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[ Opinion ]

“I relapsed when I got fat”

I relapsed when I got fat.

She said this with a matter-of-fact shrug and then gave me a smirk. She was six days sober and and teetering between the underweight and normal weight charts.

It was our first therapy session, and we were talking about her recent relapse after six months of sustained sobriety. It had been a chaotic bender fueled by meth, alcohol, and prostitution, and she identified weight gain as her main trigger for this destruction.

By our third therapy session, I knew that the bulimia she had insisted was deep in remission was, in fact, raging.

She had done treatment before. Many episodes of it. And, to give her the benefit of the doubt, she desperately wanted sobriety.

I relapsed when I got fat.

Thus far, every treatment center had focused intently on her drug and alcohol addiction, as it was designed to do. She knew the “rehab skills,” the relapse prevention tips, all the CBT language, the proper way to use her I-statements. She claimed her previous therapist told her to worry about the eating disorder later, that her addiction to alcohol and meth far outweighed any issue pertaining to body image.

And, so, she stole ice cream and pizza rolls, vomited in shoe boxes and plastic bags, weighed and sprinted on treadmills at one in the morning, binged and purged her way through inpatient treatment and sober living, all while proudly tallying sober days and celebratory chips. Six months worth of them.

I relapsed when I got fat.

We don’t talk about the eating disorder and self-harm epidemics with the same protruding fear and heart-wrenching fear laced into drug and alcohol addiction.

We refer those ones out. We sigh when they come into our care. We make calculated jokes about eating disorders; we generalize them as trends, as fads, as girlish, entitled, and privileged problems. We treat them as if they are neat and fragile, subservient to the dangerous big guys, paling in comparison to the dark and lethal perils of heroin and meth. Eating disorders are seen as “obstacles,” labeled as dilemmas that can be changed with some positive reframing and positive language. If a client has both issues, the eating disorder hardly warrants any attention. How can we focus on your weight when you only have two weeks sober? Addiction is life or death, and that “eating disorder thing” will be addressed later, when the client is more stabilized.

I relapsed when I got fat.

While most of us know that body image is a very real struggle, we still misunderstand the relationship between a changing weight and an imminent relapse. We don’t realize that the relationship between the eating disorder and drug addiction often overlaps and triggers the other. If I can’t control drug use, I’ll have to control something else. If I can’t numb or distract myself this way, I’ll use another way that works. We still struggle to understand that, even if sober, most people grapple with untreated, concurrent issues. And when left untreated, the very thing the client is trying to desperately avoid–the relapse–nearly seems unavoidable.

This is because compulsive energy is compulsive energy is compulsive energy. And numbness is numbness is numbness.

Drugs, food, sex, money, cutting- they all provide a scenic escape route, a tantalizing suppression, a perceived shortcut from the pain of feeling feelings to the pleasure of sidestepping them. They exist as stubborn coping mechanisms, and even when they induce punishment, self-loathing, and a vicious cycle of shame and guilt, they receive tremendous reinforcement with each repeated use.

I just wish people understood that gaining weight is a trigger.

Fourth session now. She had thirty days clean. This was admirable, but nothing new. She had a dozen thirty days clean in her record.

She was crying and holding her stomach with a pillow, ashamed with her body, with herself, with all the decisions she had made in and out of her recovery journey. Her peers offered the typical comments. Everyone gains weight in treatment! It’s normal!. People assumed she would be grateful for a fuller figure. Just practice loving yourself!

As if we had the magic wand to cure her of a decade-old battle with her body.

Successful treatment cannot just be about the drug and alcohol addiction because successful recovery entails complete and total readjustment of the self.

We are not one part, and we are not one problem. We are whole beings, carrying a whole spectrum of thoughts and emotions and behaviors, and we need to put as much of them out there, in plain sight, to explore and investigate. If there is any additional compulsive behavior–and there usually is–it cannot go unnoticed or minimized. It cannot be rationalized. It cannot be ignored. Because when left untreated, such compulsion tricks and tempts the individual into a relapse, or it simply seduces the individual into the slippery slide of another entrenched addiction.

Compulsive energy is compulsive energy is compulsive energy. And numbness is numbness is numbness.

Sustained recovery must be rounded, must entail whole and total revitalization of the body and soul. She had to learn how to cope completely out of her comfort zone, in ways she never perceived, in ways that paradoxically hurt. She had to learn how to fall in love with herself, how to stop using her body as a victim to various sorts of poison and abuse, how to fully release all compulsive energy and desire for numbness. This and this alone would keep her sober. This and this alone would also keep her on a journey towards eating disorder recovery and mental health wellness.

All forms of compulsion and obsession matter. All forms deserve their own working through processes. And, at the very least, all forms have to be talked about.

*All reasonable efforts have been made by this writer to protect utmost client confidentiality. Because of this, names and identifying details in this piece have been changed, omitted, and/or embellished.