EDNOS: a medical acronym that stands for “Eating Disorders Not Otherwise Specified”
On August 3rd of last year, I finally started treatment for Binge Eating Disorder. I wrote about my trepidation and my decision at length on that day.
I’ve come a long way.
I’ve spent seven months in treatment, and will probably spend a few more. Until the end of December, I had two appointments per week at The Emily Program (whose services I highly recommend). I met with a therapist once per week, and I met with a nutritionist once per week. After the turn of the year, I felt brave enough to back off to one appointment per week (meeting with the therapist and nutritionist on alternating weeks).
I feel that I’m in the endgame now. I’m now trying to piece together everything I’ve learned into some sort of mental package that I can maintain. Trying to figure out how to take the training wheels off the bike.
I look back on the last seven months and know that I spent a lot of time and a lot of money to get where I am today. I have a wicked great insurance plan that covered the vast bulk of the treatment cost, and I still shelled out a couple thousand dollars to do this. Fifty medical appointments ain’t cheap. I shudder to think what happens to people who are struggling with similar disorders and who don’t have access to that sort of money or resources.
Would I spend all that time and money again? Oh yes. A hundred times, yes.
One of the interesting things that happened while I was in treatment was that Binge Eating Disorder was redefined in the medical community. The DSM-5 was released on May 18, 2013, and the changes were trickling down to the insurance level. In the DSM-5, Binge Eating Disorder was acknowledged as its own distinct disorder, instead of being part of the psychological junk drawer that is EDNOS.
I’m not sure if this altered whether I was able to get treatment so easily, but it’s possible. Public Service Announcement: if you think you suffer from an ailment like mine and had trouble getting treatment in the past, it might be worth trying again.
Of all the things I learned during treatment, the biggest eureka moment happened when I was told that eating disorders are a part of the obsessive-compulsive spectrum.
First of all, I didn’t realize that OCD had a spectrum. I’m used to hearing “spectrum” in reference to autism, but I’d never before heard that OCD had one, too. It makes sense, though: for me, a binge episode felt like a cycle of thought/behavior that I couldn’t break on my own, and that’s exactly the sort of thing that happens to compulsive gamblers, compulsive cleaners, and compulsive skin-pickers.
The next realization I had after that was this:
The food isn’t the problem.
The food is a manifestation of the problem.
I can’t even tell you how big of a revelation that was for me. If I believed in angels, I’d say that a full choir of ’em marched in and sang at me.
It’s no use blaming the food. It’s no use controlling the food. It’s no use because food isn’t the problem.
The problem is the anxiety that feeds the cycle. You can’t break a cycle if you don’t take away the fuel that drives it. I had been trying to take away that fuel by controlling the food, and it never worked because the food was never the fuel in the first place.
Once I realized that, it made all the sense in the world.
I asked my therapist about this a few weeks back, and she said that it’s common to see people move from one OCD disorder to another if the cause of anxiety has not been treated. For instance, an anorexic might stop her or his calorie restriction, yet move on to trichotillomania. The binging, the hoarding, the hair-picking… it’s all just different flavors of the same thing.
Something I love about The Emily Program’s offices is that they have jigsaw puzzles in the waiting rooms instead of magazines. It’s fun to show up twice a week to see how a puzzle has progressed, thanks to a few minutes’ time from every patient. I often found myself showing up early just so I could work on a puzzle.
Of course, there’s something both brilliant and a little dark about throwing a bunch of jigsaw puzzles at a bunch of people who are all battling an obsessive-compulsive disorder.
How did I arrive at an eating disorder?
Growing up in the ’80s, when the aerobics fad hit. Retaining a few ghosts of mistreatment by a few men in my past. Dieting for years and years and years and years, first to simply stay at a healthy weight, and then to try to rid myself of 80 lbs that suddenly appeared on my frame. Couple those things with being ambitious and driven to succeed, and you get a nice recipe for an endless battle.
It turns out that long-term dieting is a great way to breed an eating disorder. Your desire to lose weight and control what you eat is at odds with what your body actually wants. In the short term, this is probably okay if you strive for modest, sustainable changes in your diet. Long periods of food deprivation, though… that can turn into an endless numbers game, where your brain and body bully each other over calorie intake.
I spent decades aiming at numbers between 1,300 and 1,750 calories per day. Calculators online would say that my 5’7″ frame should burn about 2,000 calories per day, and according to weight loss sources, my calorie restriction should have been in the moderate/safe zone. I’d bump up my intake if I was exercising heavily; I knew I shouldn’t have a net intake below 1,200 calories per day.
So, I believed I was dieting responsibly.
It turns out I wasn’t just training my brain into OCD. My math was also wrong.
After I was ordered to stop dieting, I spent a couple weeks continuing to count calories — but only doing the calculations at the end of the day, after I’d eaten anything I wanted. I didn’t allow calorie counts to judge what I was eating. But I did want to do the math afterward, to prove to my brain that, really, it’s going to be okay to eat this much.
When I stopped dieting, my food intake shot up to about 2,400 calories per day (and I wasn’t on a regular exercise routine). And over the period of over two weeks, I suddenly lost five pounds.
I thought my metabolism was broken. It turns out that it actually burns calories like a ferret on speed. The problem was that I was starving, and my body was trying to prevent me from starving to death.
Of course I was going to binge regularly.
It turns out the solution to my weight control problem was to give up dieting. Sometimes, you have to give up in order to succeed.
The binges faded away pretty quickly after I stopped dieting and managed some lingering anxiety. In fact, it shut off like a faucet once I started the “intuitive eating” thing.
I still get pangs now and then, a random urge to just eat until I’m numb. But being aware of that urge, and knowing what it is, helps tame the demon. Knowing how to inspect why that urge is there. Knowing that the urge comes from within, not from the food. Knowing how to recognize triggers so I know when the next urge will likely show up. Knowing how to prepare to deal with the urge. Even knowing that, yes, it’s okay to give in to that urge every once in a while.
But mostly, when I started eating enough, and when I started eating what I wanted, and when I started eating what my body told me to eat, and when I started paying attention to what would genuinely make my body happy… that’s when the binges stopped.
If my situation sounds familiar to you, I urge you to get to an eating disorder therapist. You have no idea how much your life will improve once you are no longer fighting a constant internal battle.
Also, if my situation sounds really familiar — chronic dieting and such — you might find help within the pages of Intuitive Eating by Evelyn Tribole. You should still go to therapy, because this book was only part of the solution for me, but I got a lot of value out of it. (Also, you can buy it used for super cheap used on Amazon, so it’s worth a shot.)
My weight has stabilized at the moment. I’m neither gaining nor losing weight. While I’m a touch disappointed that my weight problem hasn’t magically vanished, I am far more happy just spending my days not living and breathing calorie math. It’s like a huge weight has been lifted from my life. If carrying around a few extra pounds is the cost of living a life free of an eating disorder… that’s a cost I’m happy to pay.