Expert: Joanne - 11/2/2007

Question
I am a recovering anorexic with severe laxative abuse. I had been struggling with my illness for 5 years before I admitted my problem and decided to get help. This summer, I spent a month in an inpatient hospitalization program. At my lowest, I was 111 lbs. (and 6 ft. tall). I recall being somewhere in the mid-150s at my biggest. My doctors gave me a target weight of 142 lbs.
When I decided to get healthy, I made a commitment to myself and my family. I was tired of putting them through everything and my poor husband was afraid I was going to drop dead at any moment. Checking myself into the hospital was the hardest thing I've ever had to do, but the day I arrived I decided to do everything it took to beat my anorexia.
Nine days into my program, I found out I was pregnant! I was elated and believe that my pregnancy was a gift from God to further motivate me to recover and finally live a healthy life. Throughout my program, I never missed a beat. Eating everything that was given to me, following my therapists' advice and really working to resolve some of the underlying issues that led to my illness. When I was discharged, I went into a partial hospitalization program (outpatient) for another 3 weeks. I really felt like I'd beaten this.
Then I found out at my first ultrasound that my baby wasn't viable. She'd stopped growing at about 6 wks. (I was 10 weeks along.) I know there could be a million reasons why she didn't survive, but I blame myself. If only I'd sought treatment sooner. If only I wasn't taking 55 laxatives a day before I got into the program. If only I'd been eating... She may have made it, right? Just to live with myself, I have to believe that she was a gift and her purpose was to get me healthy, to save my life. And she stuck around (through my 12th week) before I had to induce miscarriage. She gave me the time to heal that I desperately needed.
After I lost the pregnancy, I took a downward turn. I still believed that I had to stick to my guns and stay healthy--if only so that my baby didn't lose her life in vain. I made a promise to her that I would survive. And I want more than anything to get pregnant again and be healthy enough to carry it full-term.
But I'm struggling. I haven't been sticking to my food plan. In fact, I'm eating way more calories than I'm supposed to. I surpassed my target weight and am now at 153 lbs. (but it continues to rise each week). I do exercise a normal amount, but I'm not sure how to get back on track. I decided to start a food journal to track my intake and follow a more regular exercise program. But I'm afraid if I get into calorie counting or obsessing over gym time that it will just lead me back into the throes of anorexia.
Still, I am so uncomfortable with my new body that I'm afraid I'm going to relapse at any point. So far, I've not once restricted, purged or taken a laxative. I'm extremely proud of myself, but so sad at the same time. I want to get back to the 142 lb. target weight set for me. I feel like if I'm there, I won't feel so badly -- it's the bare minimum, right? But I'm also afraid that dieting and focusing on that goal weight will just cause me to relapse. So how do you diet healthily when you're a recovering anorexic? Because I keep gaining and gaining and gaining, the behavioral thoughts are becoming more frequent. What advice can you give me to help me feel comfortable with my new body, get me back to my target weight, and keep me from eating thoughtlessly (which I think may be emotional overeating to numb myself from the pain)???? Please help.

Answer
Kelly, I'm so sorry that you have had to go through this!

You need to try to get back into your outpatient program, or at least be put in contact with someone that can give you support.

I would reckon there will be a strong link between your overeating and your grief, anger, guilt, etc.  It is almost as though you are replacing one eating disorder with another just now, which also runs the risk of you 'swinging' back to the other extreme later on.  Did your treatment team ever warn you of possible problems you may experience during pregnancy while suffering from an eating disorder?  Was there any sort of preparation for anything like this?

I think it sounds as though you could use some grief counselling, and maybe also the support of a dietician again.  My first thoughts would be to contact the program you were originally in and see if they can offer you anything, and if not, they may be able to point you in the direction of people that can.

At the moment, I would try not to focus on your target weight, but simply on dealing with your loss, and hopefully get some more guidance on what you should be doing in order to become pregnant again.

I wish I could say eat this and all will be well, but I can't, and I think that you should be getting this advice from those that are looking after your health.  Please talk to them about your thoughts and feelings about all of this - it will help!  Maybe it would be worth your husband getting involved in grief counselling as well, so that you can support each other.

Please come back if you want to ask absolutely anything!

All the best to both of you
Holly