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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Racer on March 29, 2008, at 0:29:15
My therapist doesn't notice when my weight changes, and we don't talk about my weight or my eating. We do talk about issues related to my eating disorder, but it's more about things like being afraid to eat certain foods, etc.
So, the other day, someone was saying something to me about what anorexia "looks like," and I used myself to show what the weight criteria looks like, since I'm under the 85% line again. I was telling the story to my therapist, to illustrate how ignorant most people are about the disorder, when I realized the problem. So, I said something vague about saying I was underweight, but she caught me. She asked if I was under the 85% again. I wouldn't answer, but I suspect that tells her everything she wanted to know.
I don't know why I'm so afraid of her finding out. I don't want to deal with it, though -- my weight has been up for a while, so I've given it a good try. Turns out, I don't like it. I miss so much about what life was like before I started treatment. I miss feeling better, the way I did. The only problem, of course, is that it takes so much time... I'd forgotten that -- even with TV, I get bored while I exercise, and feel guilty about all the other things I could be doing at that time. I hate that part. But I hope I'll feel better again soon.
Posted by Poet on March 29, 2008, at 14:06:07
In reply to Busted..., posted by Racer on March 29, 2008, at 0:29:15
Hi Racer,
If you were exercising to try to lessen depression you wouldn't feel guilty about what else you should be doing. Are you worried that you are over exercising? In other words instead of an hour of aerobic activity you're doing three hours? Then I can understand the guilt.
I think your T knows from your lack of response that you are under the 85%. She probably was thinking "why didn't I notice this?" Hopefully she'll wait for you to bring it up when you're ready to.
Poet
Posted by Kath on April 6, 2008, at 18:52:51
In reply to Busted..., posted by Racer on March 29, 2008, at 0:29:15
Hi Racer,
This is my first time on this board, so I don't know anyone's 'history' etc.
I don't know what the 85% thing is. Maybe it would help me get less confused about how I'm feeling right now.
I hope you feel better soon.
luv, Kath
Posted by Racer on April 6, 2008, at 19:40:46
In reply to Re: Busted... » Racer, posted by Kath on April 6, 2008, at 18:52:51
>
>
> I don't know what the 85% thing is. Maybe it would help me get less confused about how I'm feeling right now.The 85% refers to the DSM criteria for Anorexia Nervosa: a minimally normal weight is defined as 85% of normal. The refusal to maintain a minimally normal weight is one of the criteria for Anorexia Nervosa -- above that magic number, I'm officially "Eating Disorder Not Otherwise Specified," below it I'm just plain anorexic. My weight had been above it for a couple of years -- I was about 90% of normal for most of the past two or three years -- now I'm back below it again. Not a lot -- just enough to wish it was more...
So, that's the 85% reference.
Peace
Posted by Kath on April 9, 2008, at 16:32:55
In reply to Re: Busted... » Kath, posted by Racer on April 6, 2008, at 19:40:46
Thx Racer (((((((((((((you)))))))))
luv, Kath
Posted by Racer on April 11, 2008, at 22:06:08
In reply to Re: Busted... » Racer, posted by Poet on March 29, 2008, at 14:06:07
>
> I think your T knows from your lack of response that you are under the 85%. She probably was thinking "why didn't I notice this?"Well, yesterday she said something about it. Told me she had been noticing my weight loss, but was waiting for an appropriate time to discuss it. I didn't think she'd notice -- she didn't notice a while back when I lost 20 pounds. (In fact, I said something then about a change in my weight, and she asked if I was still gaining?)
I'm pretty well busted, all the way around on this issue. I had hoped no one noticed, that I could hide it...
xoxo
Posted by CareBear04 on April 11, 2008, at 23:39:33
In reply to Re: Totally Busted... » Poet, posted by Racer on April 11, 2008, at 22:06:08
racer-- what are the implications of your T knowing that you're back below the 85% mark? does that become the focus of your sessions with her monitoring you? or does it just make you feel really uncomfortable to have someone sizing you up and speculating about your habits and mindset? if your T claims to have noticed your weight loss, why didn't she point it out? i'm wondering the same thing about mine. While it kind of makes sense to wait until the patient brings it up, it seems to shift all the responsibility to you to recognize the problem and seek her help. maybe since you've had a long battle with the ED, you do know when you're in trouble...
anyway, just curious...
cb
Posted by Racer on April 12, 2008, at 14:30:25
In reply to Re: Totally Busted... » Racer, posted by CareBear04 on April 11, 2008, at 23:39:33
> if your T claims to have noticed your weight loss, why didn't she point it out? i'm wondering the same thing about mine.
I think a big part of the difference between out situations is that my T is a Certified Eating Disorders Specialist, and I'm seeing her with a diagnosis of Anorexia Nervosa; your pdoc and pcp are probably not nearly as familiar with all the issues and nuances involved in eating disorders, which would be my guess for why no one has made that diagnosis for you. Or, at least, no one has made that diagnosis yet.
What you've described sounds very much as though there's a great deal of cause for concern in your case. The DSM criteria for AN includes a certain amount of ambiguity -- "refusal to maintain a minimally normal body weight," for instance, is variously defined as a BMI of 17.5 or a weight of 85% of normal. For me, the difference between those is about 7 pounds -- meaning my diagnosis would change based on which one you used. The consciousness of the intent is another one -- and most eating disorders specialists at this point don't worry about intent anymore. Amenorrhea is another issue that comes up often: no psychological differences have been found between women who experience amenorrhea and those who don't. It's one of the criteria which is most likely going to be dropped from DSM-V, according to the working group. (Some women lose their periods before they've lost a significant amount of weight; some women continue to menstruate at weights below 70% of normal. So far, no one really knows why.) The fear of becoming fat is another one -- for many anorexics, it's much less a fear of becoming fat, as an unaccountable drive for thinness. That may not sound all that different, but it is.
Anyway, sorry -- I get onto a jag, you know?
The bottom line for you, though, is that something's wrong, and it's worth working on figuring out what it is. What is behind your weight issues? I'd say you probably qualify for EDNOS, so whether or not every criteria fits for you is maybe not as vital as all that...
Good luck, whatever the outcome.
Posted by CareBear04 on April 13, 2008, at 21:11:37
In reply to Re: Totally Busted... » CareBear04, posted by Racer on April 12, 2008, at 14:30:25
thanks, racer, for the thoughts.
the distinctions you point out do make a lot of sense, especially fear of getting fat v. unaccountable drive for thinness. i think i know objectively that i'm not likely to get fat by any measure, but it's still somewhat distressing to gain weight (even if i want to) and comforting to lose it.
what you said about amennorhea being dropped as an element of AN is also interesting. it does seem like an arbitrary measure since people's bodies react so differently. is there any particular reason why amennorhea is included in the diagnosis as opposed to any other physiological sign (i.e., bone density, low BP, low pulse)? but at the same time, its inclusion at least injects some sense of objectivity into the criteria. if ED specialists are no longer concerned about intent, what factors do they base the diagnosis on? i guess as you've said before, people with ED often present excuses/pretext for their behavior and deny intentionality. i guess also i feel that some doctors (subconsciously or not) conflate EDs, personality disorders, psychosomatic symptoms, malingering, and other loaded issues, attributing them all to one patient to stay the hell away from. i think you're probably right as far as EDNOS. my first pdoc once said that diagnoses are only good for two things-- insurance claims and drug trials. i used to think he was full of it and was using this reasoning to avoid telling me what was wrong, but over time i've come to think that he's probably right that labeling people is unproductive when it doesn't direct the treatment.
so i guess, then, that you're right that it doesn't matter whether i meet all the criteria for one or another diagnoses. but if you were me, given that my pdoc and pcp haven't raised any concern, would you bring up the issue?
thanks,
cb
Posted by Racer on April 13, 2008, at 22:36:03
In reply to Re: Totally Busted... » Racer, posted by CareBear04 on April 13, 2008, at 21:11:37
> but if you were me, given that my pdoc and pcp haven't raised any concern, would you bring up the issue?
>Yes, I would bring it up with your pdoc -- let him/her know that you've recognized that you don't have to exhibit the full criteria for AN to have a problem. Then I would talk to him/her about what to do about it. See, it's fine to get the diagnosis -- but then you have to figure out what to do about it.
I'm betting you're a good deal younger than I am, in which case I'm gonna go out on a limb here and offer some heart-felt advice based on my own experiences: Get help now. Things only get worse, it's associated with some other pretty severe psychiatric problems, it makes treating any sort of mood disorder much more difficult, etc. It's worth getting the help now, and not backing off that help when it gets hard.
If you want help finding resources to treat eating disorders in your area, feel free to BabbleMail me and I'll send you out some suggestions. If you send me your general location, I can probably find you some names.
Good luck.
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