Categories
Depression Eating Disorders Living While Fat My Story

ARFID rears its ugly head

I have eating disorders. Two, mainly. ARFID and Binge Eating Disorder [BED] (with occasional visits from the Anorexia and Bulimia fairies). It took me many, many years to acknowledge that I had an eating disorder at all. I thought I just ate too much. I thought it was because I was weak willed or addicted or some other thing. Now I know that the reason I eat too much consistently over time is because of my deeply disordered eating. I’ve posted before (see links above) about what the DSM V has to say about eating disorders. Spoiler: It’s very simplistic and reductionist and not exactly body positive.

In any case, I have been diagnosed with BED for five years or so, although it hasn’t been nearly that long since I accepted the diagnosis. Having BED means I dissociate when I am eating and eat far too much at individual sittings, to the point of becoming sick. It means I prefer calorie dense foods. It means I need to feel full to feel safe and comfortable.

But it turns out, it’s not the point. The first term I heard the term “ARFID” was about a year ago, when I met my current nutritionist, who is an ED specialist. She did my intake interview, and asked if I had ever heard of ARFID. No, I hadn’t. What was it? ARFID–avoidant/restrictive food intake disorder–is a food/eating anxiety disorder. Food makes me anxious and it is hard for me to deal with preparing or eating complex or highly variable foods. I avoid fruits, vegetables, fatty meats, anything that might spoil or be mushy. I’m hypersensitive to the texture and smell of my food. And if a food turns me off once, it can take me a very, very long time to try it again. Classic ARFID anecdote: I once tried, in a diet context, to eat a piece of pineapple in front of a group of friends. I bit down, got one hint of the texture of the stuff, gagged, spit it out, and choke/cough/gagged for about five minutes. Needless to say, breakfast was over.

I am finding ARFID much harder to fight than BED. I believe now that ARFID is the root disorder–at some point in my early childhood I became deeply anxious about food–and that BED is actually a coping mechanism to keep me from starving to death. When I am dissociated I can eat, which, honestly, is a relief after the way the ARFID makes me feel. I eat so much partially because I subconsciously know that my ARFID is going to keep me from eating again until I am famished and I need to “stock up.”

It is probably no surprise that in this most anxious of times, the ARFID is in control again. Over the past 3-4 weeks, there has been incident after incident of me panicking over food, refusing to eat until I am in pain from hunger, and being unable to feed myself or, sometimes, even move until I am hand-fed by my husband. I wept over a bloody egg. I panicked over a bag of vegetables and shoved it in the fridge still in the supermarket bag. I went to bed hungry (a lot of times).

My nutritionist says that many of her ED patients are experience an exacerbated tendency to restrictive food behaviors right now. It’s the anxiety. It’s so hard to care for oneself in general, and when you have an ED (or more than one) it is already harder. I don’t actually know what to do. I’m becoming dependent on my husband, who is learning to spot the signs that I’ve gone into an ARFID state. I ate twice today. I can remember only one day in the past two weeks when I had more than three eating episodes, and most days are either two, or two plus a middle-of-the-night panicked kitchen run by hubby. I’m regressing and I don’t know what to do, how to get out. The feeling of not eating, the knowing that I am not gaining weight even in enforced idleness and surrounded by a food-filled kitchen–it’s enticing. I don’t know how to beat it or even start fighting it.

I will say this, though–if I see one more meme about people getting fat right now and grazing too much, I am going to punch a wall.

Categories
Eating Disorders My Story

ARFID

As I have written about before, I have binge eating disorder. I have been working hard on this, on staying in tune with my body so I don’t fully check out and eat more than I mean to, on letting myself not finish food that I have obtained, and on knowing that food will be there later if I leave it now. This is working. I haven’t had what I would describe as a true binge in a number of months. I am still partially checking out. I am not eating often enough and therefore eating too much in each eating episode. I am still eating highly dense and heavy foods which I don’t even want to be eating but which seem like a good idea at the time. However, my binge eating disorder is a much less serious complaint than it was six months ago.

I am losing weight. I am not weighing myself regularly, but I did weigh myself about two weeks ago and I found that I had lost about 15 or 20 pounds from where I was in late summer. This is to be expected as I am not bingeing nearly as much. The theory is, as one gets closer and closer to eating as one’s body truly wants, one’s body will naturally approach the weight that it wants to be at–an internal set point.

Problem is, I also have ARFID, Avoidant/Restrictive Food Intake Disorder, about which the DSM V says this:

  • An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
    • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
    • Significant nutritional deficiency.
    • Dependence on enteral feeding or oral nutritional supplements.
    • Marked interference with psychosocial functioning.
  • The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
  • The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
  • The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

ARFID means I am picky to the point of disruption in my nutritional health. In my case I am unwilling to eat virtually any fruit. My nutritionist says this is fairly normal for ARFID sufferers, as fruit is very delicate and unpredictable–sometimes it is amazing and other times gross, and you can’t always tell before you bite in. I have an unnatural level of anxiety about whether I will bite into a mealy apple or a soft blueberry, and so I don’t bite into fruit at all. Veggies are a bit better, but have similar issues.

My eating habits are extremely texture- and smell-driven and focus on high calorie density foods, because every eating episode is an anxious and stressful experience for me. So I eat as much as I can in each one so as to avoid eating for as long as possible; I eat the simplest, mildest foods possible because I want to minimize the stress of the eating episode itself.

It would seem that the binge eating disorder is actually a coping mechanism–to ensure that I get enough food, I overeat when I do eat. Now that the binges have eased off a bit, I am starting to get to the root of the matter, which is that I routinely (as in at least once a day) find myself avoiding eating, even though I am hungry and aware that I am hungry, because I am too stressed out by figuring out what I am willing to eat, how to get it, etc. Hence, weight loss.

Any sane person would probably be pretty sanguine about a superfat losing weight, but to me it is a mixed blessing. Yes, I have health effects from my weight. Yes, I have social and career impacts. But I have spent the past year learning to love myself as I am and to accept that dieting is a cruelty imposed on us by a sexist, racist, cishetnormative culture. So now I am not sure if I am allowed to feel happy about losing weight. Worse, I am afraid that feeling happy about losing weight will let loose the diet culture in me all over again.

My nutritionist in fact fears that I have anorexic tendencies as well, typified by not wanting to eat because of the joy of controlling myself and the sense of cleanliness and lightness that not eating brings. Diet culture and weight loss honoring are triggers for that.

I have no answers right now. I am working to figure out what I can and will eat that is a bit more nutritious than my usuals without becoming judge-y and diet-y. But it’s a hard road so far and I’ve taken maybe 8 inches of steps along it.

Categories
body liberation Depression Eating Disorders My Story

Long Time No See

It’s been a while…I had a rough fall. In August I cut back on a med–Abilify–which I had been taking for years for my depression. I cut it back because I had been doing so well that I thought I might not need it any more. No such luck. I spent three months dealing with fairly awful withdrawal symptoms such as irritability, insomnia, and renewed depression. During the first of those months I didn’t even realize what was going on, which made it even worse. And then when the withdrawal symptoms finally settled down, I realized I was not in an ok place without the med anyway. So I started it back up and within a week or so I was back to the happy place I had been in over the summer.

Eating disorder-wise, things have also been eventful. The binge eating disorder has become fairly quiescent. I almost never have a true binge these days. But the lowering of that tide has revealed rocky shores–I am not eating properly still and there are many issues now revealed. A tendency to enjoy not eating, and a tendency to avoid certain foods. My nutritionist now believes that my primary diagnosis is actually ARFID (Avoidant-Restrictive Food Intake Disorder). More on that in another post. At the same time, she’s identified anorexic and bulimic tendencies as well as a past history of rumination disorder. So that makes five eating disorders that I either already have or have to watch out for. Yay, I’ve got the whole set!

Now that I am feeling better again, I really want to get back to blogging pretty regularly, so hopefully you’ll see me on here more. I’ve also re-started my insta. And bought a lot of clothes. So keep your eyes open for some fun ootd pics!