Tag: Eating Disorder

A closing drawbridge and a silent cry – Eating Disorders and Personality Disorder – #6

A closing drawbridge and a silent cry – Eating Disorders and Personality Disorder – #6

Protection in Emptiness

Eating Disorders and Personality Disorder – #6

“Closing the drawbridge” – eating disorders and rigidity

PLEASE READ WITH CAUTION – this post contains discussion of eating disorders (primarily anorexia), description of my eating-disordered thinking patterns, and a link to an article about studies on calorie restriction

[Wow, again it has been too long since I have posted in this series. Sorry.]

Many books about eating disorders, in particular anorexia, mention rigidity of thinking as a symptom which emerges as restriction of food increases and weight drops. When I worked at an eating disorder service, it was frequently described in inpatients on the ward. I’ve been pondering why this is and how much did I experience it when I was anorexic. I never used to think that my eating disorder was about control, although I now would take that back and I think I did use it if not exactly for control, in order to separate myself from my mother’s abuse and protect myself (and, I thought, others too) from demands, emotions and the dangers I felt they presented.

Perhaps it is logical that counting calories and measuring portions and exercise, forcing yourself to adhere to a punishing regime of starvation and painfully excessive activity in the very weakened physical state of anorexia, requires a strong, almost angry, obsessional drive. Sticking to this above and against all the natural urges of your body to keep you well and nourished, to the point that your body consumes its own muscle for energy, requires a steely determination that must be fuelled from somewhere. This could be seen as rigidity. It could easily spread to other areas of cognition and daily routine.

Certain chemical changes in the brain are thought to contribute to this rigidity as well, I believe. Two studies were conducted in the 1950s, using as participants conscientious objectors to National Service and former prisoners of war. One of these is the Minnesota Starvation Experiment, where starvation was imposed on physically and psychologically healthy participants who had no history of eating disorders. As the participants’ calories were reduced and their weights dropped, their thinking patterns became more rigid and obsessional thought and behaviour patterns emerged. When their calories were no longer restricted, they also became vulnerable to binge-eating. You can read more about Ancel Keys’ Minnesota Study here. (It would be considered highly immoral by today’s standards, although perhaps it is worth bearing in mind that one purpose of the study was in order to find out how to care for and manage re-feeding and weight restoration in victims of starvation in several countries following World War II.)

I am not sure to what extent rigid thinking was a big feature in me when I was severely underweight. Others who knew me at the time might disagree! It was mentioned to me on a couple of occasions.

On further thought, perhaps I did not struggle so much with rigidity over, say, my daily timetable – with the notable exception of excessive exercise, as I forced myself to swim a certain distance a certain number of times per week, until I was so exhausted and weakened that I could no longer move through the water which felt ice cold, my legs cramping, and I would drag myself to the changing rooms with my skin purple and blue, bruises appearing that did not heal and no number of layers of clothing warming me up.

However, if the rigidity was not externalised, it was certainly internal. This is what I think of as the “closing drawbridge” of anorexia that locks up or locks away everything we fear. I’ve talked in previous posts about the blissful, safe numbness of anorexia, ensuring my emotions were in check and flattened, and ensuring the evil I perceived in me was locked away to hurt only me, weaken only me, so that I could not hurt anyone else. Locking up the perceived evil locked up feeling, too. No more panic – just obsessive counting calories, distances, how to hide or avoid food. No more fear – just explicable pain, wonderful blanks and emptiness, safe empty gnawing in my stomach. No need to feel others’ feelings. No need to be hurt or be overwhelmed. Just glorious numb, nothing, whiter. lighter, clearer than before. No needing; no taking; just closing down, separated, apart from everything, locked up safe, pushing away and always succeeding, taking nothing in, frozen.

As a friend pointed out to me recently, emotions take energy, just as physical exertion takes energy, so with vastly insufficient calorie intake, there simply is no energy with which to feel. Despite the lack of energy, the drawbridge was shut tight and closing harder. The further I starved and restricted, paradoxically, tighter shut the door and even stronger came the energy driving me on, not to need, not to feel, not to fear, not to touch anyone or anything.

Coupled with that strength came a desperation never to leave this closed up place and never to need or feel again, to remain unreachable, to keep safe away and to keep everyone else safe away from me. If I could just be sure to hurt myself enough and never to eat, this wonderful place would stay with me. The fear of everything the drawbridge kept away joined the energy and both drove me harder and deeper into the numb place of anorexia.

Combined with my mother’s illness and abusive actions, there was no shortage of reinforcement from the outside that this numb place was good. The only period of my life in which my mother’s emotional abuse and threats reduced and in which she was even caring towards me, in which interactions with her were free of threats and scorn and twisted statements about the harm I was doing to her and my father, was when I was severely underweight with anorexia so severe it was probably life threatening. I was no longer a danger and no longer seemed to be so evil. I even thought perhaps she loved me. I even dared to hope perhaps the evil thing I was sure was in me and that came out and hurt and controlled and deceived everyone, was gone. If I could just stay like this, perhaps it wouldn’t come back. On the other hand with the drawbridge tight shut my body was mine as well, only mine, and the anorexia was mine, and she would never come near me again, literally never touch me again.

(Perhaps that was the one thing that was eventually true in all my twisted anorexic thinking. She did abuse me sexually during the anorexia but afterwards, she didn’t ever abuse me sexually again.)

Until I started to eat again and weight restore, there was only one thing that cut through my rigid defences, and that was singing. I’m not a particularly good singer but I was in a musical at my school (more because I used to be able to dance, than for my voice, I think!) and afterwards I took singing lessons, which were about the only part of my later school years that was enjoyable. Although I enjoyed singing, during the anorexia I would find that the music had a peculiar effect. We didn’t usually sing particularly emotive songs but I would often find music bringing me to want to cry or causing a strange twisting feeling of unease inside me, as though it was draining away the rigid kind of energy but I wouldn’t let it go. My mother prevented me seeking any professional help for my eating disorder but the only two people to whom I did talk about it honestly at all at school were my singing teacher and my art teacher. (My swimming coach was also very concerned about me and to some extent I did talk to her but, for some reason, although I knew she cared and was a safe person to trust, I was never able to be truthful to her, I think because in some way I feared hurting or disappointing her too much.) I don’t know why music and to some extent art, broke through the rigid protective mechanisms, but it did. I know that music can be very helpful in therapy for people with various conditions, including dementia and depression. I’ve never read about it in relation to anorexia but that might be something I should look into!

The struggles I have with overpowering, overwhelming emotions in my Borderline Personality Disorder, are the complete opposite of the protective place I entered in my anorexia, and they are an excess of feeling and needing which are probably, actually everything I feared. If I’m honest the numb place was safer. I’ve long lost the way back there and lost the key to the drawbridge and I hate that and I’ll admit that in the worst times, when I really hate myself and everything I feel and need, I wish I could return and it’s hardest at these times to try not to punish myself with cutting or purging. I’m trying to learn how to choose life and staying connected to other people – and to my body and my emotions – without the unbearable and dangerous becoming all that there is.

Ginny xx

PD and ED – some thoughts about personality disorders and eating disorders

The majority of other sufferers of personality disorders that I have met with, as an inpatient and in the community service I go to now, have difficult experiences surrounding food, for example, having diagnoses of anorexia or bulimia, struggling with fluctuating weight, punishing themselves with food-related actions (starving or making themselves sick or bingeing, or deliberately eating foods they are allergic to in order to provoke a painful physical symptom) and so on.  This is just an observation from what I have encountered and there could be many factors involved – for example, issues around weight do seem to be on the up in the UK (or at least more prominent in media coverage?) and the majority of people I know with personality disorders are women, amongst whom eating disorders are also more common.  However, it did get me thinking and resonate strongly with my own experiences of food and disordered eating and of working in an eating disorder service.

I think food is tightly bound to feelings of anger at self or at one’s own uncontrollable emotions, and makes an effective – though it hurts to use that word – form of self-harm.  When you have thoughts like: I’m so disgusting I don’t deserve to eat / don’t deserve good food only rubbish, I do not deserve to care for myself so I only eat junk, I hate my body for making these demands [to eat], go on you disgusting bitch [I say to myself] look what you’ve done you greedy pig, now get rid of it, throw up til your throat bleeds….you’re foul, you’re disgusting, look how much you’ve hurt everyone, starve and make sure it hurts……. Those kind of thoughts; or even just being too low in the darkness to respond to the basic need for nourishment.

When my eating was the most disordered, I didn’t get specialist help or even much acknowledge the problem in the worst times, despite the efficacy of the function it was serving for me.  I was also blind to it.  My mother (in part because of how her thoughts were twisted by her own sickness) also prevented me from accessing the help that my GP desperately wanted me to get. Now I know that I was underweight enough to fall into the severe anorexic weight range where dire physical consequences were a risk.  My periods stopped and I suffered damage to discs in my back during this time.  (More on my own disordered eating in another post.)  This was long before I was diagnosed with personality disorder (my eating disorder first started when I was about 14) and it is only now, nearly 15 years later, that I am acknowledging it and can articulate what its functions were.

The other day I spied a leaflet for carers in the community service I’m part of, which discussed some of the signs of personality disorders.  “Eating disorders” was actually specifically listed as a “symptom”.  This struck me in particular because personality disorder often occurs jointly with other psychiatric diagnoses but these would not be classed as a “symptom” of personality disorder.  (For example, many people with forms of personality disorder also have bipolar disorder, but bipolar would not, at least to my knowledge, be classed as a symptom of personality disorder – it is a different diagnosis which someone may have at the same time.)

I would agree that struggling to feed myself well and at times, actions that would be classed as eating disordered behaviour, are tightly related to my emotional instability, lack of control over strong emotions or thoughts that are repulsive to me, and the need to punish and hurt myself.  So yes, I would say these are “symptoms” of my personality disorder.

I talked to two friends about the leaflet I had seen – both are highly experienced in the treatment of eating disorders.  One point they made was how much eating disorders are a sign of something else painful.  It’s often thought that once someone’s problems with food and weight are treated, they are “all better”.  However, that is very much not so.  The eating disorder is often masking, indeed a mechanism for coping with, something else.

It could be numbing, or controlling.  Overeating could comfort, suppress, bury, emotions.  Starvation, I think, ironically consumes; the hunger that gnaws painfully eats away other feelings and leaves a blessed numbness.  Thinking back to my own times of starvation, I have to admit that it was, at the very least in a significant part…. fantastic.*  I was wrapped in a protective, protecting numbness, for long periods.  (The times this cracked were utterly terrible, but the times it lasted froze me in a lighter, safer state, so it seemed.)  I will explore more of this in another post.

One struggle in personality disorders is that our emotions may, with less stimulus than it ordinarily takes, reach an unbearable high where we cannot cope or think, where there’s only fear, upset, panic, darkness, anger, sadness… or much more occasionally, extremes of joy (I am not sure why the extremes of positive emotions are so much more occasional.  Perhaps do they just trouble us less as these emotions seem more acceptable, and therefore we remember these extremes less?)  In these extreme states we can’t think, we don’t act rationally, our memory may be affected, and we may take extreme actions like overdoses, self-harm, suicide attempts, and so on.  Then it takes longer to come back down from that extreme state to “normal” – the level of emotion where it is possible to cope and function and think – than it ordinarily would take.

So I think one interaction of eating disorders with personality disorders could be this.  First, the eating disorder may serve the function of numbing emotions in the first place, so that those dangerous high extremes are not reached in the first place.  Second, it may serve the purpose of bringing us down from the extreme, with their numbing, consuming, controlling effect.  It’s similar to other forms of self harm.  When I am in extreme distress and I cut, for a brief time, it deals with the emotion or makes things feel safe again because I can be sure I’m hurting myself, not someone else.

These are just my thoughts and I would love to know more about research into this.  I wonder how much there is.  I have read quite widely in my work and studies about eating disorders but have not come across very much on this topic, beyond the fact that the two diagnoses can occur together.  It strikes me that the interaction between eating disorder support services and other support services like personality disorder teams or wider community mental health teams, is something that warrants much exploration if we are to support someone not only to recover physically from an eating disorder, but emotionally as well.

*When I was in the midst of the eating disorder it frequently did feel fantastic.  I am NOT advocating eating disorders and I know rationally now – thankfully – that it was anything but fantastic when I was anorexic.  I am thankful to be recovered and for the work of specialist eating disorder counsellors and services, GPs and CPNs who so dedicatedly help sufferers.  I urge anyone struggling with food and eating to get help.

At the same time, I am acknowledging that disordered eating does serve a purpose and function.  It is a way of coping.  It is harmful, as overdosing, cutting, other forms of self-harm are harmful and risky, but it is a way of coping, just as I believe other forms of self-harm are.  I think eating disorders are a way of coping with so much more than the thought processes I have outlined here.  It is different for everyone.

I believe – and I think the clinic the two friends I mentioned work in takes this seriously – that for it to be possible to survive recovery from an eating disorder and take the next steps, treatment has to respect that eating disorders are a coping mechanism, and then enable the sufferer to find alternative coping mechanisms, for example in this case, other ways to deal with the terrifying emotions and extreme lows and highs.

Though I never was specifically in treatment for my eating disorders, I am now very very fortunate that the service treating me now is helping me find these other ways of coping, and I think that as this is the start of dealing with so many aspects of my personality disorder, it will also restore my relationship with my physical body and its need for nourishment.

Ginny x