Hospital vs. Outpatient Setting: Learning to Sit with Less Control, Rewarded by the Full Story

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By: Jennifer L. Gaudiani, MD, CEDS, FAED

I entered this field and worked for eight years in a medical hospital setting, caring for highly medically compromised adults with anorexia nervosa. In retrospect, practically every interaction I had with patients took place in a totally controlled environment. They were patients who, for their clinical teams at home and loved ones, were in fearsome danger of death. Their vital signs, laboratory values, nutritional intake, and bodies were all as unsafe as could be imagined. And yet, once they were admitted to the program I had helped run on a daily basis for so long, I knew they would be okay. Enveloped by expert professionals, introduced to carefully designed clinical care pathways, guaranteed to be monitored and nourished, my hospital patients were safe. Can’t get out of bed on her own due to weakness? There’s a nurse’s aide by her side all night long so she doesn’t fall. Overcome by anxiety? Their psychologist who sees them daily will be here this afternoon.

In the hospital setting, I could go home every night content in the knowledge that every one of my patients was in good hands, eating, getting electrolytes tuned up, taking medicines. As a result, I don’t remember spending a lot of time on the age-old clinician-patient duel: “You need to eat.” “I won’t eat.” I could, instead, sit and share favorite passages from poems with patients, to help soothe the anguish of their eating disorder voices. I was an English major in college, and poems are a part of who I am. “My own heart let me more have pity on…Maybe at last, being but a broken man,/ I must be satisfied with my heart,” counseled Gerard Manley Hopkins. “It is always a matter, my darling,/ Of life or death, as I had forgotten. I wish/ What I wished you before, but harder,” marveled Richard Wilbur. I sat with my patients and, yes, talked medicine. But I also indulged in developing metaphors to clarify their physical and emotional experiences. In listening to their stories, I learned some of the archetypal narratives that can culminate in an eating disorder. I connected with that depleted, brilliant, sensitive, exhausted, and captive audience of my hospital program, in the luxury of knowing they were getting exactly what they needed.

Now I’m an outpatient doctor and founder of a medical clinic dedicated exclusively to people with eating disorders and disordered eating. I now serve a less medically compromised patient population, but I have far less control over my patients’ lives. My patients might see me for a half an hour a week, and their therapist and dietitian another hour a week apiece, and the rest of the week they are on their own. The rest of the week, their eating disorder gets to have full access to their extraordinary minds. No one is making sure they eat enough, or don’t purge, or don’t use their substance of choice, or get enough sleep, or take their meds, or avoid triggering interactions.

And while they are less medically ill than my former patients were, my patients now clearly still experience significant challenges. The patient who has lost a bunch of weight after leaving residential, is binge drinking, and refuses to step back up to a higher level of care. The patient who has abdominal distention and pain that does not improve no matter what workup I arrange, no matter what evidence-based treatments I prescribe. The patient whose borderline tempests simultaneously pull me into the tumult of need even as they reject and revile me. They’re all my outpatients.

I used to have thirty minutes a day, every day, for a week or so, with terribly ill patients in an almost perfectly controlled setting. And now I have thirty minutes maybe once a week, for as long as they’ll keep me as their doctor, with patients who are both physically ill and struggling with concurrent mental illness, in a relative wilderness of a setting. Sure, we talk in comfort of my office, but in a medical catch-and-release, I then have to let these fragile, tenacious individuals back into their lives for the rest of the week. I have sat, looking into the stormy eyes of a furious young man whose team has set boundaries that trigger his abandonment fears, thinking to myself, “Stay in scope of practice. He has a mental health provider. You’re his internist.” I have learned to say, “I hold space for this emotion. It feels like something you need to discuss with your therapist.” At times, I’ve reflected with heartsick disappointment on the somatic suffering I was not able to ameliorate, or even diagnose. I’m supposed to be an expert. That’s why they came to me. I wanted to give them answers and instead could only bear witness to their suffering.

And yet. One of the top reasons I left my hospital program to found this clinic was to help keep patients from ever getting that sick. To put my energies and efforts behind the theory that getting better in the context of one’s life, interests, and pursuits might make recovery more sustainable. So, I have enjoyed a telemedicine session with the smiling college freshman, whose matriculation formed the backbone of why she worked so hard over the summer to restore weight, as she glowingly tells me all the incredible people she’s now meeting, and the pizza she ate with her roommates last night at midnight. I have watched in astonishment as the fourteen-year-old shrugs and says, “I can look in the mirror again. I don’t even really think about food anymore,” remembering when she first sat in my office, miserably obsessed with each calorie, four months ago. I have rejoiced with the patient in a larger body who took her first hike in five years, shyly glowing as she relates how good it felt to get out in nature. “I felt like myself again, Dr. G.”

This is what I didn’t get in the hospital setting. Because when patients left for residential programming, I didn’t get to hear the rest of their stories. The narrative arc, different for each patient, always started with near-death starvation and ended with one chapter of recovery done, the rest of the novel to come. Now, despite the lack of control, the trepidation I feel as I say farewell till next week, the utter uncertainty of it all, I get to read the whole book as they write it.

I founded my clinic because I have the privilege of venturing into the unknown. I deliberately left a secure position to create something novel, both for patients and for the remarkable people I work with. For the former, a greater opportunity to work on recovery while experiencing daily life, with its triggers and unique motivations. For the latter, a workplace founded on feminist principles and good boundaries. We can throw ourselves into work with a fierce joy and passion, and then at the end of the day fully engage with partner, family, and interests. Robert Frost wrote that he would not relinquish to time “The things forbidden that while the Customs slept/ I have crossed to Safety with. For I am There,/ And what I would not part with I have kept.” As I wrote this I realized: it turns out that there is more safety in this less safe setting than I could have imagined.

Why I am Grateful For My Relapses

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By: Lily

Over my near-decade long struggle with an eating disorder, I have relapsed a countless number of times. Some of these relapses were large enough to lead to returns to treatment centers while others were smaller, yet still significant. For a long time, I looked at these relapses as nothing other than moments where I had failed. I always compared myself to others I had met through treatment, measuring how quickly they seemed to get better to the length of my struggle.

Recently, I hit a milestone in my recovery journey as it has now been three years since I first began recovery. In these three years, I have spent the vast majority of the time in and out of treatment centers, with little time between stays, up until this most recent stretch of time where I have managed to be treatment free for the longest time since first entering it.

I remember that two years ago I felt frustrated that after several years in recovery I still was not where I wanted to be. I found myself focusing on my perceived failings and being discouraged by how much I was still struggling. I am happy to say that this year was much different. This year I looked back at all the times I returned to treatment, and I felt proud of knowing that more than once I have made the brave choice to continue fighting.

Each relapse and slow build back towards recovery taught me valuable lessons about resiliency, bravery, and my personal strength. I have decided to look at those times in a new perspective with gratitude for the chances I received to forge ahead. I learned something new about myself with each relapse, and I can now look at those times and see just how many times I have chosen not to let anorexia defeat me. The relapses gave me a chance to pause, look at what has brought me to a place of increased struggle, and then move forward with new insights.

I am learning that recovery is not about never struggling or having a rough day. Recovery is about being able to pick yourself up and keep going. All of my demons have not disappeared from my life because I have chosen to recover. However, I am learning to handle them differently. I am learning that there are other solutions to deal with the pain besides self-destruction. It is far from easy, and my fight is not over, but I now know that I do not have to do recovery perfectly. I just have to keep putting one foot in front of the other. Years ago, the words “bite by bite, I will fight” became a motto and anthem for me, one that reminds me every step forwards matters no matter if it is a leap or a tiny step. I just have to keep moving.

About the Author: Lily is a twenty-something year old with a passion for advocacy in mental health. She has been in recovery from an eating disorder and other mental illnesses for several years. She uses her own recovery story to help bring these issues out of the shadows in an attempt to lessen the stigma through her personal blog “Life and Recovery” about her recovery journey. Her hope is to return to school and enter into the field of Social Work where she can use her struggles to help others find freedom.

Defeating ED: Recognizing Inner Beauty

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By: Rachel Sheidler

In middle school I was the quiet girl in the corner. Naturally, because I was moving on to high school I didn’t want to be known as that girl anymore, so I turned to something I could be in control of: losing weight.

Little did I know that it would lead me down a path of anorexia. I can’t pinpoint the exact cause of my disease but I would venture to say it was the media bombarding young girls with pictures of beautiful, skinny women. I felt in order to be accepted by others I needed to be beautiful, meaning thin, but somehow when I looked into the mirror that wasn’t what I saw. I saw fat and ugly. I began to starve myself and exercise to the point of exhaustion. I was obsessed with counting calories. Social situations were hard for me. I wouldn’t go out to eat and would avoid going to parties because of the junk food I knew would be there. People would beg me to eat, if only it were that simple. I didn’t choose anorexia; it chose me. A little voice inside my head ruled my life. I even gave him a name, Ed (for eating disorder). I wasn’t myself because I was influenced by everything Ed told me: “You’re so fat” or “Don’t eat that, you’ll gain twenty pounds.” He controlled me similar to the way the devil manipulates people. He became so real I could physically hear him inside of me. He became my kryptonite to my superpower, controlling food.

By eighth grade, I had hit my lowest point, my rock bottom. I was a skeleton, I was cold all the time, I grew fine hair on my body, had no energy, and if not turned around quickly, my organs would start failing. I knew this, but Ed was so strong that I didn’t care. I wanted, no needed, to be thinner. Needless to say it was obvious I was anorexic, my family, teachers, and friends were concerned and I was dragged to countless doctors, counselors, and dietitians. I wanted to get better; I was tired of being known as the anorexic girl.

On August 6, 2010, right before my sophomore year of high school, I went to a doctor’s appointment for a regular weigh in. The doctor listened to my heart and found some irregularities in my heartbeat. They did an EKG and sent me to Cincinnati Children’s Hospital emergency room for further evaluation. I hated the doctor for making that decision but when I look back I realize that I wasn’t my own superhero, she was my superhero. She saved my life. When I arrived at the emergency room I was hooked up to machines for what seemed like hours. I remember gripping my mom’s hand, looking her in the eyes and asking, “Am I going to die?” I will never forget her three worded response that turned my world upside-down. “I don’t know.” Her uncertainty scared me more than anything, and at that moment I realized how serious this had gotten.

Later that day I was admitted to the hospital for what they said would only be a few days. Being my first time in a hospital, I was petrified, but my struggle was just beginning. The rules were endless. I had to be watched every minute of every day by a nurse, even when I slept, and had to eat everything on my plate in under half an hour or else they would resort to tube feedings. The bathroom door had to stay open at all times and showers were to be five minutes long. I was on complete bed rest. I cried myself to sleep feeling isolated and frustrated. The bed was uncomfortable and I was jerked awake every few hours by a nurse or beeping machine. Throughout the day I would either read, watch TV, or awkwardly chat with whatever nurse was sitting in my room at the time. Everyday a group of medical students would make their rounds to observe the patients and ask questions. They would gather around me and ask me personal questions and observe my condition like I was some type of science experiment, it was dehumanizing to say the least. I missed my family and friends more than anything, sometimes my parents would spend the night, but of course my brother had to be taken care of and my parents had their jobs. Everyday I asked when I would go home but the doctors just said they didn’t know.

After a while I learned to accept defeat. I’ve never been so angry and I took it out on anyone and everyone around me, which I regret more than anything. They were trying to help me; they didn’t deserve to be treated that way. My prayer life suffered. My mom told me to give my struggles up to God but how could God let something like this happen? Two of my best friends at the time were able to visit me, it meant so much knowing they cared enough to spend a summer day with me. Through their prayers they showed me the power of love and support. I was finally released on the 20th, thrilled that God gave me a second chance at life. Leaving the hospital gave me confidence because I know in my heart if I could make it through those two weeks I could make it through anything and I’m thankful to God for helping me realize that. My parents told me later that when they went to mass back at home, parishioners and acquaintances would come up to them and tell them they were praying for me while I was in the hospital. To this day I don’t know how those people knew. Perhaps a friend told them, but I like to believe it was the Holy Spirit working within them because I needed those prayers. When I left the hospital I felt free, taking that first breath of fresh air was exhilarating. Since my activity was greatly limited in the hospital being able to walk took some getting used to but being back at home with my family was priceless. I still had to travel to Cincinnati once a month to see the team of doctors, counselors, and dietitians and had to continue to eat on a meal plan, meaning my dietitian would tell me what to eat, when, and the amount. My weight has been fluctuating over the past few years but I’m healthy and food is no longer the enemy. I now eat what I want, how much I want, and when I want, and am more in tune with my body and have learned to appreciate it rather than criticize it. I haven’t seen my weight since then. I imagine that for the rest of my life when I go to doctor’s appointments I’ll step on the scale backwards, not because I have to, but because I want to. Why should a number on a scale matter? A number on a scale can’t determine your worth, your skills, your accomplishments, your dreams. All that matters is that I’m healthy, I’m happy, and that I’m myself again.

Looking back I’m angry at Ed for all of the years he stole from me. I wonder how I would have spent those years if anorexia had not consumed me. How would I be different? What could I have accomplished over those four years? What wonderful memories could I have made? Even though this thought crosses my mind from time to time, I wouldn’t change my experience because it made me who I am, a happy young woman who is content and proud of her body, which is something I never thought I’d be able to say. If only the team of doctors could see me now. When people ask me how I made it through recovery I tell them it was because of God. There isn’t any other explanation. I don’t know how I recovered so it must have been the work of God because His works don’t need explaining. You may be wondering to yourself “what does this story have to do with me?” Well, close your eyes and quiet your mind. Now place a hand over your heart. Do you feel that beating? It’s called a purpose. Throughout my journey I realized everyone has one because I believe I wouldn’t be here today if that wasn’t true. We are made in God’s image and He has a plan for everyone so I hope you realize that what you look like doesn’t matter to Him so it shouldn’t matter to others.

Psalm 193:14 says, “I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well.”

As humans we try to squeeze ourselves into what society thinks is the perfect standard but that won’t get you into heaven, fulfilling your purpose will. The time to start fulfilling the purpose God has for you is now. We can start by enlarging our heart, widening our soul, and strengthening our spirit.

I would like to end with a quote by Kailee Favaro. This is hanging on my bulletin board at home and gives me inspiration to continue on, “Living in perfection isn’t really living at all. To enjoy life and to take in happiness around you, you need to let go of the perfection and hold on to what really matters. Maybe then, the pain will subside and the constant thoughts of weight and food won’t always be with you. Maybe you can be happy.”

I sincerely hope and pray that all men and women struggling with an eating disorder come to this realization some day. People have asked me why I’m so open with my struggle. I realize that people may stigmatize me because of my past but if I’m silent I’m letting the disorder win. If I’m silent how can others be helped?

In the words of Jon Acuff, “sometimes God redeems your story by surrounding you with people who need to hear your past so it doesn’t become their future.”

I want to be an inspiration to others. Please know that there is hope. Recovery is possible. Beauty, after all, is a feeling, not something that can be seen. YOU are and can feel beautiful. YOU can take back control of your life. YOU have a purpose. YOU can rise above and recover.

20 Lessons I Learned From Anorexia

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By: Riya Chandiramani

Disclaimer: This article is based on my story and research that resonates with my personal experiences during my illness and recovery process. It is in no way intended to apply to everyone who has anorexia or another eating disorder. Although numbers aren’t really mentioned, I would like to also warn against triggers to anyone currently suffering or recovering from an eating disorder. 

1. Skinny doesn’t taste as good as life feels.

A couple of my peers at college had made anorexia and mental health related “jokes” in the past. Some lived by the mantra “nothing tastes as good as skinny feels.” When skinniness is achieved through involuntary self-starvation, I have to wholeheartedly disagree.

Starvation affects your body and mind. Badly. The brain shrinks as its tissue is used up as fuel. Hormones like estrogen are affected, which is why I, like many (although not all) who develop anorexia lose their menstrual periods. Bodily processing slows down to survive. My heart rate and blood pressure dropped to scarily low digits, prompting a nurse to ask me if I was alive. Starvation also affects mood and thought patterns. My parents realized something was clearly wrong because of the drastic change in my attitude. Their sweet, positive, smiling daughter was replaced by one that scowled, snapped and was uncharacteristically disrespectful and rude to them and other loved ones. In turn, I hated myself even more, and further punished myself for my behavior. I withdrew further, giving in to the illness, preferring to isolate to avoid hurting people’s feelings. Continued starvation leads to rigid thinking, lack of emotion and problems with concentration and memory. I was unable to see the larger picture and instead got stuck in minuscule details. Every decision held massive importance, so even the smallest choice took me forever. I would go to the grocery store for two hours and leave with one item. I wrote and rewrote an essay 23 times, for a freshman-level class that really should not have been a problem for a senior with a 3.98 GPA.

2. It was not about vanity.

It sometimes takes an instance of weight change (gain or loss), to trigger an eating disorder. This was the case for me, following my “Freshman 15.” What started out eating healthier and exercising to have a “better-looking” body, quickly spiraled into something completely different. In less than three weeks, repeated manipulation of a behavior became an addiction. 

For me, there was a huge moral component to anorexia. I come from a privileged background, and I always felt overwhelmingly guilty for how much I had, and how little I felt I was doing with all that I had been given. I wasn’t enough. I felt ungrateful, and to punish myself, I gave myself less so I’d suffer more. I was achieving self-respect through my self-denial. I was paying the price of success. In our culture, self-denial, especially with regard to eating, is often a “good” thing. Along with starvation, anorexia comes with over-exercise and taxing the body past its physical limits.

Personally, I was pretty satisfied with my appearance earlier on in my disorder, but I had to keep going so the effects would not reverse. I took comments about my low weight and small size as compliments, regardless of their intent. However, towards the end, my heart sank at the weight displayed on my scale, both because it was a scarily low number, but also because I knew that the only thing that would freak me out more was if that number were to increase. I was so stuck. Looking back now, I realize I looked sickly, horrifyingly thin — not ideal whatsoever.

3. It was not a diet.

With the denial that comes from starving yourself comes a powerful feeling of control, success and power that becomes an addiction. I became addicted to the sensation of hunger, because of the discipline and strength it implied I possessed. An addiction is a psychological coping skill when one feels incredibly trapped and restrained, or under immense pressure to succeed. This leads to feelings of helplessness and one looks to find a way to alleviate the inhibition. Now, I am no longer willing to put up with the pain of prolonged hunger, and don’t need to any more. It doesn’t serve my purposes. Now, skipping a meal is not an option. If I did, I would not feel good about it. I’d satiate my hunger, and recognize that food is fuel that keeps me going, and enables my body to be strong and do all the things it couldn’t do before. This kind of relationship with hunger and food, I think, is a key element of what it means to eat “healthily.”

4. Control. It was all about control.

Weight loss is a “primary gain” of anorexia — not the real cause of the illness. A “secondary gain” is the actual benefit that disorder offers, and explains why a person might continue with their eating disorder without wanting to seek treatment for it. The illness might (subconsciously) provide a sense of purposefulness, power, a distraction from the volatility or pressures of life or a feeling of self-worth, to name just a few. A sense of control tends to be the most common secondary gain for a person with anorexia. I felt powerless in the world, and in order to exercise control, I battled myself internally, rather than with the world. It was the way I could regulate and govern my life. However, it is the paradox of control that truly defines anorexia. Below the perfectly controlled surface are petrifying, debilitating feelings of lack of control. And these fears about a total loss of control manifest with regard to food. 

5. Anorexia used my body as a mode of communication. 

Anorexia was a subconscious way for me to face the things I was scared of directly confronting, and say the things I was too scared or ashamed to say. My body was the canvas on which I displayed my hurt, rage, shame and sadness, because I couldn’t vocally express the emotions I was feeling inside — I had never been able to. Instead, those got numbed out as I ate less. In a way, it was a call for help. I wasn’t OK, and I had to show it somehow. I wanted people to know I wasn’t OK, and to care. No one said anything. I wanted them to. But when they did, it was too much, uninvited and annoying. It was a frustrating paradox: if people didn’t intervene, then my I assumed I was fine. I took that as implicit acceptance, or even approval of my behaviors. At the same time, I was terrified of someone saying I looked too thin, and if they did, I would get defensive and reassure them that I was perfectly alright. 

6. I didn’t just “get” it, and I couldn’t just get better.

I am not writing this with the purpose of saying, “Anorexia really sucks. Don’t ever let yourself have it.” Telling someone not to have this is like telling someone not to have another illness. The idea that someone can just get it, and just as easily get rid of it makes it seem like it is a choice. 

It is not a choice.

It is not a “diet gone wrong,” or taken too far. It is not “going anorexic” for the month because you have eaten “too much” and feel you need to lose weight. No. What makes anorexia so distinctly uncomfortable is the cognitive dissonance: knowing and understanding two conflicting things. I knew I was harming myself and making myself miserable, but I didn’t feel it was remotely possible to do anything to change it. I was frustrated and terrified, which only fueled my addiction to control as I spun further out of control. 

After I was out of the “denial” phase, I knew I was making my life miserable. But at the same time, my eating disorder voice reminded me I was strong, and gave me a pat on the back for my hard work. “No pain, no gain,” is what it said to me. “You are doing the right thing. Life is not supposed to be easy, you have to work for success.” 

Secondly, I could not just get better. I could not just “eat a cheeseburger” and be done with it. At the time, even if I could have suddenly changed, I would have been at risk of heart failure, just from eating a “regular” amount of food again. When your body’s processing slows down to such a low rate, it is dangerous to just eat like it is no big deal. Known as “Refeeding Syndrome” cardiac and metabolic complications can arise when a malnourished person is reintroduced to food.

The media is often criticized for promoting the thin ideal and featuring models with unrealistic bodies. Whilst this definitely can serve as thinspiration for those with eating disorders, as justifications or visions for their behaviors and thought patterns, it is not to say that everyone who looks at these images can just develop an eating disorder as a result: genetics are one of the many contributing puzzle pieces that create an eating disorder.

7. It boosted my self-worth.

Another common secondary gain at the crux of eating disorders like anorexia is a (false) sense of self-esteem and self-worth. Unfortunately, our culture propagates the idea that women need to conform to a stereotype of thinness and that changing ourselves physically will make life better. Our culture’s standards regarding body size and shape determine what a “perfect” body looks like and the closer the person gets to that unattainable ideal, the higher their self-esteem gets. I had put my self-esteem in a few external buckets: my body and my achievements. I received tangible evidence for my hard work and effort in the form high grades on my papers and exams, and low numbers on the electronic scale. My control and self-discipline made me feel worthy and valuable.

8. I lived by my strange set of narrowly-defined rules and rituals.

Because my body in starvation-mode didn’t think it was going to get food again, when I did eat, I needed the perfect conditions, and the perfect combinations of food. This showed up in my food rituals: making my tiny, low-calorie meals last forever by cutting up food into small pieces, eating slow, small bites, constantly reheating my food, and staying home to eat the food that I (well, my eating disorder) wanted, in the “right” quantities. I would purposely postpone or push my meals further and further back, subconsciously train myself to view food as disgusting, dangerous and intoxicating to combat temptation, and enjoy my food vicariously through other people.

9. It is a social disorder. Relationship with food > relationships with people. 

An eating disorder fills in for the interpersonal relationships a person lacks, but seriously needs, in their life. I couldn’t control my environment and the people in it. I started to isolate from them and shut myself off, in a non-verbal attempt to define my boundaries and say, “I’m tired of giving to you, being the caretaker, the giver, the doormat. Being taken advantage of and used. I’m closed for business. Leave me alone.” People were unreliable and didn’t understand me, and worst of all, had the power to hurt me. I developed a relationship and fascination with food, as I further withdrew from real people. I followed food Instagram accounts. I spent hours collecting recipes that I would never make from food bloggers online. Food was stable. It would always be there for me, to reward me and make me feel better (or worse). Those suffering from anorexia are usually often secretive and fixed to their rigid routines. It brought me an immense amount of stress and anxiety to even think about breaking my daily pattern. I would tell friends I would meet them at a party, only to cancel sometimes five minutes before, even though in my mind my decision to not go had been made long before. I was attached to my standard meals at my desk, where I would feel most productive. I would not be able to eat without Netflix open, playing Gilmore Girls in the background, giving the illusion of familiar friends in the room with me. Then I’d take a bite, and type my essay. It was an exasperating cycle of “I don’t want to be here. But I need to be here. I’m getting stuff done. I want to be here,” and “Why do I want people? When I’m with people I don’t want to be with them. When I’m alone, I want to be around people.” I just could not win. I could not make myself happy. I wasn’t allowed to be happy.

Now, I have learned to reach out for real human support, and foster real relationships and connections with people. To do this I have to accept a degree of powerlessness and vulnerability. Furthermore, self-acceptance and developing a relationship with myself is the key. Wanting the best for myself, and knowing I deserve food and enjoyment in life, just as I feel about anyone else I love.

10. It was a new manifestation of many years of stress and anxiety.

I was an anxious, perfectionistic child. I felt I’d be loved and boost my self-esteem by doing things really well and being a “perfect” daughter, friend and student. I had straight A’s, and avoided all conflict and drama. I was a people pleaser. I had very little self-confidence and self-compassion. I forced myself to do things well, to win, to be productive, to achieve. I didn’t want anything for myself. I applied to an Ivy League institution early decision, got accepted, and was pretty emotionless about it. I recently found an old diary entry saying I was mostly stressed about not getting in because of what other people might say or think about me. I had a fear of rejection, judgment and criticism, and I wanted to avoid getting hurt by others. To manage my anxiety I threw myself into my studies, something I could control and receive physical results and evidence for — sound familiar? I used to get sick from my anxiety and pull my eyebrows out. Stress in small doses might be positive for some, but too much is fatal. Stress manifests itself in different illnesses, physical and mental, and it is deathly. 

11. I was possessed.

I was numb. I would float around feeling like a zombie. I didn’t care about anything. I lost emotion. I became so negative. I longed for my younger self, who was optimistic and spiritual and thankful for life. Before going into treatment, I described myself as a monster, a disgusting human being so preoccupied with thoughts of food. I later discovered that I had an “Eating Disorder Voice” and a “Healthy Voice.” There were situations when my real self would come out. Then all of a sudden, I was gone, and someone else had hijacked my body. It was a surreal experience. Towards the end, the unhealthy voice had completely taken over. In treatment, we were taught to construct dialogues between the two voices, so we could bring back our rational selves.

12. I was “healthy,” not healthy.

Our society is so centered on the thin-ideal, accompanied by the “healthy, clean-eating” phenomenon. Juice bars. Salads. Soul Cycle. Sugar-free, Fat-free, Guilt-free, “healthy substitutes.” Low carb. Low fat. Low sodium. Gluten-free…Happiness-free. The eating disorder voice in my head made me genuinely believe that I was being healthy and kind to my body by giving it clean, green foods free of toxins and fat (and nutrients!). 

Orthorexia, an extreme obsession with eating food that is considered healthy, comes in part due to our culture marked by the desire to be thinner, which is equated with feeling happier. It is assumed a calorie-restricted diet is totally fine because it is the norm. For me, I have found conversations about weight, size, diet, calories and appearance inescapable: “I can’t have that brownie, are you kidding? I need to fit in to my dress.” These common topics of discussion make you “fit in” to this society. To just eat whatever you wish is seen as being gluttonous, undisciplined and immoral. People who are a “larger” size seem to automatically be smothered in negative, condescending assumptions about laziness, eating unhealthy, overeating, not exercising enough — when it might not be the case at all, and most importantly, does not matter. I tormented myself physically for months, years, but spiritually was so satisfied with myself. If I did “give in” to my temptations I was so filled with disgust and remorse, and had to rectify myself through self-punishment.

I have learned there is such a thing as a balanced diet, and that there are no “good” or “bad” foods. Labeling things attaches that idea if we eat something “bad” we are doing something morally wrong. My hunger cues recently returned, and it was a very interesting experience to first encounter them again. My eating disorder voice got upset and angry with my healthy self for being hungry — it was a sign of weakness and giving up. But I reassured myself that this was good for me, and that feeling hungry was not only a sign of recovery, but also one of being a healthy human being. 

13. It made me feel good.

I have already outlined many of the reasons self-starvation felt good. The strength and willpower it required made me feel accomplished and the weight loss was a reward for my hard work. I felt more worthy, valuable, powerful and confident. Feeling hungry, but not acting on it, can lead to a temporary high. I felt a sense of stability. My entire life was structured around a rigid pattern of exercise, work and low-calorie meals at a certain time. I felt safe in my routine, and really unsafe if it was under threat of being broken. Starvation made me thinner, which I viewed as a good thing — because in our culture, it is. Unfortunately, because slimming down is the socially accepted, even expected, behavioral “norm,” it prevented people from realizing something was really wrong. In my eating disorder, I felt confident, unbeatable and superhuman. I believed I was different from other people, who needed to eat or couldn’t resist the temptation of food. I could do without it and therefore I was special and strong. I was happy to deprive myself of this need, as I felt that I didn’t have needs. But all humans have basic needs, and food is one of them. 

14. Until I felt like I was going to die.

It was torture. Self-destruction. The pain from running in the blazing heat, because you have to — even if you might faint. If I collapsed, or died, then I’d be out of my misery. There were so many times I wished I could just escape my reality. I felt dizzy and weak, but it became so commonplace I only realize the difference now. The pain from laxatives, even when I’d barely eaten anything according to a “normal” person’s standards, would be unbearable to most — but it was a necessity for me. I needed to feel empty or I wouldn’t be able to continue on with life. Eventually, the illusion of stability created through a rigidly controlled lifestyle can give way to suicidal urges. For me, my rock-bottom point was when I really wanted to escape my life and place in the world. I could not bring myself to do anything impulsive, but I had slowly been killing myself and felt that if there were a button to make me disappear, I would have pressed it. Psychologically, I was done. I didn’t even realize that physically, my body had given up as well. 

15. Unicorn Syndrome: I was the exception.

Most people who have an eating disorder clearly understand other people need to eat to survive, but think otherwise of themselves. I felt I had to do more than “normal” people to earn my food.  My thought process would go, “People struggle to control their weight, but I don’t, I have this completely under control, and that makes me special. I’m lucky to be this self-disciplined” and “I don’t need that much food to survive. If I’m going to have that to eat, I need to deserve it. I need to work hard now so that one day I can enjoy it.” This mental distortion is accompanied by body dysmorphia, meaning that the way I saw my body was not what it looked like in reality. A stereotypical depiction of anorexia is a skeletal woman looking into a mirror and seeing herself much, much larger. That actually was not the case for me. It was not that I saw myself as much larger, but I had no idea that I was getting drastically smaller — in my mind, I looked exactly the same.

16. I am blessed with support and love.

I have gained so much from my illness. Although it was an atrocious period of time that almost led to my death, and I would not wish it upon anyone else, ultimately, I am so grateful for it. This process definitely taught me who my true friends are. Seven weeks into my treatment, I wrote a letter about my situation for the first time to a handful of family members and friends. I was petrified of exposing my secret because I was so ashamed of myself (although I now know I had no reason to be). I was met with such positive responses, and many people thanked me for being open and for educating them on what this very misconceived, very serious illness is really about. I found that I had (wrongly) assumed people would have preconceived notions or judgments, like it wasn’t a big deal or “just a way to lose weight.” This is exactly why I am opening up about it now. It is the only way I can help people really understand and change the stigma and misunderstanding that surrounds this illness. It is the least I can do for myself and all the people I have met along the way who have suffered from this.

Humans need support — we are social creatures. And we need empathy before we can take advice. We need people to just say, “I’m here with you,” even if they don’t understand exactly what you’re going through. If you haven’t been exactly where that person is standing, and proved to them you have been there, you have not earned the right to tell them what they should do. “You need to go through empathy camp, several times, before you reach the point of giving advice” — this is the mantra taught to us in family therapy that has forever changed my relationship with my parents for the better.

17. There are so many people out there like me.

What was amazing to discover was that people who develop anorexia are very similar — not in background, race or appearance — but share a cluster of temperaments and personality traits, such as low self-esteem, perfectionism, shame and conflict-avoidance. Also, my peers in treatment were all extraordinarily intelligent, insightful, caring and creative. It would not be fair to judge, or assume one unintelligent for having this disorder — especially when it really is the complete opposite. 

18. I have to be patient and trust the process. Trust life.

When I first got into treatment I wanted the recovery process to go faster. I just wanted the end result: a disorder-less, normal me. I kept getting told I was doing the hard work by being there, talking about how I was feeling and eating the food. But I thought it sounded too easy. I didn’t believe the time spent there, just going through the motions, was enough to make me better. I didn’t realize throughout this whole process, I would be learning so much about myself, other people and the true meaning of life. I have come a long way since I started treatment. I am still in recovery, and I still face obstacles. But I learn something new every single day.

19. I will channel my soul self.

My soul self is my true essence, my true being. How I came into the world before the perfectionist, critical voices took over. Self-acceptance means embracing who I am at my core, and believing I was born with everything, all the values that I’ll ever need. I don’t need to be or have more: I am enough. Self-love is the cure to an eating disorder. Being recovered does not mean I will love everything about myself all the time. But I will continue to be thankful for my life, my experience, for what I have learned and for my fully functional mind and body, that work so hard to keep me alive, moving, energetic and capable of feeling love and emotion.

“The soul usually knows what to do to heal itself. The challenge is to silence the mind.” Trust your soul and listen to your feelings. What are they saying about you and your beliefs about yourself? We tend to project our insecurities on to other people, and criticize them for the things we are ashamed of finding in ourselves. By becoming more in tune with ourselves we can learn a lot, and become happier and more satisfied with both ourselves, and the people around us. 

20. I am not a number and refuse to be remembered that way.

Lastly, a morbid but powerful question that helped me was, “What would you want it to say on your tombstone?” Would you want to be remembered for being a certain weight, high GPA, annual salary or number of wins, awards or positions? If so, please think about what these numbers say about you and your value. If not, what would you rather be remembered for? What kind of person do you want to be? If you want it, you’ll make it happen. Start today.

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How Challenging My Perfectionism Is Helping Me Recover From My Eating Disorder

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By: Colleen Werner

I have been a perfectionist for as long as I can remember. From afar, perfectionism can seem positive because it often leads to productivity, however, being productive is not the same thing as being effective.

I am doing Dialectical Behavior Therapy (DBT) as part of my recovery from an eating disorder and an anxiety disorder, and one of the major concepts of DBT is being effective. Being effective is about accomplishing things in a healthy, mindful way. It is about doing just what is necessary in a given situation, not creating extra work for yourself, or stressing yourself out about tiny details. Being effective does mean getting things done, however it is not just being productive. It’s choosing to do what actually works in a situation instead of what might be “right” or “wrong.” “Right” and “wrong” are extremely subjective, and don’t lead to accomplishing much. Instead, when we focus on doing what works for us, we are able to complete tasks AND prioritize our mental health.

One of the biggest ways that I’ve been challenging my perfectionism is by learning new skills. For a long time, I convinced myself that aside from being a dancer and singer, I couldn’t be artistic. However, I recently started learning the art of hand lettering after being inspired by several friends who do it. It was really challenging for me to learn something completely new to me because I knew there was no way I was going to be perfect at it. I knew that it was going to take time for me to learn the technique and that it was going to be messy and imperfect at first. I got very frustrated in the beginning (and honestly still do) when I would mess up a piece I was working on, or when I struggled to learn a new font. I could have easily given up and decided that hand lettering wasn’t for me, however, I didn’t want to let my pesky perfectionism win. I decided to embrace the imperfection that comes along with learning something new, and chose to accept that imperfection doesn’t mean failure — imperfection means you are trying, and trying means you are living.

Perfectionism is robotic. Perfectionism is stifling. When I give into my perfectionism, I give into the idea that if it’s not done impeccably, it’s not worth it, and that’s complete BS.

By challenging my perfectionism, I’m also strengthening my recovery from my eating disorder. Like many eating disorder sufferers, my disorder thrives off of my perfectionism. Whether it’s in regards to what I’m eating, how I look, or the temptation of engaging in unhealthy behaviors to gain a false sense of control, my perfectionism is deeply intertwined with my eating disorder.

I’ve learned that when I choose to fight perfection in one area of my life, it helps me fight it in all areas. When I decide that it doesn’t really matter that much if I mess up one letter when I’m hand lettering, it helps me decide that it doesn’t really matter if my body lines up with society’s standards. When I decide that it doesn’t really matter if I get a B on a paper, it helps me decide that it doesn’t really matter if my food intake matches that of an unqualified “wellness blogger.” When I decide that it’s okay to ask for an extension on a deadline, it helps me decide that it’s okay to post a photo of me that doesn’t fit the “aesthetic” standards of Instagram.

I’m finding the freedom that lies in imperfection — the freedom that my eating disorder told me I could only find in perfection. I’m learning that every time I fight perfection, I’m furthering my recovery, and allowing myself to truly live. I’m realizing that real life isn’t meant to be perfect because perfection is boring and mechanical. I’m accepting that imperfection is the most effective option for me, and imperfection is pretty damn beautiful.

About the Author: Colleen Werner is a professional dancer, singer, writer, and mental health/body-positivity/self-love advocate who was born and raised in NY. She is a member of Long2 Dance Company in NYC, and teaches dance on Long Island, NY. Colleen is also a YPAD (Youth Protection Advocates in Dance) Certified Dance Professional, as well as a member of their Advisory Panel. Colleen is currently studying Psychology at SUNY Old Westbury, and she plans on going to graduate school to become a Licensed Mental Health Counselor who specializes in Eating Disorders. She also aspires to start an eating disorder treatment program created specifically for dancers. Her Instagram account/blog, @leenahlovesherself, which centers around body-positivity, self-love, and mental health, has deeply inspired thousands, and after creating the hashtag #BopoBallerina, Colleen was featured by Yahoo, National Eating Disorders Association, Dailymotion, A Plus,, and by several international news outlets. Her experiences with her eating disorder and anxiety disorder have inspired her to share her story in an effort to help others. Colleen is devoted to using dance to make a difference. In her free time, Colleen enjoys playing with her two yorkies Tidbit and Zen, coloring, journaling, writing, reading, and watching Food Network.

When You Go From ‘Underweight’ to ‘Overweight’ While in Treatment for Anorexia

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By: Lizzie Janniello

This is a topic that I don’t think is discussed as much as it should be. I also know that this is a very touchy topic. I will tread lightly and only explain things from my perspective and my personal journal towards recovery.

When I started treatment for anorexia 17 months ago, I was in a really bad place. I was depressed, suicidal, and very underweight. My eating disorder had a full grasp on my otherwise happy and successful life. But it tormented me and convinced me that I needed to lose weight in order to be happy, successful, and pretty. And I listened to it. With the weight loss that I so desired, I lost everything that was important to me. My relationships were strained, I couldn’t succeed at my job, and I fell into a deep depression.

Fast forward 17 months, to today. I am still in treatment. But only this time, according to my BMI, I am considered overweight. I don’t feel like myself and I’m embarrassed. All I want to do is hide. I am embarrassed and sad. So I texted a two close friends and my therapist for some support, and they gave me a few interesting things to think about.

My therapist said that the BMI doesn’t actually measure anything important.

So true. But oh, so hard to believe. How am I supposed to be confident in my recovery when I look like this? When I am, literally, overweight. I’ve struggled my whole life, always being underweight yet feeling obese and fat. But now the problem is that I actually am overweight. I’m sure some of you can understand what that feels like. I feel like a balloon, like all my clothes are busting at the seems. My friend described it as feeling like a Telly tubbie. It’s so true. I feel disproportionate, pudgey, and whalelike. This is not me. I entered treatment to help me with body image, but how is this helping me? How is taking me from one extreme to another going to help?! I simply did not understand.

My therapist said I needed to work on “radical acceptance”. I know, I know, DBT is the key. But it’s so hard. I so desperately want to look like all those models in magazines- my friend describes them as “clothes hangers” because of their lack of curves and skeletal structure. I don’t know who’s to blame, maybe it’s the media, maybe it’s how I was raised. But no matter the reason, that’s what I want to look like. And so I took my body through the extremes of restricting, and managed to change the way I looked, so that I would resemble the ideal image I had in my head. But yet my body image still told me I was fat and overweight and that I should just keep losing a little more. Even when extremely underweight, I would body check and grab and pinch all the areas where I thought I was “too fat.” I was very sick.

Well I tried to do the right thing- three times in the past year and a half, I have entered treatment. And now, I am overweight because of it. It makes me wonder what I’ve gained, besides weight. Did I make the right decision, entering treatment? According to my values, yes. According to my eating disorder, no. Is this all my eating disorder getting louder and louder? Telling me I need to lose weight? Or is that the normal voice of a girl, any girl, just striving to feel confident in her own skin?

What I’ve learned, is that no matter what size I’ve been, I’ve yet to be confident. So what does that mean? I think that means that confidence has nothing to do with our appearance. I think it’s all about the way we perceive ourself. Our smiles. Our laugh. I want to feel confident. But I know that weight loss isn’t the answer anymore (even though that means I have to fight every urge, everyday, not to lose weight). It’s about learning to love yourself and truly embracing health at every size. I know that my body needs time to heal… lots and lots of time. I’ve put it through a lot, and overshooting is just it’s way of healing. But knowing that doesn’t make it any easier. It’s hard, especially during summer. If you are in this situation, or can relate to anything I’m going through, go follow some body positive models on Facebook and instagram. Find people who are confident in themselves and try to emulate that in yourself. Embrace your curves! Love your body! Treat it with kindness and respect- after all, we will only ever have one body. But I can tell you one thing that I’ve learned- our appearance is the least interesting thing about us. This quote always sticks with me:

“We get so worried about being pretty. Let’s be pretty kind. Pretty funny. Pretty smart. Pretty strong.”

Go on that date, take the adventure, live life. And stop apologizing for taking up space. Stop hiding because you are embarrassed of your appearance. I can guarantee that you are beautiful. You are loved. You are worthy of happiness, confidence (no matter what your size), and joy. Don’t miss out on life because you’re too worried about what others think about you. Love yourself and that will draw people to you! I know you can do this. I’m trying my best, and I hope that you are too.

About the Author: Lizzie studied psychology at Hillsdale College, a small liberal arts school in Michigan. She currently works as a research assistant in Washington, D.C. She is in recovery and hopes to one day use her experiences to help others struggling with eating disorders. Lots of love and please stay strong! You’ve got this.

Sometimes Recovery Is Taking a Leap of Faith

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By: Kaity J

The night sky was full of stars, but no moon. Oh how I missed the moonlight as it shone through my window and cradled me in its light. Looking up at the star I wonder who else is seeing the same thing. My dad always said whenever we were apart; to remember we look at the same stars. He said that he thought of me whenever he looked into the sky. I did too. In science class, I learned that we are made of stars, which I can understand because the God that placed the stars in the sky also made us. I’ve been gone a lot, jumping from place to place, never really staying, and never settling. Sometimes I like it, I’m like a shooting star, you see me for a glimpse and then I’m gone. Sometimes I compare that with being my true self. I’m so obsessed with other people liking me, you cant see the real Kaity, but then, maybe like a star or maybe like a moon, I appear, sometimes as fast as lighting and sometimes as slowly as a waxing moon. Like peeling off wet clothes, one by one, the layers fall. I am scared to be a moon. It’s so much easier to just be a star, almost invisible at times, shining light from years ago.

A moon is visible and its light is present, from within. What if I don’t have enough light? What if I’m as dark as a moonless night? My family told me that they would hold onto my hope when I had none, is hope light? My hop is waning, flickering, almost out. I’m tired of being a star, yet I’m too afraid to become a moon. Because once I fully become a moon, I will never go back to being a star. While pondering all of this, a tear slips down my cheek. Running from my real self is exhausting. Looking up at the starts I start to see a moon creep over the horizon. Here is my chance and in that moment, I decide to leap in and take it.

About the Author: In recovery, figure skater, lover of animals and movie watcher!

Closet Cleanse

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By: Marlee

I purged my wardrobe. Literally, I had clothes scattered across my bed and floor. Why you may ask? Well I was running sprints one morning, and I noticed how my shorts were bunching up on my thighs. I had been noticing it a lot lately and I was kinda beating myself up about it. Why? Because my shorts fit just fine in the summer. All my shorts fit. I knew that I had gained weight but the fact that stuff that was fitting over the summer wasn’t fitting now was making me self conscious.

But before that self discriminating voice got louder I thought “Why am I trying to wear clothes that don’t make me feel comfortable and confident?”

Some of my clothes were ones that I got back in high school or during my first two years of college. As I thought about it more, I wondered if I was trying to hold on to some old part of me. Why was I trying to hold on to a person that I no longer am?

As soon as I got back to my apartment, I started tearing my closet and dresser apart. I created two piles of clothes: one for clothes to sell and one for clothes to donate. I didn’t hold back. I didn’t think twice about getting rid of something that was cute but no longer fits me.

Its still a hard concept for me to wrap my head around. Most people don’t realize, that ED survivors may recover, but we still deal with the side effects on a daily basis. Becoming comfortable with yourself is a process and a struggle. I felt like these clothes were holding me back from embracing my body even more than I already have. We should wear clothes that make us feel comfortable and confident. We shouldn’t be wearing clothes that make us feel insecure or uncomfortable.

I don’t want to wear shorts that bunch up on my thighs. I want shorts that hug my thighs and show off their strength. I don’t want shirts that make me feel self conscious about my ab-less belly. I want shirts that flaunt my curves and make me feel confident. I want dresses that make me want to twirl (an indication that I like something btw) and a swim suit that makes me want to do a cannon ball into a pool (I promise I’m 21 years old).

I’m not the size I was during my ED. I’ve gained weight since last year. I realized though that a number is so meaningless in defining my self worth. Some stores I wear one certain size in jeans, and in others I wear a different one. But you know what? WHO GIVES A DAMN?! It’s a stupid number and sizing in the clothing industry is SO screwed up. I’m gonna pick clothes that fit me and make me feel confident. And I’m sure as hell not gonna stress over the size, because really what does a number or letter mean? ABSOLUTELY NOTHING.

Purging my closet and dresser was refreshing and invigorating. You should have seen me. It was like something out of a movie. I had music blasting in my room, throwing clothes out on the floor, singing and dancing the whole time. Doing that instantly made my day SO much better.

So the moral of this whole story: meaningless material objects should not define you. If something makes you feel uncomfortable or self-conscious, DON’T WEAR IT. Hell, GET RID OF IT. It’s not worth it to keep wearing something that makes you feel horrible about yourself. You deserve to feel confident, strong, and beautiful in whatever you’re wearing. And when you feel good about yourself, that confidence radiates around you. And that is the most important thing you can wear.

This post originally appeared on

About the Author: 21, going on 22-year-old recent college graduate. Loves lifting heavy weights, blogging, french bulldogs, dancing, singing, and peanut butter. Aspires to help people find their inner fighter and embrace every part of themselves.


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Project HEAL has been asking a weekly question related to eating disorder recovery. For this week’s #WEWANTTOKNOWWEDNESDAY, we asked you:

What’s one thing you wish people would stop saying to you?

Here’s what you shared:

1. “I wish I had your problem, then I could lose weight” – Leslie M

2. “You look so much better now” – Jessica S

3. “If you just eat healthy and exercise, you can stay skinny” – Callie A

4. “I wish I had your ‘willpower’” – Presley G

5. “You don’t look like you have an eating disorder” – Danielle M

6. “Think of all the victims of the hurricanes/floods/earthquakes out there. They’d give anything to have one bite of the food you have and here you are starving yourself” – Kristi S

7. “But you’re better now though right?” – Katy S

8. “Are you sure you want to eat that much?” – Katie G

9. “Just eat” – Alisse B

1o. “You look like you’ve lost weight” – Kelly S

11. “I wish I had your problem” – Ailene M

A Letter to my Scale

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By: Kayla Hopper

Dear Scale,

You have ruined my life. I have given you power to control every aspect of my day. You tell me when to wake up, what to wear, what to eat, and when to drink. You tell me where I can go, who I can go with, and always make sure I feel worse about myself; so that I can strive to make you happier. You make me believe that the lower your number; the higher my worth is, and the safer I am. You tell me a set point and promise that you won’t demand more; until it’s not enough, I can always be better. Each day I run to you, sometimes multiple times a day, just to get your approval. To see if I am living up to the standards I allowed you to set.

But there is one thing I have now realized, I handed you the power, and I can take it back. That number doesn’t tell me my worth; I am made in the image of God, created with the utmost love and respect. I am worthy of love and compassion that you are unable to give. The number doesn’t reflect my accomplishments. I am a proud mother of four children and a wonderful wife and friend. I have allowed my body to go through tremendous pain and change just in the power of love. I am not an object, I live and breathe. I deserve to have grace on my hard days, and celebrate my victories.

I am a woman, I am valued, I am needed, I am wanted, and I am deserving. I am everything you tell me I’m not. I don’t have to be a certain size to be accepted. I don’t have to be a certain number to love myself. Loving myself is not conditional, and it is not a weakness. I have allowed you to have control for too long. I have let you wreck my body, my self-esteem, my family, and my relationships. You have caused more pain than I can fathom, all in the quest for an unfulfilling happiness. You have nothing to offer me but lies and pain.

Without you I can soar. I can be who I am created to be. Without your demands… I am free.

About the Author: I am a 30-year-old wife and mother of four. A survivor of anorexia, ptsd, and bipolar disorder.