Friday 14 January 2011

Exercise and honesty with anorexia

Oh boy, two issues here: compulsive exercise and honesty in anorexia / eating disorders. Both came to light during today's meeting with CAMHS.

First, the Good News. Ben was (brutally) honest about his exercising habits (or, more correctly, compulsions). As any parent of an anorexic will know, anorexia sufferers don't always tell the truth. The truth about hiding food, avoiding food, exercising and so on. The Good News is that, over the past few months, Ben has been very honest, if challenged about an anorexia behavior by CAMHS or, indeed, by me. This, in itself, is progress.

And now the Bad News. Ben described his 7-days-a-week exercise regime. Because of a low pulse rate and low body weight, he isn't permitted to do PE at school for the time being. We are all aware that he has a problem with compulsive exercising to compensate for this, and also to ensure he doesn't "put on enormous amounts of weight" (as he puts it) from week to week. It's a kind of purge, almost like a sufferer of bulimia might vomit to control their weight.

The extent of Ben's compulsive exercising is HUGE - much bigger than any of us imagined. Just when we thought he'd listed all his "100 crunches, 100 sit-ups and 100 press-ups" for any one day he'd interrupt with "I haven't finished yet!", not just once, but several times... And he listed exactly how many of which exercise he did when during any day, school days and home days.

Ben exercises from morning to night (but, thankfully, not during the night).

Before he catches the school bus in the morning he's already done around 500 crunches, sit-ups, etc - during the 60 minutes we rush to get up, showered, breakfasted and leave the house. I was stunned...

At school, he still runs around the building from lesson to lesson, deliberately making himself late so he has an excuse for all the running. (In the days when the anorexia was at its height I was aware that he used to excuse himself from lessons to run round the block. When sitting his GCSE Art exam separate from the others, he even did crunches, sit-ups, etc when the invigilator was out of the room. (Probably why he got a low grade in Art, one of his strongest subjects...) But, these days thank goodness, he doesn't exercise to that extent. So that's 'progress' of sorts, as well.

One reason he does mornings only at school at the moment is because he can't handle the thought of "doing nothing", as he puts it, for the afternoon as well. When he gets home, he does another few sets of the crunches, etc and repeats these throughout the afternoon and before and after the evening meal.

Most days he likes to keep even more active still, hating to "just sit around". He's much more happier if we go walking, for example. If he stays at home he gets edgy and starts to suffer from withdrawal symptoms.

In addition he does a couple of aerobic freeweight sessions every week (which I already knew about).

Unfortunately our psychiatrist wasn't there today and we saw the psychiatric nurse (the other half of the CAMHS team). She was pretty shocked and so was I.

The next stage in the treatment is to try and break this cycle, presumably just as you might try to break an alcohol or drug addiction, whilst at the same time continuing to bring him round to the idea that it's OK to put on weight rather than just maintain it.

That's the thing with anorexia and other eating disorders... Just when you've ironed out one issue, there's often something else lurking in the background about to rear its ugly head and you have to be on the ball all the time. If only it was as simple as "just being about food". But it isn't. Far from it.

But as I said above, the Good News is that Ben was brutally honest about his exercise regime (and how much he hates doing it).

Knowing exactly how much he does brings home just how much of his life the anorexia has stolen. All this planning and carrying out of exercise, and feeling ill at ease or depressed when he's not doing it... all this is time that he could be spending with his friends, living his life like a 'normal' teenager.

That's the other thing about anorexia. It steals a huge chunk of a young person's life away. It also hammers home just how much work there is still to do on the recovery front.

This is why full recovery from anorexia can take AGES.

I long for the day when 'normal' thoughts take over his mind rather than these unhealthy obsessions dominating every waking moment.

It will happen, but the progress is SO SLOW (but no-one ever said it would be quick!)

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