Iatrogenesis

Iatrogenesis

I know I’m not the only one who dreads a visit to the doctors. I generally dislike GP surgeries, although I’m not phobic of them in the way I am of hospitals, but it isn’t the sitting in an overly-warm badly decorated waiting room surrounded by sick people, or even the mind boggling rudeness of the average receptionist that fills me with dread. It’s the fact that I always, always end up feeling worse upon leaving than when I went in.

I’ve been consulting my GP (ha! Actually many because it is a group practice and I have never successfully managed to book successive appointments with the same doctor), primarily about the significant weight loss I’ve undergone over the last year. I am now underweight by some margin and look and feel like death. I’ve had a bunch of blood tests to rule out anything nefarious and thankfully, my body doesn’t seem to be the cause: I had been worried that my thyroid had been playing up again. I stepped on the scales again and my weight was the same it had been four weeks ago – that it hasn’t gone down further is a reassuring sign.

While that is a relief, it also means that my weight loss is tied to either my anxiety, or breastfeeding, or most likely both. I have been calorie tracking and I do eat ‘enough’, but probably not enough if we factor in lactation and the high metabolism that comes with anxiety. 

I have been receiving CBT with an aim to challenging the anxiety and OCD since June. I will probably only have one or maybe two more sessions. My PHQ9 and GAD7 scores show that I haven’t made significant progress, and while the tools I have been learning (or rather relearning as I’m no stranger to CBT) are useful,  they haven’t made a big difference yet. So I ask my doctor, what can we put in place for when these sessions end? 

His response was firstly to explain CBT and anxiety to me like I didn’t understand what I had been experiencing, and then summed up by saying that I had to wait until I had a crisis and then request further therapy. I pointed out that I have two very young children and that I was not willing to let myself get to that point, especially keeping in mind it had been a six month wait to get this lot of therapy even though I was supposedly a high priority patient. 

‘Hmm’

I sigh and bite the bullet – does he think it would be sensible for me to perhaps restart on an SSRI? I had not taken any since being pregnant with my second child, but now she is well over a year old I have less misgivings about potential effects on her. Oh yes! That’s a good idea (it was by this point clear he’d not actually looked at my notes at all, and knew nothing of my long history with mental illness or even if I was taking medication). He then tried to put me on a different SSRI than the one I had taken successfully before but I managed to persuade him to stick to the old drug as I know I have almost no side effects on it after the initial few weeks. 

When I ask for a note to send off to the DWP to make sure my ESA payments continue for the next four weeks, he pouts, and doesn’t look me in the eye for the rest of the appointment. He requests I book another appointment in four weeks to assess the SSRI dosage. He doesn’t say goodbye as I leave the room.

At no point did he attempt to make any kind of human contact. No, how are you? How are you finding it? What are your worries? How are your kids? A prescription and an instruction to call the crisis helpline if I relapse further once my therapy is cut off. 

I left the surgery feeling like the biggest pile of shit. I was more convinced than ever that I was somehow going to have to fix myself because no medical professional (therapists not included) I have seen has seemed remotely interested in my actually getting better – they just want me out of their hair. It’s like they know it’s hard, that it’s outside of their comfort zone, so they don’t even extend the courtesy of trying. Take the pills and bother the non-existent MH team. This can’t be because they don’t care. I think they are probably good people. But because they know there’s fuck all they can do they just put a barrier up to protect themselves. 

But it left me feeling entirely worthless. Like I was totally on my own. I’ll take the meds but I know from before they just leave me pretty vacant – they don’t alter my thought patterns or anxiety symptoms. If I’m hung out to dry with no access to further therapy I am really scared about how I’m going to get through the winter.

I don’t have an eating disorder, I’m just terrified of food

I don’t have an eating disorder, I’m just terrified of food

I exhibit a number of behaviours which have similarities to those shown by someone with an eating disorder. I often eat alone, furtively and super-quick. I might stop eating something after a few bites and throw the rest away. I struggle to sit down and eat with others and will literally do anything to avoid having to eat out, including at the homes of friends or family.

I don’t have an eating disorder. I have no issue with my appearance, my weight, and I don’t use food as a comfort. I don’t purge, or binge, or calory count, or over- exercise. I have never done any of those things, and I thank my mother in particular for modelling a healthy attitude to food and body image for having escaped the horrors of an eating disorder. 

I have cibophobia (sometimes known as sitophobia) which translates as a fear of food. Not that food might make me gain weight, but that it might make me physically unwell. I have had this phobia, at varying levels of intensity, for at least ten years, although I only discovered it had a name very recently. It’s an odd one, because this phobia is usually triggered by some kind of childhood trauma or actual food allergy. I am quite physically robust, was rarely sick as a kid, with no known allergies. But I did get an awful dose of food poisoning on a trip to India back in 2004, which I recognise was probably the original trigger, even though the phobia didn’t start to show itself until some years later. And every time I’ve been unlucky enough to get (thankfully milder) bouts of food poisoning subsequently, it’s usually triggered a relapse into heightened anxiety and OCD.

It’s very hard to explain this phobia to anyone – doctors and therapists do tend to jump to eating disorders and I have to work quite hard to convince them it’s not the same thing. I also have to explain I do not have a fear of vomiting (emetophobia). Sure it’s not pleasant, but I didn’t freak out when I had morning sickness during my pregnancies for example. It’s a fear that by eating something unsafe or contaminated, I might then be poisoned, and be so ill as to be incapacitated, and (here’s the crucial bit I think) helpless. For me, the phobia has spilled over into OCD behaviours and an acute fear of contamination by other means too (the very word ‘norovirus’ can trigger a panic attack, and I watch people around me intently to check their own hand hygiene standards). My absolute nightmare scenario would be for my entire family to be struck down by food poisoning / similar at the same time and somehow I’d still have to care for everyone else while coping with my own illness.

To avoid this happening (to keep myself and my family ‘safe’) I can go to pretty extreme lengths. Firstly, I often heavily restrict my own diet. If I’m having a bad week, I might only eat a specific brand of cereal, with perhaps some pasta and cheese and maybe bananas. If I’m feeling more myself, I will attempt to cook a proper meal for my family (a painstaking process with lots of checks and double checks and hand washing and fluctuating anxiety levels), but will often find that when it comes time to eat it, I chicken out and don’t serve myself a portion, lest it somehow despite my best efforts be unsafe. My thinking here is, if my family does get sick, at least I won’t and so will be able to look after them. Sometimes I have wonderful days where I manage to eat well, healthily, alongside the people I love but they have been a rarity recently.

It’s a hard phobia for my loved ones to understand because the rules seem to change on a near daily basis. On a really bad day, I might struggle to eat more than toast (and even then chances are I won’t eat the bit of the toast I’ve touched). On an OK day, I might eat fairly normally but freak out because my partner has decided to make himself a chicken salad (I panic that he might unwittingly spread salmonella everywhere) and then spend an hour cleaning the kitchen. On a good day I might actually cook a roast chicken and eat some of it, but chances are I won’t go back for seconds even if I’m still hungry as, to mitigate the ‘risk’, I’ll limit my ‘exposure’. I have developed so many weird internal rules and safety behaviours I can barely articulate them to myself let alone anyone else. My partner basically has to check in with me before doing anything in the kitchen, and this is a fairly major strain on us sometimes.

This phobia really fucking sucks and is ruining my life. 

Firstly, I have been either pregnant or breastfeeding or both for nearly four years straight; my body has a high nutritional need right now and I am just not able to provide that for myself most days. I have lost far too much weight, and feel and look scrawny and ill. 

Secondly, I actually really enjoy cooking and eating when I am in my right mind. I used to find cooking a cathartic, creative experience, I own a lot of cook-books, and am actually pretty good at it (I’ve never been much good at baking though). I used to love eating out, or at friends houses, or with my partner at home after a tough day. Something I absolutely enjoyed has been spoiled for me.

Thirdly, as a result of this phobia my world has shrunk and I’ve lost friends. I can’t go out for a meal with people, I can’t even manage drinks sometimes. I avoid any situation where I might be expected to eat something, lest I either a) get sick or b) offend someone by refusing. Agoraphobia and social anxiety have sprouted from this original phobia and further compounded the issue.

Fourthly, it is very very hard work to not pass this on to my daughters. Every day I try to prepare healthy food for my family and not let on to the inner panic I’m experiencing. This is exhausting.

I’m in therapy, using CBT to tackle the specific avoidance behaviours by building a fear hierarchy and working my way up it doing behavioural experiments by way of graded exposure (this week, sandwiches!). We’ve also identified that the belief underlying this fear is that it is not OK for me to be not OK (e.g. ill) – I have to be at my best and on call at all times because I am responsible for everyone and everything, because no one else can be trusted. Ironically, by fixating on food as a way of controlling my exposure to the risk of being let down by other people, I’m actually just succeeding in making myself ill in a different way.

This is a major work in progress. There are a lot of layers to it and I’m still figuring a lot of stuff out. But I wanted to write about it partly because there’s very little out there on this specific phobia – and hopefully it might help someone else going through similar articulate their own issues and hopefully receive better help.

I’ve never met someone with this same phobia so if this rings any bells for you please do get in touch.