*TW: Self harm
I am discharging from UCSD’s Eating Disorders Center for Treatment and Research in three weeks and yesterday my dietician told me I’m under my admit weight. Meaning, I’ve lost weight since I started this program. So before I talk about my progress in program, let’s talk about how much that sucks.
Basically for the duration of program, I will be adding a fattening shake to each meal in a final ditch effort to get me to a restored weight. The thing about weight restoration is, not only does it mess with your already crappy body image, but the added volume to meals is incredibly uncomfortable. When you start an eating disorder program, it’s pretty uncomfortable for you and your GI system. You’re basically teaching your body how to eat again. I firmly believe that the closest friends you will ever make are in an ED program only because of how often we pass gas in front of each other in a desperate attempt to maintain a sliver of comfort in our guts. And, of course, nothing is quite as sobering as supervised bathroom visits. I feel bad for all the therapists in our program…they’ve heard more than they ever should. Bless their hearts. Long story short, I’m not looking forward to my body doing yet another adjustment to the volume of food I’m having to intake.
In other respects, I feel more ready to discharge than I ever have. It’s terrifying, but earlier this week I was able to get a glimpse of how much I’ve progressed in the four months I’ve been in treatment. Not just with eating, but with other urges.
A few nights ago, I was suddenly overcome with self harm urges. Instead of trying to handle it myself (which I knew I wouldn’t have been able to do) I reached out to my therapist (Nikki, remember her?!). After some pretty low-key discussions about effectiveness and long term goals, I realized that it wasn’t going to be enough. I quickly told Nikki that I needed to use a TIPP skill because I was coming dangerously close to ruining the near 50-day streak of no self harm.
In short, TIPP is a DBT skill (Dialectical Behavioral Therapy, for those unfamiliar). It stands for Temperature, Intense Exercise, Progressive Muscle Relaxation, and Paced Breathing. Basically, it’s a distress tolerance to get you down from a 10/10 emotional state. When I first learned about distress tolerance, I learned that anywhere from seven to a ten on the emotional scale was the “danger zone,” and a DT skill should be used to get below a seven. After that, you can begin using emotion regulation skills to continue managing the emotion that decided to go haywire.
Back to earlier in the week. I knew that I needed a shock to my system; everything was triggering me, from the walls and door frames that I wanted to hit my wrists against, to the dinner fork sitting next to me that made me wonder how sharp the tongs actually were. The most effective letter in the TIPP skill for me is T: Temperature. The goal is to shock your system enough to clear your head. It uses the dive reflex, referencing what your body experiences when diving into deep water. To enable submersion for a long period of time, heart rate slows and blood rushes to the major organs to keep them going. By using ice on your face, getting in a cold shower, or even getting your hands, arms, and face wet with cold water, you are triggering that dive reflex.
So, with shaking hands, I filled my tub with the coldest water I could muster and dipped my toes in. But, as I stood with icy water lapping at my ankles, all I could think about was punching the shower wall in front of me. When I got to the point where my fist was resting on the cool surface of the wall, I realized that simply dipping my feet wasn’t going to be enough. I grabbed my book of cryptograms- one of my go-to distraction methods- and sat my ass down in the tub. I was crying, shivering hard, and trembling from the intense anxiety I was experiencing. On top of that, I was fiercely trying to focus on my latest cryptogram, as I had only decoded two letters at the point that I entered the bathroom.
Here’s the thing: it worked. I had no hope of it working, in fact I was convinced that my urges would overwhelm me and I would end up with bruises that I would have to explain to Nikki the next day. But the freezing water slowed down my breathing, and the puzzle held my attention while TIPP did it’s job. When my distress slipped below a seven on the intensity scale, I changed the water temperature from cold to warm, and sat in the tub with my book and relaxed my muscles. An hour later I was drifting off to sleep, bruise and scar free.
Upon reflection, I am so damn proud of myself. Not giving in to an urge that seemed so overpowering when it started is something I’ve marked as one of my biggest recovery milestones. It made me realize how far I had come since I started my first treatment program that targeted my self harm. A month ago, I couldn’t have done that. A year ago a sure as shit couldn’t have done that. Not only couldn’t I have done it, I wouldn’t have even tried.
So, yes I am still underweight and discharge terrifies me. Meals are still overwhelming, as are all other urges. But this week taught me that I am fully capable of progress, and assured me that it never ends. I will always be moving forward, and just because I have a more positive attitude about recovery now doesn’t mean I’m not allowed to make mistakes along the way.