Saturday, July 10, 2010

OCD and Weight Gain - Can I Fight One Without Fueling the Other?

My thoughts are somewhat scattered at the moment. I feel like there are so many things I could write about, and my thoughts flit from one topic to the next. Half of me wants to write about recent exposures of the past two days and the other half of me wants to write about something more abstract...we'll see where I end up.

I have been thinking about my weight more lately so perhaps I'll go with that. Like OCD, I could write volumes on my experience with weight control, my acute decline into anorexia (8 years ago now!), and what happened after my fairly abrupt "recovery." It is another one of those mental health issues that I have never gotten to talk about much, one of the elephants in the room from my past that I rarely acknowledge outside of the mental health world. And when I do, I often work daintily around the subject, sort of obtusely hinting at what was actually going on without saying it outright.

One thing that occurred as I spiraled down into severe contamination OCD last fall/winter, was significant weight loss. This wasn't the type of weight loss that I experienced, or rather forced, when I was anorexic. I wasn't calorie counting. I wasn't drastically limiting my diet. I wasn't weighing myself every chance I could get. I wasn't exercising five hours a day. Rather, this significant weight loss was a byproduct of my obsessions and compulsions rather than the focus of it.

At my worst, I spent a lot of time lying in bed or on the couch compulsively avoiding compulsions, trying to figure out how to accomplish parts of everyday living without violating my OCD rules, and finally, doing the compulsions themselves so that I could do things that I needed to do. Such necessary things included activities as basic as brushing my teeth, getting dressed, showering, using the restroom, and also eating.

I got to a point where it was very difficult for me to feel clean enough to eat - to touch things in my kitchen, to prepare food, and to actually put the food in my mouth. Since washing before eating was, according to my treatment guidelines, theoretically one of the few situations in which I was actually allowed to wash my hands, I felt that washing my hands, and doing it well, was absolutely imperative prior to eating. Granted I knew that there were many situations in which people violated this supposed rule for washing before eating, and before my contamination crash early last fall, I did, too, more than I ever probably thought about. But OCD kept clouding my memories and judgment with insidious seeds of doubt and question after question:

What if I just thought that everyone else didn't wash at certain times? Maybe they did find a way to wash or at least put hand-sanitizer on or only touched 'clean' things if they knew they would be eating and wouldn't be able to wash. Maybe I somehow missed this - somehow I might have never learned these basic rules that everyone else apparently follows. Maybe my whole life I thought what I was doing was normal when it actually wasn't, when it was actually atrociously disgusting. Perhaps I am just now seeing the way things really are and how most people really behave.

What if everyone else has been living all this time by these contamination rules that I am just now imposing upon myself? What if I was just blatantly ignorant? Somehow I might have failed to learn to do things the "right" way and was just blind to that fact until now. Maybe what I consider so difficult is just part of everyday life. Maybe everyone keeps track of all the things they touch and when, washing and sanitizing accordingly. Maybe they have done this so long that it is second nature to them, whereas this higher standard of cleanliness, this immense amount of mental energy devoted to recognizing and remembering all that I have touched (and when...and in what order...and what all the potential possibilities for 'cross-contamination' are) is simply new to me, and therefore seems frustratingly difficult. Maybe I'm just defective for not being able to keep up, for not being able to run this draining mental program while simultaneously being as productive as everyone else. Maybe I am just weak. Maybe I just need to stop whimpering under the supposed strain of all this, suck it up, and just do it...just do all the compulsions that everyone else is probably performing all the time, too, and stop complaining. And, if I just paid more attention to my hand-washing, to the things I touched, to the order in which I came into contact with things, like everyone else, the supposed compulsions probably wouldn't be required or at least wouldn't take so long! It is my own fault that I have to wash so much and so rigorously...if I just learned to do it right the first time...if I hadn't been blind all along to the way things are supposed to be wouldn't be so difficult!

That was the cruel, cruel voice of my OCD, trying to convince me that somehow I had missed some giant list of rules that were a part of everyday existence, rules that everyone else somehow learned and now followed religiously, rules that I was just now realizing had to be performed. I still feel this way sometimes. Maybe everyone else does things the "right" way, and I am just defective for being so blind, for not figuring out that I was doing things wrong my whole life.

Anyways, I have veered away from my original topic. Basically, that OCD voice in my head resulted in stringent pre-conditions for eating. I had to wash, but in the "right" way, and of course over time, that "right" way became more and more difficult to achieve. Sometimes I would lie in bed all day, hungry, but I would wait as long as possible to get up to eat because I dreaded the hand-washing and sometimes showering that I felt must be performed first. I just didn't see any other way to get to the point where I could put food in my mouth. There was no way around the ominous and threatening compulsions, no shortcut path that provided an alternative to the ever lengthening, ever more demanding trail that OCD laid out before me. It seemed like there was no way around the dense and disorienting underbrush, the thorny bushes, the false endings of the path. I could only go down it and hope that I made it out on the other side with minimal scarring and without getting lost in an endless loop of compulsions. Basically, I often preferred hunger to having to face the possibility of getting stuck for minutes or even hours while performing washing compulsions in my bathroom.. That was how I ended up losing somewhere around 15 to 20 pounds in a matter of a few months, which was a considerable amount for my fairly petite frame. I wasn't underweight, but I was skinny enough that people questioned my weight loss and warned me not to lose anymore. They were concerned and I acted like I was equally concerned, but inside I relished having finally shed these pounds unintentionally.

When I started to get better, satisfying my hunger, as well as just the pleasure of eating itself, began to outweigh the dread of performing washing compulsions, which I slowly began to gain more and more control over. But as it became easier to get myself into the "right" state for eating, I didn't immediately dive back into a normal eating routine. I rationed my eating. I intentionally ate or drank things that I knew would fill me so I could skip meals or reduce their size. I paid careful attention to calories and a few times even started keeping a food log, tracking what I ate and the approximate number of calories consumed. A slippery slope that could lead back into more and more rigid eating patterns, but it made me feel in control. It made me feel like I had something when so much else was a fight. It also made me feel that I was working on and perfecting something. If I had to let my contamination compulsions go, I wasn't about let myself waste away into sloppy oblivion. If I wasn't going to scrupulously wash, I could scrupulously manage my weight.

I had wanted for so long to lose the additional pounds that I had gained after my recovery from anorexia. I told myself that I wasn't foolish enough to go after thinness as zealously and stringently as I had years before, that I knew better now, but that it wouldn't hurt to do what I could to keep my food consumption and my calorie intake a bit below normal to fend off gaining back any of the weight I had lost. If I gained it back would I ever be able to lose it again without going through another period of extremes?

And now, I fear I have gained some of that weight back. I'm pretty sure I have, but I'm not really sure how much. I never know if I am just distorting things again like I did back when I was anorexic and constantly thought that I might be getting fatter, rather than thinner. I don't know if I am really justified in being concerned, or if my over-attendance to fluctuations in my weight and my fear of gaining it all back is simply magnifying what is only slight gain. It's just hard to tell. I'm almost certain that I have definitely gained weight. But how much? And can I get it off again if I really have gained a significant amount of weight?

These are the questions that come to mind. The only way I feel like I have ever successfully reduced my weight is through drastic dieting, first through anorexia and then as a by-product of OCD (though I think my anorexia was basically another form of OCD for me). I know that eating healthily, getting exercise, and not going to extremes is probably my best bet for weight maintenance, but I feel like I am always yo-yo-ing between extreme dieting and reckless abandon in what I eat. Right now I feel the pressure to become more rigid about my eating habits, but I also feel like I always fail at maintaining any such rigidity or resolution. And this tendency to doubt my ability to maintain any sort of normal diet plan pushes me to crash diet one day and give up the next. Sometimes I wish I could tap into the heartless, rigid, unforgiving mindset of my anorexic days again. But then, I think that is just my OCD saying, "Hey, if you just try harder, if you just do this in this specific way, it will work, you will feel better!" But just as with the washing, the rigidity and the discipline of eating that I wish I could have is not realistic. It cannot be maintained and, if anything, things only get worse and worse and worse. And then, even if I am thin "enough," I can't recognize it and I can't enjoy it. By that time obsession and ritual have swallowed up my life. The compulsive need to lose weight steals away the enjoyment, the satisfaction, of being at a weight I could be comfortable with.

So how do I find a happy medium? Can I reduce my OCD without fueling weight gain? And can I really combat weight gain without triggering my OCD? This is something I still battle with and am still figuring out. But I hope to succeed in learning to use moderation...I just can't go seeking moderation too compulsively! :)

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