Eating Disorders And Gender Identity

As you can probably tell from reading my blog, I am pretty open about my mental health, and I suppose, by putting my life online, you could argue that I am pretty open and honest about most things I experience. Nevertheless, there is one aspect of my identity that I have kept secret for years, not just online but with friends, something which I have only spoken about to my mother and certain therapists. In the past few weeks I have been asking myself why this is, and the answer to that is fairly easy (far easier than answering the question what is 4504 divided by 789 at least…NO CALCULATORS PLEASE), that being that I fear judgment and still see this aspect of myself as somewhat taboo. 

However, I have started to realise that by keeping this part of me on the “down low” because I feel embarrassed, is only perpetuating the idea that this “secret” is something I should be ashamed about, and that isn’t going to help anyone out there struggling with the same thing. What if there are people who are feeling as uncertain as I am about things but who are scared to speak out? What if they feel as alone as I do?

Ok, so it is probably time for me to stop beating around the bush and get on with the topic (the bush is fairly battered by now…there are so many leaves about I can barely see the keyboard…sorry bush, you didn’t do anything wrong…not that if you had done something wrong that would be an acceptable reason to beat you…I don’t condone violence of any kind…gosh I feel I might still be beating around the bush…SORRY AGAIN BUSH). 

The topic around which my “secret” revolves? Gender, though more specifically, my personal gender identity and how that affects my mental health and experience of anorexia. 

As you have probably all assumed, I was born and am biologically female, yet I do not see myself that way. In all honesty I feel quite ill when people refer to me as “a woman”, and every time a stranger refers to me as a “lady”, I feel physically sick. Saying this may make people think that therefore, inside, I see myself as male, but again this is not the case. With regards to my gender, I do not feel like a woman (just one of the many personal emotions Shania Twain and I disagree upon), nor do I feel like a man, in truth, I feel simultaneously like neither and both all at the same time. Thankfully more and more people are talking about gender these days what with the transgender FTM/MTF bathroom debates going on in the US, and there are even labels out there to describe people like me who do not see themselves as belonging in either of the binary box options presented on health forms. Names like agender/gender-non binary/genderqueer/gender neutral are now words many people, rather than just those whom they affect, are familiar with, and there are even more pronoun options and gender identities available in the “about me” section of your Facebook profile. Which of these “non binary terms” I best identify with I am still not sure as I find my gender identity rather confusing. 

The one thing I know for certain however, is that I am not female, and having a biologically female body has had a bigger impact on my anorexia than most people would understand. 

I have written before about how anorexia functions in my life, as a sense of achievement, sense of control, friend, identity and many other things that make it a lot more complicated than the common understanding of “people with anorexia just want to be thin”, but the other way in which anorexia functions for me is as a way of trying to minimise the “femaleness” I am uncomfortable about in my body. 

I see a lot of females on recovery websites listing perks of recovery to motivate themselves and others to keep fighting their demons, and more often than not one of the things on this list will be “recover to get your boobs back” (for when a person’s eating disorder leads to weight loss/becoming underweight, “boobs” are obviously a part of the body that will undergo some shrinkage.) Indeed I have known people whose cup size has fallen several letters of the alphabet due to their eating disorder (side note: who the hell coined the name “cup size” as a way to describe the space taken up by a boob? Why don’t we just say “boob size”? Who the hell is putting their boobs in cups? Don’t people realise those things are for drinking out of not measuring body parts? You don’t call your shoe size your “colander size” do you? No! So what is this…SOMEONE EXPLAIN). 

This loss of BOOB SIZE is often met with discomfort and people saying things like “I don’t feel female anymore” as if that is a bad thing, when for me, that is part of the point. For this reason, people trying to motivate me to recover by saying things like “recover for boobs” or “recover for curves” is more like a threat of “if you gain weight you are going to have to wear massive bras and stop running for the bus incase you knock yourself out with a rogue breast”, so I often find that I cannot relate to people with eating disorders despite sharing a diagnosis. 

In a way the idea of my chest increasing in size shouldn’t scare me as much as it does, as, in terms of revealing another aspect of myself that people are unaware of, I actually wear a binder rather than a bra. 

For those of you who don’t know, a binder is basically a very tight vest like thing that “binds” your chest somehow (magic and wizardry I think), to give you the appearance of a flat chest, and it is often a thing warn by transgender men. Indeed it was from a trans man that I myself first heard of such a garment and immediately picked one up because I too hated my chest. What I couldn’t relate to with this trans man however, was the need for things like testosterone hormone injections and a desire for facial hair, and it is there that my confusion of “what the hell gender am I then” began. 

I have worn my binder for six years now at both healthy and underweight BMI’s, so I know that technically, no matter how far I am in terms of physical recovery, when I have to go out in public I do not need to worry about my chest. At either weight I know that my binder will give me the appearance of a flat chest, but I also know that I cannot wear my binder in places like the shower which is where the appearance of my chest really bothers me. 

I know that in the past when in the process of getting to a healthy weight, one of the main parts of my body I have feared gaining weight on is my chest, and my bare chest makes me so uncomfortable that I have often refused ECG tests in the past to check how my eating disorder is affecting my heart (these scans are apparently very clever but involve you having to be naked from the waist up…not that clever in my opinion then). 

It has caused such issues in hospital before that even nurses have been confused and contemplated forcing me to stop wearing a binder as they wonder if it could actually be an eating disorder driven choice to “make me look thinner”. People have also suggested that me wearing a binder could link to my desire to remain a child and not grow up into the scary world of adulthood, but as possible as that is, it doesn’t explain the other issues I have with regards to being called “lady”, “she” or even “daughter”. You might not have noticed but if you look through any of the posts I have written previously mentioning my mother, I always refer to myself as her “offspring” and never as “the D word”. Maybe you thought that was just because I wanted to sound fancy, but in actual fact all of those instances were me trying to write on my blog honestly whilst keeping a secret, which is sort of like trying to make a cup of tea without any tea leaves. 

Other things I have seen on websites to motivate females to recover is the idea of getting their menstrual cycle back/being able to bear children, yet again this possibility is something from which I want to run away in fear rather than welcome with joy. When I lost my menstrual cycle I was secretly thrilled and as terrible as this sounds the idea that eating might make my womb work properly was terrifying. I feel so guilty saying that, as I know there are so many women out there who can’t have children so I shouldn’t be wishing my fertility away in such a manner, but I can’t help it, I don’t want a womb and I do not want a monthly reminder that I am trapped in a female body with no escape. When I was told I had osteoporosis (caused by the lack of periods), I even refused to take oestrogen hormone replacements because the idea of getting my menstrual cycle back was more frightening than the idea of breaking my spine, and my google search history has more searches like “can you get a womb or breasts removed” than I care to count.

Unfortunately, I realise that yet again it is one of those “here is a mental illness problem people struggle with” without any conclusion or advice to support those out there struggling with the same thing, which sucks because I know how horrible and complicated this whole relationship between eating disorders and gender can be. That said, considering I don’t fully understand my gender identity in relation to anorexia myself, I would be hard pushed to say anything of any worth, yet still I wanted to write this post if only to get the topic out there and the conversation started. I haven’t come to a conclusion as to “what” I am and I haven’t given advice on how to manage an eating disorder when gender identity is one of the things causing problems with recovery, but I hope I have at least shown another aspect of how complex mental health problems like eating disorders can be, and done something to dispel the idea that they are simply a case of going on a diet that gets out of hand to look as thin as the people in the magazines. More importantly though, I hope that I have made anyone else who feels as confused and alone with this as I do, feel a little less weird, knowing that someone out there does understand, and that though they are also confused, at least you are confused together. Maybe the more people who talk about it the more research will be done and the more will be understood, so as anxious as I am about posting this, I am doing it anyway to add to the voices of those telling professionals that this is a problem only to receive responses like “I have never heard of this happening before”. As I always say, when it comes to mental health problems nobody is weird or a freak, and none of you are alone in any of your struggles.

Take care everyone x

Gender

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The Difficulty Of Knowing What Counts As “A Behaviour” When You Have An Eating Disorder

How do you tell the difference between an elephant and a letterbox? You check to see which one has a trunk and which one is filled with neatly addressed handwritten letters that will soon be lost in the abyss that is “the postal service”.
How can you tell the difference between a brand new slipper and a boomerang? You throw it to see which one comes back and smacks you in the face.
So far so good (apart from the fact you may have just been smacked in the face with a boomerang or lost a perfectly good slipper), but now for the third question:
How do you tell the difference between the genuine preferences of someone with an eating disorder and the disordered behaviours of someone with an eating disorder? The answer? With extreme difficulty…if at all.

When you are on an eating disorder unit, the food aspect of things/what you can and cannot do with food, is a lot more regimented and controlled by sets of rules than it is in normal life.
Rules will vary depending on what hospital ward or inpatient unit you have been admitted to, but as a general list of examples these rules will be things like “no eating cereal with tea spoons”, “no breaking food up into tiny pieces”, “no sleeves at the dinner table”, “you must scrape the plate that you are eating from clean to complete the meal”, “only X number of minutes to eat your meal” and “no inserting parsnips into the nostrils of the person sitting next to you” (pretty sure that last one is also relevant in real life actually but I am not quite sure…my mother was never very clear when it came to table manners.)
These rules are often frustrating and can seem a bit harsh but they exist because often an eating disorder controls how a person eats and behaves around food, as well as how much or little of it they eat, so part of treatment during recovery involves tackling those food behaviours as well as things like the amount of food someone might be eating. Like I said it can be annoying, but it makes sense. Take the “you must scrape your plate to complete a meal” thing. It may seem over the top (and is a rule that will destroy the lovely willow pattern adorning all of your best crockery), but were it not for rules like that in hospital, there is the risk of people arguing that they have finished their meal when really all they have done is smear it across the good china.

With behaviours like that, I think it is easy to tell the difference between them and genuine food preferences as I don’t think I know any people without eating disorders who “prefer” trying to mash a lasagne into oblivion rather than consuming it.
There are however, a lot of actions people do where it is far harder to tell if the person is making a genuine choice or following a behaviour, and in these situations it is less like trying to distinguish an elephant from a letter box, and more like trying to tell the difference between an elephant, a tea pot and a vacuum cleaner (if you line all three up together you have to admit they do look rather similar…trunks, nozzles and spouts are easily confused…I learnt that the hard way…and broke a teapot).

For example at the hospital I am in at the moment, there are certain rules regarding condiments such as “only two pepper/ketchup/vinegar/mayonnaise/brown sauce etc sachets per meal”. The logic behind this is that some people with eating disorders tend to totally cover their food with a certain condiment in order to make it all taste the same/spoil the food and make it taste horrible as a punishment etc.
Then again, as well as people who use pepper to burn the roof of their mouths off by using it excessively, there are people who use what looks like an excessive amount of pepper simply because they like it. Every time my Dad eats a meal he uses so much pepper that even people scuba diving at the bottom of the Atlantic start sneezing because he likes the spice, and I have a friend who uses what may look like a lot of salt because she has been brought up using that amount and things taste wrong without it. Neither of these people have eating disorders, but they would still struggle living by the rules that are in place to help someone in recovery from a disorder. I guess you could say that the way you tell the difference is to see which came first, the food preference or the disorder, but that isn’t as easy as it sounds. Eating disorders are sneaky, they slip into your life gradually without you really noticing, so it is rare for someone to be able to pin point the day they officially became unwell.

What if my Dad, who currently does not have an eating disorder, developed one in years to come and had to go into hospital? Or my friend who likes a lot of salt? They might, quite rightly, argue that their preferences existed years before their illnesses began and they may be right but the thing is, in hospital, that doesn’t really matter and this is where it gets frustrating. Once you are tarnished with the Eating Disorder brush, suddenly people assume that EVERYTHING you do around food is because of that disorder and they rarely give in or believe you even when you are expressing a genuine dislike. It can be really annoying when you know that your love of toast that is not particularly well cooked is because you like soft as opposed to crisp bread, yet when you are consistently told that everything you do is disordered, sometimes you can start to doubt and be unable to tell the difference between your own choices yourself (aka the is it an elephant, teapot or a vacuum cleaner situation).

How about timings and things like time limits on eating disorder wards? Admittedly they are necessary to avoid still working on Monday’s bowl of cereal at Sunday dinner time (rather soggy cereal I would imagine), but in addition to timings perhaps being affected by disordered thoughts or behaviours, people naturally have varying eating speeds. I certainly know that in my household my Dad will always finish his dinner a good 10-15 minutes before my mum for the simple reason that he has a bigger mouth and more violent set of gnashers (not abnormally large I might add…like he is still a handsome chap and isn’t frequently being mistaken for a shark who needs to be sent back to the aquarium…just clarifying…love you Dad.)

The main rule/“behaviour” that got me thinking about this topic however, the rule I have seen come up in every single one of my admissions to an eating disorder unit and the rule that is carved in a stone tablet and worshipped on a mountain guarded by holy cherubim:

“Thou shalt not dunk biscuits”.

Some of you reading this, who have never heard of such a rule, may be a little shocked, stunned and perhaps distressed to hear that there are people all over the country being forced to eat rich teas that have never actually taken a dip in a real mug of the beverage after which they are named (I know, it is upsetting but we can get through it).
Again, as with all hospital rules there is a reason behind it, that being that people sometimes submerge and drown their biscuits rather than dabbling in a quick dunk and then smear the soggy remains around the inside of their mugs or leave them in sorrowful abandoned mush mountains at the very bottom.

The issue though, comes when you are someone who wants to safely and appropriately dunk their biscuit, yet are prevented by the rule that may not be relevant to you. Of course rules have to apply to everyone on the ward to make them fair, but that is what is annoying, i.e. having an eating disorder and then having EVERYTHING you do with food put down to your disorder when maybe you have just grown up liking a lot of ketchup on your curly fries, or genuinely prefer the texture of a cookie that has had a quick swim in a mug of hot chocolate. Dunking biscuits CAN be a disordered behaviour, but it isn’t always.

Just imagine if the world had to live by eating disorder ward rules with the act of dunking a biscuit being classed as a disordered/unhealthy behaviour and thus banned for all. How would any of us ever eat an Oreo? The dunking aspect to those delights is even in the damn advert! They literally explain how to eat them on the packet! First you twist it, then you lick it, then YOU DUNK IT. If that bit was deleted from the process the country would grind to a halt and living rooms across the world would be filled with poor distressed people holding opened licked Oreos and crying out in agony “WHERE DO I GO FROM HERE?” Think of the number of teeth that would be broken on undunked ginger nuts!

You could maybe be a generous dictator and say that only people who appropriately dunk their biscuits are permitted to do so (something I have asked for on multiple previous admissions), but how can you tell if someone is dunking appropriately? What if someone is genuinely dunking for the resulting soggy biscuit end goal but is such a poor judge of the strength of their chosen biscuit that they get the timings wrong and remove their Custard cream or Bourbon from their brew not to find a perfectly melted vanilla or chocolate cream centre but instead a blank space, an empty half in which biscuit perfection had existed seconds before it was too late and the perfection turned into a sinking disappointment of heartbreak, sorrow and missed opportunities.
Should biscuit dunking be classed as an eating disorder behaviour just because it can sometimes be used as one or can it just be a preference?

Overall then it is clearly very difficult to tell the difference between an eating disorder behaviour and a genuine food preference, especially when you yourself have the eating disorder. I guess when it comes to people who have no issues with food the answer is obvious…until that person is unfortunate enough to develop the disorder and we are caught in the whole confusing “which came first the soggy biscuit or the mental health problem?” dilemma which has plagued scientists for years (scientists who I feel are doing valuable work but are also perhaps taking advantage of their right to order in free biscuits from the big companies under the guise of “research purposes”….)
Of course there will always be ways to figure out the disordered act from the genuine preference but it isn’t always as clear cut as the elephant and the letter box example and sometimes even knowing your own reasons for doing things can get you into a confused muddle of soggy biscuit yourself.

Take care everyone x

ElephantHoover