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I can think of a handful of powerful reasons for my not wanting to ask for help with my eating disorder. I was afraid of what losing my vice grip on my body would mean for my other disorders. I was afraid of admitting that my obsessive exercise and restriction was not strong, after all, but a weakness in need of healing. I was afraid that my doctors would demand I gain weight. I was afraid of entering into residential treatment; what would that mean for my schooling, and how would my parents afford it? Above all, I was afraid of dissolving my known, meticulously controlled, eating disordered world in favor of reality, as rife with unknowns and question marks as it is.
Some of my fears were rightfully realized and some turned out to have been way off the mark. Until I sat in front of my doctor and said the words “I think I might need help with this,” I had no idea what to expect. Even now, I can’t promise anyone who’s thinking about reaching out for help that their outcomes will be the same as mine. My particular circumstances may substantially differentiate your experience with eating disorder treatment from mine. However, when I factor my observations of fellow patients in my residential treatment center into my knowledge of the process, I think I have a pretty good handle on what you can expect.
Unless you head to the emergency room due to a physical incident, your first experience with treatment will likely be a consultation with a nutritionist or general practitioner who is specially trained in eating disorders. However, in order to get to those specialists you’ll either need to reach out to your general doctors or allow your doctors to reach out to you. Some eating disordered behaviors are more easily spotted than others. A drastic weight loss or an extremely low body weight are likely more apparent than internal damage due to binging and purging or tooth decay, but neither set of behaviors is more dangerous than the other. It’s very possible that the onus of getting help before your body is seriously hurt will be on you.
I was very unmotivated to seek help. My psychiatrist had noticed my drastic weight loss and was bringing it up in sessions casually. He gave me a nutritionist’s number to call should I ever decide I “couldn’t do it by myself.” If he hadn’t done that, I likely would have gone longer without seeking help, but the fact of the matter is that I didn’t even want to give up on anorexia when I sought help. None of the cliched motivators spoke to me; an eating disorder is just a distraction from the real problem, you are beautiful just the way you are, this isn’t sustainable! chased me as I ran for up to three hours every day on my local hiking trails, dodging what I thought were just branches and puddles. I listened to rap music on as blaring of a volume as I could in my earbuds, and even as I ran for three hours in the middle of a blizzard, the power out on the surrounding streets and the white night sky falling onto me, I thought that I was so powerful, on top of the world, for being able to push past normal boundaries. The real reason I sought help?
My bones had degenerated so drastically that I could barely walk, and I wanted to be able to keep going on my three hour runs without sharp pains, dull aches, and collapsing joints. I didn’t want to hear that I needed to gain weight, or change my lifestyle, or find out why I refused to eat, why I ran so much, why the sight of my bruised legs made me smile, why I weighed myself three times a day. I wanted a quick, cheating fix to my achy bones so I could sustain my eating disorder indefinitely.
That’s not what I got when I finally picked up my phone and called the nutritionist’s number, but she didn’t give me a higher weight I had to reach, either, nor did she tell me I had to completely transform my lifestyle that day, or insist on a change of heart and total commitment to healing. In fact, when I walked through her door and gingerly sat myself down onto her furry, grey couch, she barely asked a thing of me. She let me talk, explain what I’d been doing and why I thought I’d been doing it, even as I expressed clearly sickened ideas like “it’s not really that bad, maybe I’ve gone a little far but I can handle it, I think.” Her responses followed along the lines of “I understand,” “that makes sense,” and “I know that must be hard.”
Then she dropped the “residential treatment” bomb. In truth, I desperately needed it on that day, but I was even more desperate to avoid it and was therefore not ready for it. My shrunken stomach sunk and I burst into a frantic, babbling monologue about how I just couldn’t go into residential, that I thought I needed, deserved, a chance to do it outpatient, first. My vital signs, when taken the next day, were stable enough that I could just barely win my nutritionist’s skeptical go-ahead for outpatient treatment. Emboldened by the wake up call of the “r-word,” I vehemently promised to all of my medical professionals that I was better, I was committed, I understood the risks of an eating disorder and would henceforth be stopping it!
Of course, those declarations weren’t real. I lasted a little over a month before brutally tanking again, my vitals at dangerous levels and my mouth exclusively used for sobbed mutterings. I was sent to a residential treatment center at my lowest weight since sixth grade. I had not been truly committed to recovery and had done no actual work to challenge my eating disordered thoughts and behaviors. Eating disorders are typically conceptualized as addictions, and are thusly generally treated with inpatient first, followed by tapered outpatient. But my doctors let me do it my way. They understood that there is no use in forcing someone into ED treatment who doesn’t want to be there, unless that person is in acute physical danger. If you approach a specialist and are honest with them about where you are, they will return the favor and try to meet you where you are. That’s a constant I feel confident in stating; if you can get help, you will be heard.
“If you can get help, you will be heard.”
Eventually (after about a week and a half), I fully embraced my treatment center. I faced head-on the trauma that induced my anorexia and I laid my deepest fears, angers, and compulsions bare for all to see, doctors and disordered peers alike. It was terrifying, brutal, and exhausting. The pain of it was indicative of the growth I was undergoing. I now recognize that it saved my life, but before I surrendered to it, I saw it as a red line not to be crossed; I was not leaving home, my boyfriend, my school, my friends, all to get rid of my perceived best friend: my eating disorder. My eating disorder was always there for me, at all hours of the day and through any tumult. I needed it, I would not let go!
My doctors listened to my not!s. They gently coaxed me, but were willing to take necessary measures to save my life and help me build a life worth living. Every hard decision was made while care and love oozed out of its seams, even if I resented it at the time. I didn’t want to have a nighttime snack; the word snack so obviously implied to me an extra amount of food. I won’t eat extra! I didn’t want to have a morning snack; if I ate extra in the morning I couldn’t work out as well in the afternoon, I insisted. They negotiated me down to just the night snack. My complaint about morning fullness was heard and validated, and they responded by upping the amount of food in my night snack while helping me confront my irrational emotional aversion to snacking. I was unwilling to give up exercise, so they worked with me to come up with ways for me to gently exercise that my bones (now permanently brittle) would be able to handle: swimming, biking. Doctors know well that an eating disorder is centered around control, and if the disordered patient feels powerless in their treatment, it simply won’t be effective in the long term.
So, what would I say to you if you told me you were nervous to seek help for your eating disorder? Of course you are.
Reaching out is scary. Surrendering is scary, but nothing will happen without your consent unless you’re in immediate danger. Ultimately, the most powerful, controlled, and brave thing you could do is to surrender to the unknowns of doctors and treatment. You’ll have a say over your treatment, but most importantly, you’ll learn how to have a genuine say in your body and mind. Eating disorders, though they’re adamant otherwise, snatch control from you and endanger you. Ask for help, release yourself from the disorder, and you will win it back.