ASD diagnosis notes for Dr Joseph, 2016

Deficits in communication and interaction

General I find it extremely difficult talking to new or unfamiliar people, or familiar people that I do not see frequently.

I often find it challenging communicating with familiar people.

I often struggle with understanding my friends and family, and especially communicating complex needs or explaining the motivation behind my actions.

1. Difficulties with conversation (two-way or group):

a. knowing when it is my ‘turn’ to start and especially stop speaking

b. knowing what to say when I am not knowledgable on the topic or interested in it

c. if knowledgeable and/or interested, knowing whether interlocutors are interested in what I have to say

specifically this means: detecting boredom, discerning whether the interlocutor is pressed for time, discerning whether they are able to follow my train of thought. I often assume a familiarity with the subject and race through ideas or concepts too quickly.

d. I often give too much detail (through association, i.e. everything seems equally important to include). This has been described to me as ‘going on detours’

As this is something that has occurred for as long as I can remember being in the social world (since beginning school – before that I was homeschooled and have no siblings), I am self-conscious of it as a possibility. Therefore I can be shy and quiet.

However, with familiar people I tend to experience less anxiety and therefore I tend to behave more or less naturally in conversation. This can lead to confusion, misunderstandings and hurt feelings or damaged relationships.

2. Difficulties with understanding the interlocutor correctly (what my GP described as ‘reading people’)

a. I am intensely aware of eye contact and the expectation to make it.

b. I spend a lot of time in conversation, especially with new people and situations, attempting to assess whether it is okay for me to look away and focus on what I am saying.

c. I do not experience pain with eye contact, but I find myself instantly overwhelmed with ‘data’.

‘Data’ is a flow of new information which I cannot ‘decode’ efficiently enough in the moment. This causes me to lose track of the conversation and my thoughts. I also tend lose track of my body to an extent and especially my facial expressions or movements. i.e. i may start smiling and not be aware that this has happened, which can put the interlocutor off (i.e. ‘wipe that smirk off your face’)

d. I am distracted by attempting to arrange my face and body appropriately, so as to not seem ‘odd’. i was bullied at school for my mannerisms and speech.

e. Acquaintances have in the past commented on an ‘exaggerated’ tone of voice and facial expressions as well as monotone.

f. I often miss do not hear the interlocutor’s words, in favour of sensing a Mood/vibe of the situation. conversely, I can miss the mood/vibe, but remember the content of speech verbatim (and be able to reproduce it accurately later on).

3. Problem with being perceived in a way contrary to my intention, i.e. as romantically interested, ‘forward’, unfriendly, bored or rude

a. I have a range of ‘filters’ that I am able to apply in conversation. these colour my voice and to an extent my facial expressions with an appropriate ‘mood’.

b. Often, especially when comfortable or tired I do not slot in as many filters as may be expected, or use the ‘wrong’ filters. this means my reactions in the conversation may seem contrary to the interlocutor’s expectations and cause confusion or even anger. i.e. my mother has described me as ‘robotic’ and devoid of feeling.

4. Problems with understanding jokes (on cue) and ‘being funny’. There was an episode at boarding school when I was suspended for spilling bleach on the floor of a science lab because I was trying to make my classmates laugh. Equally, in sixth form I have been accused of being deliberately disruptive, when really I was attempting to be accepted, be liked and make my classmates laugh. In effect however I believe my behaviour deteriorated during this period (16-20). See letter from Westminster School re de facto suspension. See report of outburst with therapist.

5. I observe and mimic the humour, mannerisms and lexicon of people (or TV characters, comedians) around me that I consider to be socially successful and funny, in order to avoid being perceived as ’strange’, and scrutinized. This happens consciously but also automatically (which can cause embarrassment and rejection).

6. I have a tendency to miss sexual cues. I have been sexually assaulted when I was at school (I assumed the interaction was ‘friendly’ when it was not). I continued to be particularly vulnerable to predators throughout adolescence. Very recently (December 2015), I was a victim of stalking and harassment by someone I believed to be my friend. The University are aware of this and the perpetrator has been formally cautioned.

repetitive activities, behaviour, interests

1. I struggle with taking on unfamiliar activities, spending time in unfamiliar places, and switching between activities and tasks.

a. I struggle with (sometimes) starting and (especially) stopping familiar activities.

b. I sometimes get ‘fixated’ on tasks, i.e. find it very difficult to stop doing something I am very involved in (even if it is not strictly speaking my interest). This means I tend to focus excessively on a part of a task, rather than on completing the task itself. This causes huge problems with deadlines. This means I struggle with every aspect of my life, especially my academic career, responding to emails, applying for jobs and doing any kind of job where time management is of key importance. When working as a private academic tutor or translator (this has been my only paid occupation), I have spent many more hours preparing or editing than my peers in similar occupations, based on their reports. This means I have less time and energy for other tasks, and therefore avoid them.

c. I perform daily tasks according to the same, fixed mental routines. This enables me to actually complete some of them, i.e. personal hygiene. I have had issues with showers and brushing teeth continuously throughout my life, and I have now developed fixed patterns for executing these tasks in order to minimise the stress and time-expenditure they caused in the past. Taking off my clothes completely is something I find very difficult due to a sensitivity to temperature change. I often sleep in the same clothes that I wore during the day, and change my clothes in phases. If living in an unfamiliar place, my routines will require a degree of modification, and this means my academic and social commitments cannot be prioritised appropriately.

d. I can be somewhat rigid in cohabitation. I often struggle to understand why people do not put things back in their place or perform chores to a minimal standard of consistency. I experience stress when I notice certain trivial changes (even if these have no impact on my activity plans).

e. when I am not fatigued, I enjoy organising and reorganising the space around me. I can get somewhat fixated on that activity however.

NB when fatigued (which is often), i allow clutter to build up. I find it difficult to concentrate on my thoughts when surrounded by clutter. Equally, I find it difficult to work in a ‘sterile’ room or environment, especially if the surfaces of the furniture are light, very smooth and/or reflective. I am easily distracted, and find it difficult to return to task if anything interrupts me. This sometimes leads me to become very distressed, but mostly I unintentionally dissassociate my knowledge that I should care (i.e. about deadline) from my immediate emotions.

f. when playing with other children (preschool > middle school), I invented games and insisted on the rules and premises being honoured. this occasionally caused tension, and as a preschooler I already experienced ‘break ups’ with friends. I wrote a poem to a preschool friend who stopped showing up to play with me.

g. i find it anxiety-inducing to do even ’simple’ familiar things in new ways (i.e. switching to powdered detergent instead of liquid when doing laundry. My partner insisted on the switch, and in effect this meant I began to avoid doing laundry all together). The difficulty for me is about a different set of motor skills involved in the use of powdered detergent (i.e. the balancing of the box, the effort it takes not to spill it, the intensity of the smell and the sensation of the detergent on my skin).

2. Behaviour, general. This is likely to be a short list as I am finding this difficult to visualise, and second-hand observation is necessarily required here. I therefore hope my partner’s testimony will prove more useful here.

a. I really love spinning, swings with a big amplitude, being in a car that is driving very fast, or being on a boat during a storm. I find it incredibly calming and I do not seem to develop nausea as quickly or intensely as others.

b. I repeat certain movements when stressed, to calm down or simply to increase concentration. I pace, shake my head, touch my shoulder (rolling my fingers over the blades over and over again).

c. If comfortable with someone, I can repeat the same words or gestures or jokes with them over and over again. I.e. When watching a video with someone, I can forget to ‘switch around’ my responses/remarks so that they appear truly spontaneous, resulting in me making the exact same comments in response to exact same cues in the video.

d. As a child – strong attachment to parts of toys, i.e. playing with the washing tag rather than the bunny. I do not remember lining my own toys up, but I lined up other people’s possessions.

e. I enjoy watching certain things move. I love watching cars pass. I can spend a long time staring out of the window of a moving car and attending to the relative motion between cars on a highway, now shrinking, now growing. I enjoy conversations about the technical properties of cars if these help me understand the particularity of their movement. I enjoy watching marine animals swim.

3. I have always had very strong interests, which I am compelled to honour. These bring me great joy and purpose, but there is a strong sense in which this drive has also proven to be obstructive. I tend to get very absorbed in things I am interested in, but this does not necessarily mean I will be able to work to deadline (although on occasion I produce work of a very high standard at rapid pace).

a. my family have often commented that if I develop an interest in something I tend to ‘learn everything about it’. This has been the case for as long as I can remember, i.e. as a preschooler I had a very strong interest in dogs which lasted for years, and was able to recite information about all the breeds and subtypes in the books which I had. I intensely wanted to work with dogs, but was forced to abandon this due to pet allergies. I enjoyed teaching sympathetic adults about dogs, and devised lesson plans for my mother’s friend.

b. intense interests alienated me at school as they did not match up with the interests, hobbies and fashions of my peers.

c. academically, difficulty with restricted/circumscribed interests meant that I received grades at both extremes, as some assignments I was able to excel on, leaving me no time to even begin some of the others.

d. my interests are part of my daily routine, and being unable to honour them throws off my routine completely. My sense of time’s passage (this is something my mother has said has been the case since childhood) appears to be impaired, and this is magnified when I am involved in pursuing an interest. I get ‘lost’ in the few activities that capture my attention, and do not require breaks. This means I miss meal times, go to bed many hours later than partner of family, and/or I forget to get up to urinate until I am in a significant amount of pain. Intense interests interfere with my other plans or duties. I have very limited energy and as mentioned before struggle with fatigue, and I tend to invest so much time in my interests that I am completely unable to switch to deadline-related work.

Additional material

1. planning and organisation – experience overwhelming difficulties.

a. through my BA degree, I handed most pieces of work in late, and/or incomplete. With certain modules I did not have time to revise/complete coursework at all, despite working very hard generally. This caused my mental health to deteriorate (I became anxious and depressed, my self-esteem suffered, I further withdrew socially).

b. my grades and feedback oscillated between poor to outstanding. I received very few ‘average’ grades.

c. struggle knowing when/if/how to ask for help. Even if I should ask for help, I still delay doing so. I am unsure why this happens.

d. can only use electronic software (not paper lists) to keep track of what I do. I forget to check notepads, I cannot read my own handwriting, I get overly attached to one notepad and when it runs out cannot incorporate a new one into my routine, meaning I lose it instantly.

e. throughout my degree I have had almost every single piece of work formally extended. Disability Services recommended me for flexible deadlines and a separate examination room (shared with no more than 5 people, if not entirely on my own). This accommodation made an enormous difference, I believe this enabled me to graduate and attain my degree. I have dropped out of a BA before due to an inability to cope with deadlines and ask for help. I still struggle asking for formal help or accommodation, and struggle with composing emails that inform my University of my difficulties. I often am not aware that I am struggling, and when I am aware, I do not know how to go about communicating this.

2. Struggle with /a special relationship to change

a. I regularly miss bus connections and trains if the planned route changes even slightly.

b. I easily lose things that are ‘misplaced’ out of familiar context, even if they are in the same room. I misplace my own things regularly, i.e. when I do not have the energy to take all the necessary steps to deconstruct clutter.

c. I get lost if my walking route is altered / if the environment has been modified slightly (i.e. different shop fronts can disorient me totally)

d. I wear the same clothes over and over. I was not aware of this until peers at school began to comment negatively.

e. my mental health and functioning deteriorate when sudden change to my routine is introduced. I suffered an intense and sudden relapse in binge/purging behaviour in December 2013, after moving back to Russia for a few weeks over the holidays, and forced to adjust my schedule to that of my parents (i.e. lunch is their ‘sit down’ meal, my usual ‘sit down’ meal is dinner). My relationship with my parents was fine at this point.

f. I am able to build new routines to adapt to change, but I struggle with externally imposed schedules and routines. I am often told I am uncooperative, uncommunicative, avoidant and stubborn.

g. I don’t recognise people ‘out of context’ unless I make a specific effort to remember them.

3. Meltdowns and self-injury:

a. when faced with strong emotions or frustration (usually over something fairly trivial), or failure with communication.

b. i experience a powerful drive to hit or bang my head.

c. head banging is one of my earliest memories (c. 5-6 years old).

d. i experience a massive release and soon after a meltdown my functioning is partially restored / ‘reset’.

e. however they are often followed by headaches or migraines.

4. Ongoing anxiety and bouts of depression. Can have ‘extreme’ moods, very intense and overwhelming feelings, but otherwise (normally) emotionally ‘numb’, with very limited insight into naming ‘middle of the road’ emotions.

5. Insomnia/issues with sleep (since childhood):

a. I would struggle with going to sleep if allowed to read for an hour before bed, and would be disciplined as I attempted to read with the light on. I was obsessive with my books and took them to bed as well as to mealtimes and beyond.

b. I go through period of sleeping only 4-5 hours a night. When this happens, I feel extremely unwell.

6. Motor skills and proprioception problems:

a. I have a series of early memories involved with being disciplined for breaking and dropping things too often. My mother referred to me as ‘pathological’ and ‘abnormal’ during those disciplinary episodes.

b. I frequently drop things or walk into objects or walls.

c. I often cannot feel my body, especially my limbs. I press my body into sharp corners to ‘retrieve’ the sense of my boundaries.

d. I have poor handwriting. I write very slowly, and therefore almost exclusively use the keyboard for notetaking and communication.

e. I had poor balance as a child, but I practiced certain sports (skiiing, fencing) to improve.

f. I have been described as sitting in ‘twisted’ positions and having ‘bad’ and ‘odd’ posture. I attribute sitting in odd positions to a ten.

g. As a child, I regularly injured myself through clumsiness.

7. Some difficulty grasping verbal instructions:

a. Comprehending/remembering verbal directions, understanding how to do new tasks and chores after a verbal explanation).

a. I was disciplined and punished frequently during childhood into adolescence for failing to do chores appropriately, i.e. would jumble simple steps of an instruction set (i.e. when washing the floor) or skip steps entirely.

8. Struggle with information overload & sound:

a. Cannot ‘filter out’ or ‘tune down’ voices and noises to a degree that allows me to follow conversation/a lecture/a film. constantly asking other people to be quiet). Prefer subtitles but tend to only use these in private because of worries about social perception.

b. Struggle to understand song lyrics

c. Information overload can cause crying, confusion, screaming, loss of speech and self-injury

9. My sense of time appears impaired

Preschool

1. Restricted interests:

a. I played board games (Monopoly) and table top games against myself.

b. I enjoyed learning facts from books about subjects such as animal food chains, Greek mythology, Tibet.

c. I devised intricate imaginary worlds, many of them, with detailed rules and environments, populated by imaginary species, all of which enjoyed their own properties and characteristics.

d. I perceived the world as intensely animated. I spoke to trees in (non-verbal) ‘tree’ language by humming and touching their bark. I imitated dogs’ barking (I can still imitate dogs and some birds very persuasively).

e. Overwhelming interest in dogs.

f. I collected animal figurines of a particular brand avidly and did not have interest in other types of animal figurines or small toys. Every Saturday my father would bring me a small figurine and I became very distressed if this did not happen.

g. When gifted Barbie dolls, I spent more time organizing and categorizing their clothes and items than making up stories. I do not remember a single pretend story line concerning the Barbies, although I was imaginative in other senses cf (c).

2. Play:

a. I was capable of ‘pretend play’ if I invented the game and the rules.

b. My childhood friend’s mother still recites anecdotes of my controlling nature with respect to her son.

c. When I was 6 I was introduced to a (different) family friend (then aged 10). She showed me her things, including a big shelf of nail polish bottles. Without any prompting, I lined up her many nail polish bottles and organized them according to colour. It was fun.

Primary school

1. General:

a. I was homeschooled until I was 7. I started school in September 1998, and turned 8 that December.

b. I was hyperactive and fidgety, and also constantly felt exhausted.

c. I was ‘out of touch’ with my feelings and needs. I struggled to go to know when I was sleepy or hungry. My mother had to put a lot of effort daily into putting me to bed and ensuring I am not reading instead of sleeping.

d. My mother recalls a doctor remarking that I presented as untypically ‘stoic’ (i.e. never complained or asked for accommodations) during very frequent and severe bouts of flu/bronchitis as a child.

2. Friends/play/restricted interests:

a. (This continues into secondary school) played video games for hours. I socialised with neighbourhood boys on that basis. I did not socialise with girls as we had less things in common.

b. I was initially excluded from games by other children.

c. I was accepted by the boys after bringing in my collection of Pokemon cards and demonstrating my knowledge and interest.

Secondary school (general)

1. I moved to the UK in 2002 and enrolled at a single sex boarding school

2. The pastoral staff had to introduce me to the concept of other people’s ‘personal space’ and explain repeatedly that sitting ‘too close’ to people is a problem.

3. I have been repeatedly described as ‘staring’ at other kids.

4. I was bullied in year 7-9 and excluded

5. I developed friendships with one person at a time, usually someone considered ‘weird’ but not an outcast. These friendships were intense but only lasted a few months at most.

6. I took up long distance running to avoid competition and humiliation in PE.

7. I stabbed my wrist with a knife (once) during a meltdown in 2005 after another episode of rejection.

8. I am a survivor of a non-consensual sex episode in sixth form, perpetrated by someone I thought of as a ‘friend’.

#ASD #autism #autismdiagnosis #neuroticturn

on quitting #codependency

*Before leaving*
Imagining conversations
buying favourite foods, cooking better meals, cleaning house for them
going to events despite being exhausted and sad to not be called boring and blamed for abandoning them or making them feel alone
tempering my opinions and thoughts to avoid put downs and silent treatment / passive aggression
obsessively checking phone
knowing not replying quickly will have negative and punitive repercussions
suffering intense anxiety when they arbitrarily don’t reply, assuming i have done something wrong but not knowing what it is
being too embarrassed to ask friends if they know what i may have done wrong, worried they will label relationship abusive or me as victim
breaking down when insulted or manipulated or falsely accused, then being ignored even when pleading for some conversation or affection or closure in the future, in their own time
being unable to function (pursue study, look for work, meet friends or enjoy meetings) until closure is given
mistaking ‘crumbs’ for hope
constantly feeling like i’m messy, dirty, clumsy
being told to shower after coming home, that the lounge is a mess, rolled eyes when i knock into furniture
treating housework as a way to buy kindness and affirmation
being ignored intellectually
being told my intellectual or political ideas or pursuits are not my own, consequence of spending too much time with other individuals
being told i am ‘part of the problem’ re their own extreme unhappiness
refusing to seek help
refusing to care for me when in crisis but acting like they are my primary carer and therefore entitled to private emotional information and especially my movements/whereabouts
constant checking up when i’m away
constantly ignoring me or being emotionally unavailable when we are physically together
refusing to explain why the above is the case
not admitting it is a pattern
ignoring my unhappiness re patterns and agony re future
telling me we will talk later but not bringing issue up later themselves
knowing i have extreme anxiety wrt lack of closure
acting like i am in the way and encroaching on their energy and time
when i shared a suicidal thought, shutting me out, refusing to be in the same room, telling me i triggered an anxiety attack
punishing me with silent treatment after i reach out to someone else
*Depression *
Sinking into rock bottom levels of self-esteem
Prolonged, daily feelings of hopelessness
Inability to imagine a better future or a future at all
Oscillating between numbness, extreme sadness and being acutely distraught
Normal thought patterns disrupted and replaced by rumination on relationship
Inability to think
unexplained crying at work and home
v low appetite
loss of interest in previously enjoyed activities
suicidal ideation
planning suicide
*Dissociation*
chronic feeling of being not present in the moment
disrupted ability to function in the ‘real’ world
inability to concentrate on academic work or even consider it as of personal importance (in huge contrast to the top priority it held upon enrolment)
feelings of amnesia re past life
overwhelming feelings of being nothing / of no value or potential or achievement
*Confusion*
Constantly trying to see situation frm their perspective, to get them to take some responsibility for hurtful or harmful actions, even at risk of being mistreated after
asking for my needs to be met but also silencing myself
self-harming after being psychologically hurt
*Isolation*
Not telling friends about abusive episodes because of embarrassment, feelings of personal failure and shame
Checking out of friendships out of fear of abandonment accusations
*Distance*
When I started introducing distance – not sharing my thoughts and plans, I did so because I knew what I would share would be twisted and used against me (logistics only example)
breaking isolation – reaching out to other people
desperately missing them
brutally rejected when attempting to share feelings thoughts desires
*Fear*
Fear they will end it
What if they will use my immigration status to exert control, coerce me into communicating
*Aftermath*
drastic self harm
alcoholism
substance abuse
alienation from everyone i know
i wanna hit the ground
im so sorry
http://news.bbc.co.uk/1/hi/health/3077662.stm
#suicide #abuse #emotionalabuse #domesticviolence #dissociativeidentitydisorder #dissociation #marriage #suicidal
.

-notes on ecology 2 impress my bf-

so referring to smth as ‘socio-ecological’ is basically gesturing at the idea that ecology as an ontological category is all encompassing. there is a wing of world-systems thought referred to as the world-ecological framework. it’s a framework cos it is used by folks across v different fields to organize their own theories about how capitalism and ‘nature’ (or ‘so-called nature’ as my supervisor calls it) constitute each other. although, even that formulation is somewhat inaccurate, cos a world-ecological approach holds that (at this moment in history) capitalism precisely ~is~ nature, and nature is everything that there is. patterns of accumulation r never just between humans, but encompass land, commodity production, nutrient cycles and so on. the word economy and ecology is often used interchangeably.
basic idea is as follows:
capitalism is defined and made possible by two interchanging movements. i) enactment of turbulent and radical reorganizations of nature, and ii) establishment of relatively more stable relations of production, labour forms/patterns, class structures, etc. These two moments r sometimes referred to as ecological revolutions and ecogical regimes. the end of one phase always signals the rise of the other, and this cycle basically defines modernity. A revolution might be smth like a country entering a number of free trade agreements, the expropriation of land from peasants, privatization of key industries / services. It can also be technological, cartographic, maybe even architectural. it is a violent intervention that draws up the world differently, trying to make more of it available or even conceivable as resource for accumulation. it is the series of pivotal events that happen when there is crisis, and instead of falling apart capitalism shape-shifts and keeps going. a regime is what happens after – all the relations that are subsequently produced and that endure for some time (so not just the once new plantation or latifundia, but the whole network of relation imposing smth drastic like that has on given society and environment, or simpler said the given socio-ecology). as capital accumulation is self-destructive, burning through infrastructure, people and natural resource faster than these can (if that is even possible) be regenerated, eco regimes r basically just protracted moments of violence that always end in crisis and another ‘revolution’ is triggered elsewhere.
also, regimes are defined by ‘metabolic’ relations between cores and peripheries. very briefly, cores try to establish ‘commodity frontiers’ (ie when empire goes ‘let’s make loads of sugar in this bit of the caribbean now cos we can’) and peripheries are then ruthlessly reorganized, used up, sucked away (quite literally through trade) and eventually exhausted to service those ‘needs’, until capital jumps
elsewhere and leaves ruined socio-ecologies behind to rot and fester. 
it’s not sufficient to say, however – and u kinda talk about this when u mention past waves of anti-globalization resistance – that first world counties are sapping the wealth and energies from third world socio-ecologies (so not just the people are fucked but also their land is ruined, their water soaring in price and plummeting in quality, their urban systems mutating into giant slums, the deregulated and dangerous practices of waste disposal, etc). The ‘first world’ is constituted of a dynamic and unstable network of cores and peripheries, themselves locked into sharply uneven metabolic relations, which are themselves immediately affected by more large scale metabolisms.. ie opening consumer markets to dollar-a-day products from abroad means something for the wages and standards at home, etc.
world-ecological thinking helps to get away from idea of europe or even the west as a cohesive whole, and helps analyze for instance a nation’s internal divisions as they are globally constituted, and then thinking forward to smth like a post-european socio-ecological alternative, hopefully a more expensive, nuanced and just vision of the world…

-sext, late 2017-

sometimes when i mix alcohol w ritalin i fall into oneiric sub cognitive rabbit holes and most of the time you feature. / It’s always the same scene: I come to you w my bad vibes, my sad passions and you listen to my shit until we get bored and break through my fixations on the endless negativity of the present and in a sudden shift / surprising nobody I curl you under my knees & it’s ecstatic. / i’ve had dreams about you when given evidence either i’ve come or dreamt i was on the edge of cumming it’s not / tho / what i truly want from u cmon / i’ve come enough times in my adult life to gain a sense of perspective. / I want to fuck you sober n i want to fuck u fucked but so much harder than that i just want to hold onto this shatterglass dream as long as we both can stand it / and mind btw as i’m writing this the people at the bar / normal people r having a chat about being sober and how much they low key fucking hate it, trust. / I want to be back to spaces where it is dark and you hug me from behind and singe yourself on my outlines and everyone who can tell has told you to back off but for reasons, for now, idk y but u just won’t do it.

#goodchoices

-Notes on binge/purge-

ok i’m gonna try to explain in condensed form. Ive got anorexia nervosa binge/purge subtype (no bingeing for the last 2+ years). I developed bingeing behaviour as after prolonged period of starvation when i was in my teens, having previously never struggled with overeating. My case is not an anomaly but exemplary of statistical variance in ED populations – we don’t know exactly why the hormonal changes caused by starvation cause bingeing behaviour in some sufferers but not others, but we know that it’s the case. presumably it’s a highly individualized combination of genetic and environmental factors at play in each individual instance and at different moments in the history of psychiatry different explanations were privileged. What we do know nonetheless is that bingeing is not just a straightforward case of bad choice of coping mechanism. Post war large scale studies of hunger and behaviour like the Minnesota starvation experiment have given us a statistical sense of how starvation affects a sample population (i.e. the probability of an individual developing bingeing behaviours for the first time after a period of starvation is higher than bias allows us to imagine). Ultimately bingeing is a pathological response to stress that has a compulsive character, similar but not identical to substance abuse, i.e. people keep doing it although they know it’s bad for them generally, or even if there is always a ‘come down’ period after the initial high/relief. When I had a hardcore bingeing problem I was immensely more distressed than I am today (restriction only) because every binge episode was followed up by a period of increasingly unmanageable guilt, shame, self-hatred and sometimes suicidal ideation (including one attempt). I felt trapped and reduced to doing things that to my anorexic mind were unspeakable (almost like a perverse act of self harm).
In this light consider the logic of restriction again and note the parallels between two seemingly opposite styles of ED suffering – whatever the sufferer thinks denying themselves food will achieve in positive terms is inevitably outweighed by the negative reality of being an ED sufferer/patient. Restriction is often the cause of social isolation, depression, sleep issues, paranoia, obsessive/compulsive behaviours, distorted thinking esp re self-image and generally a more circumscribed lifestyle (to say nothing of the physical risks). You don’t choose to restrict so much as you feel like you have to. Eating disorders have a choke-hold on the disoriented, distressed person grasping for ways to stabilize their life and cope.. they promise certainty *if* a number of exponentially steeper conditions is fulfilled & the sufferer doesn’t notice the goalposts keep shifting until it’s too late. Anorexia always pushes me to give up more, to make myself want less, to punish myself harder for transgressions, to lie to ever more people because it tells me nobody can be trusted, they just want to make you fat. Anorexia makes me feel like it is the only thing I can rely on, the only thing that is truly mine and truly satisfactory. In the final instance that narrative is a lie of course, but if seeing the number on the scale go down didn’t make me feel truly ecstatic i would probably be free of it by now. Same with bingeing – it’s an extremely effective coping mechanism that comes with an ever-higher price; often the only way to cope with the lows of bingeing is to binge (and purge) more, sinking deeper and deeper into the cycle.
Final thing to note is that while starvation (although not the starving woman per se) is valorized in western christianized society. Self-denial might have an addictive logic but culturally it is still understood as an honorable if slightly extreme expression of willpower and spiritual purity. In other words, it’s easier to confess to starving than to bingeing, as in the popular imaginary bingeing registers as weakness of the will and an act of surrender to low and sinful desires of the flesh. The incentive to hide any ED behaviour is already significant. For many of us, the ED is the only thing we feel like is truly our own, the only aspect of our lives we can still control; the ‘wrong’ people knowing increases the risk of a (forced) intervention. With bingeing, medics w the possible exception of specialists only monitor the most obvious factors like BMI and vital signs. Someone w bingeing issues, esp if that someone is driven by an obsession with thinness easily can slip under the medical radar for too long (ie until an easily observable/highly dangerous pathology emerges like electrolyte and heart issues), becoming ever more addicted to the bingeing in the process.

#binge #purge #bulimia #ontology