Psychiatrist said I binged - I disagree (tw)

[Plave]

So I have a history of eating disorders. I used to eat very low calories for long extended periods of time. Followed by a binge. I haven’t really followed this pattern for a few years. But it’s always a fight to resist the urge to cut calories which enviably leads to a one off binge iykwim. I was underweight for years as the bingeing never counteracted the effects of the non eating.

Anyway, I was telling my psychiatrist that I ate very poorly and it gave me feelings of shame.

My psychiatrist referred to my eating as a binge. I am very unhappy with his assessment as it is nowhere near what I used to put away )plates and plates of pasta). I have come down with a cold so was not sticking to my usual diet which is very nutrient dense.

I ate:

Beans on toast
Plain crackers x3

Triple ready made sandwiches
Half a grab bag of Walker’s crisps

Cornetto
Packet of McCoy crisps
Cocktail sausage

I am unhappy as it is just a normal day of not great eating. So for the psychiatrist to have referred to it as a binge in his report is extremely disappointing as well as inaccurate!

Everyone has days where they end up relying on convenience food.

binge eating also reflects an assessment that one's eating habits are out of control. Some of yours seem to be, if you look at it from a textbook definition perspective rather than purely the quantity.

Suggest you share with him how it made you feel for that day to be described as a binge

I think your psychiatrist would tell me I binge every day because I have 3 desserts after every meal! Yet taken wilfully and daily so no lost control. My dh laughs at me but buys my treats in the shops. I don't have a weight problem so why shouldn't I indulge, life is short. Change psychiatrist; either he's incompetent or he's just not listening to you /don't care. Both reasons are valid to look elsewhere.

Change psychiatrist; either he's incompetent or he's just not listening to you /don't care. Both reasons are valid to look elsewhere.

If he is an NHS psychiatrist then OP has probably been referred and it won't be easy to change. It would be better to talk about and resolve the issue if OP is otherwise getting on OK.

What was out of control please?

Hi.

It’s very kind of you to ask! I feel miles better off compared to yesterday. The comment just hit a nerve yesterday. I was frustrated that all my actions are seen through a very specific lens. I still don’t think it’s accurate but I am much less bothered.

:)

He’ll be looking at patterns. Maybe this is a pattern based on what he’s seen of you.

that much processed food is maybe out of control based on your normal patterns, and potentially even based on discussions you’ve had with him about what you should be eating to help feed your mental health well being

Most importantly, you’re very triggered by this word, and getting very defensive about it, which is obviously symptomatic of your anxiety.

Rather than fixate or complaining about him about this one word - which I can guarantee won’t get him told off or struck off etc - personally I think your two most sensible options are:

1. to ask him why he used the word as it triggered this train of thought. He may even say ‘oh I didn’t mean it in that way’ or he could explain something that will be useful to you and help open a window on self awareness
2. to try and find a way of interrupting this thinking about this word. Has he taught you any practical exercises you can put into play? Could you meditate?

All the food you mentioned is grabbed, convenient, and psychologically that has binge connotations

Glad you’re feeling a bit better about it. A bit of space from it can really help.

Good luck when you chat with your dr again.

I think I would feel the same tbh OP.

I'm at the other end of the spectrum (as in - fat!) and would class that collection of foods as a low amount of food, outside of what I normally eat (normally pretty healthy, just a bit too much).

If someone told me that was a 'binge' purely because it was outside of the normal foods I eat, especially when there was a reason for doing so (illness in your case) I'd be really ticked off. I get really bad migraines, and sometimes afterwards it's like a hangover - I just need salt and sugar. A coke and some salty chips might not be the norm for me but that's clearly not a binge!

Edit: just to add that I would ask the Psych why he used that word, as for someone with your history it was bound to give you pause. I grant you, a person with a completely healthy relationship with food might not take issue with it. But that's not you, and it's not me either.

"Binge connotations" doesn't actually mean it was a binge, does it? If I eat one chicken nugget from McDonald's a day, I'd be malnourished even if the food has "binge connotations". There's nuance that you and apparently a trained psychiatrist are failing to understand or appreciate.

In my experience many of the mental health specialists who are drawn to the eating disorder services are attracted to the role because of their own history of eating issues. Many of them use this lived experience to their advantage and bring genuinely thoughtful perspectives to their roles. It can be a really useful tool in their belt.

However, sometimes people with a history of disordered eating or disordered thoughts around food can relapse themselves, and this can cloud their judgement when giving therapy.

It sounds like this person's judgement is off. You ate 3 meals across a day, not hours and hours of non stop eating. The meals weren't healthy choices but they weren't unusual either. A binge is usually defined as eating excessive amounts in an out of control way. It's not a binge in my opinion. I would be seeking a second opinion.

i agree it wasn’t a binge, I wondered what the point of this therapist is now, as it doesn't sound like it’s meeting it, in general? That would be the question for me.

OP is not seeing the psychiatrist as part of the ED service.

Hmm, tricky. Not a binge because of the low volume of food, but that 'dinner' is the sort of food I would eat when I was in 'binge' mentality iyswim. Maybe that is what he was referring to.

I can see why it annoyed you though if you see this as a one off, unrelated to your previous eating.

That's rather a sweeping conclusion based on a very, very small amount of knowledge. If it's NHS I think it would be unusual for the psychiatrist to be offering therapy, but rather than this would be done by a psychologist.

Glad to see you have calmed down a bit OP. Hope you can gave a productive talk with your psychiatrist about this feeling you have—this experience you have—that you feel “seen” and judged through the lens of the former ED.

This can be a very fruitful line of therapeutic discussion and work if both you and the psychiatrist can work together. What happens inside the therapy room is just a reflection of what happens outside the therapy room. Patients often project their sadness/rage/pain onto the therapist but the wound the therapist presses pre-exists the therapist’s words and, generally speaking , is both caused and continued by incidents, systems, and relationships outside the therapy such as with school friends, families, lovers. Patients bring that into the therapy and then hold the therapist to blame for not automatically fixing or healing those negative feelings.

In my opinion this is a chance for a lot of growth if you both are up for it. We say: after every rupture there can be a repair. And also, famously, we can be stronger at the broken places and at the point if repair. inside the therapy room can be a safe space to explore your experience.

Tell the psychiatrist that you had a string negative reaction to the word “binge ” and realized something about your experience, generally, which is that you feel defined by others , like a recovering addict, as always on the brink of disordered and socially disfavored eating behaviors. Its the flip side of the ED where you are judged as too controlling of your consumption. Do you have to submit yourself to the judgement of others for the rest of your life because of your past? Its like walking out of a orison but finding lots of people outside now think they have the right to tell you how to live your free life.

Bring that i to the therapy directly. Hopefully your psychiatrist is up to the task of helping you process this insight.

This.

You need to explore why you are resisting the term "binge". This is really important.

(Fwiw, it's possible the psychiatrist considers a day of unhealthy eating/ grazing on garbage a binge as it is a self destructive swerve off the straight and narrow).

Now you've seen you can't be 100% honest without judgement. If you're sick again, you might not tell him about your non typical diet on those couple of days.

He's created a situation where a patient may lie to him to avoid his reaction. Dishonestly surrounding eating is a common feature of EDs. He knows this. It's very poor and dangerous practice to potentially strengthen an ED behaviour when he's supposed to help people break that cycle.

Move on and find someone else. His practice is potentially harmful to you. ❤

Now you've seen you can't be 100% honest without judgement. If you're sick again, you might not tell him about your non typical diet on those couple of days.

Professionals who are training to work with people with EDs would not use the term binge as a negative judgement. It would be a factual statement. If you're going into any sort of therapy believing your therapist is judging you won't get off the starting blocks.
OP felt judged (and that is something she needs to discuss with him and think about herself), but we don't know what the psychiatrist was thinking.
That's not to say a therapist just let's everything go - obviously if you are there to recover from whatever disorder you have then some of what you hear is going to be very uncomfortable.

Also OP isn't seeing this person for ED support.

I worked in ED for the NHS for years.

Here, binge on biscuits.

''Also OP isn't seeing this person for ED support.''

Then it's even more inappropriate for him to comment.

And I received intense ED support in the community for some years.

When I was told some truths they were in a factual way, I did not feel judged.

Here, binge on biscuits. is a very insensitive come back on this thread. What was your role?

All I know is that they aren’t necessarily brilliant at writing everything accurately in terms of the behavioural stuff you may have updated on. I find this very frustrating and am over sensitive about it and make them change it. You can email the secretary and comment and ask for it to be amended. I think it’s worth it if you feel upset and also bc it is then a true reflection you can look back on in time. X

Maybe that's why they feel it's a binge, because it's all junk with no healthiness? They see that you're capable of a good diet and with this you've kind of wobbled?