The truth about the rumors about me.

Yes, I'm direct.

Today I heard reference to me and how I practice, shared by a patient, spoken by a therapist. "She's extreme", the therapist reportedly said, referring, no doubt to my reaction to my new patient's eating disorder behaviors and her severely restrictive intake. I bypassed the "let's just wait and see" approach after a mere couple of visits, after noting the wac-a-mole pattern to her "recovery". Stop the laxatives, increase the purging, increase the food, double the exercise. And there weren't the necessary supports at home to help implement change and ensure her safety and her progress. 

It's not the first time strong descriptives have been used about me and my management of eating disorders. I've been called  "tough" and "not easy". It's a wonder anyone would choose to come to see me. I sound so scary, no?

So let me fess up. It's all true. 

My stand against eating disorder behaviors is extreme-- extremely intolerant. Not of the patient, but of the disordered behaviors. Purging and laxative abuse and severe calorie restriction has extreme consequences. Yes, eating disorders can and will kill, regardless of BMI. And in my view, there's no other stand to take than an extreme one, a zero tolerance for allowing the eating disorder to suck away the life of you or your loved one. 

A dietitian who tells it like it is and sets limits
isn't all that bad.

That doesn't mean my recommendations are extreme, although one's eating disorder may believe otherwise. 

Being told to stop exercising, yes stop exercising, when you consume too few calories to prevent damage from exercise can feel extreme.But so is the muscle wasting that results from starvation when your body tries to produce the fuel to sustain your workout or sport. And, the consequential reduction in bone density, the osteopenia and osteoporosis and resulting fractures. And the impact on hormone production, and mood, and energy level. Yes, the impact of eating disorders is extreme. 

When indicated, I will shake things up. I'll recommend moving from rigidity around foods and nutrients, but I'll guide patients on moving forward. I'll expect patients to be medically stable and low risk before supporting exercise. And if additional support is needed, I'll direct patients to a higher level of care when necessary.

Do families and those with eating disorders really want a provider who simply says what they'd like to hear? Someone who agrees that there's no need for a higher level of care if you don't want to go? Someone who speaks words the eating disorder prefers, shares messages that keeps the anxiety low, and placates those parents in denial about the eating disorder reality--even when things aren't going well? Colluding with the eating disorder is not therapeutic support and patients and their families deserve better.  So call me tough. 

It's my hope, though, that tough isn't equated with uncompassionate or insensitive. Because if that's the rumor something has to change. As I've written before, there needs to be support and compassion, and a sense that you and your disorder are well understood to begin to trust that recovery is possible.

Yes, I'd love to hear your thoughts! Thanks for reading. See more below:

http://dropitandeat.blogspot.com/2011/02/lessons-from-tiger-mom.html
http://dropitandeat.blogspot.com/2013/12/coming-clean-my-biases-and-what-they.html
http://dropitandeat.blogspot.com/2011/01/fuller-bodied-strong-and-intense.html