Discharge from outpatient ED program?

Eating wise, things haven’t been going well these past few weeks. My daily diet has been consisting of a protein bar, a bowl of diet yoghurt, a bowl of vegetables, sugarfree jelly and half an apple, and I haven’t been able to bring myself to eat and keep down anything else apart from this group of safe foods. My weight hasn’t dropped by more than 4kg so far, however, as of this morning my BMI was 15.98 which it hadn’t dipped to since being discharged from hospital. Part of me is pleased that I’m losing weight, the other part of me is thinking “Why am I doing this? I just want to recover.” But maybe I’ll feel more comfortable maintaining if it’s between a BMI of 15-16? That way my weight would still be underweight but on the higher end of underweight, it’ll give me ~2kg leeway between being a BMI of 15-16, and I’ll be able avoid being put into hospital under the Mental Health Act.

I’ve been seeing my psychologist at the outpatient ED program weekly. However, because they’re an outpatient service, they have a duty of care and won’t see clients if they’re medically unstable, keep losing weight or are below a BMI of 14. I’ve lost weight three appointments in a row now, and I’ve been warned by my psychologist that she is not allowed to continue seeing me if I continue to do so. I’m meant to at least maintain my weight at my next appointment which will be in a week’s time, whether I do or not remains to be seen.

The day after my appointment I did try. I had a bread roll at breakfast, but then once I started eating I felt like I couldn’t stop, and it led to a binge/purge. And now I’m afraid to try again because I’m afraid I won’t be able to stop eating and it will lead me to binge and purge again, and I’m afraid of the feeling of fullness, and gaining weight.

If I’m discharged from the service, well I guess that’s that. On one hand I know that they can’t have clients declining under their care and you have to be committed to recovery, on the other hand, it sucks that they may discharge clients for struggling. It’s hard to be able to turn things around by yourself, and it’s unfortunate that there’s no day program and/or outpatient meal support to help people to be able to do so.

Assessment appointment for ED treatment

I received a call today from the CCI, which is the only public service in the state that offers an outpatient eating disorders program. I was offered an assessment appointment which I accepted, and it’s been scheduled for next Friday. There’s a part of me though that has doubts about whether obtaining treatment is the right decision or not. As I’m now weight restored after being in hospital, I feel as though I don’t need or deserve treatment for anorexia. After all, I’m not underweight any more so not only do I not look like I have anorexia, I don’t even fit the criteria for a diagnosis any more. Although I know it wouldn’t be a good decision, I’m tempted to lose weight before next Friday because I fear I’m going to go and be told that I don’t really have an eating disorder and don’t need help, after all, I’m not underweight.

I also had a visit from A, the Community Mental Health Nurse this morning. She asked about me appearing on the media about my experiences of ED treatment in hospital, which made for an interesting conversation. She mentioned she didn’t actually see the segment when it aired on TV, but was told by other staff about it. “Which staff?” I asked her, curious to know. “Oh I couldn’t remember names,” she replied. I told her a friend was advocating for better ED treatment in the eastern states, she asked me whether I was interested in talking about my experiences so I did. A asked me what I wanted to see so I told her- a dedicated inpatient ED program like they have in the children’s hospital, for hospital to also address long term recovery and psychological aspects instead of simply force feeding, and for there to be a step down, like a day program, so that people aren’t just going straight from hospital to home with no support.

Hospital Day 3

I was woken up at 6am this morning to be weighed. I was not impressed at being woken this early. They actually did it “properly” this time- first thing in the morning, with a light dressing gown and with scales on a hard surface. Thus, it was the lowest reading over the past few days- 34.6kg.

In the morning I snuck downstairs to the vending machine to buy myself a Diet Coke. Unfortunately I was spotted by the dietitian who told me I shouldn’t be having it as it’ll just fill me up with water and caffeine while providing no nutrition. I was also told I’m on fluid restriction as my ECG came back abnormal, which was news to me. Would’ve been nice to be told these things.

I was seen by the team, consisting of the consultant psychiatrist, registrar, medical doctor, two medical students plus a nurse also present. The consultant is the same one I had last time I was inpatient in May. I was again told the dangers of anorexia, the risk of refeeding syndrome, and warned that if I continue not eating and losing weight, they will feed me through a nasogastric tube.

The dietitian then came to see me again, asked me how much I’ve been eating in hospital, and increased the number of Ensures to two daily. She also mentioned getting an NG tube if I’m not getting adequate nourishment.

Before lunch, I was told by the nurse “If you don’t eat, you’ll be put on one to one specials.” I was not impressed at all that they’ll punish me in this way if I don’t eat. Being specialled when someone is at risk of harm to themselves or others I can understand, but this? This was a thinly veiled threat of punishment. I ate some of my meal, but when I stood up the nurse commented “You didn’t finish your meal.” “But I did eat,” I protested, and burst into tears. I was also told I have to remain in the dining room for 45mins after a meal, presumably so I don’t purge.

Before dinner I was stressing and crying about having to eat, and I had some of the soup.

I’m feeling pretty miserable today. I’m scared to eat and to gain weight, and I’m scared of getting tubed and being force fed. It’s a lose lose situation either way. I don’t need this much food, I don’t need to gain weight and I just want to be out of hospital. I was feeling fine before coming in, and now I’m feeling terrible 😦