Name That Neurosis

I have a great nutritionist. I am impressed with the way she handles tough issues and her level of expertise and professionalism. But I dread seeing her, dread it with every fiber of my being. Really, she’s great. She has tons of experience with eating disorders, and she offers extremely helpful advice and information. I've seen nutritionists in the past that really didn't have a clue what to do with an eating disorder patient, the general "Well you need to add X calories, get more fat and protein" doesn't really help a lot. I’m a biologist, for crying out loud, I know that surplus calories equals more poundage. The math is not that hard, and I don't need to pay someone to tell me to eat more Powerbars.

But the one I see now is really good, I like her a lot and she really offers helpful, practical tips specifically for ED issues. But I still hate seeing her. Why? My diet right now is nothing like a "typical" anorexic, and I am more than a little self-conscious about it.

In the past, I did fit the stereotypical anorexic pattern: extreme food restriction, ritualistic eating of just a few items, rigid exercise routines. I would “save up” for days in order to allow myself a bagel that had a half a gram of fat in it. Over the years, through each up and down swing through the disorder, the balance of behaviors has evolved. The ratio of food to exercise is different in each cycle. Right now exercise is just as much of an issue for me as food, if not moreso. I eat more in one meal than I used to eat in an entire day, but my exercise has increased by orders of magnitude, it's really out of control. If someone looked at my daily calorie intake, there's no way they'd think that I had an eating disorder. What makes the difference is the pathological amount of time I spend working out every day, which means I can eat X and Y and Z and still be below 75% of my "ideal body weight."

I still have strict rules about when/what I eat, I'm not at all in denial that I do have an eating disorder. I am self-conscious, though, about whether it really seems like a valid issue, because right now I really don't fit into the cookie-cutter stereotype of behaviors. I don’t binge and use exercise to purge. Even though I eat much more food than I did in previous permutations of the disorder, everything is obsessively planned, measured, and tallied. I guess all of this makes me ED-NOS? I’ve heard the term "anorexia atheletica" before, that would probably be the best descriptor right now. Labels are for soup cans, not people, but not having a niche still makes me feel a little invalid, me and my orphan, no-named freakishness.

Thus, the reason for dreading the nutritionist. I know she works with a lot of ED patients, and I can't help but think how massive my intake must look compared to some of her other clients. That being said, I know that disordered eating isn't about number of calories, it's about the manner of the relationship with food, rigid rules about eating, etc. I also know better than to trust my perceptions all of the time. Right now I feel like I eat tons (again, not impulsively, just what I’ve figured out it takes to maintain my activity from day to day) even though I know my weight is at an unhealthy low, and over the holidays I dipped down to not significantly much more than I had weighed when I was wrapped up in my most severe food restriction as a teenager.

I try to keep that in perspective, though, by remembering years ago when I was in extreme restriction mode and occasionally I'd have a bit more and feel so guilty about a "binge"...which, looking back, was actually a pathetically small number of calories. It just didn't feel like that at the time.

That raises the question: In one month, six months, a year from now, how I will I perceive the things I feel guilty or invalid about today?