I’m thrilled to publish today’s guest post by Elizabeth Short. Just recently Elizabeth shared her story of recovery and resiliency here at Weightless (part 1 and part 2). Currently, she’s a Masters student in Counseling at The University of New Orleans, and writes the blog Finding Hope. Elizabeth is also in the process of  writing a memoir about her recovery. I love that Elizabeth is reaching out to others with her positive and hopeful message, and I love her guest post. It’s raw, insightful, brave and beautifully written. Plus, it offers really valuable advice. And I can’t say enough great things about it. I’m so grateful to her for sharing this with us.

Inpatient treatment for eating disorders:  Locked bathrooms.  Staff watching your every move, including time in the bathroom.  Meals and snacks are closely monitored.  No shoelaces, tweezers, coffee, gum or mouthwash.  6 a.m. weigh-ins.  Room searches.  Individual and/or group therapy all day long.

Sounds a little like prison to some, but for me, it was safety.  It meant I couldn’t restrict my intake or purge after eating.   I couldn’t use laxatives or diet pills.  I couldn’t weigh myself 50 times a day. I couldn’t stay isolated in my house for days at a time. It meant I didn’t have to wake up each morning afraid it might be my last — wondering if that might be the day my heart stopped beating.  It meant 24-hour support.  It meant being surrounded by people who understood what I was going through.  I didn’t have to explain why I was afraid to eat.  I didn’t have to tell them that every bite was painful.  They knew.  They got it.

Now I don’t want to give the wrong impression of IP — it wasn’t always a warm, fuzzy feeling.  It’s extremely difficult.  Take 10-15 individuals who are being stripped of their means of survival and you get a lot of anger, sadness and acting out.  It wasn’t fun and it definitely wasn’t pretty, but it was safe.

Leaving treatment can be terrifying.  Freedom equals responsibility and responsibility, for many eating disordered individuals, is scary.  I didn’t trust myself.  Each relapse reinforced the belief that I could not take care of myself.  I would never make it.  And the relapses made the next time I left inpatient treatment even harder.  Sometimes it felt like I had been on the boat getting fattened up for the sharks below and now I was being thrown overboard.  I would walk outside those safe, protective walls and wait for the world to attack me.

The good news is that leaving IP can also be very exciting.  It is an opportunity to create a new life — a healthy, fulfilling life.  I would spend months in treatment learning new skills to help me live this sort of life, but the trick is to stay free from ED behaviors long enough to use them.

Many times I would leave treatment and immediately run back to my eating disorder.  I didn’t give myself a chance to see if anything else worked.  I had to find tools to get me through the urges, so that I could put into practice all I had learned.  Here are some things that worked for me:

1. Letter to self: I wrote a letter to myself to read when I started to have urges.  I put it in an envelope and wrote “READ NOW!” on the front.

Dear Elizabeth,

You must be feeling scared, overwhelmed, anxious, lonely or out of control right now.  The urge to give in to your eating disorder is so strong that you don’t think you have a choice.  The truth is you do have a choice — choose life.  Yes, bingeing and purging will take up time.  Yes, it will take all your emotions away for a little while.  Yes, it will give you an accomplished “high” for a short moment.  Yes, it will probably dehydrate you enough to make the number on the scale go down.

But it will also make you weak and tired.  You will feel disgusting and even more worthless.  You will hurt the body you have been learning to take care of. You will dehydrate yourself and may end up in the ER again.  It will damage your heart, stomach and esophagus.  It may even kill you.  The doctor told you last time that you are lucky to be alive.  How many chances do you think you will get?  Your body does not deserve punishment — it has been through enough.

You cannot live the life you want if you go back to your eating disorder.  It will continue to destroy you physically and tear you down emotionally.  Your life has changed so much over the past years.  Your passion and energy for life turned into a passion only for food and weight loss.  And the energy left altogether.  Where has it gotten you?  Emotionally void and in the hospital time and time again.

Do not let this time be wasted.  Use it.  Take what you have learned and apply it right now.  Journal, pray, read, scream, cry, get outside, play with the pups, call a friend…whatever you need to do.  Your ED will ultimately make you miserable.  You can choose to be healthy.  You can choose life.  You can do this.  Choose life today.

2. Urge Cards: These are cards with the urges listed on the front and affirmations and alternate, healthy coping skills on the back.  For example, I would have “restricting” written on the front of a card and “I deserve to be healthy” on the back.  Then I wrote a list of coping skills: journal, call a supportive friend, self-soothe. I made a commitment to trying each thing on my list before engaging in the eating disorder behavior.

3. Consequence List: This was a list of the consequences of my eating disorder.  It was a reminder in the moment that my eating disorder does not give me the life I desire to live.

  1. Death
  2. Hospitalization
  3. Heart, teeth and stomach problems
  4. Depression
  5. Loss of relationships
  6. Loss of school/job
  7. Increased shame

The list goes on and on.  My eating disorder took away a lot more than it ever gave me.

4. Structure: This has played an important role in my recovery.  I needed to schedule my entire day, because down time usually led to strong urges.  This didn’t mean that I was always doing; I scheduled time for just being too.  Here is an example:

  • 6:30 a.m.   Spend time in prayer/ meditation
  • 7:00 a.m.   Breakfast (Spend 15 minutes journaling after)
  • 8:00 a.m.   Yoga
  • 10:00 a.m. Snack (Spend 15 minutes journaling after)
  • 10:30 a.m. Take care of daily responsibilities (i.e. bills, grocery, clean)
  • 12:30 p.m. Lunch (Spend 15 minutes journaling after)
  • 1:30 p.m.   Write out affirmations
  • 2:00 p.m.   Therapy
  • 3:30 p.m.   Snack (Spend 15 minutes journaling after)
  • 4:00 p.m.   Take pups to the dog park
  • 6:00 p.m.   Dinner (Spend 15 minutes journaling after)
  • 6:45 p.m.   Do something I enjoy (i.e. watch a movie, take a bubble bath)
  • 8:00 p.m.   Make plan for next day/ Get ready for bed

5. Setting goals: My therapist often talked to me about creating a life worth living.  I wrote out spiritual, emotional, social and physical goals that would help me create this life.  I worked to meet at least one goal in each of these areas every day.  These were things that healthy people probably don’t have to think about each day — they just automatically do them.

But for me, it was work.  An example of an emotional goal would be journaling and saying affirmations.  A social goal might be calling at least one friend a day or going out with friends at least once a week.  Physical goals were focused on following my meal plan without restricting or purging.

These are now second nature for me, so I keep them in a drawer in my house.  But for a long time they stayed in my purse so I could access them at any time — even in the drive-thru line of a fast food restaurant.  It’s never too late to interfere and stop a relapse.

My nutritionist always says, “Do the next right thing.” If I do end up bingeing and purging, the next right thing is to immediately get back on my meal plan.  This means eating the next snack or meal, no matter what.  If I skip a meal or snack, the next right thing is to eat it as soon as I acknowledge the relapse.  It does not mean waiting until dinner to make up for a day’s worth of food.  (This inevitably leads to bingeing and purging.)

I have also changed my view of relapse.  I learned to have compassion towards myself.  Relapse is often a part of the process.  This does not mean that I give myself permission to relapse, but that I do not beat myself up for it.  Relapse does not mean I have failed; it only means I have more work to do.