Psychiatry & Psychology--General/Anorexia Relapse

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Question
QUESTION: Hi,

I'm a 20 year old female, and starting this past Friday, I relapsed with purging type anorexia. I previously suffered from this and overcame it on my own in 2011. Since, I've been diagnosed with generalized anxiety disorder and depression.
I know this time is worse; the last time, I knew I should stop and I wanted to, but I couldn't for a long time. This time, I don't want to stop. I've been eating 600-800 calories per day, and purging or exercising if I go over. I've lost 8 pounds in 4 days, and I'm to the point that after I do eat, I feel really anxious.
I see my psychiatrist in a little over two weeks. I don't know if I should call him or just ride this out. I'm 5 foot 5 and 166 pounds, so it isn't critical physically, but I'm afraid to go down this slippery slope again.

Am I okay to ride this out, or should I call and tell him sooner?

Thanks for your help,

Cassie

ANSWER: Hi, Cassie, thanks for your question. In terms of time ... well, you are not likely to die, immediately, from vomiting, so it may not be an emergency. OTOH, a psychiatrist will only prescribe medication. You need to see a counselor, and you should call for an appointment tomorrow - right away! The reason is because you can die, in time, from this - it is quite dangerous to your physical health. Often, vomiting is caused by feelings of anxiety (as well as, perhaps, a number of other feelings). Vomiting reduces the emotional feelings by converting them to the physical world. It becomes almost physically addicting, due to being physiologically rewarding. Many people are addicted to things that they know are bad for them, in the long run, but they put off doing anything about it today. Unfortunately, the longer you let this go on, the more it will become an ingrained habit, the more difficult it will become to undo. Trust me, you don't want to wake up at 50, with a ruined life, and think 'if only I had gotten counseling like that guy said'. Perhaps even worse, you don't want to force your family and friends to attend your funeral, leaving them wondering 'what could I have done to change things? If only I had done it differently, Cassie might still be alive".....

You will need to realize that, in order to feel better in the long run, you may have to be willing to feel worse in the short run. What I mean by that is that, by not vomiting, you will feel 'worse' than you do when you vomit. This is because vomiting is rewarding immediately, and facing your feelings/problems is difficult.

---------- FOLLOW-UP ----------

QUESTION: Thanks for the advice. I know this is a slippery slope. My attitude about it scares me. I've been diagnosed with GAD and depression, an I'm already feeling anxious after I eat  when I'm not going to purge. I was seeing a therapist for talk therapy, but after several months I wasn't experiencing any relief and found it was generally not helpful. I'm in the process of getting an appointment with a new therapist, but it's a larger company and I'm waiting for them to assign me a counselor who will contact me this week. Right now, I just have my psychiatrist, who knows I have struggled with this in the past but is currently unaware of my relapse. I just don't want to get too far down this slippery slope before I try to turn around, which is why I wasn't sure about contacting him. I don't know if he would increase my SSRI or anything.

Answer
Cassie, meds are helpful to an extent, but you need to realize that they don't solve the problem. All they do is temporarily numb the emotional pain. There are some bad therapists of course, but the best therapist in the world cannot help you if you are not willing to face the problem head on. It's like the old joke - how many therapists does it take to change a light bulb? Only one, but the bulb has to want to change. In the same way, you have to be willing to go thru the extra pain of doing real work on yourself. Until the problem bothers you enough to do that work, you may remain stuck.  

Psychiatry & Psychology--General

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Bruce Borkosky, Psy.D.

Expertise

any related to psychology, especially related to forensic psychology

Experience

15 years as a licensed psychologist, 15 years in private practice. My practice began primarily doing individual and group psychotherapy, is now devoted to assessments, but I occasionally do take on clients in therapy.

Organizations
American Psychological Association

Education/Credentials
B.A. psychology, B.A., music, Ohio Wesleyan U., 1978 MCS, computer science, University of Dayton, 1984 MA, psychology, Miami Inst. of Psychology, 1991 Psy.D., psychology, Miami Inst. of Psychology, 1993 post doctoral training in Neuropsychology, Fielding Institute, 1995-1997

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