Monday, October 10, 2011
the same old tricks and DSM-IV diagnosis
Firstly, thank you to Krystal for your lovely comment on my last post. You're always so supportive and I love how you always seem to understand what I mean. I love your comments!
Now that it is well and truly exam season I'm going back to the same old routine that always happens when I do exams. I am now going to attempt to explain why this time it is the same things but with a big difference.
I'm 21 years old now and I've sat my fair share of exams. I've been at university for 5 years now and have developed my own way of coping with the medical school exams. There are a few things that always seems to happen.
1. I start eating lots of junk food. No regular meals, just some sort of continuous stream of weird food.
2. I start writing lots, this time it is in blog format, before it was in journals. Always some sort of contemplative, reflective piece. I always try to sort out major life issues during exams.
3. I plan lots of things to do after exams, it seems like I'm doing my utmost to distract myself doesn't it.
4. I spend a lot of money on casual "study" clothes, hoodies, loose pants, shorts, things that I normally wouldn't wear. I buy them online at bargain prices, they never arrive early enough for me to actually wear them during study and so I never wear them.
5. I buy the things that I have been putting off buying all of that year, things that I said I wouldn't buy because people wouldn't approve, like tapers for stretching my ears.
6. And possibly the most important rule...anything goes. I do whatever I want to. As long as it keeps me calm enough to do some form of study, I will do it.
The difference this year is that even though anything goes, I am still very concerned about my weight. And this isn't something that has ever happened before. I have never worried about exam weight. It was always something that needed to happen in order for me to pass and so it didn't matter. But this time, I'm worried about it and I'm making plans of how to lose weight after exams.
To me, this is a real sign of how far I have come in the course of this year in terms of eating disorders. Now it is something that can't be fixed by someone telling me quite honestly that I am beautiful. It is something that won't go away no matter how much people get worried. It is something that won't go away no matter how much people tell me I don't lose weight or look thin. It is something that won't go away, not even if my career is threatened (and it has been, even if he was joking, I know there is some truth behind it).
I think about being thin with each bite of food that I take. Even if I'm binging, I'm acutely aware of my eating, making most of my eating very unenjoyable. But yet I still binge. And yet I can't bring myself to purge because each time I stand over the toilet I think about Mallory Weiss tears and decaying teeth. But I still binge, and I hate myself for it.
During exams, this becomes acceptable, just this time, it becomes something I will deal with later. I think it's fair to say that this has become something that is definitely here to stay.
I've dug up a copy of the DSM-IV and it would appear that I meet some of the criteria for anorexia nervosa and some of the criteria for bulimia. This surprised me a lot because I never thought I would meet any features of bulimia, but then I didn't realise exercise and starvation could be a method of purging. I thought purging was only self induced vomiting. I meet all of the requirements for anorexia except I am still in the normal weight range (but I'm working on that one!). So right now I qualify as EDNOS. Although there has been a lot of discussion about this, as 90% of those with eating disorders have EDNOS, and this suggests that criteria for anorexia and bulimia are too stringent.
The whole point of EDNOS is to have a category to put those who are harder to diagnose, and if 90% of those with eating disorders can't fall into a proper diagnosis then there is something wrong with the categories. I wonder what the DSM-V will have.
I wonder if I will fulfill criteria for anorexia in future.