Firing eating disorder triggers

17th March 2008

Firing eating disorder triggers

Several weeks ago, I wrote a story on a candlelight vigil and walk to commemorate National Eating Disorders Awareness Week organized by a local psychologist who specializes in the treatment of eating disorders (I swear I will post the photos and recap of the event soon). Such specialists are a rarity in Cincinnati, a fact made painfully evident to me when I tried to seek help for my own disorder five years ago. Dr. Susie Mendelsohn moved her office here four years ago and now requires a waiting list. Some days, she sees up to 9 patients a day.

Susie and I really connected – she takes an unconventional, holistic approach to eating disorder treatment (and sees higher than average success rates) that really resonates with me. Not only are we in agreement on the nature and treatment of eating disorders – Susie battled her own eating disorder for 15 years – she is very personable and approachable, a no-nonsense, in-your-face kind of person who doesn’t speak in the psychobabble some therapists distance themselves with. Plus, she’s a cat person like me. Those who have furbabies will understand the camaraderie.

We kept in touch after the vigil and have plans to work on some projects together. In discussing one of those projects today, the subject of eating disorder triggers came up. Susie told me how she asks a patient at the onset of treatment to list those forces which trigger eating disordered behavior for them. Then, in the middle of the treatment plan, she says she throws a “wrench” into therapy by insisting the patient stop using triggers as a crutch. You have to learn to successfully avoid triggers, and if you can’t, to manage them, she said. Your triggers cannot be used as an excuse to perpetuate your eating disorder.

Triggers are as individual and relative as eating disorders are to different people. Sometimes all it take is a perceived degrading comment to trigger disordered behaviors for some people; in others, major life changes like a pregnancy or divorce can spark a relapse in recovery. Often, but not always, triggers are the very same situations and experiences that led to the development of the disorder in the first place. For more on triggers, read here.

For me, stress is still a big trigger, something I realized last Christmas when I insanely attempted to go to graduate school full-time while working full-time. It’s also triggering when I go shopping and nothing fits rights, or at least, none of the cute clothes that are readily available in straight sizes. Instead of expecting the clothes to fit my body, I immediately think I should instead mold my body to fit the clothes. The weight loss “success” stories of others, too, instantly inspire a sense of competitiveness in me. I think, “Oh yeah? I’ll show you some real weight loss!” without pausing to think that those who cross that winner’s line and hiss “I showed you!” are really the losers, both literally and metaphorically.

We cannot change some of the situations in which we find ourselves nor can we always control those urges to revert into eating disordered behaviors. I psycho-analyze myself way too much and understand my neurosis perhaps better than any psychiatrist ever could. And yet, at times I still find myself compelled to go back to my tried and trusted eating disordered ways to deal with problems in my life, even though I rationally, logically and emotionally understand the forces behind the urges. Yes, I may appear as the paradigm of eating disorder recovery on my blog, but my disorder is still something I actively struggle with, albeit to a lesser degree, on a daily basis. And it’s not that I am powerless to stop the urges to relapse – I’m not – it’s that its much easier to give into them instead of finding real ways to confront and solve the larger issue. In this sense, I am not a victim, but rather a co-conspirator in my own relapses.

We may not be able to eradicate our triggers entirely, but what we can do is change the way we react to them. I dealt with the stress in my life by dropping down to a part-time course load, even though it absolutely killed me knowing that I will now be in graduate school for twice as long, when I feel as if I’ve already wasted so much time just in getting my undergraduate degree. Like many people with an eating disorder and/or ADD, I wants results immediately – do not pass go, no waiting, NOW, NOW, NOW. I also went back on medication for depression, something I now I need in order to function. And when I take a second helping at dinner or indulge in foods like pizza and feel the need to purge, I combat this by trying to engage my mind in other activities, hoping it will forget. There are foods I still cannot eat without throwing back up, like Indian food, my absolute favorite food ever. My solution? I don’t get Indian food often, even though I’m sure I could eat my weight in veggie samosas every night.

Eating disorders are a crutch, and there comes a point in each of our recoveries to throw them down and learn to walk on our own, proudly and with confidence. Has there been a particular instance in which you’ve triumphed over a trigger? What are some of your own triggers and/or tips in managing them?

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This entry was posted on Monday, March 17th, 2008 at 12:06 am and is filed under Eating Disorders, Personal. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

1 On March 17th, 2008, Brie said:

I have quite a few triggers that are mostly unavoidable. Simply viewing a beautiful and thin girl/woman can trigger me. Not doing well in school triggers me. Being embarrassed triggers me. I can’t avoid any of those things! I can’t avoid going outside (Well, not without going crazy), going to school, or doing anything in the company of other people.

I still haven’t figured out how to manage them, yet, outside of screaming in my head positive mantras.

posted on March 17th, 2008 at 12:19 am

2 On March 17th, 2008, queendom said:

I also have plenty of triggers – and that’s even truer for my social phobia than for my ED. My worst trigger is probably either being criticized or expecting to be criticized – and of course I expect to be criticized/ not liked/ being seen as awkward and stupid in almost every social situation to some degree. This is a difficult trigger to manage because my expectations are a) based on previous experiences and b) are hard to disprove – people could theoretically talk/ think bad about me without me knowing it.
The thing is this, however that while I made a lot of bad experiences in the past the past is over (most of this happened during my teens and early twenties – I am 28 now) and by letting it determine my life and my actions today I give it undue power over my future. In addition, I have evidence that there are some people who do like me and believe in me and who think I have valuable things to contribute. Those people usually know me quite well – so it would be a good idea to trust their judgment. Finally, using excuses will not change my situation, independent of if these excuses are valid or not. I would prefer it if I would not have to fight so hard to live a life that feels good and worthwhile – but if I want that life I will have to fight, it’s as simple as that. It’s no use saying that it is too hard and that it is unfair that I have to struggle with this – it might be too hard, I might fail, but if I don’t try I won’t ever get what I long for.
Sometimes going through all of this helps me to go out and interact with people or not to feel terrible and be afraid that I behaved stupidly after I have interacted with people (and not to binge or diet), sometimes it doesn’t. However, allowing myself to believe that I am dealing with is something that is more difficult than what some others have to deal with takes away the shame of sometimes not succeeding. I believe that’s one of the tricky things in dealing with triggers – in order not to feel bad that you have these triggers you have to allow yourself that it is not just weakness that lets you react to them while other people don’t. On the other hand, you still have to accept that while it is not your fault that you have those triggers, you will have to fight to overcome them if you want a better life without your disorder.

posted on March 17th, 2008 at 7:12 am

3 On March 17th, 2008, peggynature said:

I dealt with the stress in my life by dropping down to a part-time course load, even though it absolutely killed me knowing that I will now be in graduate school for twice as long, when I feel as if I’ve already wasted so much time just in getting my undergraduate degree.

Hooooooboy do I know how this feels! I have been an undergrad for SIX YEARS and, because I’m only doing part-time (also working), it’s going to take more than a year to finish the damn thing. It can be so frustrating.

But lack of time and stress definitely contributes to weird eating behaviours in me, whether it’s just eating a crappily unbalanced diet that leaves me feeling shitty and tired, or just not eating enough because the stress makes me lose my appetite. I may have to drop my courseload even further in the coming terms to keep myself sane. It sucks, but you gotta know your limits (and for me, I gotta know my limits are different than other people’s limits, and not feel BAD about that!)

posted on March 17th, 2008 at 7:15 am

4 On March 17th, 2008, libbyloo said:

One of my biggest triggers… the one that was at the forefront when I relapsed a couple of years ago… is organized athletic competition/teams. I was on a swim team. I love, love, love to swim. But there is nothing that gets my ED-voice going like a coach barking at you to swim faster! Go harder! Be stronger! My competitive side kicks in, and the part of me that likes to count and analyze and go for better and better numbers takes over. And pretty soon I’m punishing myself with extra laps when I come in second in a race and weighing myself daily to see if those extra laps took off an extra pound.

There are some parts of being on a swim team that I really do miss. I miss the camaraderie. I miss knowing that when I go to the pool there will be other people there waiting to do the same crazy workouts I like to do. I miss the creative ideas that different coaches I’ve worked with come up with to drill strokes or improve endurance. But the situation is a major trigger. And I really think my true recovery began the day I realized I needed to quit my swim team.

About a year after I left my team, a friend across the country and I decided to train for a triathlon and meet in Chicago to do it. And so I got a few books on tri-training… put together a training schedule… And POOF. Like magic, that inner-coach appeared, and within days, I’d doubled my running schedule and I’d berated myself for my biking times. And I realized that this was going to be a trigger, too. So I stopped. And I called my friend. And even though, her inner-coach is a motivator and she didn’t understand why this was a problem for me, I backed out. I couldn’t do it without risking relapse.

Someday I do want to be able to participate in organized events again. I’m not sure that I’ll ever be strong enough to be on a team again, but I’d like to think that maybe I could do a single event, like the Chesapeake Bay Swim or one of the Alcatraz Swims. But for now I have to abstain. And if, in my solo workouts, I hear that inner-coach telling me that my flip turn wasn’t good enough, and I must do 8 more laps to make up for it… Well… that’s my signal to get out of the pool and take a few days off from swimming.

posted on March 17th, 2008 at 7:25 am

5 On March 17th, 2008, Jackie said:

I haven’t had experience with a ED. However, I did use to cut myself, mostly picking my skin. I think it’s similar in the sense of triggers with ED, cause there are things that make me feel like cutting myself, like stress. I think that I have dry skin, definetly is a trigger, but I don’t really bother myself with buying lotion. I find that if I get upset like crying, I feel guilty cause then the other person is upset by my crying, so for a long while I cut instead of crying. Sometimes I do feel that urge, like it would be easier just to cut myself than go through the process of purging emotion. There’s also boredom, perhaps as well Seasonal Affective Disorder. I did notice I was wanting to cut myself more during winter than other seasons.

I know it must seem like alot triggers me, but actually it’s very rare that I cut myself now. I find that if I keep busy, I won’t cut myself. I think that’s true for anything, if you’re busy you won’t have time to keep bad habits. I think I’m having more trouble resisting the urge to sleep than the urge to cut, lol. It’s part of getting out of the Seasonal Affective Disorder messed up sleep cycle.

posted on March 17th, 2008 at 8:19 am

6 On March 17th, 2008, DG said:

Seeing photos of myself, whether it is now or when I was heavier, sends me reeling.

Also, just seeing someone I haven’t seen in a while with their partner can trigger me. Why have they met the love of their life and I have not?

And of course–the scale.

I really appreciated this post today, Rachel, so thanks for writing it.

posted on March 17th, 2008 at 10:32 am

7 On March 17th, 2008, Charlotte said:

I don’t have an ED, but I have triggers that send me into a despressed state or make me feel bad about myself. Lately, I’ve been struggling with being 22 and single (never dated or anything like that) while seeing a majority of my friends dating/engaged/married. Almost every time I see a couple (whether or not I know them) I get angry and wonder why no man finds me desirable and dateable.

I love today’s post, very honest and heartfelt.

posted on March 17th, 2008 at 12:15 pm

8 On March 17th, 2008, Lillian said:

I think eating disorders is narrowly defined. Many of the behaviors here could be just considered competitive or dieting. Most Americans have been on a diet sometime during their life and not everyone has an eating disorder.

When I was a teen, I tried to lose more weight than my body would allow. I ate less than 800 calories some days. I had stopped having my TOM, I was cold all the time, exercised compulsively, even resorted to purging a few times. I was never underweight. Even my lowest weight was seen by my doctor as ‘fat.’ I don’t see it as an eating disorder, more as trying to reach a goal weight that was below my body’s design. I never tried to be that thin again.

posted on March 17th, 2008 at 12:50 pm

9 On March 17th, 2008, Aya said:

I’m starting to think that the diagnosis for eating disorders is too narrowly defined. I technically have never had an eating disorder, but everything about the behaviour I have engaged in throughout my life seems to scream otherwise. I only realised what I was doing to myself about six months ago, so I’ve been doing a lot of self-examination about triggers and controlling how I react to my many triggers (since most of mine are pretty much unavoidable). Obviously, I’m just getting started and I’m still figuring a lot of things out, but I have figured out a few things that help me to focus my attention elsewhere. I’ve started doing more yoga (which just makes me feel better all over), I’m knitting and beading more, I’m reading more, and I’m meditating more and baking more bread (because it’s like a meditation for me). While it’s horrifying to think about all the time I’ve wasted hating myself and my body, it’s been really nice just learning to take some time to focus on things that make me happier. I haven’t had much of a chance before this period of my life to focus on what’s good for me. It takes a lot of getting used to.

And by the way, thank you so much for your blog. It has been a huge help to me.

posted on March 17th, 2008 at 3:41 pm

10 On March 17th, 2008, Rachel said:

Much obliged, Aya

Not every woman who diets or hates her body will develop an eating disorder, but there are many women who certainly possess disordered thinking about food and weight and body image, neither of which are constructive or healthy.

posted on March 17th, 2008 at 4:44 pm

11 On March 17th, 2008, Nemohee said:

My triggers: Anti-”obesity” doctors. I had a bad experience with a doctor at a health department one year, and I didn’t eat for two days. Luckily, that’s been my only major relapse (thanks to some awesome support from family members and friends). I also have a problem with mirrors and photos. Anyone who walks into my house will notice it is relatively mirror-free. I have a total of three: the two that came with the house in the bathrooms, and the floor-length that I use to make sure my clothes are on right. Seeing myself in the wrong light (or hell, just seeing myself) can make the urge to starve myself very tempting.

Perhaps my greatest triumph over a trigger: The gym. I used to be an anorexic with an exercise addiction. Any time I would enter a gym after I started recovering, the urge to stay there for hours would kick in, causing me to want to avoid them, because I didn’t know how to stop it. Finally, I started limiting myself. First, I would only exercise for 15 minutes on the elliptical. Once I could trust myself with that, I gradually increased it to 20 minutes. Then I discovered that I couldn’t exercise on the same machine for longer than that (hooray ADD), so I would quit after 20 minutes, and switch to ten minutes on another machine. I’m happy with this combo, and it seems to be working. I now look forward to going to the gym, but no longer feel like three hours is a reasonable workout.

posted on March 17th, 2008 at 7:26 pm

12 On March 18th, 2008, Tina said:

My question is if there are more people in the USA with weight problems, how come there are not more stores or styles for over wight people. You go to a mall and there may be one clothing stores that carry over weight sizes. You go to the movies and the seats are very small, cars are also designed for the thin trying to be comfortable while your driving and your over weight it not going to happen.Everything is designed for thin people but I keep hearing that in America more then half of the people are over weight. my question is to the consumer What are you doing? If in America we are more then Half over weight then why are they not making good to go in that direction.

posted on March 18th, 2008 at 9:23 am

13 On March 18th, 2008, Jeanne said:

My main trigger is stress – and I’m still learning to manage it. Right now, work is my major stressor. What I try to do is remember to breathe and to connect with others (even if it’s only for a few minutes.) That helps me get through sometimes… but I still struggle with my eating disorder behaviors when other stresses are added onto work stress…

posted on March 18th, 2008 at 8:19 pm

14 On March 21st, 2008, livingrainbowcolor said:

Your post resonated with me, and I noticed that I have more triggers than I can count. But the way to handle them is always the same: changing how and what I say to myself.

posted on March 21st, 2008 at 3:43 pm

15 On February 10th, 2009, Amelia said:

You said this very well:

“Eating disorders are a crutch, and there comes a point in each of our recoveries to throw them down and learn to walk on our own, proudly and with confidence”.

posted on February 10th, 2009 at 1:13 pm

16 On September 3rd, 2009, plant said:

Very helpful post. Thanks.

My #1 biggest trigger is also “anti-obesity” doctors, or any doctor who makes the slightest weight criticism: a disapproving look at my body (the PCP I had until recently would looked me up and down with an exaggerated facial expression of revulsion and nausea to let me know how much she loathed my body whenever I said I wasn’t trying to lose weight.)

- A doctor telling me to lose weight.

- A doctor telling me to eat more healthily (need for weight loss implied.)

- A doctor telling me to go on a diet, or cut calories, or eat frequent SMALL meals (it’s the “small” part that’s triggering).

- A doctor telling me to restrict food in any way.

- A doctor telling me to eat certain foods, but not including grains in the list, as if people can or should go without grains, which are intentionally the mainstay of my diet: my primary source of calories, to keep my diet low-fat, and also satisfying and keep me feeling good.

- A medical assistant asking to weigh me (I always refuse, so the doctor won’t focus on my weight up or down a pound or two, and hopefully focus on healthy behaviors rather than weight loss).

- Mirrors.

- Trying on clothes in stores.

- A doctor telling me my size is unhealthy and her/his being miseducated about size and health.

- Going to an appointment where I might be asked to be weighed, or my weight criticized.

- Having to go to the ER and having a crapshoot regarding doctors who may dish out weight loss advice or criticism.

- Being hospitalized and having to eat according to the unhealthy or restrictive hospital diets.

- Having people watch, monitor, criticize, or control what I eat.

- Ordering food to share, such as Chinese or pizza.

- Public eating with people I know: their watching what I eat and how much.

- The thought of a high school reunion, or seeing very old friends.

What started my ED? Surprise, surprise: being put on a starvation diet by my pediatrician when I was 14 years old, though I was exercising 4 hours/day and at a BMI of 22. He said I’d gained 10 lbs since the previous year, but no height. He said, “At that rate, you’ll be a blimp by the time you’re 30.”

He used a terrible method to determine how much I was eating daily, (I starved, out of embarassment, for the 24 hours he had me go home and write down everything I ate, and the calories.) When I came back the next day, starving, and desperate to go home to be able to eat, he said, “You ate 1500 calories over the past 24 hours. Now you’ll need to cut out 500 calories from this each day to lose 1 lb. per week. Come back and get weighed weekly.” (A college nurse recently told me that women athletes exercising 4 hours/day should be eating ~3000 kcals/day, which is why I was starving on 1500.)

By the end of the first evening, I was climbing the walls for food, so I ate a little, then a little more…all evening, til late at night, til I’d eaten 1500 kcals that day. The next day, I awoke stuffed and mortified that I’d failed my diet the first day. To lose 1 lb. that week, I knew I’d have to cut out 500 more kcals on day two, to make up for “overeating” on day 1. Instead, I “overate” by 500 kcals on day 2 (1500 kcals total), so on day 3, I tried to eat nothing, to break even. I continued to try to do that, to eat typically 500 kcals daily, or nothing, with nightly bingeing, for the next four years.

The first day I tried to undereat (for the doctor’s diet) was the start of the disordered eating: feeling guilty for eating when hungry, associating eating and responding to hunger with being “bad” and disobeying the doctor’s diet rules.

No wonder I’m sensitive to doctors’ weight/size criticism and judgment to this day. By the way, his name was Dr. John Richards, in Los Altos, California.