Body Image

While self-esteem and confidence have never been my strong suits, I do a fairly decent job of pretending. Shockingly, I've even had several people tell me over the years that they were intimidated by me, particularly before really getting to know me. I find this absolutely preposterous, mainly because I have never been sure of myself, never felt good enough. Apparently, I am a much better actress than I thought.

So much of my idea of self-worth is wrapped up into my body image that it's almost hard to distinguish between the two, even now. I have never been happy with my body...or myself. Never. I remember going to a pool party in third grade and feeling absolutely disgusting, hating myself and not wanting to go. Being slightly bigger than many of my classmates never helped matters. When I say "slightly" and look back, I can honestly say that I do mean only slightly. I wasn't obese or even really all that overweight, but I wasn't perfect and thin. From then on, before I was even 10 years old, I knew that I hated myself. I knew that how I looked directly correlated to how people thought of me, how they treated me, and ultimately, how I treated myself.  

I've said this a million times over the years, but I would give anything to be as "fat" as I thought I was in high school. I see pictures of myself then and my heart hurts for the pretty blond girl who hated herself so much and could see only flaws. It breaks for the girl who thought her only redeeming quality was a huge pair of boobs and believed that she could use them to her advantage to find "love". My heart shatters into a million pieces when I think of the girl who pretended to be so cool, more one of the boys than a bitchy girlfriend. I thought that being the good-time girl was the ticket to love. Ha. That got me absolutely nothing but use and abuse.  I read Gone Girl earlier this summer and   Gillian Flynn hit the nail on the head with this one:  

“Men always say that as the defining compliment, don't they? She's a cool girl. Being the Cool Girl means I am a hot, brilliant funny woman who adores football, poker, dirty jokes and burping, plays video games, drinks cheap beer, loves threesomes and anal sex and jams hot dogs and hamburgers into her mouth like she's hosting the world's biggest culinary gang-bang while somehow maintaining a size 2 because Cool Girls are above all hot. Hot and understanding. Cool girls never get angry; they only smile in a chagrined loving manner and let their men do whatever they want. Go ahead, shit on me, I don't mind. I'm the Cool Girl'. Men actually think this girl exists...” ― Gillian Flynn

That was me. I was Cool Girl. The drugs, the booze, the sex. Always a Cool Girl, never a girlfriend. The Cool Girl image morphed out of my own self-hatred, which I know after many a therapy session over the years. I honestly thought that was the only way to love and attention. What I wouldn't give to go back and be able to save myself. Yes, I had a lot of fun. I had enough fun for myself, for you, for your best friends, and your entire graduating class. I don't remember much of it, to be honest.  Much of it has been blocked from my memory entirely. I can't even count all of my "conquests", and frankly, I don't honestly think I'd want to know. SHAME.  

I only felt attractive when someone wanted to sleep with me. It was approval.  It told me that my body wasn't freakishly awful, that I wasn't enormous, and that someone thought I was "OK". My standards were pretty much nonexistent, likely because I thought so little of myself. I shudder to think about my life from 16 to about 22.  

Right before bypass, I had given up. I was morbidly obese and absolutely disgusting. I hated myself, but in a different way than I did when I was younger. I didn't even hate myself that much during and after pregnancy. Now, after bypass, I hate myself in yet another way. It's funny how things change, yet the theme remains exactly the same, huh?  

My boobs have deflated completely and now look like two huge empty, wrinkly scrotums on my chest. I was a J while nursing my daughter and am now down to a DD, if that tells you anything. My nipples point to the floor and there is no evidence of the Cool Girl I once was, at least not there.  

My enormously fat stomach has become a sagging apron/skort of excess skin and fat. It hangs, it flops if I try to move too quickly, and I absolutely detest it. Looking in the mirror is pure torture. I dream of just cutting it off. I could probably wear pants that were four sizes smaller if it would just go away.

That sagging mass of nastiness ends right at the top of my flabby thighs, adding insult to injury.  God only knows what sort of lift can be done to fix that mess.  

My face is so thin now that I could swear my already large nose has grown, even though my rational mind knows that it's probably only because my nose was dwarfed by the size of my bowling ball head. Looking at pictures from a little over a year ago, it looks like my face was going to explode. So, now I'm not only thinking about a breast lift with implants, a tummy tuck and skin removal, and whatever can be done about my thighs, I guess I'll need to add the Ashlee Simpson treatment for my nose.  

Don't get me wrong. I've lost over 120 pounds and I am THRILLED with that success. I love being more mobile, having more energy, and having a little more confidence. I love the compliments. I love seeing the numbers on the scale continue to fall. I love having more than two stores to choose from when shopping for clothes. But, I just can't be happy.  It's not enough for me. I've only swapped one set of body image issues for another. Will I be happy with myself after plastic surgery? I like to think I will be, but I know myself well enough to know that I probably won't ever be happy. Do I even have it in me to be happy?

Issue #5,347 to work on:  Figuring out how to be at least OK-ish with what I have to work with.  

Any thoughts and suggestions on how to deal with this, apart from continuing in therapy, are more than welcomed and will be very much appreciated!

A little self pep talk...

Day off today and I'm home alone, which can always be dangerous for me. I've been prepping myself for a great day of relaxation, writing, and self care and giving myself a little pep talk.  

A la Stuart Smalley, my affirmation for today:  

I will not let the kitchen call my name. I don't need to binge. I don't need to purge and hurt myself. I can write, I can go down to the gym, I can walk the dog. I can start a new book, I can clean, I can catch up on paperwork. I will call my grandpa to catch up with him. I can do anything I want for the next five hours until the little lady comes home from school. It will NOT revolve around food.  

I would love to know why my thoughts automatically turn to food. Why is it such a preoccupation? Why is it always on my mind, even when I'm not hungry? How do you change such automatic thoughts? They've always been there and I know it will take a long time to change them, but I just wish I had more control over them. 

For those rainy days...

Because I've had more than a few "rainy days" lately, I thought I'd share one of the writing exercises from treatment that's meant to be reread in times when you're not feeling well and are struggling to cope. It's a letter offering support and guidance from your strong, calm, and wise self to your vulnerable, lonely, hurting self.  

Things to include in your own "note to self": what helps you feel better at particularly difficult times, what has helped you keep on keepin' on in the past, guidance on what to do and what distraction techniques you can use, advice on what NOT to do, and reminders of your personal strengths and resources. Be compassionate, caring, supportive, understanding, and encouraging. Your vulnerable self needs your love!

Tackling Treatment

After spilling my (rearranged) guts at the intake interview and leaving feeling like they wouldn't take me, like I was "too crazy" for just an ED program, the director called to let me know that my insurance had approved without any hassle and that my carrier mandated that I start within two days of approval. Yikes! At this point, I was freaking out and trying to back pedal. "Oh, it's not that bad. I'm totally overreacting and exaggerating. I don't have a "real" problem." Um...yeah right.  

They had me start in a "partial hospitalization" outpatient program that ran from 8:00 am to 2:00 pm. It was a real stretch to be away from my daughter for that amount of time, not to mention the stress it put on us as a family in terms of running around, juggling schedules, childcare, etc. Plus, it seemed to be mostly patients who needed the structure and intense supervision to be able to eat real regular meals, whereas I had the opposite problem. I needed supervision to keep me from eating, lol.

But, as I spent a few more days in the program, I began to realize just how disordered my eating and thinking really are. I say "are" because I am in no way "cured". I am in a much, much better place than I was before treatment, but I still have such a long way to go. I slip up. I slip up too often. I had a really bad "slip up" on Friday and I felt horrible, but I reminded myself that it's OK, that it's not the end of the world. A few weeks ago, I found the most amazing quote in a fortune cookie and had to tape it to my refrigerator to use as a personal mantra:  

One. Day. At. A. Time. It's all I can do.  I have to remind myself of this over and over...and over and over.  

Even though I wasn't the sort of patient they typically saw, they were absolutely wonderful and worked around my dietary needs, scheduling needs, and emotional needs to figure out what would be the best fit for me. We finally decided that their intensive outpatient night program would be the best place for me. I came to enjoy it and look forward to my nights there, with people who "got it". While they may not have been able to relate to the issues that bypass presents, we were joined by the feelings, the underlying issues, the negative beliefs, the lack of self-esteem, the self-hatred, the never-ending barrage of the ED voice. Because when you really break it down, no matter the eating disorder diagnosis, aren't we're all the same at heart? Broken-hearted, sad, desperate, shamed, angry, scared...  

I'll delve deeper into the nitty gritty of my time in treatment as we go along and I'll share a lot of what we worked on in group, as well as the some of the more private writing I've done over the past few months. There will be positive, but there will be a lot of negative, too. I'm tired of sugar-coating and pretending to be OK. I've done it for so long that I'm not sure if I even know the "real me".  Admitting that I needed help to battle my ED is but one piece of the puzzle, yet it's one that has really made me so much more self-aware and I know that this realization is going to be key to my long-term success after bypass. I want to keep this weight off so desperately. I cannot go back to where I was. The fear of failure is a strong driving force, both in terms of recovery and staying healthy and also in favor of retaining the ED behaviors. I go back and forth between needing to be rid of my ED and desperately trying to hold on to my habits for fear of regaining any weight.  Such a double-edged sword, but that's definitely a topic that deserves its own post.  

Reaching Out

I "knew" I needed help roughly 15 years ago, but knowing and doing something with that knowledge in an active way are two completely different things.  

My daughter has a progressive neurometabolic disease and we had decided to begin counseling to help her deal with all she goes through. During the intake interview, the psychologist asked me how I was doing. Hmm...how was I doing? That was something I had to really ponder. Honestly, until I had gastric bypass in November 2011, I had pretty much given up on myself completely: my health, my mental health, my sense of self, my goals and dreams, my body, my weight. I guess it was pretty obvious that I was far from OK after discussing a bit of both my history and my current dysfunction, lol. I wasn't seeing anyone for therapy at the time, so she had me schedule an intake for myself.  I will admit that I have many, many things I could/should work on, but we don't have time to list all my neuroses/diagnoses/etc. right now. That list will take a long time to explore, but we'll get there.  

I've dealt with severe depression and anxiety all my life and currently have a diagnosis of "mood disorder NOS" while they attempt to rule out bipolar. In the course of a few meetings with the new therapist, I had revealed my long struggle with ED and it made me infinitely more aware of just what I was doing to myself and how badly I could damage not only my newly rearranged anatomy, but everything else, too. I was absolutely terrified that I was doing irreparable harm inside: stretching the pouch that was my new stomach, causing ulcers, weakening the lines of staples in my "old" stomach, weakening the sites where my intestines were rerouted and joined back together. I had vivid visions of internal bleeding, emergency surgery, and not being able to care for my daughter. But, I couldn't stop the bingeing or the purging. Stress relief, but in a horribly self-destructive form.  

The therapist had me start journaling daily, basically just reflecting on the day and my feelings. Being open and honest and actually facing everything I had pushed down and used food to keep down was incredibly difficult and emotionally exhausting. I really started to feel like I was hitting the bottom, but it felt good...in a way. I knew that it was time to actually do something and opening up (again) in therapy was the catalyst I needed to force me into action. I had an appointment set with a doctor in my surgeon's office for a check-in the next week and I decided to go in and just be brutally honest.  

So, I did it.  

It was nerve-wracking and embarrassing. I was mortified, but I just went in and told the truth. What a novel concept, huh?  I was sure that they were going to be disappointed, even mad at me. I felt like a little kid in trouble. Adding insult to injury, she even had an intern with her that day and I know he got way more than he had planned out of that patient visit.  

To my surprise, she wasn't mad. She was amazed that I was brave enough to admit what was going on and actually ask for help. I can assure you that "brave" was not an adjective that I would use to describe my feelings in any way that day. She had a powwow with my therapist and they found a treatment program close to my home that focused on ED in all its ugly forms:  anorexia, bulimia, bulimarexia, binge eating, EDNOS, night eating syndrome, bigorexia (muscle dysmorphia/"reverse anorexia"), etc. 

Because my life is one never-ending extenuating circumstance, it wasn't feasible for me to do any sort of inpatient program and I didn't feel that that was what I truly needed. I was worried that when I had the intake interview with the program's director that she would think I was "too crazy" for outpatient and would try to admit me. I was really afraid that someone would think I was somehow "unfit" to care for my daughter. But again, like my doctor, she didn't judge me or make me feel bad. I was more honest than I had probably ever been in my life and I'm so, so glad that I was. I needed this opportunity. Desperately.

Tune in next time to see where I ended up and the treatment plan we formed.

Opening Up

INVITATION If you are a dreamer, come in. If you are a dreamer, a wisher, a liar, A hope-er, a pray-er, a magic bean buyer . . . If you're a pretender, come sit by my fire, For we have some flax golden tales to spin. Come in! Come in! -Shel Silverstein

Come in, come in!  Welcome to a dark little corner of my life. Ok, so maybe it's a little bigger than just a corner. Not quite as big as a guest room, since no one would ever want to stay in here...on purpose, at least. Maybe a den? Either way, it's (slowly) becoming a smaller and smaller space, occupying less of my mind, my time, and my life. As I open the door to the closet and let (most) of the skeletons pour out, I'll open the shades and let in the light so I can see myself a bit better. You, lucky you...you'll get to come along for the ride.  

This blog will chronicle my lifelong battles with food addiction, binge eating, body image, and bulimia. I had roux en y gastric bypass surgery (RNY) on November 29, 2011, naively expecting it to be the supreme road to happiness and weight control, and have lost over 120 pounds so far this year. However, I realized that the old demons had managed to sneak back into my life, manifesting themselves in more and more covert ways. I entered eating disorder treatment in July 2012 and completed six weeks in August. Am I "cured"? Of course not. Am I in a better place than I was? Absolutely.  

The content will definitely not always be pretty, of that I can assure you. But, I promise that I will always present my stories and my ramblings with absolute honesty. My main goal in opening up and putting it all out here is to be able to help those who are walking the same path, since I know I cannot be the only one dealing with disordered eating after weight loss surgery. My surgeon's office claims that most people turn to alcohol or drug addiction as a substitute for food addiction after surgery, but I know disordered eating after surgery has to be way more prevalent than anyone knows or cares to admit. Honestly, you don't get to over 300 pounds and the point of needing your insides rearranged to manage your weight without some form of disordered eating. If you really think about it, the eating plan and way of life after surgery are all about eating disorder behaviors: constant weighing and measuring, restricting carbs, tiny portions, etc. I just hope that I can maybe convince anyone considering surgery to be extremely honest with themselves about the "why" of their problem with obesity BEFORE surgery.  

Even though I was completely open about my history both with my surgeon and at the pre-surgery psychological evaluation, I don't think anyone could have predicted how I would respond to life after surgery. Body image issues, which everyone has, are amplified to an extreme. Sagging, drooping, extra skin, hair loss. Even though the compliments keep coming, the negative thoughts seemed to outnumber them 10:1. Oh, how I wish someone would have forced me into treatment before surgery, if not 15 or so years ago. Of course, hindsight is 20/20. But, if I can help even one person face the facts and get help, sharing my story will be fulfilling and worthwhile. It's not easy to open up, even anonymously, but I need to do this for myself as much as I hope to be able to help someone else.  

So, follow along for all the "fun". I'll let it all out, work on recovery, and continue working on my weight loss to get to a strong and HEALTHY weight.  I'll laugh, I'll cry, I'll bitch and moan. And, I always promise to take it one day at a time.  

It's all I can do.