The ED Grieving Process

This week the discussion topic in one of my classes was death, dying, and the grieving process. Kind of depressing, right? Death isn't something that I spend much time thinking about for that reason.

Most people don't realize eating disorders are the number one cause of death among all mental health disorders. Although there are huge consequences for remaining sick, many of us struggle to ever to get better. As I have gone through recovery, there has been somewhat of a grieving process that has taken place as I have let go of my old, familiar, and comfortable best friend - the eating disorder. 

Over the years, if I was having a bad day and needed to numb out, the eating disorder was there. If I was feeling in inadequate, I would just remind myself that I was the best at restricting my food intake. In a very sick way, the ED made me special. That constant false sense of accomplishment kept me going when everything else seemed to be crumbling before me. 

According to many psychology books, the grieving process has five steps:

 Denial - "My eating disorder isn't THAT bad. I don't need help."
Anger - "How could my parents have left me at this place (treatment). They must not love me. How can these people make me eat this food?!"
Bargaining - "If I'm going to eat this much, I should be able to walk every day."
Depression - "I hate this. Let me stay in bed all day. I don't know how to deal with all of these surfacing emotions."
Acceptance - "There's no turning back. Recovery is the most difficult thing I will ever do, but it sure beats living with an eating disorder."

For this post, I am going to focus on the depression stage of the grieving process because it seems to be the most challenging part for many of us in recovery. In the book, "The Road Less Traveled: A New Psychology of Love, Traditional Values, and Spiritual Growth," written by M. Scott Peck, there is a chapter describing the healthiness of depression. According to Peck, during the process of giving up something it is normal to feel depression because,

"The feeling associated with giving up something loved - or at least something that is part of ourselves and familiar - is depression. Since mentally healthy human beings must grow, and since giving up or loss of the old self is an integral part of process of mental and spiritual growth, depression is a normal and basically healthy phenomenon (pg. 75)."

This might explain why it often feels impossible to give up old, destructive habits. Many of us are unwilling or unable to suffer through the pain associated with giving up our eating disorders. Consequently we cling, sometimes forever, to old thinking patterns which of course keeps us sick.

A few months back I did a post on the Washout Phase, where patients often feel like they have hit a brick wall in recovery and they begin to question whether or not changing is worth it. I think this depression phase of the grieving process is a huge part of the Washout Phase. The good news is, however, once I pushed through that depression phase, I had my "ah-ha" moment and realized there was no turning back.

In a way, living with an eating disorder is like living with death. Although I didn't realize it at the time, I was slowly killing myself. Everyday that I spent caught up in my ED, a small part of my soul was taken away. I became emotionless, vacant, and somewhat unaware of the world around me. Nothing mattered except my rigid routine.

Losing something we have grown to love is not easy and unfortunately many of us have to go through a phase of depression in order to get to the other side; however, keep in mind this part of recovery is completely normal. If you find yourself in that depression phase at this moment, remind yourself that not only is it necessary to heal, but it will also pass.

Making the choice to stop living with death (my eating disorder) was one of the most difficult things I have ever done; but one year later, regardless of the pain, it is clearly the best decision I will ever make.

Progress.

Rain, Rain Go Away...

For the past five days we have seen nothing but heavy rain and occasional sleet. For the next five days, the forecast is predicting nothing but heavy rain and occasional sleet. 

Back when I was in the midst of my eating disorder, I used to crave rainy days. When the weather was gloomy, I didn't feel as much pressure to put on a happy face; it was a perfect excuse to sleep the day away, and I could blame my low mood on the weather. Rainy days bring out my depression, which isn't something I talk about very often. 

Depression and anxiety are often two of the most common underlying issues associated with eating disorders and I was no stranger to either of them. While anxiety was (and still is) typically a much bigger issue for me, depression always found a way to sneak up on me when I least expected it. Initially, before I was diagnosed or treated for an eating disorder, I was prescribed anti-depressants; like taking pills would magically solve all of my problems.

One of my favorite quotes about depression comes from a book I read years ago: Elizabeth Gilbert's "Eat, Pray, Love." I read this book very recently after being diagnosed with depression and this quote about depression and loneliness has stuck with me ever since;

“They flank me-Depression on my left, loneliness on my right. They don't need to show their badges. I know these guys very well. ...then they frisk me. They empty my pockets of any joy I had been carrying there. Depression even confiscates my identity; but he always does that... But he [Depression] just gives me that dark smile, settles into my favorite chair, puts his feet on my table and lights a cigar, filling the place with his awful smoke. Loneliness watches and sighs, then climbs into my bed and pulls the covers over himself, fully dressed, shoes and all. He's going to make me sleep with him again tonight, I just know it.”

While stuck in a bought of depression, it can feel absolutely hopeless and as Gilbert describes, it often confiscates my identity. Some of the most common depression symptoms include: lack of interest, difficulty concentrating, fatigue, feelings of worthlessness, insomnia or excessive sleeping, change in appetite, and persistent aches and pains, to name a few.

Eating disorders and depression are a deadly combination. Being severely underweight and malnourished can cause psychological changes to the brain that have been proven to negatively affect mood. Perfectionistic tendencies and feelings of inadequacy, which I have discussed multiple times on this blog, only add to the fire, making those depressive thoughts even worse.

Depression is just one of the many mental health disorders commonly involved with eating disorders; obsessive compulsive disorder, anxiety, post-traumatic stress disorder, bipolar, borderline personality, and panic disorders may be involved as well. In addition, substance abuse, self harm, and even potential suicidal behaviors are coexisting issues and can all lead to depression and anxiety; making the recovery process that much more difficult.

The mental health world is a scary one for most people, myself included. By admitting that I do struggle with depression, anxiety and substance abuse, in addition to my eating disorder leaves me feeling self indulgent and weak; once again adding to the depression fire.

The good news is, however, I have learned that mental health disorders are nothing to be ashamed of. I have been shocked multiple times to find out people I would never expect, also struggle with similar issues. Just like I would never treat someone suffering from cancer with disrespect, I should never be disrespectful towards myself and my issues.

Eating disorders are the number one cause of death among all mental health disorders. This is not a matter that should be taken lightly.

Thanks to this rain, I have been constantly reminded of my old depressive ways. Although there is still nothing better than a nap in the rain, my depression no longer jumps for joy on rainy days. Depression might occasionally sneak up on me from time to time, but I no longer feel the need to spend my entire day indulging.

Yes, this weather is awful, but today I am choosing to snuggle up with a big mug of hot cocoa, my girl, Muzzy, and enjoy feeling cozy- rather than depressed.

Progress.

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Thinking Errors

In my fist class yesterday, I found out my English teacher wants to keep my final research paper for an example to use for future classes. As I walked to my next class, I felt like I was on top of the world and couldn't stop smiling at random people (who probably thought I was crazy). The sun was shining and life was good.

In my second class, however, I had a lab exam that I had spent hours studying for, but ended up getting a not-so-good grade. Before I even turned the exam in, I knew it was not my best work and the self critical thoughts immediately out numbered my "I feel smart" thoughts from the class before. As I got in my car to drive home, the need for my afternoon nap hit me pretty hard. I immediately crawled into my bed when I got home and let myself drown in the negatives.

The most frustrating thing is, I knew exactly what I was doing. In that moment, I was allowing a thinking error to dictate my mood. After years of therapy, I am finally realizing when I am engaging in a few of the most common thinking errors.

Thinking errors, also known as cognitive distortions, are extremely common in people who suffer from anxiety or depression; which are typically underlying issues for an eating disorder. By engaging in thinking errors, I am allowing myself to believe something that isn't even true. Once I start going along with these thinking errors, I begin that downward mental spiral that I always refer to in my posts. 

Sadly, after many years of engaging in thinking errors, I have become very good at believing they are true. The first step in changing this problem is to recognize them when they happen; so I made a list (from an old worksheet I was given in treatment) of some of the most common thinking errors:

Mental Filter:

Mental filtering is when we focus exclusively on the most negative and upsetting features of a situation, filtering out all of the more positive aspects. For example, my day yesterday; I received a huge compliment on my research paper, but completely forgot about it after bombing my lab exam.

"All-or-nothing" Thinking:

“All or nothing” thinking is when we see things purely in “black-or-white”. These types of thoughts are characterized by terms such as “always”, “never” or “every”. Everything is seen as “good or bad”, “successes or failures” and it is generally the negative perspective that is more readily endorsed, ignoring the shades of gray that lie in between. An example of this, would be me feeling guilty for not getting 100% on a test and thinking of myself as a failure (which also happened yesterday).

Overgeneralization:

Someone thinking in an over generalizing way will often see a single unpleasant incident or event as evidence of “everything being negative”. If something bad happens then it will be seen as part of a never-ending pattern of negativity and defeat. A bad job interview or a bad date, for example, might lead someone to believe they will never get a job or fall in love. 

Jumping to Conclusions:

An individual who ‘jumps to conclusions’ will often make a negative interpretation or prediction even though there is no evidence to support their conclusion. This type of thinking is often made when thinking about how others feel towards us and is often divided into two categories: 

        -Mind Reading: Assuming the thoughts and intentions of others.

       - Fortune-telling: Anticipating the worse and taking that as fact.

Magnifying/Minimizing:

Thinking in a magnifying or minimizing manner is when we exaggerate the importance of negative events and minimize or down-play the importance of positive events. In depressed individuals, it is often the positive characteristics of other people that are exaggerated and negatives understated.

Personalization: 

A person engaging in personalization will automatically assume responsibility and blame for the cause of negative events that are not under their control.  

"Shoulds" & "Oughts" 

Individuals thinking in “shoulds”, ‘oughts” or “musts” have an ironclad view of how they and others ‘should’ and ‘ought’ to be. These rigid views or rules can generate feels of anger, frustration, resentment, disappointment and guilt if not followed.

Emotional Reasoning:
Emotional reasoning is when we assume feelings reflect fact regardless of the evidence– “I feel it, therefore it must be true”. “If I feel ugly and stupid, then I must actually be ugly and stupid” or “I feel guilty, therefore I must have done something bad and be a bad person”.

By taking the time to recognize these thinking errors, I am also giving myself an opportunity to change the way I react to them. In yesterday's situation, I could have reminded myself of the nearly perfect grade I received on my English paper and focused on that instead. Our brains are extremely powerful tools, but it's also important to remember that not everything we believe is true.

Next time something like this happens, I will do my best to recognize my thinking errors and move on with my day. Sounds simple enough, right?

Progress.