Today was a big day in terms of treatment. Like a really big day.
Firstly, I had an appointment with the Psychiatrist at my EDU. Obviously, I was weighed. It was down from last time by a few kilos, but I think that’s due to natural variation due to time of the month, what I’d eaten etc. Still well within the healthy range though. My BMI has settled to a healthy 21 (ish), regardless of what I eat or how much I exercise. I’m getting a whole load better at understanding my hunger signals – I eat whatever, whenever. Today I even had a greasy spoon sausage baguette (don’t judge me. It’s literally one of my favorite foods. Deep fried, bad quality sausage in a buttered white baguette tastes so boom its almost obscene) which is something I never thought I’d ever eat again. The Psychiatrist was so pleased with my progress. She said it was really surprising considering some of the shit I’ve had to deal with whilst with them, yet I stuck with the treatment plan fairly consistently for an eating disorder patient and that she’s really impressed with my perseverance. She has pronounced me eating disorder free! I know that my eating is something I have to keep my eye on (probably forever) as relapses are common and eating disorder behaviours can sneak back in or manifest themselves in different ways, but right now, I live basically eating disorder free. It’s actually really good. Life is a lot less tense. Plus I actually am getting used to my body and don’t entirely hate it. I’m almost sad that summer is over because I can’t wear crop tops as much any more. Today I did wear an incredibly tight, incredibly short black dress though so it’s not like I’m ashamed of my body. I don’t even think I’m that big. I look big sometimes, other times not so much. I eat what I like, but I don’t want to eat everything. I don’t have weird cravings to eat all the dried fruit or all the calcium or all the nut butter or all the honey. Some of my recovery foods seem a little bit sickly now. It’s ok though. I don’t always want biscuits or chocolate or chips, but when I do, I can eat them happily. I can and do eat whatever I like, yet I don’t actually want to eat everything, all the time. I didn’t think it’d ever be possible again. Sometimes I eat so much cake I feel a bit sick, but I don’t purge and my weight doesn’t change and it doesn’t upset me too much. Sometimes I don’t eat enough, so I grab some extra fruit or have some cereal or whatever. It is entirely possible to get to this point. You’d think it wasn’t, but it is. I’m even losing my food morality things. I used to thrive in the moral superiority in eating low-calorie, low-fat, lots of veggies, lots of fibre, lots of fruit, or nothing at all, especially when other people are eating around me. Now I’ll happily munch on some chips smothered in salt and pepper in front of everyone I know. I’ll even make chip sandwiches because they are too lovely (carbs go so well with other carbs I swear). It’s not hard to order something I know is higher calorie than what people around me eat. The best bit is that I don’t think about food or plan food or count calories 24/7. And my fat is redistributing a bit. My belly isn’t too big – it’s kinda soft and nice. My arms look so much healthier it’s ridiculous. I actually think my legs are well buff, even though my thighs definitely touch, almost entirely.
So yer, I’ve basically been discharged from my EDU. I never have to be weighed by anyone but myself for the forseeable future and that makes me happy. I hate other people weighing me. I like to weigh myself first thing, naked, before a shower which might be weird, but it’s entirely fine because it doesn’t disrupt my life at all. I’m just more comfy when I’m at my lowest possible weight of the day, but I’m also fine with the fact that that weight will increase as the day goes on, I just don’t have to see it. I’m never going to see my EDU psychiatrist or dietitian or family therapist again. It actually makes me happy. The only reason I’m not fully discharged is because I’m still seeing the Psychologist until I’m under the care of a more appropriate service because he thinks it’s crucial that I have regular contact with mental health services. I’m a “high risk” and “unstable” patient so the NHS have to know whether I need urgent intervention or crisis care. As soon as I’m under more appropriate care though, I’ll be out of the EDU. Hopefully forever. I’ll be really sad when I lose the Psychologist, but I’m happy to be out of the rest of it because I honestly don’t feel like I belong there anymore. It took over a year, but I just don’t think I need their help any longer. I am thankful to them in every way though. I know lots of people have terrible experiences of eating disorder (and mental health more generally) treatment on the NHS, but I can really only sing their praises. There are obviously issues with waiting lists and being able to contact your psychiatrists and stuff, but without their treatment, I’d probably still be sick. The treatment the offered me was all in line with the best evidence based treatment I’ve learnt and researched about. I had regular contact with everyone on my team, there was a heavy focus on refeeding as the single most important aspect of initial treatment, an emphasis on reaching a BMI over 20 and flexible care that tailored around my needs as they changed. They’ve been so brilliant. I literally could not see a way out of anorexia, but with their help I found one and I’m all the better for it.
So now I’m no longer classified as having anorexia nervosa or an eating disorder or disordered eating or anything. I’m ‘recovered’ or ‘in remission’ or however you’d like to put it and I intend to stay that way. Ker-fucking-ching.
Today was also the day of my initial assessment for IMPART. It was basically a screening for all axis II disorders, so all the different personality disorders were checked for. I can officially say that I don’t have antisocial or narcissistic or schizotypal or histrionic or avoidant or dependant or schizoid or paranoid or obsessive compulsive personality disorders. That is good news. That’s so many mental health problems I don’t have to worry about.
However, I did finally receive an official diagnosis. Only a personality disorder specialist psychiatrist can officially diagnose personality disorders and now, it’s official – I have borderline personality disorder. Although I already knew that, I kinda hoped it would turn out to not be true and that a specialist would tell me I was fine. I also hoped they’d tell me it was true so I could be given the hope that I might one day have a better quality of life. It’s a mixed bag of emotion. Apparently I score very highly on the borderline part of the test and am considered to be “severely affected” by the disorder. I guess I knew that already, but I hate when people say it. The assessment was over two hours long. It was seriously hard work and incredibly stressful, but I got through it.
So now I’m on another waiting list – this time for a psychologist to become free to take on my treatment. Apparently its six to eight weeks, though it could be shorter because I was one of the earlier ones to receive a round one assessment after the summer break and they still have a lot behind me. The psychologist may decide that I’m not suitable for treatment with IMPART at all so again, it’s scary. I tend to think that everyone will see that I’m not deserving of help so I always assume people will think I’m completely fine and don’t need their help and be told to go away. The second assessment tries to work out what the best course of treatment is for each individual. It also screens for any axis I mental health problems which may need to be treated before treatment for BPD can begin. Thankfully, because many people with personality disorders have suffered trauma, PTSD won’t rule me out, and because substance abuse is high in people with BPD, that won’t rule me out either. Both are treated within the service. If, for example, I was still suffering with anorexia, that would have to be treated for that first so IMPART wouldn’t take me on. I don’t consider myself depressed (even though I have that diagnosis right now) and I don’t think anxiety would be too much of an issue for them as it’s probably part of the BPD package. Seeing as I have no other diagnosis and don’t think anything else is wrong with me, I hope it’ll be ok. I’m worried about it though. If they take me on, I could be offered 6, 12 or 18 months treatment of CBT or DBT, but the woman who assessed me thinks it’s pretty likely I’ll be offered 12 or 18 months DBT, considering my high risk behaviours and BPD score level, with options to continue treatment if necessary after the completion of the initial time frame. That’ll involve a weekly group session and a weekly individual session. There’s also a possibility I’ll be put into other group therapies like mindfulness group or anxiety group, but that’ll be worked out at the next assessment. She also thinks my treatment will involve regular telephone consultations with whoever my psychologist ends up being. It all sounds pretty intense and apparently it’s actually a lot of hard work, but so was my eating disorder treatment so I’m hopeful I can manage it.
For now though, I have been given her work mobile number to contact her with any queries or questions, either through call or text. I’ve also been invited to join a group session specifically designed for people in this phase of treatment – all the people with personality disorders who are waiting for their second round of assessments. I don’t know if I’ll go yet. It’s quite far away from my house and in an area I don’t know that well and I get pretty scared in places I don’t know. It’s essentially a starter group for CBT and DBT style treatments and to get comfortable working in a group, as well as keeping in contact with the service in order to remain more likely to comply with treatment. We’ll see I guess. I also got a self-help pack. No lie – the NHS have stated that if I’m feeling distressed, I can comfort myself by smoking a cigarette. They also suggest making a secret code, smashing a watermelon, having a polo, trying to wake up before lunch time, building a house of cards, staying in bed, eating chocolate, asking a friend to hold me and creating my own cartoon legend (yes they did use the word legend). There are other things as well, but those are the strangest. There’s also some stuff on relaxation exercises, emotional health and mindfulness in it, as well a lot of numbers to call in a crisis. I got given a crisis card to keep with me as well (in case I ever need to contact crisis services out and about).
All in all, it’s been a very emotional, hard, happy and stressful day. So much to think about – both good and bad. I’m both optimistic and devastated. Excited and anxious. Happy and sad. It’s a lot to take in and I think I might need a little bit of time to recover from it all. Lots of sleep and puppy times ahead I hope.