anyone been treated at eating disorders clinic as an outpatient?

[singingcat]

My dr is thinking of this for me now. i am not very bad but underweight and am not able to put on more due to not liking food, having v small appetite and other issues.

Has anyone done this? do you have to see a psychiatrist? I am worried about having it on my notes that I have seen one, will it affect anything in the future like job medicals or health insurance?

did it work for you?

If i don't do this, I am thinking of asking to see a dietician to help me understand food better and having weekly appts with dr or practice nurse for weigh-ins.

Hi singingcat I had anorexia for 10 years and am now 'recovered' believe it or not. I'd be happy to answer any questions you have but I have to go offline now til tomorrow- it does sound like you need to do something about this and it's encouraging that you recognise that and that your GP sounds supportive. I'll be back tomorrow

Oh hester, Ive just seen your post

You are right. I exist on about 1000 cals a day, even though I know you need 1400 to keep your body running even if you do nothing! I also get complimented for being slim, aren't you lucky etc. which validates it.

I'm so sorry, singingcat. I do think you need to address this with expert help. There's so much I'd like to say to you, but maybe not on here... do contact me directly if you'd like to. Otherwise, let me at least assure you that life can get better than this. Like Vino, I am recovered from anorexia. It was a long haul but I got there, and you can too.

Christmas is a really tough time for everyone with eating disorders. Take great care of yourself this week.

I don't even feel like it's affecting my life that much, but I guess thats just because I'm used to it. I really don't have much energy at the moment, which makes me feel stupid. Part of my problem is that I genuinely don't want the food anymore. I don't have to restrain myself from eating it.

It's a half life singing cat. Stepping outside what you know is scary. But things will change, either by you getting weaker and more tired, or by you getting help.

You don't have energy. You don't want food anymore. You feel stupid (one of the signs of starvation is loss of upper brain function - I used to know my weight was too low when I found it hard to do simple maths).

Speaking very bluntly, I don't think your problem is having a small appetite. I think your problem is that you are terrified of your appetite. And right now you are at a fork in the road where the disadvantages of your eating patterns are threatening to outweigh the benefits. The exhilaration of feeling free of food, of having everyone marvel at your great figure, of being in control, are being overshadowed by your growing awareness of the grimness ahead if you carry on down this path. And believe me, it gets really grim. Your body won't tolerate this sustained abuse for ever and nor will your mind. Your life will get narrower and greyer and it will become harder and harder to get back to where you were.

I'm sorry to be speaking so harshly. I don't want to sound mean, but I really benefitted from two women speaking in similar ways to me when I was ill. The first time was when a friend told me to stop bullshitting and admit I was anorexic. That's when I first went to my doctor. The next time was when I was at the self-help eating disorders group I'd been going to for some time. I was sitting there, feeling pretty chuffed with myself as I perched on my cushion (because it was too painful to sit on a hard seat without one), aware that I was now the thinnest person in the group (a constantly shifting honour, as skinnies got shipped out for inpatient care). One of the women there rounded on me and said, "I know exactly what's going on with you. You think you're near the end now, you've tried everything you can to overcome anorexia without actually having to put on weight. You're thinking that it will get sorted out soon because you'll die and that will put an end to it. But I can tell you that this half-life you are living can go on for years and years. You've completely wasted your 20s, when you should have been travelling the world and having wild affairs. You're now going to waste your 30s, when you should be having a family. And then your 40s and your 50s, and your whole life, and all you'll have to show for it will be your bloody food diary and your tiny little clothes".

It really shook me up. Because she was right: I had prided myself on being able to control my body in a sophisticated, strategic, grown-up way, not in a chaotic adolescent way, but the end result was just the same. I obliterated years out of my life, years when all I thought about was my body and food, instead of love and life and art or whatever. And early on in that process, singingcat, I would have said exactly what you are saying here.

So please forgive me if I'm talking out of turn or being too strident. I'm just worried about you, because you sound intelligent and thoughtful - and those qualities can make you a dangerously effective anorexic. I wonder if you hope, at some level, that a dietitian will actually help you become a better anorexic? That you will get better information on how to maintain a low weight while minimising the health risks? Do you have any idea how many anorexics actually become dietitians? - I've met loads! And why have weekly weigh-ins with your GP? You know if you're losing or gaining weight, don't you?

What you really need is someone who understands who you are, what you're doing, what you're going through, and who is at least as clever as you are. That person may or may not be found at the outpatient clinic, but I think it's a better place to start than with your GP or a dietitian.

Oh Lord, sorry about the length of that post.

No hester, you're right. Thanks for writing so much.

I don't have scales in the house, so the only way I can find out how much I weigh is to go to the doctor and be weighed. I also feel like I need a HCP to regularly tell me that I still need to try with my weight. DH is concerned, but still thinks I'm beautiful and perfect because, he says, he's so in love. So when he tells me how lovely I am, I feel that he wouldn't think that if I was heavier (even though he says he would, and that he would prefer it). He also doesn't really know much about the health risks, whereas the doctor does and can keep telling them to me to keep me focused.

I think the waiting list is quite long for outpatients, so the GP may be my only option for now. He is very clued up and intelligent as well.

keep us posted singingcat, if you want to
and good luck

Thanks everyone

I do really want to have more energy, be able to exercise and build muscle, have a softer body. It's so difficult that the messages to be thin are everywhere, even some stupid article in the paper saying that if you put on half a stone your partner will lose interest in you (from a study funded by Slimfast ffs). So many people want to lose weight, especially after Christmas, that it's everywhere and I feel like I should do it too. Am I never going to be able to open a newspaper again??

Hi singingcat. It sounds like you gave a great and supportive GP. However I would urge caution with that method. I was anorexic for 10 years from 8 to 18+
I, at one point, was weighed weekly by my GP because he was worried about me and wanted to refer me. This suited me in my anorexic world because it wasn't real treatment. I bargained with the poor man and too much ended up resting on his shoulders. I'd go and see him weighed down with things, and I even reached a point where he said 'you can't keep losing I'mreferring you' so I said 'I promise not to drop below xkg' and he said 'ok if you drop below that you're being referred immediately' well, 'xkg' was critically low anyway and on that occasion after teetering along just under that for quite a while I fell into a coma in his GP practice at the start of one appointment and was taken to hospital by ambulance and on life support. I also was in a coma a few years prior to this. I have been in the extremes of anorexia but it is equally dangerous if not more so to be a long-term anorexic. My best friend died this year- her anorexia began in her teens and she died at almost 50, very thin, still the same. Managing it at home with some GP contact, occasionally seeing a nurse blabla. She lost her fight and she never reached the extreme lows, it is life threatening before that.

I am now fine, I feel I have recovered. I have a slightly distorted body image but I eat a lot and I don't freak out about food, anorexia has lost its control over me. It was like living in a hell, in a prison for years.

Anyway basically I have had treatment at outpatients clinics, one to one psychiatrists, treatment in general hospitals, treatment in general psych ward once (awful), adolescent eating disorders homes and an inpatient stay at a well known rehab clinic for a year. I have to say the only thing that ''worked'' was the inpatient stay. Anorexics tend to avoid effective treatment though because they are scared to gain weight and effective treatment= weight gain most of the time, so that's why you are probably thinking of seeing your GP and carrying on like you are.

I did relapse after my year's inpatient stay, critically, I was on life support and had a 20% chance of surviving. I was in nappies. I couldn't lift my head or turn my neck. It's pretty revolting actually, what I did to myself. I also, prior to that, spent a month in a coma. It's all such a waste of my life and my potential and it makes me very sad.

The 'cure' for me, really, was moving away from where I lived and getting on with life and getting busy- since then I've had 2 children who I never thought I would be able to have. I had to focus and drive myself away from the illness which had taken so many years of my life and education away from me to finally be free. And sometimes, yes I have a little voice in my head (not really!) saying 'fat' or 'ooh that's scary cake' but you know what, I eat pain au chocolats for breakfast, I scoff biscuits on the office, eat huge sandwiches at lunch and eat massive evening meals, I'm not fat- I'm a size 8-10 even when I am 'recovered' with no anorexic part of me at all. Recovery doesn't have to mean being HUGE!

Ijust really want to say to you that this is serious and very life threatening. You can carry on thinking you're maintaining and you'll be okay but you're not you're losing and you're doing extreme damage to your body and your biochemistry, your electrolytes, your body itself. An anorexic can collapse and die from a heart attack in an instant, or from any other reason. It is a very dangerous illness.

I think your GP sounds kind but I think he would be taking a big risk to allow the arrangement to continue because you, the anorexic, are not using it to recover- you need to see this is a problem for you and you need to want to get better and beat it. Nobody can force that upon you but it sounds like you are tired of anorexia and want to be free from it. It's you vs anorexia, it's nothing to do with your DH or anyone else really, this is a battle you must fight and win.

I am rambling but I want you to think why you are anorexic. If it's media pressure, everyone is airbrushed!!! If it's more than that though which I believe it really is then you need to address what's really wrong. You do need support and ongoing help and you need to start to re-build 'you' but I'm one for recommending the most dramatic head-on treatment possible because it's the most effective (in my book). So maybe you could ask your GP where he can refer you? Maybe ask if he can get PCT funding for some outpatient days at a good private clinic and some psychiatrist appointments? I found 1-1 talking therapy was more beneficial than groups, myself, but many disagree with this. Many people find Cognitive Behavioural Therapy a very useful tool.

I cannot tell you how good it feels to be 'free' now, it's worth it, it really is.

Sorry to be blunt but it's pointless worrying about what might happen in the future about jobs/insurance if you are going to have an ill and unhappy time and possibly a shortened life.

The new law on equality means that employers cannot discriminate against you for any health issue and they cannot request medical records until after a job offer - then they would have to have a compelling case as to why your job could not be done with your health issue. Frankly, any employer is going to look at you and see you are underweight and unless you are up for a job in certain corners of certain industries even subconsciously they will have you down as not looking too robust and find other reasons to say you were not the best candidate. As for health insurance, if it's with a big employer, usually it's blanket cover for all risks. Private might refuse to cover you for risks associated with anorexia such as osteoporosis but as someone else has already said, this is already on your medical records as every GP visit is documented so too late to worry about that.

Do mention it to your current counsellor, they might have had extra training in it. If not, they should be following a code of ethics that means they tell you that they cannot treat you and tell you where best to get treatment.

You are very lucky to be offered treatment, in many areas there is simply none available. Take it and give yourself and your family a future.

Thanks Eurostar, that's interesting about discrimination laws. Although the GP notes shouldn't make any difference, because the only person who can formally diagnose a psychiatric condition is a psychiatrist. I don't think the way I look would actually stop anyone offering me a job. I got my current job at the weight I am now, and am often told by people that I have a 'perfect' figure, at 34B\C-25-38. One work colleague even said to me 'So many British women are overweight and unhealthy, and women like you just prove that there's no need to be like that' It's comments like that which make me feel it can't be that bad and are an incentive to stay this weight.

If I weighed 6st and people gasped in horror when they saw me, then it would be easy to see there is something wrong. But that doesn't happen. But my GP is adamant that staying at the weight I am carries a lot of health risks for the future, and I'm choosing to believe him now. It's just difficult because at times what he says can seem so academic, because my day to day experience is that I am not unhealthy or scary-looking. Even DH, who was worried when I was just a few pounds lighter than I am now (apparently my face looked a little 'V. Beckhamesque', says that I look fine at this weight. However, because of what the GP said he is encouraging me to put on weight.

I need to change counsellors, I think, because the one I have now really didn't see why I was discussing eating disorders, brushed off my BMI and what my GP said, and basically implied that I 'couldn't' be anorexic.

Agree with Eurostar. Equality Act 2010. Also, I've never had a problem. The only problem may be if you ended up being detained under the mental health act for treatment, but you sound very sensible and that won't apply.

Thanks, it was DH who brought up all that about health insurance and jobs as he was worried it could affect it

singingcat, can I just caution against using compliments to validate a low weight. IME the compliments used to dry up when I was around one stone UNDER the weight at which my periods stop. That is dangerously low weight. It is not just you and me who are fucked in the head about body issues: it's the society we live in.

Vino: that is a very powerful post. I take my hat off to you for coming such a long way. Most people don't realise how terribly hard it is to recover from anorexia: it takes strength and courage.

I know what you mean hester. You have to be seriously ill before anyone thinks there's something wrong just from looking at you. As long as your boobs are still there they think it's all fine

Sure a lot of people are screwed up about what's healthy weight wise. A friend of mine was very, very ill a couple of years back and went down to a skinny, unhealthy weight, probably BMI of about 15. Some other women I know actually made jealous comments about how thin she'd got!

Humans are incredibly easy to manipulate, it's up to you to stand up against this, to find some other way of seeking affirmation. Find yourself a course on self-esteem. Is this something about fear of being seen as "mumsy" and wanting affirmation that you are still an attractive woman? There's a list as long as your arm of "iconic" skinny female celebrities with osteoporosis and another of ones with fertility problems that the world's most expensive doctors have been employed to help.

Don't forget too that a constant lack of essential minerals and vitamins and hormonal imbalances will affect your mental health to encourage more depression and anxiety.

Your DH should be shot for discouraging you from seeking treatment - and your counsellor does sound poor - is she BACP?

It's a he, and yes he is BACP. I suppose he just thinks I don't look like a skeleton, therefore no problem.

DH is encouraging me to seek help and wants me to eat more, but I don't think he quite understands the medical issues the way my GP does (despite having had them explained to him). He thinks I look nice, my face isn't gaunt etc. but did say I would look better at a size 10 (am now an 8, occasionally a 6). I think he's secretly pleased I'm not overweight and frumpy. The whole thin-is-in thing goes quite deep. Despite all these surveys saying men prefer curves etc. I haven't noticed it to be the case at all. On the contrary, there seems to be some status-symbol thing about having a slim wife.

"I think he's secretly pleased I'm not overweight and frumpy. The whole thin-is-in thing goes quite deep. Despite all these surveys saying men prefer curves etc. I haven't noticed it to be the case at all. On the contrary, there seems to be some status-symbol thing about having a slim wife"

Sounds like your H doesn't want to hurt you by saying you are too thin but he's made it quite clear that he'd like to see you a healther weight "he did say I would look better a size 10". Sounds like you are doing a lot of mind reading and twisting people's comments to suit your own agenda.

Interesting that you chose a counsellor who discounts eating problems, how did you find him? Even if he doesn't see it, it is not his place to dispute it, he should be asking you why you think you have a problem and be reflecting on it with you. He is failing in his duty of care as, if he'd taken the time to find out you are on about 1000 calories a day, it would be clear that you are hurting youself. You'd be better with a CBT person anyway probably who could help you see how you are filtering out anything but comments and attitude that support your desire to be thin and get you to start challenging this.

This situation sounds rescuable if it's true that you never had a problem pre baby - you need to start to drill into your thoughts and behaviours as soon as possible. Partly the loss of appetite can be down to chemical imbalance - did you know that most of the body's serotonin is produced in the gut for instance?

Can you afford to see a private nutritionist? A good, trained nutritionist who is a member of BANT might help to build your confidence around eating again.

Meanwhile - get yourself a copy of "overcoming anorexia nervosa" by Freeman and Cooper so you can see the approach that many clinics take.

Good luck. Hope you can enjoy today with all the food pressure. Remember, you need to be a healthy, happy Mummy for your DC - what would they like to remember? A thin, sad person who was too tired to get up from the sofa most evenings or a vibrant Mum with a zest for life?

Yesterday was alright, thanks. I ate Xmas dinner and then a smaller version of it in the evening! No pudding though, couldn't face it

How do you find a nutritionist, just google 'BANT'?

I think I'm going to get rid of my counsellor, we end up talking about what he wants to talk about and what he finds interesting about me. He was recommended by a different GP but I'm not impressed.

Hi singingcat, glad yesterday was ok. Christmas is one big fat hell for anyone with eating disorders, isn't it? I remember (with a shudder) one year I spent days preparing a banquet for Christmas breakfast (stuffed pancakes, stuff with satay, creme brulee...) which I then forced by partner to eat at 7am. Before Christmas lunch. While I watched, refusing to touch any of it.

Seems crazy now, made sense then!

Do find a good counsellor, someone you can really trust and open up to. This is too important to be polite to somebody that doesn't really work for you.

xx

Sorry, I am an outsider coming into this thread.

I don't think you are anorexic but I do think you have disordered eating and overvalued ideas about your body image. Research shows you share this trait with a large number of women who have never had any psychological/medical help.

I think ultimately it comes down to why you want to change. If it's purely because your GP thinks you should then it's not really coming from your motivation.

It's not too disimilar to the thousands of people who drink too much but are not dependant and there is only a subtle low level of dysfunctionality ( is that a real word?) in their lives.

Why do I think this? I used to be like this for years. What changed me was a combinaton of:

1. going to the gym to look healthy and gain muscle tone rather than lose weight
2. Having counselling for a relationship breakdown which also improved my self esteem
3. Getting married and having kids - I no longer felt the pressure to look desirable ALL the time. (it's mostly none of the time now!

I think it's very difficult to view this low levelled eating disorder as pathological even though it still takes over your life and I totally agree with the statement that you are living half a life.

Personally, I believe self esteem ( or enhancement of it) is the roots of it and I wonder what kind of job your counseller is making of this. There are a lot of self help books that can also help in this area.

I'm coming at this from a different angle.

Please seek help with your eating disorder before your child/ren are affected by it.

My mother has been anorexic/bulimic for most of my life. It has profoundly affected me and meant that I too have had years of counselling in order to cope with the emotional fall out of being the child of an anorexic.

If you ask my mother, she would say that she hid it from me. She was wrong.

I agree with you amijee that it is low-level and can't be described as pathological. But it is something that needs to be sorted out. I want to take more exercise, definitely, and build muscle. Despite the fact of being underweight I do actually have quite a lot of flab for my size, probably as a result of burning muscle as well as fat due to undereating. I also want another baby.