and then with a huff would say, “look it up!” I tried to remain as inconspicuous as possible in her classes. I purposely sat in the middle row closest to the wall with the door so I could make a clean and quick exit at the end of each class. Halfway through my first semester with her I was pretty sure she couldn’t place my face with my name on the roster and I was perfectly okay with that. Then one day everything changed.

As I was making my usual clean exit I heard Dr. N shout my name. “Hey… you. Rebecca? Come back here!” Cue major panic on my end. What on earth had I done wrong?!?

“What’s your story? Where are you from? What are your plans? Do you actually like this stats stuff or are you just good at it?”

This was her way of initiating conversation with me, you know… socially awkward style. Little did I know this was the beginning of a very unusual but positive relationship that would shape my future.

Dr. N started inviting me back to her office after class to chat and before I knew it I was TAing two of her classes and spending most of my free time in her tiny cramped office assisting her with research. I soon learned that Dr. N was not the scary grouchy old woman I once thought she was. Okay, she actually was pretty grouchy, but only because she got upset when students failed to live up to her high expectations. However, she could also be quite friendly and warm once you got to know her.

Working with Dr. N served as a major turning point for me in my academic journey. At a time when my identity was very much tied up in the eating disorder, she helped show me that I had more to offer. I spent the next two years working for her and although my troubles were far from behind me, she helped keep me going. In the fall of 2008 my eating disorder took a turn for the worse and although I never told her exactly what was going on, she knew something was wrong and encouraged me to get help. When I returned three months later a good XX lbs heavier after my intense stay at NYSPI she greeted me with, “Oh wow, you don’t look like you’re dying anymore! This is so great.” Yep, that was Dr. N. Had anyone else made such a comment (and they did), I would have been undeniably triggered and in full over-analysis mode. I was already self-conscious enough about my massive weight gain, and here someone was drawing direct attention to it. With Dr. N though, I was actually able to take this comment at face value. She wasn’t calling me “fat” or shaming me for my weight gain, she was genuinely happy that I appeared healthier because it meant I could devote more energy to the things I was good at.

Now, I wish I could say this was the end of my struggles and that I went merrily on from here with my renewed love for research and stats. Unfortunately, the next couple years were some of the hardest, but I can only imagine they would have been even harder had I not had my work with Dr. N to keep me going. She helped me navigate the university bureaucracy that was making it extra hard for me to get my damn degree. She listened to me go on for hours about my research interests and how I came to be so passionate about getting people to understand mental illness. She also encouraged me to apply to graduate schools.

In the summer of 2011 I made the cross-country move to Los Angeles to begin a master’s program in Experimental Psychology, something I never would have imagined myself doing just a year earlier. As I’ve revealed in previous blogs, my transition to LA was not the easiest, and my struggles continued throughout my time as a graduate student. However, in late 2012 after yet another major low point followed by some quality time at BHC/Reasons, I was finally able to start initiating serious life changes that would help me become more functional and “healthy” than I had ever been. When trying to make sense of this transformation I’ve mostly just thought of it as a result of me finally becoming fed up enough with my eating disorder to start doing something about it (like, actually doing things that were initiated by me and not some outside force of treatment). And yeah, I’m sure this was part of it, but I’m now realizing what a pivotal role my commitment to education had in this transformation. It’s the one thing other than my eating disorder that followed me wherever I went. As sick and depressed as I got, I still kept coming back to my love for learning.

I was fortunate enough to be introduced to yet another amazing mentor through my master’s program, Dr. A or “Andy.” Andy loves to tell the story of the first party I attended at his house just shortly after moving to LA. Being among one the newest members of the lab, I didn’t know most of the people at the party. I was also about 10x more shy and “socially awkward” than I am now and I was well aware of this fact. So aware, in fact, that I felt the need to apologize for this as I was leaving the party. Yes, on my way out I turned to Andy and said, “I’m really sorry for being so… socially awkward…” and he started cracking up. I like to think that comment broke the ice for us, and from that point on I gradually grew to be less and less “awkward.”

I truly believe that the general-experimental psych program at CSUN is a hidden gem that few people know about. The advanced statistics training is outstanding and the professors are among some of the best and brightest who are willing to mentor students with a wide variety of research interests. My research interests were more clinical than most so I was able to cross-over into the clinical psych program to work with professors and take additional classes.

Just as valuable as the academic training, however, was the dedication to students’ personal and professional growth. Without this, I may have lost myself along the way. Midway through the process of applying to research-heavy clinical psych PhD programs, I had an epiphany and realized I actually did not want to go that route. My love for research hadn’t gone anywhere, I just realized that I was applying for all the wrong reasons. I didn’t want to wait another 6, 7, or 8 years before I could start working in my chosen field. I didn’t want to be forced to move to some random place in middle America just because that’s where the research was being done. I didn’t want to fall into even more debt. I had already wasted enough time and wanted to actually start doing something. I shocked everyone and withdrew my applications and started applying to jobs instead. At first Andy and others told me I was crazy; I was throwing my life away. No, I thought, I was finally not throwing my life away. I was finished doing things just because they seemed like the “right” things to do, or because they may sound more impressive on a resume. With my eating disorder, I had spent a huge chunk of life doing things half-assed and without my full devotion. I was ready to start doing real meaningful stuff all the way through. When I first interviewed at Hathaway-Sycamores, I instantly felt connected. This was a place where I knew I could make a difference.

Part of my job involves supervising undergraduates who complete research internships at our agency. I’ll admit at first I wasn’t sure how much I’d like this task, but it quickly became one of my favorite parts of the job. I see bits and pieces of myself in a lot of the interns, and I love helping them discover their passions in this very fascinating field of work. It takes me back to that day nearly a decade ago when Dr. N approached me with, “Hey you! Do you actually like this stats stuff or are you just good at it?” Yes, I do like it, and I get just as excited when I see my interns enjoying their work.

“Hi, I’m Becca and I’m kind of crazy”: Discrimination that isn’t really discrimination and Best Practices (according to Becca) on disclosing mental illness in school or in the workplace

The other day I came across this article, and it really made me think. A quick summary of the article– a medical student decided to be completely up-front in her med school application about her long struggles with depression, anxiety, and suicide attempts. She was accepted into a program and was lucky enough to be matched with a really understanding and compassionate advisor. However, she struggled pretty severely from the start, failing an exam in the first two weeks and having frequent panic attacks that prevented her from fully participating in the program. The school let her re-take exams she ran out of and decided to let her do her second year of coursework over two years instead of one.

I’ll admit, my first reaction to reading this was, “Shit, maybe she’s not cut out to be a doctor if she’s already having this much trouble in her first year of med school. I imagine the workload and stress is even greater down the road. How will she handle that??” This may seem like a judgmental reaction, especially coming from someone like me who should be more sensitive to these kinds of things, right? Well, I disagree. I’ve seen similar situations play out before, where someone with a mental illness claims to be a victim of discrimination when to me it doesn’t seem like discrimination. Medical school is very demanding and not everyone makes it through in one piece, mental illness or no mental illness. Residency and eventually working as a doctor (depending on the specialty) can be even more stressful and may require sacrificing sleep and working 70-80 hour weeks. That’s hard enough for a completely healthy person to handle, but for someone with a serious mental illness, it may be irresponsible or even impossible. To me, discrimination based on a mental illness would be if there were negative repercussions to a med student disclosing her mental illness despite there being no issues with her performance. When there are issues with performance, they should be addressed just like they are with any student. If standard protocol is to kick students out who routinely fail exams, then that should hold true for all students, even those who may have legitimate “reasons” for failing. The goal of med school is to prepare skillful and responsible doctors, right? If they’re not learning or retaining the material they shouldn’t be blindly passed through the system regardless if it’s because they have a mental illness or because they just don’t study.

Think of the consequences. You wouldn’t want someone with an active substance abuse problem performing surgery just the same as you wouldn’t want an actively suicidal person counseling depressed individuals. I am all for people with mental illness following their dreams and not letting their issues hold them back in life. I also think there is a time and place for accommodations to be made. It may take someone extra time to finish school because they’re getting intensive treatment for their condition, and in many fields, this is not a problem. Likewise, some career fields may allow more room for error than something like medicine, so setting the bar lower for certain students may make more sense.

As much as I often struggled in school and other areas of life due to mental illness, I never wanted anyone to give me special treatment or expect any less from me. When I first decided to major in psychology as a college freshman, my ultimate goal was to become a therapist who treats eating disorders (so original, I know). However, I soon realized this was not a good option for me. There are some people who can make this work and end up being better therapists because of their experiences. Others end up being really bad therapists because they either can’t handle working with the ED population without falling back into it themselves, or they unintentionally trigger their clients by displaying signs of their own struggles that they may not even be aware of. As much as I wanted to believe I could be that first type of therapist, I had to be honest with myself. I know firsthand how perceptive and easily affected clients are when it comes to their therapists. Even being where I am now, I still wouldn’t completely trust myself to work with ED clients without unintentionally triggering them in some way. I also wouldn’t completely trust myself to work with that population without being triggered or negatively impacted by my clients. I am so glad I realized this early on, and that I wasn’t too proud to admit it. All my non-existent clients from my alternate future thank me for this too, I’m sure.

I mentioned this because I think so often we want to believe that anyone is capable of anything– that we have to support everyone in their chosen life path because “anyone can do anything they set their mind to.” That’s kind of crap though, isn’t it? Someone with a serious mental illness may not be cut out for medical school, and admitting this shouldn’t automatically be seen as discrimination. No one is saying that person can’t be successful in any number of other career paths, they’re just saying that maybe, just maybe, medicine isn’t the ideal path, for the person’s own sake and the sake of their nonexistent future patients. I can think of several therapists who I wish had been told this at some point– “Hey ______, we get that you really want to help people and you have the best of intentions, but maybe this isn’t the ideal career for you?”

I also wanted to touch on the subject of disclosing mental illness in a professional environment, whether that be in school, work, etc. As I said before I think in general people should feel more comfortable speaking up about their struggles. That said, this should be done with much thought and consideration into all the possible outcomes. Opening up about my eating disorder to people at work was not a decision I made on a whim. I waited until I had been there for nearly two years and was pretty sure no one was going to hold it against me or treat me differently as a result. I also made sure I was in a place where I could confidently say that my eating disorder in no way negatively affects my work or my ability to do my job. This is just my opinion, but I think it’s always best not to state these things upfront before people have gotten a chance to know you. When I was applying to grad schools, I was advised not to talk about my past in my applications, because that’s the first thing they’d associate me with and it may very well work against me. Just the same, I didn’t walk into work on my first day and announce, “Hey guys, I’m kind of crazy!” I waited until I had established myself as reliable, competent, and hardworking employee and until I was confident they were a safe audience.

At the end of the day, the main thing a school or employer should be concerned with is whether or not you can succeed in the program, or the job. If you can– awesome! The fact that you spent more time in the psych ward with your psych ward buddies than with your school-aged peers should be irrelevant. If you can’t succeed at the job, well, you should be treated just like the lazy slacker down the hall who can’t succeed at the job. It just isn’t for you, at least not at this time. Is this harsh? I don’t know, but I’m putting it out there.

Finally, I want to make it clear that I know very little about the woman in the article I linked to, other than what she revealed in the article. She may very well be “cut out for” a career in medicine and my suggesting she may not be was merely to illustrate a point in the larger context of things. Her story was just a jumping off point for this blog. 😉