A little bit of information from mashable:

While anorexics’ posted writings and photos can be disturbing, study results revealed that pro-ana bloggers are looking for support, rather than trying to recruit others to follow their unhealthy path.

“These communities are providing support, albeit supporting an illness that may result in someone’s death,” Nicole Martins, research team member, said in a statement. “But until they’re ready to go and seek recovery on their own terms, this might actually be a way of prolonging their life, so that they are mentally ready to tackle their recovery process.”

It has been my experience (past experience! past!) that individuals on “pro-ana” blogs and forums don’t want to help each other die. Maybe that’s what they are doing, but it’s not the intent. Somehow they feel like they are coping and even helping others cope in that same way. Sure there’s a lot of “good job for not eating” posts and “thinspo” pictures out there… but I think there’s a camaraderie that’s meant to be positive. Eating disorders are really isolating, and you’re looking for someone to talk to about it — and when you’re in a bad frame of mind, you’re really looking for someone to support your sickness.

So, I agree with the first point.  Now, the second quote… I’m not so sure about the idea of being ready to go and seek recovery on your own terms.  My opinion on that is not mutually exclusive to pro-ana sites, though.  In general, I think it’s irresponsible to just let someone hurt themselves until they feel ready to change.  Sure, ultimately they have to do it for themselves, but you can’t just wait until that time comes.  People die in that interval — and I highly doubt that pro-ana sites improve their mental readiness let alone prolong their life.

What I do think the sites do, is offer care / concern / support that could push an individual to get help.  You make friends, and some of them get help.  Some of them freak out on you and insist you get help.  There’s a role that individuals on those sites play that family / friends in your everyday life aren’t (although they should be).  I don’t think they have made some large mental shift about recovery and the value of their life… but they are choosing relationships over the eating disorder.  They have enough trust and connection in these friendships to take a risk and get help, even though they might not really want it.

So, do I think that pro-ana sites could lead to recovery?  Sure.  Am I glad they are being removed from facebook and other places I would run into them?  Yes.

1. Mentors
2. Peers
3. Mentees
4. People you don’t like

I know the last one is harsh, but I don’t have a better way of putting it.  the groups are unique to each individual — someone’s peer might be another one’s mentor.   Interestingly enough, I think that these roles are more common in an intense treatment environment than outside… and maybe that makes a big difference in being able to maintain recovery and move on with your life.  There’s that connection in treatment, when you are most vulnerable and need to rely on others… as well as the closeness with others who you want to take care of.

I think that whole idea of the “self-made man/woman” is BS, and that maturing and recovering requires time and many different kinds of relationships.

I’m going to break this subject into a few posts, because I have a lot to say about it (and you probably don’t want to read something 7 pages long!)  So, today is mentors.

Qualities of a Mentor:

Inspiring:
I’ve always been able to find at least a few people in the community who are further along in their recovery and are inspiring.  They aren’t necessarily the ones closest to their goal weight or who have been there the longest, but they have a contagious attitude that makes you WANT to do better.  I describe their attitude as “yay recovery,” because you can tell that they really WANT it… and they want it for others, too.

Experienced:
Often these individuals have gone through difficult things and worked through them in therapy.  They are also aware of others’ experience and life stages, which lends them the ability to ask questions, offer experiences, counsel and encourage.  It makes them a trouble-shooter and go-to person when you’re having a hard time or need advice.

Available:
I think a lot of mentoring is just about spending time together… being there when you need them — and when you aren’t having a crisis and don’t need them.  Just having a mentor in the community changes the  vibe and can make or break a group.  Having them there to hold your hand through the recovery process makes all the difference.

Not a guru:
I don’t think mentoring is about having the answers.  In fact, I don’t think they often have “solutions” at all… but they can give you tactile advice that comes from their own experience to bring you to your own conclusions and decisions.  I think it’s different from the therapy “leading you to the answer of a question” though, because it’s giving advice that maybe you can use yourself to make it through a difficult patch.

Still learning / recovering:
When I say “mentor,” I don’t mean someone who is super-far along in their recovery and not struggling at all… I just mean someone one step ahead of you who can relate and help you through something.  They’re just a little further along down the path.  They are investing in you — impacting you — while they are working on their own recovery.  And I think that having the opportunity to do this strengthens their own recovery, for a few reasons:

1. It feels good to give back or to “pay it forward”
2. Often you need to see others struggle to better understand your own situation
3. It’s a reminder of things you need to keep working on
4. You’re acknowledging your own hard work and progress

Summary:
One last thing about mentoring — I think a lot of us are screaming for a mentor.  We’re saying “help, lead me, support me, be there for me.”  And, when we find someone who can be that support and help to take us to the next level, we need to hold onto that person and not let the go.  It’s hard and risky to stay connected to others when you’re out of treatment, but personally there are some individuals who I still turn to and rely  on for advice and support… who I can see them doing well and being happy and want that for myself.  When I’m having a tough time and want to throw in the towel, they can remind me of why I wanted this is the first place.  I can see them have a life and be okay.  They’re not okay 100% of the time, but they are living life without solely relying on the ED to cope — and that’s what I need.  I need to see that you can live life without falling back on the eating disorder, and that I have the love and support for others to hold my hand and help me down the path through all of it.

Definitions of contagious:

• from dictionary.com: tending to spread from person to person:
• from answers.com: transmissible by direct or indirect contact; communicable:
• from merriam-webster.com: exciting similar emotions or conduct in others

So, contagion can be a good thing.  Walter’s article specifically addressed negative influences and bad examples that had contagious implications throughout a treatment center — which is probably more often the case — but I wanted to mention some of the positive “contagions” that I’ve personally experience in higher levels of care:

1. finishing meals — when everyone around you is eating their meal, it’s easier to finish your own… even when it’s the last thing in the entire world that you want to do.  there’s this understanding that it sucks but that you do it anyway.  the drive to keep moving forward and pushing on is contagious.
2. recovery-minded feedback — regardless of what you are actually thinking, it usually only takes a few people to pipe up and make some “yay recovery” statements for others to join in.  if someone is having a bad night, the positive group-support is contagious.  everyone wants to make him/her feel better (or most everyone).  even if you felt triggered by this person for whatever reason, hearing others express concern and empathy somehow gives you a different perspective and elicits sympathy within yourself.
3. friendships – people come into treatment all the time with “screw everyone here, I don’t give a damn about them” attitudes — and eventually discharge in tears as they leave all these friends and close relationships that they’ve formed throughout their time in treatment.  the camaraderie is contagious.
4. motivation to change — this one is really hit-or-miss, and completely depends on the kind of community that you have together in treatment.  even one or two good or bad influences can change the entire atmosphere, though.  when you have individuals who are really motivated and in a good place, that’s contagious — you look up to them and want that, too.  now, you have a handful of negative influences in the group, and things can go downhill pretty fast.  still, it works both ways.

these are just a few examples of positive contagions within treatment.  sure, people pick up new food rituals, purging behaviors, self-harm that they never engaged in before, diet tricks, and all kinds of other dangerous habits in treatment.  I’m sure lots of parents would consider the risks of sending their child to a residential facility (or any kind of higher level of care) not worth the benefit they may receive in that particular treatment, and in some cases they are probably right… but there are plenty of positive behaviors that are just as contagious in this eating disorder subculture, and I don’t want those to be overlooked or completely discounted.

In the first part of the survey, participants were asked a few general questions, in cluding self-diagnosis of the type of eating disorder they were showing most recently:

• ANR or anorexia nervosa restrictive type (underweight, restricted food intake, no purging);
• ANM or anorexia nervosa mixed type (underweight, purging and/or binge-eating);
• BN or bulimia nervosa (binge eating, more or less normal weight);
• EDNOS or eating disorder not otherwise specified (different from previous ones)

Several things caught me off-guard:

1. The use of “ANM” rather than “ANP” — ANM may actually be more accurate, upon second thought, but it’s new terminology to me
2. The lack of the mention of purging in bulimia nervosa. Isn’t that a pretty key element of the disorder, and something that separates it from binge eating disorder? Whether it’s purging through vomiting, exercise, or fasting… it’s still purging, and still criteria for bulimia.
3. Where’s BED or binge eating disorder? BN sounds more like BED… so in that case, where is BN?

These important points aside, what I really wanted to talk about was the self-diagnosis of eating disorder type. Unfortunately, so much of ED research (and treatment) depends on self-report, so I understand why this was used in the study… but from previous experience, I know that no matter how sick I really was, when I was younger I would have never classified myself as anorexic. Actually, having spent some time on eating disorder boards (back in the day of AOL monitored-forums… does anyone else remember those?), I considered myself to have “pre-anorexia” (aka: anorexia light). I used this terminology because I didn’t feel like a “real” anorexic, despite meeting the criteria. It wasn’t a knowledge issue… I knew about the DSM. It was more of an acceptance thing. To this day, I have a hard time with the anorexia diagnosis because of the “sick enough” factor (I’m sure I’ve mentioned that before).

Personally, I’ve had enough treatment that I probably would have considered myself ANR, but it would be really tempting to choose EDNOS.

I wonder how many (if any) other individuals struggled with their diagnosis when self-reporting in this study. I’m pretty sure I’m not the only one. I would also be interested to see the discrepancy between self-report and official diagnosis, which could be obtained through psychological evaluation. Maybe self-diagnosis is a better indicator… I haven’t read the research on that. Overall the article left me with a lot of questions, that hopefully I’ll address in future posts.

On a final note though, I would like to thank Walter Vandereycken for sending me his article and thinking of me whenever he publishes his new research. If I would have to choose one research subject that I’m most interested in, it would have to be eating disorder subculture. I’m sure you’ll see a trend toward that as Grey Thinking progresses — so you have all been warned

this isn’t my first “hi I’m back” post — but hopefully it’ll be the last time I take such a leave of absence from a site (and cause) that I care so much about!

Until my last stint in residential treatment, I never though of self-injury as being contagious.  Maybe this is because when I was younger, I couldn’t imagine hurting yourself.  I hated getting a shot, letting alone the thought of self-harm.  In my mind, it was something that crazy people did.

Now, unfortunately, it’s something that I struggle with (although I’m doing much better than a year ago).  However, I noticed in residential treatment that when one or two people would self-injure, suddenly there would be a flare-up of self-harm… including individuals who had never done such a thing before.

I did a little research on this, and found some interesting information:

From Self-Injurious Behavior in Adolescents:

“It is widely assumed that NSSI is contagious, although lack of empirical data necessarily limits our capacity to test this assumption. Nevertheless, studies of contagion among adolescents in clinical settings demonstrate the tendency for NSSI to spread in a population [37]–[39] and the presence of self-injury in media, such as in music, movies, and newspapers, has increased dramatically in the past several years.”

The study gives several reasons for this:

1. the shaping of norms
2. providing social reinforcement of behaviors
3. providing (or limiting) opportunities to engage in the behavior
4. facilitating or inhibiting the antecedents for the behavior

Personally, I think that self-injury has become more socially acceptable than it was 10 years ago.  It’s still not looked upon in a positive light, but it’s more common and easily recognizable.  There’s a huge stigma attached to it, but maybe a little less judgment.  As far as “providing social reinforcement of behaviors,” I think of that as showing the pain that someone is going through.  A lot of the time people don’t know about emotional pain… but self-injury makes it more real an communicates “Hey, I’m not okay.  Something is wrong.”

There’s also a great PDF (free full text) on The Influence of Social Contagion and Technology of Non-Suicidal Self-Injury, which I highly recommend that you take a few minutes to read.

Self-Injury and Subculture Status:

“Two patients in this study stated that cutting did not relieve any anxiety or anger, but rather were influenced by the self-injury of others because they themselves did not want to feel like outsiders. There was also an instance wherein a patient was treated by others with contempt and accused of being a fake. Two of the four patents who acted accusatory toward the “faking” patient had co-occurrences with this patient’s one instance of self-harm. This may indicate that there are social rules that must be abided by during instances of contagion, which may bring meaning or value to these events.”

In conclusion:

“…because of the nature of psychopathology and individual (developmental) differences in psychological functioning, it is likely that only some portion of the population would be susceptible to instances of self-injury contagion under normal circumstances.”

Like with everything, not everyone is predisposed to self-injurious behavior… but with the first point, I think it’s interesting (and unfortunate) that even individuals who weren’t inherently driven to self-harm engaged in the behavior anyway, because it was a sign of sickness.  As competitive as eating disorders are, self-injury (kind of like the existence of trauma) someone makes you “sicker” than the rest.

My final thoughts:

There is a lot more research out there, but my big question is — does the learned self-injury continue after discharge?  Or, is it limited to that residential / inpatient subculture?  Many individuals learn to purge during treatment, and end up swinging to bulimia or purging anorexia, but I have no idea if that is the same situation with self-injury.  I’d love to hear your thoughts.

When I was in treatment, I took it upon myself to create a list of reasons to recover.  I have one list which is composed by ideas from other patients, and another of ideas that I created myself.  I should probably post them somewhere I can always see them, or keep them in my pocket for when I’m having a tough time, but for now I’m sharing them with you all:

My reasons:

• to have a future and family — both with my husband, dogs, and hopefully kids someday
• to feel like my life has meaning and purpose
• so that I can let myself believe that people care about it — and actually feel it.
• because reaching out for help isn’t needy
• so that hugs feel better than self-harm
• to have genuine relationships and and not have to keep so many secrets
• to feel lovable and worth caring about, even when there isn’t a reason — just because I am me
• because connection requires vulnerability
• because not asking for help, hurting myself, and what feels like protecting a relationship actually kills it — then there is no relationship
• while loving can cost a lot, not loving always costs more
• to not be afraid of wanting love
• to not feel so empty
• to spend less time obsessing about the future and more time living (and enjoying) the present
• so that I don’t always feel so abandoned and hurt
• to not let unfortunate events in the past ruin my life
• because my treatment team says it’s possible, and I trust them
• because God made me to be more than just “good enough”
• so that I can see my dreams come to pass
• to believe that I am someone special, and to share that with the world.
• so that I can pay it forward (all of the help, support, and care that I’ve been given)
• to be able to do something significant with my interests — grey thinking and art
• to not allow complacence to keep me in mediocracy
• because God forgives me
• to be able to accept that I am a work in progress, and to let God to continue to change me for the better
• because recovering doesn’t mean my past experiences and struggles don’t matter… I don’t have to keep re-victimizing myself to make those true.
• because while I have made progress, I know that this is not where I am supposed to be.

Reasons from erika:

• so that I can be the person I’ve always wanted to be
• so that I can move on with my life (and actually have one)
• so that my story can have a happy ending
• to stop wishing and start living
• to be happy with my body
• no more scars
• because I deserve to be okay
• to feel like life is worth living
• do it for those who love me
• so I can start trusting people and letting my guard down
• to not be consumed by these thoughts and actually have time/interest in thinking about other things
• to be able to forgive myself
• because I shouldn’t feel like I need to get hit every time I screw up
• to be able to trust myself
• so the good memories outweigh the bad ones
• to stop being so afraid… and making decisions based on fear
• because hurting myself won’t make me the person I want to be
• to be able to experience emotion, rather than running from it
• no more nightmares

I’d love to hear any other reasons you might have…. you can never have too long of a list!

I’ve probably written about this before, but another blog post sparked my interest in it again, and I think it’s an important enough topic to bring up more than once.  Craig Harper calls it “I’m-not-good-enough-itis,” whereas I’ve always referred to it as the “enough factor.”

From Craig’s blog:

If you don’t know already, I’ll tell you now: you were born good enough. It’s only your thinking, beliefs and fear that get in the way. Naturally, we all have strengths, weaknesses and flaws but the underlying question we seem to want answered is not really, ‘am I good enough to do A, B or C?’ but rather, ‘am I (me, the person) good enough in general? This kind of common thinking and self-doubt speaks to our sense of unworthiness and insecurity. For a range of reasons, many of us seem to live with an overwhelming feeling of inadequacy.

Personally, this is something that I’ve struggled with my entire life.  In search of that assurance that just being myself is good enough, I’ve tried to get there through A, B, and C… getting good grades, having a good job, always behaving, never asking for anything, and trying to screw up as little as possible.  However, none of these accomplishments have ever helped me with that inferiority complex.  In fact, they probably set me back, because I could rationalize that I’m only accepted because I’m doing enough.  If I weren’t, then others wouldn’t care.  There wouldn’t be a reason to care.

It’s amazing how many people I’ve met in treatment who struggle with the same thing — especially since they are such amazing people that it’s hard to watch them hurt themselves.  It’s part of the eating disorder, self-injury, anxiety and depression, PTSD… and I could go on and on.  There’s this constant questioning of yourself: is my trauma significant enough to count as trauma?  Am I think or sick enough to deserve treatment?  Am I struggling enough that I’m worth being taken care of?

What Craig says about being born good enough is absolutely true… but I think that really what it comes down to is learning to trust yourself and your own experience of reality.  I get stuck in this world of “what is objectively enough?”  How do I know for real if my trauma counted, my eating disorder is really an eating disorder, etc.  I want the objective criteria sitting in my hands so that I know for sure.  Otherwise, maybe I’m just making it up.  Because I don’t feel like I can trust myself, I don’t feel like I have an accurate grasp on the world.  Screw MY experience of reality — I want to know what THE REAL reality is.

Once I explained this to my therapist, and she said the “enough factor” was scary… because nothing was ever enough, and I could continue in a downward spiral without ever really hitting that bottom (I’ll write about bottoms someday, but I don’t exactly believe in “rock bottom.”).  I understand what she’s saying… it’s just hard to put all the pieces together in my mind, let alone ACT accordingly!

My take away message from this is: the more that I try and be enough, the less I feel that just being me is okay and good enough in general.  You have to screw up sometimes, be vulnerable, and let others in to learn that you ARE lovable and that you are worth everything.  Otherwise, you’re going to keep rationalizing that you’re only okay because you are doing everything “right.”  Try doing something wrong and relying on someone — that’s the only way you’re ever going to learn otherwise.

From an episode of Glee:

Emma: You know how we’re always talking about moving towards marriage, and nothing really ever happens. I mean, Sue said I should be all liberated and ask you to marry me. Um, do you want to be with me? I mean as your wife?

Will: Of course I do.

Emma: But?

Will: I love you, you know that. But what if we get married. What happens when we have a house… and a baby? How are you going to handle spit-up on your special Wednesday sweater? Sweetheart, you can’t control another person. What if it’s all just too much?

Emma: Uh, I mean, I’ve been taking my medication…. some days are great. Some days are not so great, but I’m I’m I’m, I mean, I’m doing the best that I can. I’m I’m I’m, I’m doing everything that I can.

Will: I know you are, I know you are, and it’s not your fault that you have this… disease. Sometimes, it just seems so hopeless.

Emma: Wow, okay, um. *sigh* Can I promise you that I’m going to get better? No. This is what you get, you know, this incomplete person with toothbrushes and with rubber gloves and with so much love for you. *cries* But if that’s not what you want, then you need to be honest with me. And with yourself. And the sooner the better.

This was difficult for me to hear, even though I don’t struggle with OCD.  It seems so cruel… like because you have a mental illness, you don’t get to have all the stuff in life that you want and that everyone else has.  Even if you’re trying your best to get better, that doesn’t necessarily mean it’s enough.  It seems so unfair.

But it’s true.

The reality of it is, Emma is still very stuck in her OCD… and while she’s getting therapy and taking meds, it doesn’t change the reality that it’s still a really big problem for her.  Will makes a lot of good points, because Emma is struggling to manage her everyday / routine life… let alone a whole new life that involves things that are “messy” and out of her control.

It’s the same with eating disorders, depression, anxiety, etc.  Personally, I want all of these things in my life so badly.  I am married, I’ve been in treatment for a long time, and am a lot better off than I used to be… but if I’m struggling with body image so much right now, how will I handle the weight gain of pregnancy?  How will I eat what I need to, when my meal plan now already feels like a lot?  To a large extent, people are still taking care of me… therapists, dietitians, doctors, my support system, etc.  I need to be at a point where I can take care of someone else.

It’s not just about getting married and having kids — it’s really about having a satisfying future.  You can’t be partially committed to recovery and life a complete life.  It just doesn’t work like that.  It’s easy to think “I’m doing well enough,” but really that translates to “My life is okay enough.”  Emma’s life isn’t bad.  My life isn’t bad.  But in both cases, we want MORE.  And it totally sucks to be trying and to be able to see your future, and not be there yet…. or to ever get there.

See, you don’t “get” to do all the “normal” stuff when you aren’t better — even if you are trying your best, are so much further along than you were before, and are partially recovered.  It’s not your “fault” that you’re stuck in this mental illness–which is what makes it so unfair.  But it is true that “regular” life requires a level of “normalcy,” and regardless of whether or not it’s fair… being partially recovered is only going to give you a partially complete life.