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Do you think that "harm reduction" can be a viable strategy for an ED? When I say that, I mean trying to use ED behaviors less often or less severely.

 

I'm struggling a lot lately not to restrict or fast. I've made a deal with myself and my therapist that I will make sure to get enough protein every day, and try to at least meet my BMR. But even that is sometimes too much for me to handle. It doesn't help that I'm dissociated all the time, and sometimes have trouble remembering things. It honestly slips my mind to eat.

 

I'm maintaining a medically healthy weight. I've lost a few pounds, but nothing that bad. When I keep any kind of regular eating schedule, I have to fight myself every step. I always end up breaking after just a few days, and taking a fast day. Every time I break, it gets harder to go back to eating.

 

I failed treatment because I couldn't force myself to want to get better. My mind is still bent into thinking that the disordered goals are what we want. Do you think harm reduction like this is okay, or does this need to be more all or nothing? I'm being as honest as I can with my care team. I hate being so touchy and defensive about this. I don't think recovery is an option for me at this point. I feel bad for asking for that.

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I used harm reduction. I was really ambivalent about recovery for a good long while. It worked for me (although I still struggle every spring). I prefer it because it acknowledges that failure is part of recovery. I don't understand all or nothing thinking as I fail to see how it differs from disordered black and white thinking. 

 

If you're dissociated have you tried using an alarm? I keep my phone on me (dissociation is my primary dx) and I can set multiple alarms on it. As a result when I'm struggling I set an alarm to go off five times daily that just says "eat [item]" that way I have a schedule built in and I don't need to think about it as much. The more mechanical that you can make it the easier that it will be.

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I used harm reduction. I was really ambivalent about recovery for a good long while. It worked for me (although I still struggle every spring). I prefer it because it acknowledges that failure is part of recovery. I don't understand all or nothing thinking as I fail to see how it differs from disordered black and white thinking. 

 

If you're dissociated have you tried using an alarm? I keep my phone on me (dissociation is my primary dx) and I can set multiple alarms on it. As a result when I'm struggling I set an alarm to go off five times daily that just says "eat [item]" that way I have a schedule built in and I don't need to think about it as much. The more mechanical that you can make it the easier that it will be.

 

Thank you for replying.

 

I feel under pressure from my family and treatment team to be "in recovery." Trying to make myself keep up with that is hard when my heart's not in it. I know they're only doing it because they're concerned, but sometimes I resent it. It makes me anxious to be torn between the persuasive ED thoughts and the constant pressure to act opposite for everyone else. It feels weak and self-indulgent to not want to be "well." I feel like they must all think I'm a bad person, or that I'm being difficult on purpose. I feel like I should feel guilty for not being able to let go of the ED thoughts.

 

The alarm is a good idea. I'll do that, thanks. That will help me remember to take my vitamin supplement, too. :)

Edited by The Dead Guy
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Yes. There is a lot of external pressure to not be disordered. From the outside looking in an eating disorder looks like self-imposed misery. It's inexplicable and lots of people don't understand that the misery (or at least, mine was/is miserable) isn't really self-imposed. That that's the crazy. 

 

Also, eating disorders have a really high death rate (often from a side effect of malnutrition). If you're still losing anything then malnutrition and all the attendant physical ailments are all still possible. They don't want you to fall physically ill, but they may not be expressing that in  the most supportive manner. What might them supporting you look like, for you? Is there a way that you can help them to get there? For me, sometimes I really need someone to just sit with me and even rub my back while I try to eat for an hour or 90 minutes. And to see how hard that is for me even if they don't understand why or how it's hard. 

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Yes. There is a lot of external pressure to not be disordered. From the outside looking in an eating disorder looks like self-imposed misery. It's inexplicable and lots of people don't understand that the misery (or at least, mine was/is miserable) isn't really self-imposed. That that's the crazy.

 

That's a good point. I think my family (and maybe my treatment team) and I are frustrated with each other. Maybe even for the same reasons. My perception is that we have the same conversation over and over. It usually ends with me hearing that I'm not trying hard enough or that they don't know what to tell me. They are frustrated with me because it seems like I'm not trying. I'm frustrated with them because I am trying, it's just that it doesn't always look like it "should" on the outside.

 

 

Also, eating disorders have a really high death rate (often from a side effect of malnutrition). If you're still losing anything then malnutrition and all the attendant physical ailments are all still possible. They don't want you to fall physically ill, but they may not be expressing that in  the most supportive manner. What might them supporting you look like, for you? Is there a way that you can help them to get there? For me, sometimes I really need someone to just sit with me and even rub my back while I try to eat for an hour or 90 minutes. And to see how hard that is for me even if they don't understand why or how it's hard. 

 

One of the promises I made to my therapist was that I would at least meet my protein need by body weight every day, and take a multivitamin, so that the health effects were minimized as much as possible. But I know I'm still at risk, and I should be more concerned than I am.

 

From my family, it would be nice if they trusted me a little more. It would be nice if they trusted that I was doing my best to learn different ways of dealing with this. I feel like they have something negative to say no matter what. If I eat something small, or I'm sticking to my schedule and it isn't time to eat yet, I'm not even trying not to be disordered. If I eat with them, they say something like, "oh, you decided to show up this time." What I eat is always subject to commentary, too. I wish they wouldn't. I don't want to talk about it with them. If I say that, it sparks arguments too.

 

I think with my doctors it isn't so much that they're putting me under pressure deliberately. I'm just touchy about this. The new prescribing doctor I'm seeing hasn't become involved heavily yet. I was just asked whether I was taking treatment, and what that looked like. Most of the support I've been getting has been from my therapist, but she has tried hard to meet me in the middle. I still go into my appointments anxious and on edge. I think anything she said would make me feel defensive. I feel a lot of guilt and responsibility for the ED, so having attention called to it is uncomfortable. I feel like a huge failure.

Edited by The Dead Guy
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my recovery looked more like harm reduction.  i refused to go to an ED day program when i was at my worst, but at the same time, promised myself i would do *something*.

 

that part of me that wanted to continue not eating didn't go away.  the nasty thoughts about weight and body image didn't go away.  i still cried through a piece of toast.

 

but i found something bigger than needing to control food.  i found that my family didn't want to see me anymore because they could not, would not, watch me die.  i looked really awful, even though i maintained the minimum BMI considered "healthy" (that was my excuse, nobody could force treatment on me unless i got below that number).

 

that broke my heart.  i couldn't live with myself knowing i was breaking my mother's heart.  as bad as i wanted to be thinner and thinner, i wanted my mother to stop crying even more.  probably because i have a daughter, and i was imagining what it would be like to watch her do what i was doing.

 

so i didn't set up any rigid new rules or anything like that, it would have been too much.  but i did start thinking in terms of "what do i need to eat to stay alive and not die from this".  i started eating a little protein.  then some carbs.  oh the panic over eating anything that had real sugar, or more than a gram of fat... it was awful.  eventually i got used to each new food being a part of my day.  but i had to do it slowly, and i had to choose which food was okay to add. i had to have CONTROL over the process.  

 

i put up pictures of my family on the fridge to remind me that even if i don't care about hurting my own body, these people DO care, enough to lose sleep over what i had done to myself.

 

by the time i was eating probably half of what normal people eat, i wasn't beating up on myself as much for having eaten.  it got easier.

 

i don't know if that approach works for everyone.  but i can say it did for me.  i haven't seriously relapsed in probably four years (i think, my memory sucks).

 

i wish you the best of luck.  you deserve to be healthy.

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My current therapist is definitely in support of harm reduction, which I have used for both SI and the eating disorder. Instead of focusing on abstinence from behaviors, I focus on decreasing the number of ED behaviors over time while also increasing meal plan compliance. I do not think I would have been as successful if I only focused on decreasing negative behaviors though, I need to also increase positive behaviors at the same time.  

 

I do not like the black and white, all or nothing thinking that some people use to describe recovery. I also don't see recovery as an end point, but as a continual process that looks different for everyone. (I acknowledge that everyone views recovery differently and my way is not necessarily right.) Recovery for you right now might look more like harm reduction than abstinence, and that is perfectly fine. 

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Thanks for the support.

 

Lysergia, I think that's what I'm missing. I need that "something bigger" to attach myself to. Identity? Something like that. I was thinking a lot about this. I think this ED kind of comes from the DPD in a way. At least I think they're tied together somehow. The counting, reading, learnig about food and metabolism, that's been my "something bigger" to focus on to deal with dissociation and anxiety/mood problems. I think. I could end up working on this as I work on my dissociative issues and start learning to feel "properly." Haha, I'm like the pick up sticks of mental illness.

 

Thank you so much for your post. The thoughts you expressed and your story are going to keep coming back to me. My current strategy is somewhere between what you described and what Mythweaver described.

 

It helps to know that others have gotten positive results from a similar strategy. I have trouble self validating. Whenever someone says something shitty I have a terrible tendency to go along with that. I'm way too suggestible at times. These small things help. Knowing that other people do the same things and don't get called stupid, etc. That's nice. Thank you.

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i'm so glad what i said helped... to be honest i almost went back and erased it because i thought it wouldn't.

 

identity is a biggie.  anorexia had warped my identity into "i am whole when i am thin".  or "i am strong and worthy when i can resist food".  "if i am fat i am nobody". that's still hard, but not like before.

 

i guess the identity shift was "i am someone's mother.  i am someone's daughter.  i am someone's wife.  i am someone's sister.".  none of those things depend on my being thin, or fat, or anywhere in between.  they depend on my being alive.

 

i'm suggestible, like you.  it was really important to have people "boost me up" at that time.  my self-esteem was so threatened by the thought of gaining weight.  it meant a lot when people started saying i looked good (because the dark circles under my eyes were fading, and i didn't look grey anymore).  while i was losing the weight i heard so many positive things - people are idiots when it comes to size, and it's like any kind of weight loss makes people say "oh good for you!".  and it felt so good to hear that i never wanted to stop.  i paid attention to the people who believed that when i ATE, i looked better, and avoided those who thought that thin at any cost was a good idea.  who you surround yourself with makes a really big difference.

 

you aren't stupid.  you are trying making a plan to get healthy that works for you, which is really hard and really brave.  don't give up.

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I'm glad you didn't erase it. :) Thanks for writing all that.

 

 

"i am strong and worthy when i can resist food"

 

 

I relate to this way too much. I tell myself things like, it's only what I can do that matters. I'm only what I do for other people. I'm only what I can make, or accomplish. Without accomplishments, I might as well not even be here. Unfortunately, restricting is something I latched onto as an "accomplishment." Even when I know now that it's not a productive "accomplishment," and that it's a lot like self-harm in some ways, I still get stuck on having any kind of "positive" change on myself or my environment. I think. Maybe it would help to think of other things I'm good at instead?

 

 

 

i'm suggestible, like you.  it was really important to have people "boost me up" at that time.  my self-esteem was so threatened by the thought of gaining weight.  it meant a lot when people started saying i looked good (because the dark circles under my eyes were fading, and i didn't look grey anymore).  while i was losing the weight i heard so many positive things - people are idiots when it comes to size, and it's like any kind of weight loss makes people say "oh good for you!".  and it felt so good to hear that i never wanted to stop.  i paid attention to the people who believed that when i ATE, i looked better, and avoided those who thought that thin at any cost was a good idea.  who you surround yourself with makes a really big difference.

 

 

Maybe I need to think more carefully about who I spend my time with. My circle is small. I'm dissociated and out of it a lot, and I've been depressed and spent some time hospitalized this last year. A lot of my acquaintances are drifted away now. Maybe I could get out a little more. Or at least try to come hang around on the forums here, where I can talk to people who "get it." Maybe having people around who were supportive would help. I wonder if I asked my family for that, how that conversation would go?

 

I've gotten some comments about how I've lost weight. I packed it on in treatment, and now I'm just back into the "healthy" weight range. People are saying kind things to me because I've lost a lot so I look "normal" again. It's disorienting. It feels good in a way because like you said, any kind of loss makes people say encouraging things. I need to think and hear "well done on sticking to the new plan" more often, maybe. The compliments will stop soon, if I lose too much more, and the teasing will start. It's not de rigeur for men to be skinny. :rolleyes: But maybe that will help me detach myself from needing that from other people. I need to learn to rely on it coming from myself. I wonder if more self reliance would be a doable positive step in the dissociative disorder too? I need to write that down to take to the therapist.

 

 

 

you aren't stupid.  you are trying making a plan to get healthy that works for you, which is really hard and really brave.  don't give up.

 

 

Thanks for the encouragement. I hope it doesn't sound as corny as I'm afraid it does, but it does help. :) I'm trying not to give up. I hope that if I stick to repeating this long enough it will stick. :P

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i am all for having that conversation with your family.  great idea.

 

focusing on something else that you're good at - or even something you can FINISH (not always easy for me) is a really big deal.  i was most proud of my ED when i thought i was good at nothing else.  it was really hard to sit with a blank piece of paper and try to list things that i thought i was good at besides starving.  but i made a list of little things, like i can be good at cooking if i want.  or i can be good at housework if i want.  i can be good at listening.  i'd pick something from the list (when i remembered) and try to make that the goal of my day - that i cooked something really awesome (i probably didn't eat it, but my family appreciated it).  or that at the end of the day, my living room looked perfect.

 

my tdoc is really big on socializing.  she says that it can feed our self-esteem to have the good things about us reflected back by others, and that we don't tend to see these things unless other people illuminate them.  i always think i'm boring and worthless but when i talk to other people, they like talking to me!  i'm always the first to end the conversation.  so i get a little bit of "see you aren't so bad!" just from being around others.  the more i can do that, the less i think i have to "prove" something (by starving, or any other measure).  and as a result of that i beat myself up less, and as a result of that i don't feel the need to starve.

 

if you can do a little of that while being mindful to avoid the people who support your ED, it will go a long way.  family, if you have a good relationship with them, is a good place to start.

 

if i'm talking too much let me know :).  i needed a lot of people to talk to me when i decided i wanted to get better.  so i'm projecting heh.

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If you can't recover, then yes harm reduction is a great idea. When i was restricting i used to make sure the calories i did consume where nutrition rich, for example if i allowed myself 700 calories i would have some fruit, some semi skimmed milk, tuna, veggies, instead of empty calorie foods like pasta.

 

I also took a multivitamin and iron and calcium supplement.

Edited by cady
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If you can't recover, then yes harm reduction is a great idea.

 

One of the habits I'm trying hardest to break is calorie counting. I learned a lot about metabolism and nutrition, and I'm trying to stop figuring out what my "numbers" are, like BMR and all that. It gives me itchy fingers to eat something and not weigh it or write it down. I can't seem to stop keeping rough track in my head yet, but I'm trying. And what I do eat, I try to make it count. Lots of fish and such. Small goals like "fruit with peanut butter" because I had a carb counting thing for a long time. Stuff like that. Thanks for the support. :)

 

Lysergia, you definitely aren't talking too much. I appreciate you taking the time to type all this out and read what I'm writing. :)

 

i am all for having that conversation with your family.  great idea.

my tdoc is really big on socializing.  she says that it can feed our self-esteem to have the good things about us reflected back by others, and that we don't tend to see these things unless other people illuminate them.  i always think i'm boring and worthless but when i talk to other people, they like talking to me!  i'm always the first to end the conversation.  so i get a little bit of "see you aren't so bad!" just from being around others.  the more i can do that, the less i think i have to "prove" something (by starving, or any other measure).  and as a result of that i beat myself up less, and as a result of that i don't feel the need to starve.

 

if you can do a little of that while being mindful to avoid the people who support your ED, it will go a long way.  family, if you have a good relationship with them, is a good place to start.

 

if i'm talking too much let me know :).  i needed a lot of people to talk to me when i decided i wanted to get better.  so i'm projecting heh.

 

I don't have the best relationship with my family as far as the ED goes. I can't seem to get across to them that I really am trying to improve, but this isn't as simple as "just eat something." When I feel bad, I start to think it's because they don't care, or because they see me as nothing but a nuisance. I don't think that's the whole truth, though. I think they're impatient because they don't get what's going on, and they don't see the inside of it. It's possible that they do care, they're just frustrated because I don't seem to make any progress and they don't know what to do with the fact that treatment hasn't fixed it yet. When I asked them not to bring it up, that didn't go well, Maybe if I asked, instead, for specific things, like asking them to ask for treatment updates, instead of commenting on what it looks like I'm doing, it would go better.

 

I get stuck in thoughts of being boring and worthless, too. Maybe I should set a goal of just talking anyway, even when the little voice in the back of my mind tells me nobody will be interested. I've been trying to do that here, where I'm anonymous and it doesn't matter as much, and the positive feedback (and the lack of negative) has been a pleasant surprise. There's obviously truth in that. I just need to actually do it. :P

 

focusing on something else that you're good at - or even something you can FINISH (not always easy for me) is a really big deal.  i was most proud of my ED when i thought i was good at nothing else.  it was really hard to sit with a blank piece of paper and try to list things that i thought i was good at besides starving.  but i made a list of little things, like i can be good at cooking if i want.  or i can be good at housework if i want.  i can be good at listening.  i'd pick something from the list (when i remembered) and try to make that the goal of my day - that i cooked something really awesome (i probably didn't eat it, but my family appreciated it).  or that at the end of the day, my living room looked perfect..

 

That's a good idea, starting with small things. The little stuff, like being good at small repairs or knowing how to grow things, still counts. I mean, it could be argued that a large part of any person is a compilation of small things in everyday life.

Edited by The Dead Guy
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