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Psychiatry & Psychology--General/Unhealthy thoughts about weight loss. What should I do?

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Question
Ok, so in the last 2.5 months, I've been trying to lose weight. I'm 5 feet, 10.75 inches tall. I started out at 262 pounds. I'm 248 now. I haven't been exercising because exercising reminds me that I'm fat and it's partially my fault (I'm on medications that probably caused about 60 pounds of the excess weight), and exercise badly triggers my self harm addiction and my self-hatred. I also don't deal well with some change because I have Asperger's Syndrome. Sometimes I don't care that I've lost 14 pounds, because it's not as much as what I was supposed to lose, since I often think I should just exercise and take the unhappiness. I'm on Bupropion to help me lose weight and seriously I can only work hard enough to lose about 7 pounds with a month of weight loss medication?! I feel lazy, undisciplined, angry, sad, disappointed, and hopeless. I feel that it's hopeless that I'll ever do what I should to get to a healthy weight. I don't know what to do about stopping these thoughts.
I have Asperger's Syndrome, borderline bipolar disorder, ADD tendencies, OCD, Generalized Anxiety Disorder, a self harm addiction, and borderline Auditory Processing Disorder. Although I don't see how that last one could be related, I felt I should talk about all of my diagnoses.

Answer
Helo,

I am sorry you are having such a hard time. To start out with, I understand that you have some challenges that have made your life difficult. You tell me you have Asperger's Syndrome, borderline bipolar disorder, ADD (ADHD?), OCD, GAD, you self-harm and have a learning difference. That is a lot to handle and I am curious who has made your diagnoses and how you are being treated for all these issues. Do you see a psychotherapist? A psychiatrist? Do you see these specialists regularly or just every 6 months for medication management? What are the medications that are causing you to gain weight? Are your doctor's working together on a health care plan that is coordinated or are they working individually without consulting with each other? One thing I would recommend is that, if these professionals are not working together, it is time to get them working with one another in your best interest.

I would approach your problems from a little different perspective. First I would make sure that all these different psychological diagnoses are real or if there might be another way to approach this, looking at it from a big picture viewpoint, to see if we might be able to simplify this complex picture. I would rather look at it from a unique perspective of not relying on what categories you fit into but rather looking at the constellation of symptoms to see how these symptoms might actually have been developed as some kind of defense against trauma or threat.  I would look at your history of relationships and experiences to see what has happened in your past that might shed some light on the problems you are having now. Then we would work on these issues through talk therapy as I coordinate your care with the other health care professionals that you see.

What if we take a look at your weight problem from a totally different point of view? I would rather you don't look at it as "How many pounds can I lose this week?" You could look at this without concentrating on the 'restriction' aspect of food deprivation but rather, substituting better, more nutritious foods for ones that have far less nutritional value. Once you adopt the attitude of needing to 'restrict,' you have lost the battle. Once your body/mind complex sees this as a deprivation, you will develop cravings and food will be on your mind 24/7. If you look at it as eating more healthy foods and eating those foods more slowly and mindfully, it will become a lifestyle change and one that will feel more satisfying. I am one of the few who firmly believes that diets never work in the LONG RUN and that healthier eating is much more successful and works well over time.

If you read some of the public postings that I have answered on this site, you will see that I am a psychotherapist. Therefore I do have a bias in support of talk therapy as a way to permanently change mind. It has been shown that changing the mind also changes the brain. It would be quite beneficial, from my point of view, to seek the support and counsel of a good psychodynamic psychotherapist…one who is skilled at developing a trusting relationship with the patient and one who utilizes the technique of talk therapy as an intervention to any number of psychological issues.

If you have any further questions on this or if there is any other way I can help you, please do not hesitate to ask. I wish you all the best.

Psychiatry & Psychology--General

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Jacquelynn Cunliffe

Expertise

I would like to answer under the category of Psychiatry and Psychology. However, I would like to see a separate category for Psychotherapy/Psychoanalysis. I do not answer questions about medications as I do not prescribe. My expertise is in psychotherapeutic treatment.

Experience

I am a psychotherapist and psychoanalyst who specializes in the treatment of mental health issues caused by childhood trauma, domestic abuse, eating disorders, relationship difficulties, and a wide variety of psychological disorders. The kind of therapy I do is often referred to as deep therapy, talk therapy, or psychoanalytic therapy. Please note that I am not against medications and when managed well, medication can be an adjunct to psychotherapy intervention. I think it is important for the public to realize that psychodynamic or psychoanalytic psychotherapy DOESmake changes not only in people's minds but those changes can also be detected in their brain structure. Psychotherapy and psychoanalysis are powerful interventions to help people change their lives from the inside out.

Organizations
American Psychoanalytic Association American Psychiatric Nurse Association Member of Psychoanalytic Center of Philadelphia Member of National Eating Disorder Association

Education/Credentials
Ph.D.-University of Pennsylvania, Psychology and Education, Division of Human Development M.S.N. and R.N.-B.C. Board Certified Nurse in Psychiatric and Mental Health Nursing. 2-Year Adult Psychotherapy Program graduate 2-Year Child Psychotherapy Graduate Current: Candidate in Psychoanalytic Training at the Psychoanalytic Center of Philadelphia

Past/Present Clients
I have worked with clients who have experienced significant childhood traumas. These patients come with a variety of mental health issues, including anxiety, depression, suicidal ideations, relationship difficulties and diagnoses such as Personality Disorders, Adjustment Disorders, and, though rarely, Dissociative Identity Disorder (formerly multiple Personality Disorder)

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