Wednesday, September 18, 2013

Symptom Swapping & Comorbidity

As some of you may have guessed, based on my last couple of posts, my emotions have been all over the place recently. One of my best friends from treatment was readmitted to a different facility this week, but not for what you'd expect. After being out of treatment for nearly a year, this individual's eating habits have returned to normal, but unfortunately there are still several underlying issues that need to be dealt with. 

As a result, different self-destructive behaviors have surfaced that do not involve eating, also known as symptom swapping. Symptom swapping is going from one addictive behavior to another. For example, some of us with eating disorders might begin to get our eating related symptoms under control, but begin drinking or smoking instead. Many of these behaviors, such as OCD tendencies, self harm, or shop lifting, are often present during the eating disorder; however, they become much more prevalent during recovery. Without the eating disordered symptoms to numb out and/or avoid, many individuals resort to these other self-medicating tactics.

Another aspect of eating disorder recovery that is often overlooked is comorbidity. Comorbidity, in contrast, is when two disorders are present at the same time. Many of us who suffer from eating disorders also deal with other mental health disorders such as anxiety, depression, bipolar, borderline personality, PTSD, obsessive compulsive, ext.; which makes treating the eating disorder even more difficult. In one study, it was found that 94% of patients diagnosed with eating disorders also struggled with comorbid mood disorders and 22% deal with substance abuse. 

I found this list of comorbid disorders, but please keep in mind there are several other disorders that may coincide with eating disorders.

 "Depression and anxiety. Disordered eating behaviors like restricting intake, purging or food rituals can serve as powerful stress relievers for those suffering with anxiety and depression.
 Obsessive-compulsive disorder (OCD). Eating disorders symptoms can often mirror OCD symptoms. Rigidity, compulsivity and the creation of elaborate rituals around food and exercise often display in both diagnoses.
 Bipolar disorder. Seen most commonly alongside bulimia, bipolar disorder shares several key symptoms with bulimia, including weight issues and impulsivity.
 Substance abuse. Abuse of drugs and alcohol offers a mechanism for those suffering from eating disorders to numb their pain and anxiety. The use of substances that decrease or suppress appetite in an effort to manage weight tends to be an anorexia comorbidity, while the abuse of substances with no effect on appetite or weight tends to be a bulimia comorbidity."



In my personal experience, I honestly cannot think of one individual I know in recovery who has not gone through a period of symptom swapping or suffered from comorbid symptoms, myself included. It's frustrating to say the least. We go into treatment, develop a new relationship with food, and gain weight only to have these other issues surface. I oftentimes question why I can't just have one disorder to deal with, as if that isn't enough.

My heart breaks for my friend who is back in treatment this week, but I am also incredibly proud of her for taking care of these co-occurring issues. Symptom swapping and comorbidity are much more common than I realized. It is also beginning to make sense to me why recovery is never a straight line. We are dealing with more than just eating related issues and if we choose to ignore these things, a full recovery is not possible.

My friend has taught me there is no shame in dealing with other mental health illnesses along side the eating disorder. In fact, it is perfectly normal. Let's all follow her lead and do our best to get the help we need beyond the ED symptoms.

Progress.

11 comments:

  1. This seems very logical to me because in the end behaviours are a bad coping mechanism to numb the underlying issues. i often ask myself if an underlying depression caused my ED or if my ED caused the depression. Of course i felt extremely hopeless and depressed while i was "in" my ED but after i was physically recovered i fell back into the depression way more often and i brought my eating habits down too. And i probably had some OCD tendencies before because i really DO those control rituals since years that have nothing to do with food but i never talked about it to my therapist because it was never that bad. do you think there´s a connection ?

    How are you dooing with the intuitive eating ? if its hard at the beginning i promose its worth it.
    <3

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    1. Most likely there is a connect, but I'm not a specialist so don't take my word! ha ;)
      Intuitive eating... is that what it's called? For some reason I don't really like that phrase and I don't know why. I'm still estimating calories in my head a little bit. I feel much more at ease when I have a general idea how much I am eating, but like you said, it will get easier!

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    2. probably i should talk about it to my therapist even if those little things dont disturb me that much compared to my other issues it could be important.
      I think its just normal eating if you don´t like that term but if you search for intuitive eating on yt for example you find very helpful videos from people recovering from EDs or are fully recovered trough it. I think its more about beeing aware of what you truly feel like eating and how much you eat instead of beeing influenced by other people or the media. Maybe the term sounds like "clean eating" or another "new programm" to you but its really not. maybe this channel gives you an idea of what im talking about its really helpful http://www.youtube.com/channel/UCmV0_l34f7yHNT9mr3rTm3w

      I continued counting too at the beginning but it was really stressful and even though i havnt been weighing food or counting exactly since months it still felt very disorted. i have no idea how much i´m eating at the moment and i´m not weighing myself i just listen to my body and hunger cues. and it feel so right that i think it would be probably even worth it if i would gain a couple of pounds if thats what is right for my body. well, of course if would feel a little uncomfortsble at first but i don´t want to miss this new freedom, beeing able to eat what is right for my personal needs and not obsess about food and calories anymore.

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    3. Wow! To hear you say even if you gain a few pounds it's okay because it's worth it for your body is HUGE! Like that's really exciting and kind of made my day haha. It's all about that sense of freedom. :) Thanks for the youtube video. I will definitely be looking into this stuff.

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    4. I mean i´m not sure if i would be really ok with it if it would really happen because i struggle A LOT with my body image but i logically know i am at a low healthy weight and i would never get too heavy that way and the way i eat right now feels so good i don´t want to miss it and in the end i AM not my body and i have to accept it anyway one day so why not trust my body to know what will make me feel good in the end ? :)

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    5. Yes, it's all about doing what makes you feel best in the long run! xo

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    6. and this is recovery and i think i am at a place where big changes inside happen and i am finally at the point of letting go :)

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  2. I think this is a super interesting article to cover just because it is so true that most have another aspect to it. I know it was hard for me to hear that depression and anxiety go hand in hand in that aspect because you have to tackle all aspects to actually leave space for the ed recovery to happen as well.

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    1. I almost think the depression and anxiety get worse (at least temporarily) once we get our ed symptoms under control. It's a really complex thing to treat. So it makes me feel better knowing I'm not so crazy, after all.

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  3. Yes, it is very common to develop multiple addiction. It does not have to be alcohol or smoking. It can be anything like shopping, hoarding, and etc, because the root is codependency. It takes a long time to recover, and I do believe that recovery is a life long lesson. And, when we start to face life in life's term, our real issues start to show up. In a long run, lots of things happen in life, and living in recovery is not easy for addicts. When we are obsessed about our addiction, life seems to be outside of our scope. Sometimes, I miss the time when I didn't know what was going on at all... If there was no awareness/honesty at all inside, there would no pain associated to addiction. It is just fun time. I believe that for some reasons, some start to feel pains and those are gifts because those people are given the second chance to do life as it is supposed to be. I am a bit depressed... I am so glad that I have a place to come and talk, "your blog"! xoxo

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    1. Yes yes yes. I also think we will be dealing with some type of addiction or another throughout our entire lives. The level of severity and our abilities to cope will improve, but if we aren't constantly aware of these things then they will always be there to haunt us. I'm so glad you come here and talk! haha <3

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