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You and me both.

I am so happy to hear your voice again! I was really worried about you.

Letting go of one small thing would be a good thing to try. What might that be?

Are you able to meditate now? You could focus on your breathing for a period of time. Or on sounds or thoughts, identifying and acknowledging each of them without judgment.

Then there are grounding techniques. Perhaps pay attention to physical/sensation based things like how your body touches the bed/chair/floor. How many people pass by your room. What colors you can see and how may of each. What you can observe of outdoors, if you can do that.

Hang in there, many people here are pulling for you!

Thanks. I like the idea of letting go of one small thing, I just need to come up with something I could actually tolerate and not freak out about. I think I could handle trying to observe my thoughts and feelings and not judging them. I think I'm going to try that. I really am not thrilled about how I've handled this last week and totally ruminating on it and I need to try and let that go and move on and act in the future in a way I'm more accepting of.

What are some possibilities for the one small thing? And if okay pros and cons for them.

If you do decide to observe thoughts and feelings nonjudgmentally, I think it might be helpful to write them down if possible, even if only sketchily. That would amount to a thought/emotion journal. Journaling can help you separate a bit from the thoughts and emotions: to see that they are just thoughts and emotions.

I saw this post of yours on the ED update thread. It is a good example of identifying feelings and thoughts. I would just make a suggestion: that instead of saying that you "should" be focusing on bettering the above, consider first non judgmentally identifying the thought involved, which I think is that you are also attracted to healthier behaviors, you are ambivalent. And then you can also say, if true, that your intention is to choose healthier behaviors (rather than saying that you "should"). Or whatever your intention is, perhaps you are ambivalent in your intention as well.

Sorry it took me so long to reply. For some reason, this is a really tough topic for me. In all honesty, I don't really know where I am. Sometimes I want to get better, sometimes I just don't care, sometimes I don't think I'm "sick enough" yet and have this weird urge to keep going until I reach...I don't even know what. Honestly, I know people talk about "rock bottoms" a lot and I don't really think I have one. I think my rock bottom would be death. And that should scare me a lot more than it does. I think I've been so sick so many times that I kind of have this invincibility complex and am convinced that no matter what, I'm going to pull through it. And that's just not the case. My labs are showing that's not the case as multiple things are starting to fail, yet as I don't "feel" like I'm dying, I'm convinced I'm fine. Yet I've been in the hospital for how long? Obviously something is seriously wrong. Sorry, that was kind of going completely off topic. I'm going to really try this. I'm going to try to identify my feelings as whatever they are and then set intentions to choose healthier behaviors. I don't have anything to "prove" to anyone. I don't need to be any sicker. This has gone on long enough and I've done enough damage, I need to focus on moving forward with my life as a healthy individual, not just as a sick anorexic...
Thanks for this.

I think that what you said was on topic, as right there you stated some beliefs and feelings that you have. The belief in invincibility. The ambivalence, the diverse desires. The dissatisfaction with your concept of rock bottom. The suggestion that in the past you did need to prove things to people, and now you do not. In the past you needed to be sicker, but now you do not.

I read an article recently, a qualitative study, that might interest you. At a certain French hospital, applicants for admission had to provide letters as to why they wanted in-patient treatment. The article examined these letters for recurring themes. The recurring themes reported were: 1. Loss of control, both of actions and of thoughts. There used to be control, that was a thrill if you will of the ED, but now there is not. 2. Inner distress, from exhaustion and from isolation. 3. Ambivalence: wanting to recover versus wanting to restrict more, and fear of recovery. Recovery would mean giving up the ED and therefore a part of oneself. The ED initially brought comfort and an identity, to give it up would be to enter an unknown and could require mourning, even though giving it up would also mean freedom from the isolation and loss of control that ED brings.

To move forward as a healthy individual: what does that mean for you now, as a next step?

That is interesting. I would actually be interested in reading that. I think you kind of hit the nail on the head as to what's holding me back now. What does it mean for me to move forward as a "healthy" individual. Good question. Probably means I'm going to actually have to do something about all this and stop being complicit and take some action. Positive, forward thinking action. Like seeking out further inpatient treatment. I'll likely be discharged from the hospital pretty soon and I need to have a next step ready...
I definitely can relate to all of the recurring themes found in the study. Loss of control. Check. Inner distress. I don't know how to say yes more strongly. And ambivalence, absolutely. You'd think that'd make me ready to get treatment. You'd think that make me change. It should. But for some reason, the ambivalence piece is strongest right now. I just kind of don't care about anything and am fine with leaving things how they are. But I'm not. Not really. I just don't think that I believe I can really change. Things have been this way for so long...
What does is mean for me to move forward as a healthy individual? I guess I need to put some serious thought into what I'm willing to do to move forward into recovery. And conversely, what I'm willing to give up to stay sick. I'll think about it.
Thanks for replying.

Thanks for your reply. I would definitely be interested in hearing what you come up with (if okay). For now just think in terms of a next step or two, to move in the direction of change. Think in terms of one or two small steps at a time. I believe that you can start the process of change by finding and taking one or two small steps.

Here is the article:

Subjective Motives for Requesting In-Patient Treatment in Female with Anorexia Nervosa: A Qualitative Study

Thanks for the article. It was interesting. I too believe changes are made up of baby steps, I just seem to be stuck regarding what exactly to do and what exactly I'm willing to do. Im going to be discharged (finally) this week and I have an appt w my therapist next week. I guess a small step I'm willing to do, and granted it's really small, but im willing to have a discussion regarding possible inpatient treatment and listen with an open mind, not just my screwed up ED brain. Im also going to make a sincere attempt to cut down on my pacing bc a) it's driving everyone crazy and b) it's probably nothing great for me right now. Does that seem reasonable? Does that seem like enough?

[COLOR="DarkOrange"]Hello dear pinkflower17.
I'm so glad you've found Psych Central[, it's truly a good place to gain support and share ~ no matter what your issues may be. Hope you feel better soon, and maybe make some friends in the future. /COLOR]

I am really happy to know that you are well enough to be discharged. Yay!

I see this as a good step. You had talked previously about going inpatient. I wonder if there can be some accountability though. For example, after speaking with T, how about if you give us a balanced report about the pros and cons as T presented them to you? And with your own assessment of them.

I wonder if there could be some thought devoted to positive things to start, in addition to negative things to stop. So if pacing stops, and nothing else changes, then there is a void in your life and some ED-related behavior is liable to move into the void. So I ask you: what small healthy behavior can you introduce/reintroduce into your life?

With regard to cutting down pacing, can a goal be expressed in measurable terms? e.g. I will pace less than ____ minutes per day. With a specific, measurable goal, you can readily see whether or not progress is occurring.

Right now as I see things we just want to start going in a healthy direction. For now, anything that helps move the direction towards health is enough. But do find out what T thinks about this.

I know, thank goodness, it's been forever. So happy to be going home.

I do probably need some accountability because I'm fighting this tooth and nail and rationalizing and trying to come up with any and every excuse in the world why inpatient wouldn't possibly work. I need to go, but I really, really don't want to right now. Not that I want things to stay how they are, maybe I'm just afraid of change? Maybe I don't want to put all the work in that I know it's going to require? I don't know. I just know I'm terrified and angry and really resistant right now towards inpatient treatment.
I think though, that instead of having my therapist presenting the pros and cons, it would help me more to try to objectively make a list of pros and cons and then share it with her and see if she agrees. And of course I'd love to share it with y'all. I think that's kind of what you were saying, only maybe a little role reversal.

As to what positive behavior I can introduce, this one's a lot harder. So much of my time is spent on just getting by or just making it through whatever crisis is going on, I don't seem to have time to or haven't been able to find time for much positive. I don't even know what I like anymore to be honest. I guess, two things come to mind. 1) journaling's helpful for me. I could commit to spending 30 min/day journaling. I've got a lot going on. There' s got to be something for me to write about. 2) I've lost touch with a lot of my friends/family. I could commit to spending 15 min/day e-mailing, facebook, talking on the phone, in general catching up.

Regarding the pacing, I probably pace 5-10 min out of every hour, 17 or 18 hrs/day. I can commit to not going over 10 min any given hour and trying to keep it closer to 5 and cutting down to 14 hrs/day.

Overall, there's a lot more I should be doing. Career stuff, other ED behaviors etc and I do want to start working on that soon, I NEED to start working on that stuff soon. I had my electrolytes and a CBC drawn yesterday after they skipped labs for a couple days because my electrolytes hadn't been too terrible and pretty much everything - my sodium, phosphorus, calcium, hemoglobin, magnesium, and potassium came back low with my potassium, magnesium and sodium critical. And then they did an EKG which was abnormal, so it turned into a big drama. It sucked. Obviously they corrected everything IV, but there's obviously a bigger issue that I need to change. I'm not going to get out of here if I keep coming back with critical labs. And I want out. It's just...I'm so overwhelmed by everything right now, I'm not sure I can do a whole lot more, as pathetic as that is.

Am I just making excuses? Is this reasonable to start with?
Sorry for the length. This was good for me to think about.

This was truly a fine response. Thanks!



Not in my mind.

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Is this reasonable to start with?

Yes.

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Sorry for the length.

Not at all. Any length that is helpful is fine with me.



I like your idea very much and I would love to read what you put together. When would you be able to do it?



I like these ideas very much!



In general, this sounds good. I suggest that trying to keep it closer to 5 could be more precise though. What if you alternate: 10 minutes for even numbered hours, 5 minutes for odd numbered hours?

I am a little concerned about going cold turkey on those three to four hours, it is a substantial change. How about dropping two hours for now and then if all goes well considering dropping an additional two hours in the near future?



I want to make sure that I understand you here. I think you are saying that you still have a lot of ED behaviors, and these behaviors are leading to the lab results you described. This is why you have an urgent need to change ED behaviors. But on the other hand it will be hard to change ED behaviors quickly when you are so overwhelmed and not at an inpatient ED unit.

How accurate was that? If it is basically accurate, then what one or two ED behaviors are the most important to address first in order to get consistently acceptable lab results?



Thank you very much for your kind words. Hang in there!




.

So I already started a pro/con list both for getting treatment and a pro/con list for not getting treatment. I have a lot of them completed. I'll have them all the way completed by tomorrow, probably in the morning, definitely by the evening. Thanks for the accountability .
Regarding the pacing, you're definitely right, dropping that much in one day was too much. I completely screwed that one up. I managed to drop it by one hour, only 16 hrs today, but that's it. And every hour was definitely much closer to 10 min, so strike two on that one. I do need to make it a little more manageable, but at the same time, I also need to just suck it up and do what I need to do a little bit too. Tomorrow, I'm going to commit to only pacing for 8 min., out of 14 hrs in the day. It's not as much of a drop as I need to make, up at least it's a start. I'd like it to be less than 45 min total by the time I'm discharged, but that's a huge drop, so we'll see.
Your understanding as to what's leading to the abnormal lab values is accurate. I'm purging. A lot. Almost everything. And I'm not eating nearly as much as I need to be, even with tube feeding. And I'm manipulating the tube feeds so I end up getting less than I'm supposed to and I'm not taking the supplements I need. All of this lead to...horrible, critical labs. On a regular basis. You're right, it's going to be very, very difficult to break this cycle while I'm overwhelmed and not getting any eating disorder specific treatment, only medical management. And it's only going to get harder once I go home, which makes me really, really nervous. I don't know how much "worse" my body can handle. It scares me to be honest, which I guess is an improvement, because it didn't for a long time.
The change I really NEED to make is stopping the purging, but I just don't think I can do that on my own. That, along with increasing my oral intake and decreasing the exercise are going to be the hardest habits to break. I'm already super anxious tonight because I paced like maybe 10 minutes less today than yesterday. I feel like I'm crawling out of my skin. And just writing about eating more and/or stopping purging is currently making my heart rate monitor alarm because my heart rate is going through the roof. But the purging is doing the most immediate, life-threatening damage. Okay, this sucks, but I'm going to commit to a) not messing with the feeding tube pump tonight and b) keeping one snack down tomorrow afternoon. And I'm really going to try to stick to this. If I'm successful tomorrow, I'll try to improve upon that the day after. I only have a few more days in an environment where I at least have some support. That is until I enter an IP ED program. And I'd like to stay alive long enough to do so.
That being said, I'd kind of like your opinion on that. I'm really, really ambivalent right now regarding IP treatment. Honestly, I don't want to go, and I'm coming up with any and every excuse in the book to avoid going. I know I need to go...but I don't know if just plain don't want to or are scared of the work involved or what. I do know I don't want to miss anymore family/friend events or work. I also know I'm scared of some issues from my past that probably need to be dealt with if I'm ever going to get over this. Additionally, I'm afraid I'm going to completely lose it if I do face these issues. What I don't know is how to confront these issues or how to convince myself to go regardless of how I feel about it or how to motivate myself to do the work required in order to reach recovery when a lot of times I really don't think I care one way or another if I live or die. Any bright ideas? I'd really love your input here.
Thanks for your reply. Looking forward to your response.

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So I already started a pro/con list both for getting treatment and a pro/con list for not getting treatment. I have a lot of them completed. I'll have them all the way completed by tomorrow, probably in the morning, definitely by the evening.

I look forward to seeing these!

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Thanks for the accountability .

You're welcome.

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Regarding the pacing, you're definitely right, dropping that much in one day was too much. I completely screwed that one up. I managed to drop it by one hour, only 16 hrs today, but that's it. And every hour was definitely much closer to 10 min, so strike two on that one. I do need to make it a little more manageable, but at the same time, I also need to just suck it up and do what I need to do a little bit too. Tomorrow, I'm going to commit to only pacing for 8 min., out of 14 hrs in the day. It's not as much of a drop as I need to make, up at least it's a start. I'd like it to be less than 45 min total by the time I'm discharged, but that's a huge drop, so we'll see.

I think it best to stick to a more measured pace of change. I think that today was good, actually. Progress day by day I think. I question that you can more or less arbitrarily pick a number that seems reasonable and just expect to reach that number by discharge. I see that as a path to feeling defeated.

I think that targets should be firmly connected to where you are now. So today you maybe averaged 9 minutes for 16 hours. That is better than yesterday. Maybe it is only 6 percent better (about 1/17), but 6% is a good change for one day.

I also question whether you will just be able to drop every day, day after day. I would think that allowing for some adjustment and plateauing is more sustainable. So If you are able to do 8 minutes for 14 hours today, I would stay in that area for a while, like say 5 days. That would be a substantial change as it is: from roughly 17 x 10 to 14 x 8. Allow yourself time to adjust.

When you are discharged, I expect that you will see some falling back as you might need to pace more at home. Maybe I am wrong. But I say allow for that, see if it happens, and then stabilize before trying to move forward again.

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Your understanding as to what's leading to the abnormal lab values is accurate. I'm purging. A lot. Almost everything. And I'm not eating nearly as much as I need to be, even with tube feeding. And I'm manipulating the tube feeds so I end up getting less than I'm supposed to and I'm not taking the supplements I need. All of this lead to...horrible, critical labs. On a regular basis.

I am wondering what is the reasoning behind discharging you to home when these large problems exist.

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You're right, it's going to be very, very difficult to break this cycle while I'm overwhelmed and not getting any eating disorder specific treatment, only medical management. And it's only going to get harder once I go home, which makes me really, really nervous.

(and more wanting to pace I suppose)

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I don't know how much "worse" my body can handle. It scares me to be honest, which I guess is an improvement, because it didn't for a long time.

How much does feeling scared encourage change?

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The change I really NEED to make is stopping the purging, but I just don't think I can do that on my own. That, along with increasing my oral intake and decreasing the exercise are going to be the hardest habits to break. I'm already super anxious tonight because I paced like maybe 10 minutes less today than yesterday. I feel like I'm crawling out of my skin.

Yeah. Don't try for huge drops in pacing. Aim for little by little.

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And just writing about eating more and/or stopping purging is currently making my heart rate monitor alarm because my heart rate is going through the roof. But the purging is doing the most immediate, life-threatening damage. Okay, this sucks, but I'm going to commit to a) not messing with the feeding tube pump tonight and b) keeping one snack down tomorrow afternoon. And I'm really going to try to stick to this.

Good.

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If I'm successful tomorrow, I'll try to improve upon that the day after. I only have a few more days in an environment where I at least have some support. That is until I enter an IP ED program. And I'd like to stay alive long enough to do so.

You mentioned staying alive and you speak below about often not caring about that. What are your reasons to die, and what are your reasons to live?

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That being said, I'd kind of like your opinion on that. I'm really, really ambivalent right now regarding IP treatment. Honestly, I don't want to go, and I'm coming up with any and every excuse in the book to avoid going. I know I need to go...but I don't know if just plain don't want to or are scared of the work involved or what. I do know I don't want to miss anymore family/friend events or work.

You'll recall from that article that ambivalence about change is a hallmark of people entering an ED program. It comes with the territory. And as to family/friends and work: well it sounds like right now those will be limited anyways, due to your health. Recovery, though, gives you a shot at having them for a long time.

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I also know I'm scared of some issues from my past that probably need to be dealt with if I'm ever going to get over this. Additionally, I'm afraid I'm going to completely lose it if I do face these issues. What I don't know is how to confront these issues

I am wondering whether now is the time to speak about confronting issues from the past. I agree that you will need to do that eventually, but right now it seems to me that the main thing is to work on staying alive if that is or can be a goal and I hope that it is.

Suppose a person is (re)starting to study math. She could say to herself Ah, this is too daunting, how could i ever (re)learn calculus? and consider giving up. But of course, in due time, she could work her way up to calculus.

I think that when you are stronger and further along in recovery you will be in a position to look at these issues from the past. They would be rough to look at now, I imagine, but you don't have to do that.

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or how to convince myself to go regardless of how I feel about it or how to motivate myself to do the work required in order to reach recovery when a lot of times I really don't think I care one way or another if I live or die. Any bright ideas? I'd really love your input here.

Well I saw you post in the ED update thread (btw I suggest starting a new thread there with your question).

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Theoretically, am going to go to Johns Hopkins inpatient program within the next week or so, but I'm dreading the idea so much. I don't even know if I can handle the idea of being back in the hospital AGAIN, this time, likely for longer. I feel like all I'd get out of it right now is some weight gain and I wouldn't purge or overexercise for however long I was there.

This sounds useful for giving yourself a chance to live.

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I just don't know if I'm ready to give all those behaviors up and I feel like I might just go right back to where I started....If I don't do something, I'm going to die. I get told that on a daily basis, multiple times a day, but I'm just so tired of it all and I just don't know if I have the strength I'll need to do this whole treatment thing right now.

I go back to my question about reasons to dies versus reasons to live. What are reasons to die? Right now you are essentially making death the default option: if nothing changes, people are telling you that you will die. Is that what you actually want, or is it just what you might accept by default, rather than attempt to change?

I think that reasons to live can help you summon the strength you need for treatment. So what might be some reasons to live? You seem to enjoy and take satisfaction in supporting others here with your professional knowledge and you do so in a caring manner. You seem to have a good "bedside manner" here, as they say. Are there reasons to live underlying what you do here for others?

You've mentioned family and friends, being apart from them and wanting to connect via facebook, email, etc. (Did you do any of that today?) Could they provide reasons to live? You've mentioned journaling (which would be a good outlet for frustration and other feelings arising from reducing pacing). To what extent could self-expression provide a reason to live?

Think about times in your past where things went well, even if not completely well.

Think deeply and tell me: what are reasons for living?

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Thanks for your reply. Looking forward to your response.

Thank you for your kind words, again. I am always happy when i see that you have posted.

Okay...this is going to be super long. I woke up early and read this and I've been thinking about a lot of it ever since. A lot of it really made me think. I think I've come to some kind of rough conclusions, but I needed to get there eventually. I just don't think I want to admit some things that are probably painfully obvious to everyone else.
My lists: 1) Pros of no treatment: I'll be around for friends and family events in near future, I can focus now on moving forward with my life in other areas (theoretically), along the same lines, I can focus right now (theoretically) on future planning regarding career, relationships etc, I don't have to worry about admitting to family/friends (who don't already know) or work that I'm "sick", will hopefully boost my self-esteem by giving me a chance to prove to myself that I'm capable of "saving" myself, will allow me to deal with the ED in the real world in real life situations as it's likely going to be a life-long battle and IP treatment just isn't the real world, won't miss any more work and it'll be easier financially, will allow me more time in the immediate future to focus on preparing to return to medicine
2) Cons of no treatment: the physical complications that are occurring are pretty serious, could and probably will kill me in the near future if nothing changes, due to the malnutrition and purging I'm kind of a mess - mood swings, irritability, anxiety, depression etc, I've spent and will likely continue to spend way too much time in the hospital, ER, doctor's offices, at the infusion center etc, I generally feel like crap most of the time - I'm always dizzy, nauseous, always have a headache, pass out regularly, heart palpitations etc, all the time I spend obsessing over food, calories, exercise etc could be much better spent focusing on career, family, friends, other relationships, it's much less likely I'll ever be able to move forward in life if I continue to be stuck in the "ED pt" role, less likely I'll ever get married, have children, be where I want to be career wise if I don't recover - areas that are really important to me, uncertain if I'll be able to recover without help via an IP program. At the very least will be much more difficult to break this cycle, I obviously haven't been able to thus far, even being hospitalized for close to 6 wks.
3) Pros of treatment: Will likely result in me being mentally more stable, will likely have an improvement in physical health and much less likely to die in the next couple weeks or months, I MAY feel better eventually if I deal with past issues, it may be what I need to do in order to move forward, I'll have more time to spend on other, more productive and/or more fun things, emotionally, there will be more room for other people/activities/career in my life, people in my life will likely stop worrying so much, more energy to devote to other interests and moving fwd w life, it may be easier to recover with extra help/support/accountability, eventually, hopefully will have room in my life for marriage, children, career path I want, recovery will give me a chance to reinvent myself outside of the "pt" role - this may be, more likely than not easier with IP treatment than with only outpatient treatment
4) Cons of treatment: It's a locked unit - due to past trauma issues, I have big time issues with this idea, I honestly don't know if I can handle even the idea of it, I'm not sure I'm ready to deal with past issues that I'm guessing from past experiences the team will want to discuss, I'm kind of scared who I am without my ED - it's been more than half my life, I'm terrified of gaining weight, my family and most of my friends will assume I'm 100% better the second I leave treatment and will expect me to act and function as such, I'm also afraid I'll lose what little support I do have from them once I look like there's no longer an issue, I'm afraid I'm going to fail at everything - ED tx, my career, life, I almost don't even want to try, I almost feel like I'd rather not try than try and fail, and practical issues - I'll have to miss even more time off of work, which may endanger my job, and I've already missed a lot of friend/family stuff. I don't want to miss even more.

So that's my list....

As far as the pacing goes, I see your point. It's a valid point. I really am going to try for 8 min X 14 hrs ( so far so good..). I'll give myself three days of that and then try to drop down another hour or two. It makes sense not to do too much too quickly. Dropping every day IS probably too much. And you're right, it's probably going to increase once I go home. To be honest, if I'm able, I'm going to probably going to start running again, or at least going for long walks, so I'm going to have to really watch that and keep an eye on how long and how hard I'm exercising so I don't backslide too much.

They're discharging me home primarily because there's no real reason to keep me anymore and I really want to go home and I've been pushing for it for a while. It's a medical hospital, doesn't have a psych ward (not that I would ever allow myself to be admitted to a psych ward - it's complicated, but it would cause huge issues with my medical license. For some reason they don't seem to care about receiving ED treatment), the electrolyte issues are pretty easily and quickly correctable, and the cardiac stuff - the prolonged QT etc corrects when the electrolytes are corrected. For a while, there was a lot of other stuff going on - I was septic with a serious infection, my sodium was so low it had to be corrected over a week or so in the ICU (I've had previous brain stem damage from over rapid correction of my sodium) and my heart was really malnourished and wasn't pumping correctly essentially due to loss of muscle mass. The infection is gone, my sodium is often low, but not nearly as low as it was and I've gotten enough nutrition that my cardiac function has improved. I want to go home for a lot of reasons, but one of them is so I can pack. It's stupid, but if I'm going to IP treatment, I don't want to be directly transferred there. For some reason, probably not logical, but I really need to be the one to pack for treatment, clean my house, run some errands so I'm sure I have absolutely everything I could possibly need etc. And I'm just plain tired of being in the hospital. It's boring, it's mundane, I'm tired of telling 19 people the same thing ten times a day etc. Yes, I'm obviously not doing well and my attending was talking today about keeping me here until I could be transferred, but I totally shot her down because a) I'm still ambivalent about going and b) all of the above. We've made arrangements for me to see my therapist once a week, my doc once every two and I'm going to the infusion center once a week for labs, IV fluids, electrolyte replacement and they'll monitor my tube feeds for the 8 hours I'm there . This probably isn't enough, everything probably needs to be doubled, but this is what insurance is allowing to begin with, so that's how it's going to be. It's likely I'll end up in the hospital again fairly soon, not that I want to, I really, really don't, but things are just that unstable. Unless I make some very drastic changes like now.
Honestly, feeling scared doesn't encourage change at all anymore. It should. I wish it did, but I have this ridiculous invincibility complex and I'm convinced that no matter what, nothing's going to happen to me. My esophagus has ruptured twice resulting in borrehaave syndrome and mediastinitis, I've had two heart attacks, I've had central pontine myelinolysis (brain stem damage from sodium correction)I have seizures and myoclonus (twitches) due to brain surgery for an infection that was a direct result of my ED, I've had abscesses in my throat, neck and spine, even the meningitis was indirectly due to this damage (it's complicated) and I have tons of other more minor issues - GI probs, nerve damage from vitamin deficiencies, dental issues etc and I've somehow walked away from it all when I probably shouldn't have. So nothing really scares me anymore. Like yesterday, they came in and said your potassium is 1.6, your sodium is 119, your phosphorus is 0.7 and your magnesium is 0.9 and my response was, "Oh, it's fine, they've been lower before". Those are critical levels. They can result in cardiac issues, neuro issues, all kinds of things and I totally disregarded it. So, this is really long winded, but no, being scared doesn't help me change at all. I really wish it did.
Some of the time staying alive is a goal. Sometimes, I just don't care what happens one way or the other. I could live, I could die, it's all kind of the same to me. I agree that it may be very difficult right now to address past issues, but my therapist is really pushing for it and I do trust her and her clinical judgment and I think that may be part of what's holding me back and why previous IP treatments didn't work for long because I need to find a place of acceptance for some things and in the past, I've left treatment, done well for 6 months or so and then started obsessing about past mistakes, hurts, things done etc. And that's usually what's begun my downfall. So I think I do need to suck it up and face things. Maybe not in the very beginning, but shortly after.
Why do I want to live? Great question. A lot of times, I don't really know. Other times, I know I want a chance for a future. As I said above, I want a family, a solid career, hobbies, a chance to be happy (whatever that is), the opportunity to do the things I've always wanted to do - travel to Russia, return to Sweden to see my cousins again as I haven't been in 3 or 4 years, do some volunteer work, spend more quality time (not in the hospital) with family and friends, find some new hobbies, run another marathon etc. And I really do like "helping others", as cliché as it sounds. Thanks for saying that. I've always been told I've had a good bedside manner and I like to think I do I try to. Everything I say, I do say because I honestly care and want to help. All that kind of stuff is a large part of what keeps me going, I became a doctor because in part I was fascinated by medicine, but also because I honestly really enjoy trying to help others. It does help to feel like I'm at least doing some small thing that may help someone else and that maybe, if recovered and healthy, I'll be able to go back to medicine and do what I really want to do. That's probably my single greatest incentive for everything - staying alive, trying to recover, getting treatment etc right now.
Why do I want to die? That one's a little easier. Mostly because I'm just so tired. Tired of everything. Physically tired, mentally tired, emotionally tired, tired of struggling, tired of doctors and hospitals and IVs and meds, I guess I'm sick and tired of being sick and tired, which I've heard a lot as an impetus for change, but just the very idea of all that work exhausts me. And I'm honestly afraid of what the outcome will be and that I won't like or won't be able to handle what or who I become, not that I'm doing a great job with where I am now...And you're right, if I don't make a decision and soon, the decision is going to be made for me and I'm going to die as I'm spending hours debating the pros and cons of life and death and treatment vs. no treatment. And I think that would ultimately be sad, especially if I end up saying I want life and treatment and my body says, "so sorry, so sad. Too late, too much damage done". And I end up dying anyway. That would really suck.
I get ambivalence is common, but it still makes it really hard to seek out treatment. I wonder what is different between myself and the pts in the study and why they wanted IP treatment while I'm so stuck on the ambivalence piece that the other factors aren't playing quite as big of a role?
I do get that my time with family, friends isn't great quality right now and I'm probably using wanting more time with them/not wanting to miss anything else as an excuse. I really just need to admit some things to myself. And accept them as true whether I "believe" them or not. The idea that I'll have better and more fulfilling relationships once in recovery is one of them.
I did spend some time texting a friend and also spent a couple hours speaking with a high school girl I'm mentoring, so not quite a family/friend, but it was good, a good distraction nonetheless. She's going to come to the hospital on Sat and I'm doing her hair and make-up for prom, so that'll be fun. And I did spend some time journaling. Not quite 30 min, but I will today. I've already started. I think you're right, I think it'll be a good outlet. I'm not sure how or if it'll provide a reason for living, but I definitely think it'll help me cope with everything so I can see past the negative and hold on to other reasons for living.
The time in my life when things were going the best they've ever gone is when I was in residency. I had a built in support structure - fellow residents, great attendings and med ed director and I was doing what I loved and learning a lot. And I was busy. I didn't have time to obsess over things like my weight or food when there were more important things to worry about. There was meaning in my life, what I did every day made a difference, it mattered if I got up and did my job and how I did my job everyday. I felt like I mattered for maybe the first time in my life. I felt like what I did or didn't do mattered so it became much more important for me to make healthy decisions and lead a healthy life.
You asked what are my reasons to live? I think the single greatest reason is just to give myself a chance. A chance to be who and what I want to be, to do what I want to do and what I have the potential and capability to do. If I die, I'll never have that chance, I'll never know what might have been or what could have been. And I don't think I want that...I don't think so. Not at this moment anyway, but who knows how I'll feel tomorrow or 5 hours from now. It really is exhausting being stuck in this cycle.
Thanks for this. This really made me think. It was hard, but in a good way

Thanks so much for your reply.

Quote:

Okay...this is going to be super long. I woke up early and read this and I've been thinking about a lot of it ever since. A lot of it really made me think. I think I've come to some kind of rough conclusions, but I needed to get there eventually. I just don't think I want to admit some things that are probably painfully obvious to everyone else.

What are some things that you do you not want to admit?

Quote:

My lists: 1) Pros of no treatment: I'll be around for friends and family events in near future, I can focus now on moving forward with my life in other areas (theoretically), along the same lines, I can focus right now (theoretically) on future planning regarding career, relationships etc, I don't have to worry about admitting to family/friends (who don't already know) or work that I'm "sick", will hopefully boost my self-esteem by giving me a chance to prove to myself that I'm capable of "saving" myself, will allow me to deal with the ED in the real world in real life situations as it's likely going to be a life-long battle and IP treatment just isn't the real world, won't miss any more work and it'll be easier financially, will allow me more time in the immediate future to focus on preparing to return to medicine

I don't have a good handle on how much working you can realistically do in the current state of your health. How realistic is it to hold a job steadily now and otherwise move forward as described here?

Quote:

4) Cons of treatment: It's a locked unit - due to past trauma issues, I have big time issues with this idea, I honestly don't know if I can handle even the idea of it, I'm not sure I'm ready to deal with past issues that I'm guessing from past experiences the team will want to discuss, I'm kind of scared who I am without my ED - it's been more than half my life, I'm terrified of gaining weight, my family and most of my friends will assume I'm 100% better the second I leave treatment and will expect me to act and function as such, I'm also afraid I'll lose what little support I do have from them once I look like there's no longer an issue, I'm afraid I'm going to fail at everything - ED tx, my career, life, I almost don't even want to try, I almost feel like I'd rather not try than try and fail, and practical issues - I'll have to miss even more time off of work, which may endanger my job, and I've already missed a lot of friend/family stuff. I don't want to miss even more.

Some of these issues it would seem could be addressed proactively. But then I don't know what happened at previous ED units, maybe people have already tried these things.

To what extent can your support people be taught that you are not 100% cured when you leave? Or is this something you just have to deal with?

The locked unit: can this be specifically looked at promptly with cognitive therapy? It sounds like a panic-type disorder, has/could a therapist help you with this?

In general I am puzzled about the past issues: here you say that staff at a unit will want you to look at them and you won't want to...but below you say that your T wants you to look at them and you trust her clinical judgment.

It sounds like ED is something of a refuge from an overwhelming fear of failure. What do you think? As long as you are sick you don't have to take your chances in any of the areas of life that you mentioned.

You mentioned your residency, and it sounds like a wonderful time: what happened to the fear of failure then? Somehow you functioned well despite it, you overcame it. How? And what happened after that in your life/career?

So the fear of failure brings up two big issues in my mind: 1. I speculate/assume that this overwhelming fear is rooted in whatever happened in the past, which it seems from what you are saying included a less-than-fully-supportive family who perhaps expected virtual if not actual perfection and did a lot to make failure so feared today, and 2. what bad things do you think will happen if you "fail"?

Quote:

So that's my list....

Thanks!

Quote:

so I'm going to have to really watch that and keep an eye on how long and how hard I'm exercising so I don't backslide too much.

Good.

I of course read everything you said about your health now, your attending, and about going home. All I can say is: I worry. I worry about whether you can keep yourself safe with what is, admittedly, support well below that which you might need right now.

Thus: I worry.

Quote:

It's likely I'll end up in the hospital again fairly soon, not that I want to, I really, really don't, but things are just that unstable.

Then maybe it is safer not to leave?

Quote:

Some of the time staying alive is a goal. Sometimes, I just don't care what happens one way or the other. I could live, I could die, it's all kind of the same to me. I agree that it may be very difficult right now to address past issues, but my therapist is really pushing for it and I do trust her and her clinical judgment and I think that may be part of what's holding me back and why previous IP treatments didn't work for long because I need to find a place of acceptance for some things and in the past, I've left treatment, done well for 6 months or so and then started obsessing about past mistakes, hurts, things done etc. And that's usually what's begun my downfall. So I think I do need to suck it up and face things. Maybe not in the very beginning, but shortly after.

I completely agree that it was unwise to be allowed to be discharged from ED treatment, multiple times it seems, without addressing underlying issues from the past. Still, that level of wellness is not where you are now. Now you are unwell. What sort of schedule/plan would your T have for working on past issues? How readily could she accept that being done at JHU?

Quote:

And I really do like "helping others", as cliché as it sounds. Thanks for saying that. I've always been told I've had a good bedside manner and I like to think I do I try to. Everything I say, I do say because I honestly care and want to help.

Quote:

All that kind of stuff is a large part of what keeps me going, I became a doctor because in part I was fascinated by medicine, but also because I honestly really enjoy trying to help others. It does help to feel like I'm at least doing some small thing that may help someone else and that maybe, if recovered and healthy, I'll be able to go back to medicine and do what I really want to do. That's probably my single greatest incentive for everything - staying alive, trying to recover, getting treatment etc right now.

You said above that being scared doesn't motivate you. What about being "scared", if that is the right word, for your patients? You care about them, a lot, when you are at their bedside. What if you bring them to mind when you are deciding, let's say, whether or not to purge?

I mention this to help you see your greatest motivating factor--your greatest incentive--every day, in every moment. Could that happen? Could you see them when you are tired--sick and tired--to help you move forward when every ED impulse is telling you not to?

Quote:

I get ambivalence is common, but it still makes it really hard to seek out treatment. I wonder what is different between myself and the pts in the study and why they wanted IP treatment while I'm so stuck on the ambivalence piece that the other factors aren't playing quite as big of a role?

We could look at the other factors: where are you when it comes to control (behavioural and thoughts); how exhausted and isolated are you?; how intensely do you fear recovery?

Maybe it is the last one? Maybe you have an intense fear of recovery, as discussed above. What do you think?

Quote:

I do get that my time with family, friends isn't great quality right now and I'm probably using wanting more time with them/not wanting to miss anything else as an excuse. I really just need to admit some things to myself. And accept them as true whether I "believe" them or not. The idea that I'll have better and more fulfilling relationships once in recovery is one of them.

I would put it slightly differently. I'd say act as if those beliefs are true, even if you don't right now believe them.

Quote:

I did spend some time texting a friend and also spent a couple hours speaking with a high school girl I'm mentoring, so not quite a family/friend, but it was good, a good distraction nonetheless. She's going to come to the hospital on Sat and I'm doing her hair and make-up for prom, so that'll be fun.

This is great!

And while it is a distraction, I don't see it as mainly a distraction. I see this as beginning to rebuild yourself, block by block. Getting back to caring about others in action, in person, getting back to what made you a doctor, getting back to what makes you you. I see this not just as distraction, but as recovery. How did this relationship get established?

Quote:

And I did spend some time journaling. Not quite 30 min, but I will today. I've already started. I think you're right, I think it'll be a good outlet.

Excellent!

Quote:

I'm not sure how or if it'll provide a reason for living, but I definitely think it'll help me cope with everything so I can see past the negative and hold on to other reasons for living.

That sounds really good. You do know that you are allowed to write about the negatives? It is okay, it is most desirable, to expressin the journal whatever is on your heart at that moment in the journal.

Have you ever done the raisin mindfulness exercise? You examine the raisin in great detail, from all perspectives, turn it over, listen to it, smell it, and eventually eat it slowly and with full attention. You can do that same thing with negative thoughts, feelings: examine them, look at them with great interest and curiosity, rather than try to bury them.

Quote:

The time in my life when things were going the best they've ever gone is when I was in residency. I had a built in support structure - fellow residents, great attendings and med ed director and I was doing what I loved and learning a lot. And I was busy. I didn't have time to obsess over things like my weight or food when there were more important things to worry about. There was meaning in my life, what I did every day made a difference, it mattered if I got up and did my job and how I did my job everyday. I felt like I mattered for maybe the first time in my life. I felt like what I did or didn't do mattered so it became much more important for me to make healthy decisions and lead a healthy life.

This is still true. Just not so obvious. Your healthy decisions today help tomorrow's patients--and they help your mentoree today.

Quote:

You asked what are my reasons to live? I think the single greatest reason is just to give myself a chance. A chance to be who and what I want to be, to do what I want to do and what I have the potential and capability to do. If I die, I'll never have that chance, I'll never know what might have been or what could have been. And I don't think I want that...I don't think so. Not at this moment anyway, but who knows how I'll feel tomorrow or 5 hours from now. It really is exhausting being stuck in this cycle.

Really it sounds like you have two greatest reasons: to give yourself a chance, and to use your self to help your patients (as above).

Quote:

Thanks for this. This really made me think. It was hard, but in a good way

I am glad to try to help you start to find you again.

[QUOTE=Bill3;4402591]Thanks so much for your reply.

[COLOR=Magenta]What are some things that you do you not want to admit?

I don't have a good handle on how much working you can realistically do in the current state of your health. How realistic is it to hold a job steadily now and otherwise move forward as described here?

Some of these issues it would seem could be addressed proactively. But then I don't know what happened at previous ED units, maybe people have already tried these things.

To what extent can your support people be taught that you are not 100% cured when you leave? Or is this something you just have to deal with?

The locked unit: can this be specifically looked at promptly with cognitive therapy? It sounds like a panic-type disorder, has/could a therapist help you with this?

In general I am puzzled about the past issues: here you say that staff at a unit will want you to look at them and you won't want to...but below you say that your T wants you to look at them and you trust her clinical judgment.

It sounds like ED is something of a refuge from an overwhelming fear of failure. What do you think? As long as you are sick you don't have to take your chances in any of the areas of life that you mentioned.

You mentioned your residency, and it sounds like a wonderful time: what happened to the fear of failure then? Somehow you functioned well despite it, you overcame it. How? And what happened after that in your life/career?

So the fear of failure brings up two big issues in my mind: 1. I speculate/assume that this overwhelming fear is rooted in whatever happened in the past, which it seems from what you are saying included a less-than-fully-supportive family who perhaps expected virtual if not actual perfection and did a lot to make failure so feared today, and 2. what bad things do you think will happen if you "fail"?

Thanks!

Good.

I of course read everything you said about your health now, your attending, and about going home. All I can say is: I worry. I worry about whether you can keep yourself safe with what is, admittedly, support well below that which you might need right now.

Thus: I worry.

Then maybe it is safer not to leave?

I completely agree that it was unwise to be allowed to be discharged from ED treatment, multiple times it seems, without addressing underlying issues from the past. Still, that level of wellness is not where you are now. Now you are unwell. What sort of schedule/plan would your T have for working on past issues? How readily could she accept that being done at JHU?



You said above that being scared doesn't motivate you. What about being "scared", if that is the right word, for your patients? You care about them, a lot, when you are at their bedside. What if you bring them to mind when you are deciding, let's say, whether or not to purge?

I mention this to help you see your greatest motivating factor--your greatest incentive--every day, in every moment. Could that happen? Could you see them when you are tired--sick and tired--to help you move forward when every ED impulse is telling you not to?

We could look at the other factors: where are you when it comes to control (behavioural and thoughts); how exhausted and isolated are you?; how intensely do you fear recovery?

Maybe it is the last one? Maybe you have an intense fear of recovery, as discussed above. What do you think?

I would put it slightly differently. I'd say act as if those beliefs are true, even if you don't right now believe them.

This is great!

And while it is a distraction, I don't see it as mainly a distraction. I see this as beginning to rebuild yourself, block by block. Getting back to caring about others in action, in person, getting back to what made you a doctor, getting back to what makes you you. I see this not just as distraction, but as recovery. How did this relationship get established?

Excellent!

That sounds really good. You do know that you are allowed to write about the negatives? It is okay, it is most desirable, to expressin the journal whatever is on your heart at that moment in the journal.

Have you ever done the raisin mindfulness exercise? You examine the raisin in great detail, from all perspectives, turn it over, listen to it, smell it, and eventually eat it slowly and with full attention. You can do that same thing with negative thoughts, feelings: examine them, look at them with great interest and curiosity, rather than try to bury them.

This is still true. Just not so obvious. Your healthy decisions today help tomorrow's patients--and they help your mentoree today.

Really it sounds like you have two greatest reasons: to give yourself a chance, and to use your self to help your patients (as above).

I am glad to try to help you start to find you again.
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I think mostly what I don't want to admit is just how sick I really am and how bad things really are. Whenever anyone asks how I'm doing, my immediate response is, "I'm fine". I really don't want to admit I let things get so far out of control. But I'm not fine, not really. I'm pretty far from fine in reality. I also don't want to admit that I have a "mental illness" because that's completely frowned upon in my family. According to my family, mental illness simply doesn't exist, you just suck it up and do what you need to do regardless of what's going on mentally. Furthermore, I'm embarrassed to admit that I have this problem that I can't "fix" myself. I'm always been a pretty self-sufficient person and I've spent most of my life taking care of others. I really hate to admit that I have something going on that I can't solve on my own. I think those are the main things I'm hesitant to admit.
How realistically is it to hold down a job and try to begin moving forward? I honestly don't know the answer to this one. I have two to three doctor appts/week, plus I'll be spending one full 8+ hour day at the infusion center. In general, I'm weak, tired, preoccupied and often not thinking as clearly as I could or should be. Give me some time to think about this one. I'll get back to you. I really don't know. I'd like to think it's completely doable and that I'm superwoman and can do anything. I do however, have my doubts that I'll be able to handle much right now. It's pretty unlikely I'll be as effective as I would be if I was either in recovery or at least a lot closer to it. I don't know though. There's one more thing I don't want to admit.
I think the whole family believing I'm "cured" once I'm weight restored is just something I'm going to have to deal with. It has been addressed with at least some of my family members at several different treatment centers and they claim to understand and claim their support will continue as long as I need it to, but it just never works out that way. A few weeks into IP treatment, when the immediate, life-threatening danger has passed, the calls stop, the visits stop, the comments questioning when I'm going to go back to work, when I'm going to get married, when I'm going to have kids etc return. Stuff like that. I think it's just kind of the way my dad was raised, hence the way we were raised and is pretty ingrained and not going to change anytime soon. If I were to continue to try to discuss it, they'd likely call me a baby and ask me why I was being such a drama queen and say I was just looking for attention.
The locked unit issue is related to PTSD and a pretty traumatic event. I'm not sure I'll ever be able to deal with it regardless of how much or what type of therapy I get and I haven't ever addressed it and don't want to. I guess I could bring it up in my session next week (the issue with the locked unit, not the event itself, never talking about that) and see if we can come up with some things to maybe help with deal with it so JH could still be a possibility. I have my doubts though. I'm feeling panicky right now just thinking about it.
Regarding the past issues, I could just be projecting. In past treatments, whatever therapist I've had has always wanted to look at root causes of the ED and obviously this entails dealing with some past issues. I'm assuming a new one will take a similar approach. I could be totally off base. And as this is really something I don't want to do, maybe it's something I could discuss NOT addressing with them ahead of time. Yes, my current therapist has brought up several times that I'm going to have to deal with whatever issues are holding me back in order to move forward. However, it wasn't until the session before I went into the hospital that we discussed them on anything more than a very superficial level. I do trust her judgment. Almost implicitly, which is incredibly hard for me to do and if there are things for me to deal with ( and there are), I'd much rather do it with her than with someone I've just met, barely know and don't trust.
I wholeheartedly agree the ED is a refuge from fear of failure. I'm absolutely terrified of failing. I'm so, so scared of failing. I'm so scared of failing that a lot of times I'm scared to even try. You totally hit that nail on the head. If I'm "sick", it's not my "fault" if I don't succeed or don't achieve what I could or should achieve. I couldn't help it, I was too sick. Most of, well all of the time, that's the only time I feel like I'm allowed to get any kind of help of have any kind of attention paid to me, so I think subconsciously I perpetuate that cycle in order to keep getting that attention, negative or otherwise that I think I need. And I think I'm just as scared of succeeding as I'm am of failing if that makes any sense at all. I'm not really sure why? Maybe because then I'll have to face reality that I am an adult, I need to act like an adult and while it sucks that my childhood was spent taking care of my dying mother, father and younger brothers, so I never got much of a childhood, that's over with and done with and I'm never going to get it back and I just need to get over it and move on with my life. As an adult. I'm not a child. I need to stop acting like one. It seems like as long as I'm ill, I'm safe in this protective little bubble. Unfortunately, that's not the case and the real world continues to go on without me and I've missed out on a lot of really great things because of I've been so wrapped up in this world. I don't want to do this anymore. I want to live a real life in the real world with real people.
Residency was a great time. I don't really know what happened. I just know I was succeeding and doing well and in a very supportive environment with wonderful people and I guess that allowed me to be comfortable with who I am or who I was at the time. All this allowed me to take the risks necessary to be successful and achieve what I needed to achieve. In all honesty, I still haven't really figured out what happened. I don't really know what started my downfall. I can piece together parts of it, but not everything. It's a long convoluted story. I'll save the story of my fall from grace for tomorrow. I'm tired. And this would turn into an even longer reply than it already is.
You're right on again with the origins of the fear of failure. My family, primarily my father did expect perfection in everything I did and didn't tolerate much less. I'm not really sure what I'm afraid of happening if I do fail, it's not really a rational fear, more of a fear of not being "enough" as a person, of failing in life, that I'm a failure as a person, a daughter, a sister, a friend. Does that make sense?
I'm sorry, but I'm going to reply to the rest of your comments in a couple hours. I don't feel very well today. I think my electrolytes are off again (and I think I should be going home in 3 days, I'm obviously totally logical )
Thanks again for all your help. It really means a lot. You really make me think. It's good. And I do think it's helping.

In your family you were always the one responsible to help others, it feels alien and embarrassing to need to receive, and to receive, help from others. To have a "mental illness" is impossible in the eyes of family members, so it is very tough to believe and admit that you have one. You need to be fine in order to believe that you are in control.

That was another thing mentioned in that article: control. What is your thinking about that right now?

What would it mean if you were to admit how sick you really are?

Thank you for your thoughts about having a job. I'd really like to hear back on that when you are ready, if okay.

Okay, that is the reality of the situation: You will need to deal with it. Tell me about that: What does it mean to you to hear all of that from them? How might you deal with it?

Yes, the locked unit, not the event.

Are you familiar with safety behaviors? When something causing anxiety, there is a temptation to defuse the anxiety by avoiding the situation. So if someone is anxious in a crowd, they go food shopping at 7:00 a.m. That is a safety behavior. They avoid that anxiety, but they never face or cure the problem, it just persists indefinitely and their world gets that much smaller. The solution generally involves facing the fear, living with the anxiety, towing it along, if you will, doing what makes one anxious (in real life and/or in imagination), and over time the anxiety goes down.

Of course, in addressing causes of anxiety one generally starts with lower anxiety issues and works their way up a "fear ladder".

I of course expect you would be panicky about being in the locked unit, and maybe it is too big of an anxiety/panic for right now. But see if T can help, talking it over could be a very positive step.

How did you decide on JHU?

Yes, I think that most Ts are going to want to discuss the past with you to some extent as part of treatment. I think that a lot of the past is intertwined with the ED and needs to be understood and unraveled.

I completely agree that it would be best to discuss it with the T you know and trust. I wonder if that could be done by skype let's say at an ED unit. Or maybe by chat/email with her, like what we are doing. Or what about Ts at units: do you ever get to trust them over time--or no?

It is quite significant that you can trust her implicitly, and really good to hear.

But what about talking with me? You have been able to be candid with me about many things. It seems that you can trust me to some degree--and I hope always to be worthy of your trust. What is it like for you to speak with me?

What sort of help and attention did you get growing up?

What bad things do you think would happen if you got well and did not get the attention that you think you need?

Fear of success is a known phenomenon, but I don't think that it has to do with "just getting over" the very rough things that happened in childhood. I think you can be very hard on yourself.

Here are a few thoughts on fear of success. Sometimes people who have survived a rough/traumatic/tragic situation feel survivor guilt when they think of those who did not survive or whose lives were even more shattered. They might not want to succeed then, because success could increase the guilt.

Another possibility is that in your childhood you were never considered good enough, you always fell short of perfection and were criticized for it. So "I am not good enough" might be like the air for you: it is just always there, it is what you grew up with, it is what you take for granted, it is a core belief. To succeed is to question the very basis of your life, to question your most core belief about yourself. It feels alien and disorienting.

I want that for you too.

Okay good, when you are ready. I think there is a lot to be learned from looking at what happened.

Yes.

What happened growing up if someone in your family did in fact fail at something? Or maybe that just never happened, it was utterly unthinkable?

Obviously.

It is okay, your health is the most important thing. I hope that you feel better!

Good. Thanks for letting me know.

If it is okay, I would like to ask about two small things in connection with how you present yourself here. First, how did you choose the word in your screen name, pinkflower? Also, it interests me that you use the magenta color in this thread. Thanks!

I'll reply this afternoon. I just spent two days replying and this stupid thing erased it. Stupid thing. So frustrating.

Oh that is so frustrating! I'm sorry that happened.

I guess I chose my user name for a couple reasons. One, I use a very specific user name a log-in of most of my both personal and professional stuff (probably stupid, I know) and I wanted something completely different. I guess, pink is my favorite color by far, and ....I like flowers? I do like specific flowers - peonies, hyrangeas, most of the various kinds of roses, cherry blossoms, tulips, sweet peas, ranunculus etc ( I was planning for a while which was supposed to be this month. Yet another reason to hate april). I guess I didn't want anything anyone could possibly relate to me, so that I think this of anyone else, but I am embarrassed to have a medical illness).

Yes, people did fail in my family, but it was never "okay". We were never told; "I'm proud of you anyway or I know you did the best you could or God forbid, "I love you anyway". It was more along the lines of "what happened?" Or "well, that sucks", or "what happened to the rest of the points?" (If a grade wasn't 100%) or just lots of yelling an screaming about what a failure and screw-up we were, mostly me. I was the oldest, I tried to take the brunt of the anger for my brothers, tried to protect them, and I was also blamed for their short-comings for not "raising" them correctly. I was 9 when my mom got sick, 13 when she died. My dad had a lot of anger that he was forced to take care of all these kids that I don't think he really wanted, and was bitter than my mom was so sick and I think blamed her a lot for it. She was a type I diabetic with an eating disorder and never regulated her blood sugars the way she should have or could have. I know I blame myself for her death for not "taking care" of her better, but I also blame her for not caring enough about us to want to stick around and make sure we were okay. Does that even answer the question?

What happened after residency? I think it was multi-factorial. I lost a lot of my friends/support group as they moved away, I was forced to grow up and had a lot of responsibilities, essentially responsibilities for life and death that I just don't know if I was ready for and I think the main part is I felt really alone and stuck. I had gotten engaged during my intern year, and my ex-fiancé was verbally abusive and toed the line towards physical abuse and there was no one I could tell, no one I could talk to about it. I just felt really, really alone. I was in a new town with new people with a less than supportive staff, after coming from a very supportive administration and staff and I think all of this played a role and I just retreated into what gave me comfort, what was familiar, what I knew and it quickly got out of control. Does that make sense?

Sorry this is jumping around a bit, but my feelings regarding control haven't really changed all that much. I really still feel like I'm in control. If I really think about it rationally, I know I'm not, I know I'm out of control and I need to do something to figure out how to get myself back under control, but that scares the **** out of me and right now, I just can't admit that, despite all evidence to the contrary, I can't admit I'm not in control.

I've never been good enough, I've never been enough. At anything. At anytime in my life. It is a core belief, I can't even imagine thinking any other way and it's definitely been reinforced by those whose opinions matter most to me in my life. Even my doctor (see my PM), doesn't believe that I'm good enough or that I'll ever accomplish anything or be or do anything worthwhile in my life.

I didn't realize fear of success was that common. I always thought it was more of a fear of failure. I absolutely have survivor's guilt. I don't feel like it's right that I'm still alive when others I cared about aren't here and would probably be leading much more productive, successful, happy lives. I feel like they should be alive instead of me. I feel like God made a mistake and it should have been me who was killed and not others. I don't really know why I'm so scared of succeeding. Maybe because then, I'll have to face the reality that, while it sucks that I cooked the meals, took care of my brothers, got them up in the morning and put them to bed, paid the bills etc while my mom was sick and dying, it's over with and done with. I lost most of my childhood and I'm never going to get it back and while that does suck, it's reality and I need to learn to deal with it.

I think if I got well and all the attention in my life ceased, I'd probably honestly relapse. My family just doesn't give much positive attention to positive things, they've just been kind of expected. I suppose I need to seek out that attention in a positive manner through other means and other people, but it's just hard for me to do that, when it's been ingrained in me that my family loves me....but only when I'm sick. If I get better and my family ceases to be concerned, I guess I'll just cease to matter as well. And if I don't matter, there's really no point in me trying at anything - getting better, living, anything. If I'm not making a difference and I don't matter in this world, then why the hell do I even have to be here?

I didn't get much help or attention growing up except for negative things. I went through a very brief "bad period" because I think I was looking for attention, but that just resulted in a lot of yelling and other bad things.
My dad actually got child protective services called on him twice while I was growing up. More or less for neglect. The first time because he refused to put any of us in counseling after my mom died, and her death was pretty traumatic and one of my brothers had a very difficult time with it and the second time was when I reached a dangerously low level weight wise (think less than 3/4 of low triple digits) and my dad once again refused to put my in counseling or any kind of treatment. He tried to buy me milkshakes a couple times, but that's it. This was the early 2000's, so all that came out of it was a home visit (and they pretty much blew that off bc my father's a prominent attorney) and 3 visits with my guidance counselor. When I won track or gymnastics meets, I got a distracted "good job", when I got A's, if it wasn't 100%, I got asked about what happened to the other points etc etc. My father's and my relationship was very much more of an equal adult team, rather than a parent child, and any needs I had were pretty much swept under the rug. It's easier to ignore problems than deal with them.

Yes, for whatever reason. I'm almost completely comfortable speaking with you. I don't really know why. I have huge issues with abandonment and with being rejected. I'm always afraid to post anything about myself, to put myself out there, so to speak, because I'm afraid people will be horrified and disgusted and I'll be "too much" and nobody will be able to handle me and I'll lose what little support and social interaction I do currently have in my life. I guess it's because you tend to "show up". I'm always incredibly reassured when I see you're replies, it makes me feel like I didn't make a complete food of myself yet again. I have a very, very difficult time trusting people, but once I do, I tend to trust them almost implicitly, at least until I have a clear cut reason not to. I too, hope I'll always be able to trust you

Regarding the whole job thing; could I handle a high stress, full time job. No, absolutely not. I didn't even get out of bed yesterday after I was discharged, buy could I handle a low stress part time, like 10-15 hr/wk job? I think so. And I think it might be good for me. It would provide some accountability, it would give me a reason to get up in the morning, it would help financially, hopefully it would give me some sense of accomplishment and achievement, get me out of the house for things other than doctors appts and give me some more social interaction. I think ultimately, it could be a good thing, as long as it's low key, and kept under control.

Regarding the locked unit, yes, I do need to deal with it, but I don't have the slightest idea how and I don't even know where to begin. I'm terrified just at the idea of thinking of being in a locked unit. I honestly don't know if I can deal with it. I really don't. Yesterday was the worst day of the year for my PTSD and it's very rampant right now. The only thing that comes to mind is medicating myself throughout the whole process or just trying to ignore the fact that it's occurring. I don't think that will work though.
Are you talking about desensitization therapy? I get the idea behind it and agree theoretically it should work, but you can't desensitize oneself to what I went through. I just don't know how I'm going to handle it. I think my best option is to discuss this with my therapist and relate to her that I'm never going to discuss the instigating event and I'm absolutely not willing to discuss anything related to it with the interim therapist and leave it at that and just immediately change the subject if it's ever brought up. I have to protect myself and that's the only way I can see myself being capable of doing so.

I decide on JH mostly by default. I was rejected by many major treatment centers due to current and past medical stability (the central pontine myelinolysis, the esophageal ruptures, the boerhaave syndrome and mediastinitis, the electrolyte abnormalities and cardiac complications, the heart attacks, the blood clots in my lungs, legs and arms, severe asthma and food allergies, chronic head and neck problems form the brain surgery and meningitis, the history of re-feeding syndrome with congestive heart failure, the seizures and myoclonus, the nerve damage, the overwhelming fatigue , the dependence on the IV fluid and tube feedings etc etc,etc). I was all set to go to Princeton, but then they got my medical records. Most are terrified something horrible is going to happen again. And it very well might. So I need to be in a large, tertiary care hospital with very advanced medical care available at a moment's notice. So, John's Hopkins it is. I'm not thrilled about it. I'm not a huge fan of their program. I would have much rather gone to Princeton, but I guess we don't always get what we want in life.

I would much rather deal with my current therapist while in treatment over Skype or something else, but she's very professional and I know she won't want to step on any toes and will reserve my treatment while I'm there to be done by therapists there, good, bad or indifferent. I don't agree with this and I really wish it could be different. I will bring it up, but I'm 99% sure of what the answer will be.

I think that's everything. I'll answer the stuff from yesterday tomorrow. Today was a very rough day. It took everything I had just to type this e-mail. Frankly, all I want to do is curl up in a ball and never wake up. I'm just not interested in living anymore. There's no point. My life has no meaning and is never going to and I'm really just tired of trying. Sorry to be so negative.
Thanks so much for your reply. You have no idea how much it means to me. I really hope to hear from you soon.
Kirstyn

Thanks for explaining about your user name. I did not understand tyhe passage about april though:

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I do like specific flowers - peonies, hyrangeas, most of the various kinds of roses, cherry blossoms, tulips, sweet peas, ranunculus etc ( I was planning for a while which was supposed to be this month. Yet another reason to hate april).

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Yes, people did fail in my family, but it was never "okay". We were never told; "I'm proud of you anyway or I know you did the best you could or God forbid, "I love you anyway". It was more along the lines of "what happened?" Or "well, that sucks", or "what happened to the rest of the points?" (If a grade wasn't 100%) or just lots of yelling an screaming about what a failure and screw-up we were, mostly me.

I'm sorry that you had to go through this.

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I was the oldest, I tried to take the brunt of the anger for my brothers, tried to protect them, and I was also blamed for their short-comings for not "raising" them correctly. I was 9 when my mom got sick, 13 when she died. My dad had a lot of anger that he was forced to take care of all these kids that I don't think he really wanted, and was bitter than my mom was so sick and I think blamed her a lot for it. She was a type I diabetic with an eating disorder and never regulated her blood sugars the way she should have or could have.

I'm so sorry for the loss of your mother. I'm sorry for the loss of your childhood.

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I know I blame myself for her death for not "taking care" of her better, but I also blame her for not caring enough about us to want to stick around and make sure we were okay. Does that even answer the question?

Yes it does answer the question. Thank you for that, it must have been painful to write.

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What happened after residency?...Does that make sense?

Yes, it makes sense. I'm sorry that all of those things happened to you. You were so very alone.

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Sorry this is jumping around a bit, but my feelings regarding control haven't really changed all that much. I really still feel like I'm in control. If I really think about it rationally, I know I'm not, I know I'm out of control and I need to do something to figure out how to get myself back under control, but that scares the **** out of me and right now, I just can't admit that, despite all evidence to the contrary, I can't admit I'm not in control.

You have a desperate need to be in control. That makes sense, too, when one thinks about what has happened in your life. So much happened that was out of your control, with such devastating consequences. And it was enlightening also to learn that your mother had an eating disorder, they run in families. Something else that you could not control: a genetic inheritance that might have tended you towards an ED, and then a family environment that tended to activate that inheritance.

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I've never been good enough, I've never been enough. At anything. At anytime in my life. It is a core belief, I can't even imagine thinking any other way and it's definitely been reinforced by those whose opinions matter most to me in my life. Even my doctor (see my PM), doesn't believe that I'm good enough or that I'll ever accomplish anything or be or do anything worthwhile in my life.

Challenging that core belief will I think be a central part of your healing.

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I didn't realize fear of success was that common. I always thought it was more of a fear of failure. I absolutely have survivor's guilt. I don't feel like it's right that I'm still alive when others I cared about aren't here and would probably be leading much more productive, successful, happy lives. I feel like they should be alive instead of me. I feel like God made a mistake and it should have been me who was killed and not others.

This would be another core belief to address: that you should have died and others lived.

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I don't really know why I'm so scared of succeeding. Maybe because then, I'll have to face the reality that, while it sucks that I cooked the meals, took care of my brothers, got them up in the morning and put them to bed, paid the bills etc while my mom was sick and dying, it's over with and done with. I lost most of my childhood and I'm never going to get it back and while that does suck, it's reality and I need to learn to deal with it.

You tell yourself Learn to deal with it. You can be very hard on yourself. we do have a main way to learn to deal with a loss: grieving. Have you been able to grieve for the loss of your mother? Another good part as i see it of your recovery: would be to grieve, to mourn the loss of childhood. and grieving is done with patience and compassion, not with get over it, learn to deal self-criticism.

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I think if I got well and all the attention in my life ceased, I'd probably honestly relapse. My family just doesn't give much positive attention to positive things, they've just been kind of expected. I suppose I need to seek out that attention in a positive manner through other means and other people, but it's just hard for me to do that, when it's been ingrained in me that my family loves me....but only when I'm sick.

i agree that consistent, positive support--whether or not you are sick--will be very important.

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If I get better and my family ceases to be concerned, I guess I'll just cease to matter as well.

This strikes me as a cognitive distortion: If I don't matter to my family, I don't matter to anyone.

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And if I don't matter, there's really no point in me trying at anything - getting better, living, anything. If I'm not making a difference and I don't matter in this world, then why the hell do I even have to be here?

And this too strikes me as distorted thinking: there are many ways to make a difference besides mattering to one's family. You have already done a lot of them, you are doing some even now, and a good goal would be to get back to doing more of them as you heal.

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My dad actually got child protective services called on him twice while I was growing up. More or less for neglect. The first time because he refused to put any of us in counseling after my mom died, and her death was pretty traumatic and one of my brothers had a very difficult time with it and the second time was when I reached a dangerously low level weight wise (think less than 3/4 of low triple digits) and my dad once again refused to put my in counseling or any kind of treatment. He tried to buy me milkshakes a couple times, but that's it. This was the early 2000's, so all that came out of it was a home visit (and they pretty much blew that off bc my father's a prominent attorney) and 3 visits with my guidance counselor.

I'm sorry that, in this example as well as the others, you did not get the care and attention that you needed.

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Yes, for whatever reason. I'm almost completely comfortable speaking with you. I don't really know why. I have huge issues with abandonment and with being rejected. I'm always afraid to post anything about myself, to put myself out there, so to speak, because I'm afraid people will be horrified and disgusted and I'll be "too much" and nobody will be able to handle me and I'll lose what little support and social interaction I do currently have in my life. I guess it's because you tend to "show up".

When I show up I am implicitly stating that you are not "too much" and I am not horrified or disgusted. Which I am not.

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I'm always incredibly reassured when I see you're replies, it makes me feel like I didn't make a complete food of myself yet again. I have a very, very difficult time trusting people, but once I do, I tend to trust them almost implicitly, at least until I have a clear cut reason not to. I too, hope I'll always be able to trust you

Thank you very much for your kind and heartening words.

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Regarding the whole job thing; could I handle a high stress, full time job. No, absolutely not. I didn't even get out of bed yesterday after I was discharged, buy could I handle a low stress part time, like 10-15 hr/wk job? I think so. And I think it might be good for me. It would provide some accountability, it would give me a reason to get up in the morning, it would help financially, hopefully it would give me some sense of accomplishment and achievement, get me out of the house for things other than doctors appts and give me some more social interaction. I think ultimately, it could be a good thing, as long as it's low key, and kept under control.

Sounds reasonable to me.

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Regarding the locked unit, yes, I do need to deal with it, but I don't have the slightest idea how and I don't even know where to begin. I'm terrified just at the idea of thinking of being in a locked unit. I honestly don't know if I can deal with it. I really don't. Yesterday was the worst day of the year for my PTSD and it's very rampant right now. The only thing that comes to mind is medicating myself throughout the whole process or just trying to ignore the fact that it's occurring. I don't think that will work though.

Right that will not be a healthy way to handle things.

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Are you talking about desensitization therapy? I get the idea behind it and agree theoretically it should work, but you can't desensitize oneself to what I went through. I just don't know how I'm going to handle it. I think my best option is to discuss this with my therapist and relate to her that I'm never going to discuss the instigating event and I'm absolutely not willing to discuss anything related to it with the interim therapist and leave it at that and just immediately change the subject if it's ever brought up. I have to protect myself and that's the only way I can see myself being capable of doing so.

Okay, i agree that discussing it with your therapist is going to be a good first step.

The main issue for the moment is for it to be possible for you to stay in that unit, so you can receive treatment. Getting to that point does not have to involve disclosing why you feel as you do, or what happened.

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I decide on JH mostly by default. I was rejected by many major treatment centers due to current and past medical stability (the central pontine myelinolysis, the esophageal ruptures, the boerhaave syndrome and mediastinitis, the electrolyte abnormalities and cardiac complications, the heart attacks, the blood clots in my lungs, legs and arms, severe asthma and food allergies, chronic head and neck problems form the brain surgery and meningitis, the history of re-feeding syndrome with congestive heart failure, the seizures and myoclonus, the nerve damage, the overwhelming fatigue , the dependence on the IV fluid and tube feedings etc etc,etc). I was all set to go to Princeton, but then they got my medical records. Most are terrified something horrible is going to happen again. And it very well might. So I need to be in a large, tertiary care hospital with very advanced medical care available at a moment's notice. So, John's Hopkins it is. I'm not thrilled about it. I'm not a huge fan of their program. I would have much rather gone to Princeton, but I guess we don't always get what we want in life.

Okay, this all makes sense to me.

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I would much rather deal with my current therapist while in treatment over Skype or something else, but she's very professional and I know she won't want to step on any toes and will reserve my treatment while I'm there to be done by therapists there, good, bad or indifferent. I don't agree with this and I really wish it could be different. I will bring it up, but I'm 99% sure of what the answer will be.

it is good to bring it up, it is good to state your feelings and desires, even if it turns out that they can't always be met.

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I think that's everything. I'll answer the stuff from yesterday tomorrow. Today was a very rough day. It took everything I had just to type this e-mail.

And you did it.

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Frankly, all I want to do is curl up in a ball and never wake up. I'm just not interested in living anymore. There's no point. My life has no meaning and is never going to and I'm really just tired of trying. Sorry to be so negative.

I am glad that you can state your current thoughts and feelings here. Sometimes i wonder if you start to feel sorry for yourself. Like here. I am not telling you to change your feelings, your feelings are what they are, but I am urging that you be aware of them, look at them closely, think about what they mean to you.

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Thanks so much for your reply. You have no idea how much it means to me. I really hope to hear from you soon.

Thank you so much again for your kind and supportive words. Speaking with you means a lot to me as well.