Spoke to GP

[BraveButShaking]

He is referring me for psychiatric help.
What does this mean? I thought standard was counselling.

It has never been so hard to be honest. I need a hug...anyone?

[Mellifera]

Brave
I read the whole thread and it’s heartbreaking and think you‘ve been let down. You haven‘t had ‘proper‘ therapy at all? Weekly, with a properly trained therapist?
CBT isn‘t the holy grail.

I would recommend going private if you can somehow afford it.

Schema / Trauma therapy with ED specialist therapists helped me, same issues.
It sounds like your care is focused on your eating disorder, when it should be focused on the underlying reasons for it.

Sending you a hug, you amazing and brave woman.

[TheOrigBrave]

OP here (had to re-register).

It has indeed been acknowledged by my ED nurse that I really need some CBT in order to see whether I can give fighting the ED a better shot.
She has done some CBT with me, but it's not really her job to go over all the past stuff with my ex and has also said that it seems it's too much for me at times.

I have been told that CBT will probably make the ED worse before it gets better, as it will be very difficult, and they want me to be stronger emotionally and physically before starting.

Aside from the £, I am reluctant to go private as I feel my team do know a great deal about me now and a psychologist would have access to my notes from the ED nurse and the psychiatrists.

I don't know, I feel a bit lost really.
I next see the ED nurse towards the end of Jan, am meant to see the psychiatrist mid Jan, but prob won't go (not much point IMO). I guess I will just stop seeing the ED nurse (I'm nearly out of NHS appointments anyway).

There is one person in the CBT team for the whole MH team in my area. I was called beginning of Nov and haven't heard a thing since. My ED nurse didn't know whether my case had even been discussed at their team meeting. They are over-stretched and I am not high priority.

[Aridane]

Please go to your appointment with your psychiatrist in January

[TheOrigBrave]

The last appt was dreadful and I'm not doing what he wanted me to do. I'm wasting their time really. If I'm not taking the meds he can't help me more, can he? And what if it's yet another doc? I've seen 3 different ones over 4 appts.

[Aridane]

Why aren’t you taking your meds?

[TheOrigBrave]

I was taking 40mg Prozac. Couldn't see any difference.
I was meant to be taking 2g pregabalin but found it made me too tired to function (felt unsafe driving etc). So I stopped the pregabalin.

My own research shows that Prozac has only been shown to help with binge purge behaviour at 60mg dose.

The psychiatrist (from the terrible appt) didn't even ask about the pregabalin so I presume he hadn't read enough of my notes to know I was prescribed, and I think he should know the dose Prozac most effective at.

Then I was pissed off so all things considered I thought sod it!

I'm doing ok, I feel sharper. My moods are more extreme at both ends of the spectrum, but they are MINE, not drug induced.

[Aridane]

Oh, OP - Prozac can take weeks to kick in. And it’s quite usual to start on a lower dose and build up. You have done so well to ask,for help- you do though need to take it.

[TheOrigBrave]

Sorry...didn't explain. I'd been on 20mg from March (changed from citalopram), then increased to 40mg in June. I stopped taking them in Dec.

[TheOrigBrave]

Yes, I did ask for help, and the help is not there, apart from in the form of brain altering drugs.

I am not responding to the help the ED nurse provides.

I realise I sound like I recalcitrant child but can you understand why?

[TheOrigBrave]

Actually I started Prozac in summer and increased 6 weeks later to 40mg

[Aridane]

Yes and no - if the medication wasn’t working, you go back medication review / adjustment.

You appear askance at “brain altering drugs” - but you are mentally unwell with an ED. I really would go to,the psychiatrist and at least review the medication options.

[TheOrigBrave]

I know you are right, I'm just pissed off. Psychiatrist is meant to review treatment (from ED and psychologist), but he didn't even know name of ED nurse, least of all have any knowledge of what treatment I was having. And of course there is nothing to review with CBT.

[Abitlost2015]

TheOrigBrave
You have taken the hardest step which is starting the recovery journey.
It sounds like now you are losing your initial determination.

The Nhs is far from perfect and this affects patients but don’t waste your energy trying to think of how things should be (could this be the control talking?)

Trying to hide behaviours from those around you may also be the need for control still taking charge.

Even if he is new, even if he is not familiar with your whole history, the psychiatrist is there to help you when you are in front of him.

You have described many of the issues around therapy. Could you share your personal goals? What has the nurse asked you to try? We may have suggestions on how to achieve it.

[TheOrigBrave]

Thank you. I have seen 3 different psychiatrists over 4 appointments, it is hard enough to go to these appts as it is, then when I am faced with someone new and have to go over very difficult things all over again I just feel so low and dejected, like I'm just going over old ground so they can get to know me rather than any actual progress.

To be fair to the last guy, I'd had a massively difficult morning actually getting to the appt (with ex and DS2 - basically the reason I'm there in the first place..the irony!) so was very wound up when I arrived.

Anyway, I have identified that I need to go over the abuse I was subjected to during my long marriage. This will help me deal with the flashbacks which floor me, the memories which haunt me, the fear I still have of him. I need to build my resilience. His abuse is ongoing but he uses our son now. While I am still dealing with his abuse it's hard to find the resources to deal with the past.

I am going back to court to sort out the current problems. This is not an easy thing for me to do - the time and energy, fitting it in among my existing responsibilities etc. To then add dealing with my past is going to be hard - I'm worried how I'll manage.

The ED nurse has pretty much said she thinks I'm not ready to recover yet, that I'm not ready to let it go. But while I'm hammering my body in this way, I won't have the strength I need to sort DS2 out. I need to have support for both at the same time.
She has helped me identify what works for me - distraction, calling Samaritans, planning my day to the last 5 mins; I just need to put those things in place when I have a crisis.

She has encouraged me to keep my journal up. I come and go with this, but when I'm low I stop writing. I can do this though. Also she's suggested I keep a little note book and write 3 things that made me happy each day. I've been doing that.

[Abitlost2015]

Hi Brave
Thanks for taking the time to write.

It’s all good advice and I am glad some of it helps even if not yet solved all the issues.

And it’s also a good base to tackle the ED.

ED can be difficult to tackle without coming out of your routine (as routine becomes such as important part of your life) I have seen the day units help enormously to break the bits from your routine that are unhelpful. There is never a good time to go there but it may be good to make the time. Would you consider taking leave to do this? If you plan it it may seem more doable?

You are doing all this work whilst the main stressor (your ex) still is in the picture, this is very hard. Keep reminding yourself you are doing well (with failures in between and all) because you are doing the best you can each time and you are not giving up.

You are indeed Brave.

[Mellifera]

Hi Brave
I think the way the NHS has handled your case has made you worse. They watched you deteriorate and only offered meds and inadequate support.
3 different psychiatrists in 4 appointments is utterly awful treatment.
No wonder you got stroppy. So would I.

If you went to a private therapist, one you see weekly, you could ask for your case notes and take them with you. She/He will work with you consistently, you won‘t have to speak to different people again and again.

I never went down the NHS route as I know from my sister how she‘s been dealt with - appallingly. She‘s been on meds for 10 years and never had proper therapy.
That was never acceptable to me. I‘ve been on meds twice, with clinical depression, both times for a year, then stopped meds (against psychiatrist‘s recommendation) because I felt like you, at least my emotions were mine and I felt disconnected from everything while on them. If I feel suicidal again there is no doubt I would be back on them like a shot.
The eating disorder was totally unaffected by the meds.

A good therapist could make ALL the difference to you. Especially now as you are still battling with the awful and abusive ex on an almost daily basis. You need someone on your side who knows all about you and can catch you if you stumble.

It sounds as if you are still struggling on your own, because appointments many weeks apart are no good.

If you google therapists in your area with specialism ED, hopefully someone will pop up with Trauma Therapy training or Schema Therapy, as it sounds your needs are far too complicated for a ‘simple’ course of CBT (but that is the NHS‘s first choice, regardless).

All the best!

[AtrociousCircumstance]

Agree that a private therapist is an excellent idea. You can feel more in control of who you choose to see, and then you will have consistency.

As the PP said you can request your notes and your therapist can review them if you wish.

It’s obvious from your thread that the problem is the abuse you suffered over a long period of time. The ED is a manifestation of it.

Please, if you can, source a private therapist and take it from there. A good therapist will not rush you or push you, they will be on the journey with you.

Good luck. Hang in there

[TheOrigBrave]

How much is a private therapist and would I need to come out of NHS services to use one or can you do both?

Despite its short comings I have built up a good relationship with my ED nurse, who I have been seeing since March.

Would calling my crisis team push me up the list for CBT or are they independent?

[TheOrigBrave]

I was thinking that I could set myself a date (probably March, by which time I would be well established in my new job) and then consider the day unit.

I really don't know how it works though. Would there be an expectation to go daily for a number of weeks? Could I take my lap top and work (I can essentially work wherever there is WiFi).

The thought of it (or maybe the acceptance of the scale of my problem) causes me great anxiety.

[Abitlost2015]

Brave
Different units may work slightly different. The one I know would set some ground rules you have to follow. There’s routines, activities, therapy, do’s and dont’s. There’s also free time and WiFi.
Accepting the full scale of the problem is not a bad thing, minimising it doesn’t allow you to tackle it.
Much love

[TheOrigBrave]

Abit do you speak from patient experience or from the clinical side?

My ED nurse said the unit was for people who are motivated to change but have found community support hasn't worked, but she recognised the huge impact it would have on my other responsibilities.

[TheOrigBrave]

Thank you drainpipe. Kind words. I feel angry and sad. I told my ED nurse that I had been coping by putting everything back in its box and just not thinking about it - keeping busy, not trying to fight the ED.

She said it usually doesn't work trying to put the genie back in the lamp. I just shrugged....what else am I meant to do?

[Abitlost2015]

My best friend was a patient. Prior to discharge two friends (I was one) spent two days there with her and we tried to help with the transition of being discharged. She is doing fine now.