Hi, I’m 26 years old and have struggled with depression and anorexia since I was 13. In the past 3 years, my anorexia has got particularly bad (before, I managed to maintain a BMI of 15) after an eating disorder (ED) admission which triggered some very distressing memories and I was consequently diagnosed with PTSD.
My anorexia has become a coping mechanism and every time I’ve got to safer weight, my depression/ PTSD gets worse, particularly when trying to address them in therapy. I do want to be well but I’m caught in a cycle and have no idea how to get out of it. I was sectioned in 2018 for a year after my BMI dropped to 11/12 and then got transferred to a residential house for people with severe and enduring EDs. I’ve got to a BMI of 15 but I’m already slipping backwards and am unable to work on my PTSD due to the COVID-19 situation and my therapist thinks I won’t cope mentally due to being trapped in a house with 4 other patients plus up to 3 staff (I’m very hypervigilant). I’m so tired of it all and just want to feel better/ happier and not have to feel so on edge and not have nightmares constantly.
I’m feeling pretty hopeless and don’t know how to keep going. Any suggestions? Can I ever get out of this situation?
I understand that this is very difficult situation made even more challenging with the pandemic. Much like yourself, people are feeling more stressed than usual. People are frightened of becoming sick, losing their jobs, and not being able to leave their homes. A Newsweek article recently reported a 34% increase in the number of anxiety medications and other mental health medications being prescribed. People are clearly struggling.
Insomnia and nightmares are also problems for many people. One Harvard University professor collected approximately 6,000 dream samples from over 2,400 people. She was able to collect such a large sample of dreams because of the increased number of people discussing their pandemic dreams. Many of them are dreaming about being sick with the virus, being in crowded public places without a mask or inappropriate levels of social distancing. Others dream of losing control, and some are simply nightmares. That suggests that people are struggling, missing out on the things they are used to, and reacting to the stress of this unprecedented time in our lives.
In some respects, much of what you’re experiencing is consistent with what many others are experiencing. Unfortunately, you’re experiencing it on top of the other issues you mentioned including anorexia, depression and PTSD. Understandably, it can feel overwhelming but there is hope for you. All of the disorders you have are treatable. It may take some time, and it may take you finding the right therapist or type of therapy but it is worth trying. There is hope for people who have these disorders.
You have a therapist now and is important to evaluate whether or not she is the right therapist for you. In addition, it’s important to evaluate your current type of therapy. Are you in the therapy you need to be in? Are you feeling at least slightly better after each session? Are you working with a therapist who has successfully treated other people with similar problems?
As you may already know, anorexia is a complex disorder. It is thought that environmental and psychological factors influence the expression of genetic risk that leads to the eating pathology. The most current research would suggest that anorexia is a brain-based disorder that overlaps neurobiologically with anxiety disorders and addictions. Studies have indicated, regarding treatment, that eating disorder-focused therapy is superior to individual therapy among adolescents. It is less clear what treatment modality works best with adults. One novel treatment that is showing promise is cognitive remediation therapy (CRT). This particular therapy aims to improve cognitive flexibility and holistic information processing. Another potential promising therapy is exposure therapy for anorexia. Exposure therapy involves fear conditioning, by systematically and slowly exposing one to one’s fears in order to overcome them. Other approaches involve medications such as olanzapine which can increase one’s appetite.
The most important thing for you at this time is not giving up and realizing that there is hope for you. It might be helpful to read the stories of individuals who have overcome anorexia, to learn more about what they did, and their mindsets. It may also be helpful to work with your therapist to adjust your medication during the pandemic as well as developing better coping skills. The more coping skills you have, and the more flexible you are in your thinking, the easier it will be to endure this difficult time.
I mentioned flexible thinking and coping mechanisms because I think they’re vitally important in overcoming anorexia. The fact that anorexia has become your coping mechanism suggests that a modification is desperately needed. The most concerning aspect of anorexia is the physical toll it takes on one’s body. It has the highest mortality rate of all psychiatric illnesses. Thus, it’s important to develop alternative strategies for dealing with stress, and there are many of them. You have to be willing to use them which means being willing to tolerate the discomfort that comes from not giving in to your more habitual coping mechanisms (i.e. anorexia).
Finally, you might find it useful to watch the show Obsessed. It used to be on the A&E Network but most of the episodes can now be found on YouTube. Obsessed focuses on individuals with obsessive-compulsive disorder. You don’t have obsessive-compulsive disorder however, I think there are many similarities between OCD and anorexia, specifically the inability to be cognitively flexible and the unwillingness to tolerate uncomfortable feelings. Part of what makes the show potentially helpful is that they demonstrate how exposure therapy can work quite effectively for individuals with OCD. It might help you to see what it’s like for people to tolerate uncomfortable feelings. An important element of exposure therapy is that even when someone feels uncomfortable and excessively anxious, those feelings eventually diminish and subside. It’s helpful to see firsthand that even when feeling overly anxious, eventually those feelings will subside.
To answer question directly, yes you can overcome this situation. Please don’t give up and keep trying, until you find something that works for you. You might also try treatments that are focused more on depression and/or PTSD. Perhaps, if those issues are dealt with, you might have an easier time overcoming the anorexia. Good luck and please take care.
Dr. Kristina Randle
