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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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I had an eating disorder 11 years ago which consisted of alot of laxative abuse. I have

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I had an eating disorder 11 years ago which consisted of alot of laxative abuse. I have been recovered for years and have 2 children ages 2 & 4. Lately I have relaped into some of the bad habits of my disorder like starving. can you have a relapse this long after recovery? I feel quite alone in this. thank you for any help you can give me Laurie
Submitted: 4 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 4 years ago.
Hello. I believe I can be of help to you with this issue.

it is interesting that you posted your story and question at this time. I have a graduate student who has very recently examined all of the research on eating disorders in older women (e.g., age 45 and older). (I do research in this area for a living and train psychologists to treat eating disorders). What we are finding is that the prevalence rate of eating disorders in older women isn't much different from that of younger women. Relapse rates in the eating disorders run well above 50%. So continuation of the disorder (i.e., having a chronic case of anorexia nervous) and relapses of the disorder are quite common---but almost no one seems to know this fact. On the other hand, brand new or first-time cases of eating disorders emerging after age 45 are quite rare.

You had an eating disorder for a long enough period of time and are wise enough to understand that a re-emergence of your eating disorder symptoms means that you are now facing some fairly intense and difficult physical and emotional STRESS in your life. I suspect you recall that your self-starvation literally means you are struggling to gain controll over a stressful life that feels quite uncontrollable right now--they make you feel helpless and emotionally, quite overwhelmed. I think you can recall from your past that your intense food restriction behavior primarily serves an emotion-regulation function i.e. helping one cope with strong aversive feeling states that can feeling confusing, chaotic, and overwhelming. We call this difficulty,---it is almost universal in individuals with eating disorders. Finally, the stress and health problems you are experiencing undermine your self-esteem and feelings of confidence in yourself as well.

What all of this means is that the return of your symptoms is a clear sign of significant emotion regulation problems in your life right now. What is worrisome to me is that this is also a sign that you are susceptible to clinical depression. I'm going to pause here and solicit your reaction to this post. I have to retire for the evening right now and will be back in the morning to read your post. I hope you can excuse the delay.
Customer: replied 4 years ago.
I have been having some stressful times lately. I love my family. I have 2 little boys ages 2 & 4 and I help my husband with his business in the office. About 2 yrs ago I had my gall blatter out and ever since I have had all kinds of stomach issues. I could eat a bowl of cereal and in less than an hour I am in the restroom sick; either vomiting or loose bowel; none of which I did purposely. Lately it has been so bad that it is easier to not eat than eat.
This has brought alot of old feelings back. I have been not eating for at least a week. Would you say this is part of a relapse or am I making something out of nothing. I really appreciate your time talking to me.

Thank You Laurie
Expert:  Dr. Michael replied 4 years ago.

The key to understanding what is going on is to take a long hard look at the function if any, of the food restriction. If this is a relapse, then you would be experiencing once again, a strong compulsion to become thin, or what we call a 'drive toward thinness', psychologically. Your description doesn't sound like you have a strong weight loss motive, so there isn't a function to the weight loss you are experiencing (i.e., relieves the stress and urgency one feels that they must lose weight because they feel too fat). What you describe is more of an eating avoidance response because emotionally, you are afraid that if you eat something, you'll merely become nauseous and throw it up. If you fear a nausea and loose bowel reaction to your eating, then this is quite different from anorexia. It is more along the lines of what we call a classically conditioned avoidance response. For example, if young puppies eat food that makes them sick it only takes one trial or eating experience for them to avoid consuming this food in the future, even though it might taste very good to them. So my question to you is, "Do you believe there might be a weight loss motive associated with not eating, or is food avoidance more associated with fear of throwing up, nausea and embarrassment of having loose bowels?"
Customer: replied 4 years ago.
I have had a weight issue since my eating disorder. When this happened years ago, I lost 50lbs in 2 months. I felt, at that time, that the "not eating" was the only thing that I was able to do right and it showed results which I liked. Needless to say, when I recovered so did the weight. I have had 2 little boys in the last 4 years and I am still fighting to lose the weight that I put on since then. I am 5'1'' and weight 161. I would love to weight alot less than this and when I get into a rut like I am where I don't eat and or get sick when I do, I love the fact that I at least see good results on the scale. I lost 8lbs in 2 wks, however, since I've been down this road before, I guess I might be more aware of old urges to lose the rest of the weight in a bad way. I have not taken any lax. yet, but alot of the old urges are back. I skip eating for 2-4 days at a time, then I try to eat a little something, then get sick and the whole fasting starts again. I do work out at the gym, take care of my little boys, keep house and work my husband's business. I guess lately I feel that I don't where to go at this point except what I am doing.
Thanks again for your time. Laurie
Expert:  Dr. Michael replied 4 years ago.
You have clearly started slipping back into your old habits and it does appear that the weight loss functions to help you manage stress, feel better about yourself. Your skipping eating for 2-4 days is truly a bad sign of course. Going to the gym is a good thing at this time. I think you probably need some regular 'reality checks' at this time regarding what you are doing day in, day out with your eating. By this, I mean that it wouldn't hurt to set up regular appointments with a clinical dietitian or a clinical psychologist who specializes in eating disorders. You do need someone to 'check in' with about your eating, your moods, your feelings of stress, etc. You would for example, probably do better if you had a predetermined menu, but consumed the menu across 5-6 mini-meals during the day, rather than eat in "meal-size" portions. And, you realize that when you starve yourself for several days, you begin to increase the strong likelihood that you may then overeat or have eating binges. Starvation or full food restriction sets one up for binge eating. This is why eating very small amounts of food many times a day is such a good thing to do for a person with a history of eating disorders, who may be having some 'slips' or signs of a minor relapse. If getting sick and throwing up is starting to get connected with eating a certain amount of food, the way around this is to break even the small mini-meals (the 5-6 per day I spoke of) into even smaller amounts you premeasure or set aside in baggies. You literally nibble a bit, go do something for a short time, then nibble some more. You'd feel like you are eating 'all day long' which can be frightening, but if you pare measure fractional portions of mini-meals, you'll know intellectually, that you are eating, at the end of the day, the same amount you always have. So you may be experiencing a classical conditioning 'nausea' or illness response to eating, and the best way to unlearn or recondition this is through eating micro portions of food literally, most of the day, until you get your daily portions in. But I'd like to keep touching base with you if you'd like, about your progress here. What do you think?
Customer: replied 4 years ago.
I'm sorry I couldn't get back to you sooner. Very busy here. I feel overwelmed by the thought of eating 'all day', but I could try it. Sometimes lately, if I eat and don't get sick after, I feel that I should to get rid of it. I haven't done that yet, but I got to tell you the urge is so great. The last 2 weeks have been such a struggle. I really appreciate all your time. I just don't know where to start.

Thank You

Expert:  Dr. Michael replied 4 years ago.
Laurie, what I'd suggest is to rehearse to yourself that you merely need to try the eating- tiny-amounts-all-day idea is an EXPERIMENT I recommend you do for just two days. You will know whether you can continue with this longer term. What Should happen is that your impulse to throw up will decrease a good deal, by the end of the second day, if you can get through these two days with eating tiny amts and never throwing up. So what this involves is what psychologists call 'exposure' i.e., we want to expose the person to the thing they fear (in this case eating and then throwing up) in very small amounts or 'doses', at a level they can at least tolerate emotionally, and then repeat this over and over (i.e., break your daily food allotment up into tiny amounts and eat them almost continually, until you reach the allotment). This would be similar to an approach you'd take with any anxiety-related activity or phobia. How would you get a young child who is afraid of the water to take a bath, when they want to avoid the bathtub? You get them playing in the bathtub with water toys, but no water; later that day, you fill the tub with a 1/8 inch of water and have the play with water toys in it. Enough water to splash around but not really get wet with. Then you add more water in the next play session, and more the next, etc Their anxiety response begins to disappear after repeated exposures.

So first step would be to simply focus on a 2-day meal plan; you are plenty wise, experience/smart to do this but if it helps, talk to a dietitian about how to break this up, pre-package your food allotments, etc. Remind yourself that you will only 'have to' try this for two days and see how it goes. WHEN YOU ARE SUCCESSFUL at the end of 1/2 day or the first day, decide now what you will do to 'pat yourself on the back' or reward yourself for making it through the day. Go to a favorite movie, visit the library or bookstore, ask a friend out for coffee or a drink; do something nice for yourself!!!
Then, do the 2nd day. If you jot notes to yourself during these two days about how you are feeling emotionally, you'll find that at the end of the 2nd day, much of the urge to throw up or feelings of nausea will have dissipated greatly. This should then provide you with the clue that you can perhaps do a 3rd or 4th day.

Let me know how this goes for you and write back if you want to chat some more. Click on the green Accept button at the bottom of the screen. Thanks.
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