I'm departing from my usual format of writing about my point of view and my patients to write about myself and a slip, a fall, a lapse—whatever you want to call it—I'm having for the first time in a year.

     "When we first started working together you said to me, I'm an anorexic and I'll always be an anorexic." Dr. Adena* reminded me. Dr. Adena and I have been working together for over six years. She has seen me through many slips, falls and relapses of my anorexia, the most recent ending a year ago. Although last spring I barely avoided hospitalization on an eating disorder unit, I was  medically hospitalized, which is what opened my eyes to the gravity of my situation. After a brief stay in the hospital, I was able to gradually increase my intake and gain the needed weight.
     What I didn't expect was for my body to enter menopause and for my weight to shoot up past where I had always been able to maintain it. I had always sworn I wouldn't be one of those women who gained the menopausal ten to fifteen pounds. But here I was. I felt out of control, tremendously anxious, and very fat.
     I tolerated this new and strange body for a year with the help of Dr. Adena and my nutritionist Miranda.* At one level I knew if I started restricting and losing weight, I ran the risk of losing all that I had worked so hard for; my job, my burgeoning writing career, my new relationships. On another level I knew from experience, from my relapse last year that as my weight decreased, my ability to concentrate and focus declined as well. But I held onto magical thinking that this time would be different; I would be able to stay skinny and function at my usual full steam ahead mode.
     Several weeks ago, I sat in Dr. Adena's office and sobbed continuously, "I just want to be thin." That declaration ringing in my ears, I went home and skipped dinner. Additionally, my eleven hour work days plus an hour commute each way, made it easy for me to rationalize a level of exhaustion that justified walking in my apartment door, feeding my cat, taking my meds and falling into bed—without dinner.
     I began cutting calories on other meals, purging using methods other than vomiting, weighing myself every day. I don't have a scale so I use the scale in our building's locker room, off the gym. When I was not entrenched in my eating disorder, I could go for months without knowing my weight.
As the numbers on the scale decreased, as I fit into clothes I had not been able to for months, the high of the anorexia took over. My hunger cues disappeared quickly and I restricted even more.
     One night I was experiencing chest pains during my session with Dr. Adena. I had these before and I attributed them to anxiety over hiding the restricting from her. I knew if I told her what I was doing she would not be happy and a protracted discussion would ensue from the confession.
     When I got home that night, the chest pains intensified. I knew that my heart could possibly be affected from the restricting and the purging behaviors. I wasn't a kid anymore with a young heart —my heart has been through twenty-five years of on and off again abuse. I was afraid of waking up in the middle of the night with a heart attack and not having enough time to call 911 and get to a hospital. I didn't want to die.
     I took a cab to the emergency room and had an EKG, an x-ray of my chest, and bloodwork to determine if my heart had been damaged. Everything came back normal and I was extremely relieved. For reasons that remain elusive, even to me, I did not stop the anorexic behaviors.
     I related the series of events to Dr. Adena during our next session, several days later. "What's the plan?" she asked simply.
     "I'm seeing Miranda tomorrow," I answered.
     "So you and her will put together a healthy meal plan?"
     I nodded.
     I met with Miranda and we did just that, but I'm only half following it and I'm still purging occasionally.
     Dr. Adena and Miranda say that I have to trust them as far as my body image is concerned because mine remains distorted. I fight with them every chance I get; they say I look good now, they remind me that last year when I was at the weight I consider ideal, I appeared ten years older than my age. I do get compliments from friends and co-workers that I am thin, slender. But I don't see it. I glance in the mirror and see a belly that looks six months pregnant.
    What drives this self-destructive force within me? Why, after the fear of dying from a heart attack do I persist in these self-defeating behaviors?
     I don't know.I don't have an answer, or the answer. All I know is that it's connected to my extreme hatred of myself, which is something I continue to explore in therapy.

 * Names have been changed

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