Eating disorder assessment

Note: This post will discuss disordered eating thoughts, behaviour and issues.

On Thursday, I was assessed by Eating Disorder Services (EDS).  To say that I was terrified, would be an understatement.  I have so many conflicting views about the assessment, and the reality of my disordered eating…  I constantly question whether I have an eating disorder, or not.  I hold up the evidence that suggests what I’m doing isn’t a big deal… my BMI is in the healthy range; I eat three “meals” a day; and I don’t do many of the stereotypical behaviours attributed to those with an eating disorder.

Then, I stand back a little, and look at what I’m doing… I have lost a substantial amount of weight over the last 18 months, to the point where people I haven’t seen in over a year, no longer recognise me; I’ve had an increasing number of people telling me that I need to stop losing weight; my diet has become narrower, and narrower over time; and my exercise regime has started to become a little obsessive.  Then, there are the physical issues… I’m losing hair; my skin is becoming dry; my fingernails are constantly breaking; fatigue hits me more frequently; I get sore muscles for little, or no reason; and my digestion is obviously compromised.

But, probably the scariest thing, is my eating disordered thinking.  I never really comprehended what people were talking about when they referred to the all-consuming thinking of an ED… now, I understand it a little more.  In the past, when I had issues with food, I would get glimpses of the odd logic and reasoning that I could come up with… I’d start to eat something, and then suddenly become repulsed by it… I’d look at food, and it would morph into something unpalatable and impossible to eat… or, just the thought of food would make me have a panic attack.  Often there would be no context for these previous issues with food, and they seemed like random occurrences.  I could attribute some of them to stress, but not all of them…  Now, things are different, it’s like I’m living in that space all the time.  I think of food, and become scared.  I’m not even totally sure what the fear is about… yes, there’s an element of “food = calories = weight = bad” to it; but, that’s not the real story.  That’s the veneer that is acceptable to describe, but there is so much more to it all.

I’m well aware that there is a mix of the past influencing my thinking…  My father was a butcher during many of my formative years, which has resulted in me always struggling to eat meat of any kind.  My mother has had many issues with her weight over the years… as part of her own issues, she would often make derogatory comments about my weight…  My ex-husband considered himself a chef, which has probably triggered one the most destructive of my food issues… an inability to eat salad.  Yes, I realise how silly that sounds… I mean, salad is good for you, right?  But now, I find myself frozen in front of the salad aisle of the supermarket, totally unable to pick-up any of the healthy food in front of me…  Part of the reason for this, is because my ex-husband made such a performance about making amazing salads; so there’s a negative association.  But, a bigger part of my issue with food, is an inability to touch it in order to prepare a meal.  To give you an idea, the last time I helped to prepare a meal from scratch, was last Christmas… I don’t remember the time before that…  I’m not totally sure how this fear developed, but I think it may have to do with touching raw meat, and the feelings generated as a result… associations with my father, and the butchery… flashbacks… fear… terror…

It’s for these reasons, that when I told my mother that I was going to be assessed for an ED, she commented that she wished them luck as the things that I eat are so limited.  It’s this sort of reaction that helps me realise that my disordered eating isn’t about trying to get attention from my family.  When my oldest brother was in his early 20’s he developed Bulimia Nervosa… the comments he received from our parents were hardly supportive… my father called him a skinny wimp, and my mother ignored it.  My brother managed to find his way through his eating disorder without outside help… but he still struggles with food 20+ years later.

With all of this baggage, I went into the assessment on Thursday… it was pretty much a disaster.  It was meant to be a 90-120 minute assessment, but the nurse called it off after 45 minutes.  I was at my tongue-tied best… staring at the carpet and becoming more and more anxious, despite taking medication prior to the assessment.  The only good thing, was that because EDS are part of the Mental Health Crisis Team, she had my notes which outlined my abuse history and diagnoses.

There were some harsh moments leading up to the assessment… having an ECG was a reminder of the physical damage that I could be doing to my body… the fasting blood tests were an odd contrast to what was meant to be achieved… but, the worst thing, was the terrible drive to restrict food as the assessment approached.  There were fears that if I wasn’t “serious/light enough”, they would call me an attention seeker; or, that they would force me to eat, so I had to counter that by going in as light as possible; and then there were the conflicting views about what being accepted, or not, by EDS would mean… all of these different reactions played out in my disordered eating.

I wish those fears, and behaviours had eased with EDS accepting me into their services… but, they haven’t.  The assessment ended with me being given the diagnosis of EDNOS, and being asked to add some cereal and milk into my diet.  The assessing nurse kept telling me that the changes would be slow, and about helping me to gain health, not weight.  But, I’ve been looking at the cereal in my pantry like it’s the enemy…  I wish I could just pour some in a bowl and eat it, just like they showed in those misguided made-for-tv ED movies of the 80’s and 90’s.  I guess real life isn’t like the movies after all… stink!

—————-
Now playing: INXS – Beautiful girl

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13 thoughts on “Eating disorder assessment

  1. Real life not like the movies?? Phooey to that!!

    Not touching meat when your asshole abuser was a butcher? Yea, that’s a no brainer for me. But I’m being a little flippant.

    In seriousness, I am so sorry you’ve been battling this, I really am. Also very sorry you had to endure another assessment with the crisis people. I know how difficult they have been for you in the past.

    However, I am hoping they will be able to help you. I really want to see you well. Perhaps can you try all different cereals until you find one that works? We can buy individual serves in the supermarkets here – perhaps that might help? I don’t know – just a thought.

    Please take gentle care; I know this will be a difficult time for you. ((hugs))

    • Hi Kerro,

      I know, I was operating under the illusion that movies and real-life were synonymous… I’m a tad disappointed πŸ™‚

      Thanks for the support, I really appreciate it… I’ll check out the individual servings, I hadn’t thought of that.

      Take care,
      CG

  2. CG you are definitely NOT an attention seeker. Hopefully the realization from your mother’s comment will stay if that helps you to see the truth of that…although I’m sorry that her reaction was so cavalier.

    I’m glad they had your records because I was really worried about you having to talk about all that to get them to understand.

    The connection with your father and food makes complete sense to me. And yes, the salad makes sense too. It’s not as easy as having one appointment and then going home with a positive attitude and pouring a bowl of cereal…gotta love movies. πŸ˜‰

    But, I do think that it’s a good goal because it doesn’t require a complete lifestyle change. It’s better than having them giving you a ridiculous list of 50 things to do by next week, so I’m grateful they didn’t go overboard.

    Hmmmm…is cereal in New Zealand different than cereal over here? I’m thinking it’s like Corn Flakes, is that right? Or is it like oatmeal? Anyway, is it possible for you to even break that step down and try a few bites instead of a whole bowl? Just a thought.

    I honestly admire your strength. The food issues aren’t about vanity, you have real pain behind what’s happening. You deserve care and good health. Little steps…

    • Hi CI,

      Thanks for your support. I know you are going through your own struggles with all of this; and for that I’m really sorry.

      It was good to hear that they weren’t expecting big changes. But, I worry that I’ll be seen as non-compliant if I don’t jump through the right hoop immediately.

      The cereal that I can usually eat, is a museli… So lots of nutrients, and good things in it πŸ™‚

      I hope that you can see the truth in your words for yourself, as well. You deserve care and good health, too. It does take little steps, and the sooner you can take them, the easier the journey back to good health.

      Take care,
      CG

  3. I remember those movies too. They were often more like fairy tales IMHO! :-/

    The assessment sounds like it was really rough for you. I’m glad the nurse called it off. All those thoughts and feelings – you describe them articulately – but it sounds confusing and scary.

    Is it a good to have a diagnosis of EDNOS? Do you feel like you were taken seriously but not seen as an attention-seeker? I can imagine you’re not the only one to feel caught between the two – I’ve had similar feelings when seeking help. Did the nurse’s attempt to focus on health rather than weight help?

    I don’t much like cereal – too cold and crunchy for morning-times – but INXS could almost make it bearable πŸ™‚

    • Hi Annelise,

      Yes, those movies were very fairy tale based. I remember one where the main character was shown to recover by “suddenly” deciding to eat. This sort of thing was reflected in a book that I recently read… it was so disheartening… these survivors were talking about one day realising that they could eat. That sounds so simple, yet they couched in within a framework of a 2-5 year therapy timeframe… so, not simple at all.

      The assessment was confusing and scary. I think she might be used to working with people who are able to communicate… she opened with the infamous “tell me about yourself…”. I had no idea what she wanted, it was really odd. I asked her what she wanted, but such an open ended question seemed odd. How many people would be able to answer that in a meaningful way?

      Having the diagnosis is helpful, in that it encourages me to take a look at what I’m doing. But, it’s not overly meaningful.

      It felt as if she listened to me, and she did notice that I wasn’t coping; but, it also didn’t feel genuine… if that makes sense. She was nice, but it felt like she was saying the right things from a script – mainly about the health vs weight talk. I know that may well be my issues, and scepticism with the Mental Health Services coming through, so I’m trying not to buy into that thinking too much. I’ll see how the appointment this week goes… she did ask if I would be back, almost like she was expecting me to say I wasn’t going to…

      I usually had the cereal for lunch… πŸ™‚

      I was surprised watching the INXS video again, I’d forgotten how strongly it featured the distorted messages that we’re bombarded with…

      Take care,
      CG

  4. I’m sorry this is so hard. But I am also glad you are dealing with it. That you know you need help. And that they are offering help to you.

    My experience is that the disordered thinking about eating becomes so whacky that you don’t really believe anyone when they say it can be deadly. But as you know it can be deadly. Which is why the protocol includes an EKG check for a baseline. You can tell things are changing with your body. You may perceive this all as gradual and think that it will always be gradual, and that you are in control.

    Unfortunately, if it is not reversed, the major physical issues can end up cascading, and what used to be gradual suddenly is not.

    I am glad for you because you know what situation you are in and you know it’s serious. The “grip” of the disorder is, as you know, absolutely tenacious.

    From the distance of time, I view suicidality, depression, eating disorders, and dissociation/DID all differently, with eating disorders warping thinking and behavior in a way that others do not. I don’t really know how to explain it. There’s a vortex to ED that is not the same in any of the others.

    Personally, I think this was unavoidable for you. You were vulnerable to it. And this will be hard. But you will find a way to heal from it, and I think with that work will come new insights that will lead to leaps forward.

    Thinking of you.

    Paul

    • Hi Paul,

      I know that I’ve been heading down this road for quite some time. I’m still not sure that I believe I’m in trouble… well, at times I do; but then it passes, and I’m back to the warped thinking. It’s very confusing.

      You’re right, the ED thinking is very different. There are elements of the other thinking in there (the worthlessness, hopelessness, etc), but it is not the same. It’s all consuming. It’s the only reality.

      I’ve already learned quite a bit about the system that I didn’t know. I would rather not be in this place to find them out though.

      The nurse was very clear, in that there is nowhere for me to go. My options are what is being offered, and DBT. It feels like she is expecting me to refuse the help. But, I don’t know how much of that is my being too sensitive. Will see…

      Thank you for your support.

      Take care,
      CG

  5. I’m sorry the assessment was so bad 😦 Hmh.. it sounds to me as if the nurse doesn’t really understand the connection of your ED and what happened in your past. Although she had the record. 😦
    Have you from now weekly appointments in the EDS? Always by the same nurse? or a additional therapist?
    btw. is it sure that you alone have the ED or are there some others of your system involved??? Only a question to think about… from my own experience….

    and those movies… I remember the one you’ve mentioned…. a sudden healing…it’s hilarious *sigh*

    Take care and I’m glad you’re going to the next appointment in the EDS. Don’t let yourself get discouraged. Even if it’s hard.
    LSC

    • CG. When you said it was a disaster, are you mainly talking about your perspective on it? I didn’t read anything in what you wrote that said you felt as though they didn’t understand what was going on. Or did I read it wrong? I’ve often gone into first interviews and come out blaming myself for not communicating well… I think, though, clinicians do get that when what you are struggling with is so hard and deep that it’s not easy to trust a stranger and communicate your entire experience.

      • Hi Paul,

        It felt disastrous because I became so anxious, and couldn’t communicate. It felt like the other assessments with the Mental Health Crisis Team, and worse because she so casually asked me to change something within my diet. It felt like there was a disconnect between what she was saying, and meaning.

        It was obvious that I was struggling with the assessment, and she was responsive to that. I’ll see what happens this week…

        Please take care,
        CG

    • Hi LSC,

      The nurse had my notes, but hadn’t read them. She knew I’d had contact with the team in the past, and confirmed a history of abuse. She said she’d read them later.

      Yes, I have weekly appointments with them now. I think it’s with the same nurse, I’m not sure. I know that I was meant to meet a nutritionist, but that was delayed.

      Thank you for your support LSC… I know you struggle with food issues, and I really hope it is easing for you all.

      Please take care,
      CG

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