What do you picture when you think of someone who has anorexia? Today’s guest shares her journey with anorexia, from her sickest points, her diagnosis and treatment, and what life is like now that she is in recovery. She tells us how society’s limited understanding of eating disorders contributes to the care of those most in need being ignored.

Anorexia survivor and mental health advocate Alex Carroll shares her firsthand experiences of her recovery journey. She candidly talks about what it was like to be hospitalized, what happened to her after getting out of inpatient, and how anorexia is so much more than an out-of-control diet. Join us for a powerful firsthand account of life with anorexia nervosa.

Alex Carroll

Alex Carroll is a mental health advocate with a passion for educating the community and raising awareness about the reality of eating disorders in society. After being diagnosed with anorexia nervosa during her sophomore year of college, Alex went to an inpatient treatment facility to begin her recovery journey. Now authentically navigating her own recovery, she uses her experience in a positive way by speaking at various universities and events, organizing philanthropic initiatives focused on mental health, mentoring students living with an eating disorder, and supporting families that have a loved one going through treatment. Visit her on Instagram @alexcarroll98.

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

To learn more about Gabe, please visit his website, gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of Inside Mental Health: A Psych Central Podcast. I’m your host, Gabe Howard, and I want to quickly thank our sponsor, Better Help. You can grab a week free by visiting BetterHelp.com/PsychCentral. Calling into our show today. We have Alex Carroll. Ms. Carroll is a mental health advocate with a passion for educating the community and raising awareness about the reality of eating disorders in our society. After being diagnosed with anorexia nervosa during her sophomore year of college, she went to an inpatient treatment facility where she began her recovery journey. Ms. Carroll is also a member of the RV Healthline family as the associate social media manager for Psych Central. Ms. Carroll, welcome to the show.

Alex Carroll: Hi, Gabe, thank you so much for having me.

Gabe Howard: I am very excited that you are here. Now, unlike our listeners, I have the advantage of being able to see you. And I want our listeners to know that unlike their six foot three, 250 pound host, you are a smaller framed individual. Now, if I had no understanding whatsoever of eating disorders, I can see where I’d be quick to say, how did you ever think that you were overweight? Did people dismiss your eating disorder because they just assumed that you were fine based solely on your looks?

Alex Carroll: I think that a lot of people did assume that I had an eating disorder, unfortunately, because I do fit that mold of what society thinks somebody with an eating disorder looks like. I am five three, I am more on the petite side, I’m blonde, I’m a white woman. Then that completely reinforces the stereotype that men can’t have eating disorders or black women can’t have eating disorders or older women.

Gabe Howard: But it seems like people were constantly discussing just what you looked like rather than the dangers of being malnourished.

Alex Carroll: Oh, yeah, and that is a huge issue with society’s understanding of eating disorders in general. A lot of the times you’ll hear people say that they’re jealous of somebody with anorexia because they’re so skinny and they are so good at dieting, where it is a very complex and serious illness. The physical symptoms associated with malnourishment that I experienced, it was bruising. My hair fell out. I had lanugo, which is like this thin hair that your body starts to grow to try to keep itself warm because I had no fat on my body. My skin was gray, my nails were breaking. I didn’t have enough vitamins to keep myself healthy. When I was first diagnosed with anorexia, my family didn’t really have the understanding of. My understanding of it was, oh, anorexia is when somebody just refuses to eat. And that could not be further from the truth. But to my parents who are looking at their daughter and are worried and they’re frustrated. They’re saying, why don’t you? You were beautiful before, you were so much happier. You looked great, Alex, we’re worried about you. You don’t need to lose any more weight. And so then they were saying, oh, OK, up until this point, your eating disorder was OK, because now you look really great. But if you lose any more, that’s when it’ll be scarier.

Gabe Howard: Can you walk us through you being diagnosed and receiving treatment?

Alex Carroll: Over the summer, going into my sophomore year, I had been going back and forth in my mind thinking, do I have an eating disorder? Is this normal? Because at first it started out very normal in terms of what you would expect from a diet. I was getting ready to go to Beach Week and I made a goal for myself. I’m going to lose X amount of pounds. I was going to be fine after that. And I was like, I’ll go back, I’ll eat pizza after the beach. But then I decided I wanted to keep it up. I had gotten praise for the weight that I had lost. I became addicted to the numbers. Food wasn’t food to me. It was OK, I ate a thousand calories today. Let me try to get to nine hundred tomorrow. Then I would say, OK, I did nine hundred. Let me try to do eight fifty. And the more times that I was beating what I wanted to eat that day, that pride would skyrocket.

Alex Carroll: But as that pride skyrocketed, I started noticing that my lows were getting so much worse. If I ate above my goal at first I was like, OK, we’ll try again. Quickly turned into, in my mind, what are you doing? You’re disgusting. How could you have had that second bowl of strawberries? You completely ruined your diet. Now you have to overcompensate. And my birthday is in August and the entire time I was dreading it because I knew that with birthdays came birthday dinners and birthday cake. That was terrifying and I was dreading my birthday and that’s when I truly did realize that something was wrong for me. That was confusing because I thought, OK, my boyfriend at the time, my family, nobody was saying anything to me. And so it must not be that big of a deal if the people close to me aren’t saying anything. I secretly wanted that validation of somebody to express the concern because I felt like I wasn’t going to be able to put a name on it. And when that finally happened, my dad and I, we were on a walk and he had told me that he was getting worried about me and that he would like for me to see the therapist on campus when I went back to school.

Alex Carroll: And I agreed because at that point it had been months of me feeling very alone and it was exhausting and I did not want to be sick. Nobody with an eating disorder wants to have an eating disorder. I wanted to get better. And that’s hard to say as somebody with an eating disorder, too, because you can personally want to get better, but your eating disorder will completely take over your mind and tell you you don’t want to get better. That’s the worst thing you could possibly imagine. When I was on campus, the whole time, I was like, OK, I’ll go to see the therapist. I’ll go see the dietitian, saw a psychiatrist who had prescribed medication and so was going through all of these steps. And I still didn’t feel like I was sick enough, no motivation at that time to get better. And the scary part about my eating disorder was that when you were restricting food and nutrition, to the extent that I was, I was eating no more than 50 calories a day. I stopped taking my vitamins because I didn’t want those extra fifteen. When your body is that malnourished, the only way that it can keep itself alive is to put all of the energy, all of the nutrients it has towards your vitals. So I didn’t have the energy to feel emotions. My body put all of my nutrients towards my vital organs. So that’s why my hair fell out.

Alex Carroll: That wasn’t essential. I saw all of these physical symptoms and I still thought to myself, I’m not sick enough. And my team had told me all about the statistics. I knew that behind opioid addiction, anorexia was the leading cause of death among all mental illnesses. And it’s because it gets so severe and people will have heart attacks or go into organ failure. And I knew that and I knew that that was a reality. But I still thought, no, it’s not going to happen to me. Even when I was put on a Holter monitor to monitor my heart, even when I was passing out walking up a hill to a class, I still felt, no, I’m still not sick enough. And I think that one of the turning points for me was I had to go to a hospital and get bloodwork done. Now again, being so malnourished and dehydrated, my veins were very small and they could not get a viable vein. They used baby needles. They were trying everything to the point where they were saying, if we can’t get any more blood, we will have to get it from your neck. And luckily, they finally found one vein and they saw that my blood sugar was so low and they put a soda in front of me and gummies and they said, you have to eat and drink these or you are going to be admitted here overnight against your will.

Alex Carroll: And I looked at them like they were crazy because, of course, I wouldn’t be sitting there if I could just drink a soda and eat these gummies. And it took me about an hour to get the soda down. And I felt extreme guilt after that. And I think that that was when I knew that I was so sick. I watched my parents and they were just terrified. And there came a point where they kept persuading me to go to treatment. Everybody was in my corner except for me. I truly didn’t feel like I could even get better. I didn’t want to. I didn’t care about anything anymore. I felt nothing. But the one thing that really stuck with me that got me to treatment was when my therapist told me that she knew that I wanted to be a mom. And that’s something that I value. But I was told you likely won’t have that opportunity if you continue down this road, one, you’ll either die. But I had stopped getting my period. I wasn’t able to have normal functioning organs. And so I knew that if I wanted to be a mom, I had to be healthy. And if I wanted to raise a son or a daughter, I had to be healthy to promote a healthy life for them. So that was what really got me to go to treatment. So I wasn’t doing it for me. I wasn’t doing it for my family, unfortunately. For my boyfriend at the time, it wasn’t. It was finding that one thing that really could push me through, and that was the prospect of being a mom one day.

Gabe Howard: If I understand correctly, you were in treatment for quite some time. So long that you ultimately made the decision to drop out of college. What was that decision like? Because college was a goal. Being well is a goal. It’s a rock and a hard place, at least it seems so from my perspective. What was it like for you?

Alex Carroll: College is a goal, but being healthy is a necessity. I was thinking this is going to ruin my life, because I don’t want to miss out on a semester. I don’t want to have to leave my classes. And then that will mess up my credits, which will mess up my internship opportunities, which will mess up my life, yada, yada, yada. That was the mentality. I think we can all laugh now, especially going through a pandemic, knowing you can’t even guess what’s going to be a year ahead of you. But back then, I thought that I had my whole life planned out and I was terrified to deviate from that. I didn’t know what it would be like. And then finally, because I had such a great support system from the Deans and from my family and peers at school, I knew I would be coming back to a completely supportive team on my campus. And I also know that when I put my mind to something, I’m going to do it and I’m going to do it well and I’m going to come out on top. So once I decided that, OK, it’s going to be hard, I’m going to have to really bear down for the rest of my college, but it’ll be worth it because I’ll be able to be back on campus. I knew that that would mean taking five classes every year to graduate on time, and I knew that it would set me back socially in terms of missing a big event. I was fortunate that nobody ever made me feel unaccepted or felt like a black sheep. People were incredibly supportive. But it was terrifying. It was terrifying to make that decision.

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Gabe Howard: We’re back with Alex Carroll discussing her recovery journey with an eating disorder. Let’s talk about a day in the life of treatment, what was that like? Were you in, and please pardon my ignorance, were you in a room with other people with anorexia? I’m trying to imagine what it looks like in there. And one of the things that you said earlier is still sticking to mind, which is you looked the part. So therefore people helped you. And I just keep thinking, well, I know what those walls must look like because I saw a movie about it and I’m realizing that that movie was probably way wrong because even in that movie, all young white women with only one eating disorder, it’s much more complicated than that. Right?

Alex Carroll: Oh, yeah, absolutely, so I think the first thing, and if anybody is listening and thinking that going to treatment is going to be like what you see in movies of a padded white wall or it being very much like a hospital, that was not my experience at all. So a day in the life there, we would wake up in the morning fairly early, around 6:30, coming from college, that was very early. And there are people of all different backgrounds, all different ethnicities, ages. And it was incredible. Women who were in their 40s or their 50s. And then there were younger men. People had bulimia, binge eating disorder, anorexia. It was all different types of eating disorders, and it was people at different points in their recovery. I came in really needing weight restoration and there were people there who had maybe hit their restoration weight and they were in maintenance. And I am so grateful for that experience. And that was the first time that I had been around so many diverse people.

Alex Carroll: And they taught me so much, hearing what their experience was like. And that was incredibly eye-opening and amazing for me, honestly. We would have our three meals and three snacks a day and we would have group sessions and that could been anything from DBT or ACT therapy. It could have also been sex and relationships and how that ties into our lives, our mental health and our eating disorder, having groups for family therapy. We would go to these groups, and that could have been 15 to 20 people, but then you would also have your individual therapist, your individual dietitian, and you would have that personal time with them. You really just get to grow as a person in so many different ways. You’re there completely to focus on yourself, but you’re also there with so many people that are battling demons just as you are and who can really understand what you’re going through. I don’t want to minimize this, but the way that I like to compare what treatment was like is to summer camp, except you probably cry more and you have worse gas pains.

Alex Carroll: And that sounds gross to some people. But when you get into treatment, there is very little privacy in terms of bodily functions. You have to show the bathroom monitors the toilet before you flush because they will check to make sure nothing was in there that shouldn’t be as if you had gotten sick or used any kind of disordered behaviors. But they were also tracking your stool. I came in very malnourished. That also meant that I had not had a bowel movement in a very long time. And it was gas pain to the max while your stomach was getting used to having food in it again. It was celebrating your first B.M. It, it’s kind of fun. And you get to a point where everybody’s in this together and you have good times and you have free time where you can play games and get to know people. But it’s not a walk in the park. It’s not. And you’ll learn too, going in there. You think that you have it the worst, but then you’re sitting there and you’re talking to a mom who missed out on major points in her children’s life because of her eating disorder. You will be talking to a young man who was an athlete in college who he was no longer able to run because he was so malnourished. It’s very eye-opening.

Gabe Howard: How long were you at the treatment center before you were released, and then my follow up question to that is I’m assuming that the day that you left the treatment center wasn’t recovery. That wasn’t the end of treatment. What’s next?

Alex Carroll: I was at the eating recovery center for about two months. When I came back to Richmond, I was in partial hospitalization. So I would go there in the morning and leave probably around 8:00 at night and repeat the next day. And once I was in a place that my team felt like I could be more free, living on my own and still going to treatment four days during the afternoons, outpatient treatment. That actually fell at the same time as when my spring semester at my university was beginning again. What I would do was I was taking a light schedule, and then I would leave campus at 5:00 p.m. Go to treatment from 5:00 to 9:00, and then come back and do my work. And it was hard. I was doing that dance for about a month. And then finally I was released to the care of my team back on campus. And I would see my therapist once a week, I see my dietician twice a week, the psychiatrist once a week. And I needed that because you come out of treatment and you have this freedom again and your eating disorder can run rampant if you let it. And that’s very common. So having my team, keeping me accountable constantly after I was out of the facility treatment, that was where the real work began. It’s how am I going to fight to maintain that recovery?

Gabe Howard: And what have the last few years since you’ve reached recovery been like, do you just get to forget about it? Is it all over? Does it take monitoring? Maintenance? What is life in recovery from anorexia like?

Alex Carroll: Man, I wish that I could say that it was smooth sailing and that I have been able to manage it perfectly. But the reality is that having an eating disorder, that affects me for my whole life. I try to compare living with an eating disorder to somebody who went to treatment for alcoholism. When they leave treatment, it can be hard for that person for years to come. They go to a restaurant and they might feel triggered or have that anxiety and they think about their disorder when that wine list gets put down in front of them. And, you know, that’s still something that they have to monitor. They go to meetings. The same is said about eating disorders. You don’t go to treatment and everything goes away. For me, I didn’t regain weight, come back and everything was OK. It’s not like that at all. I still think about my eating disorder. It’s not as bad. But you have to actively choose recovery.

Alex Carroll: Every single time that you sit down for a meal, every single time that you are going to exercise, every single time that you are really doing anything in life because you have to eat to live. I wish so badly that I was quote unquote normal to the point where I can just have that innate ability to eat and something that should be so natural. But that is something that I struggle with. And at the end of the day, when you’re living with an eating disorder, the only person that can make the final decision to recover is you. The thing that people don’t always see is the internal struggle, because you might see me or somebody else and I might be eating a burger and fries and you would not think a single thing. What you don’t see, though, is inside my mind is me trying to constantly have this mental battle and so it can be emotionally draining.

Gabe Howard: This is a very weird question, and I apologize for not being 100% sure how to word it, but I’m wondering when you sit down to eat, what goes through your mind?

Alex Carroll: When I was struggling, it was like a war zone in my mind. If I were to plan out my meals for the day and I were to eat exactly what I had planned and allowed myself to have the day, it was much smoother sailing. Now there are times where we would say, OK, we’re actually going out here for dinner. And I would panic and I would think, how is this going to fit into my meal plan? I don’t know the calorie count on their menu. And it was this anxiety spiral. You start to feel this genuine panic in your chest and the panic that I felt and still feel. Occasionally I compare that to parents when they lose their child in a very crowded public place. You’re walking, you look down and they’re not there anymore. And that immediate panic that everything that could happen is going to happen. The terror, the what do I do? That swirling feeling, that is what it would feel like when I would have a mess up in my meal plan or if I was sitting in front of a terrifying food, I didn’t know what to do. And if you’re not a parent, think about it like if when you were a child being lost in a grocery store and you can’t find your parent, you’re going to be kidnaped or they’re going to leave you there forever. And that panic, that anxiety you feel, that was what I was feeling essentially every day around meal time and sometimes after when the guilt would set in after a specific meal.

Gabe Howard: So to try to take me through it just a little more, we have to eat, right? It’s not something that we can just be abstinent. Did you have any rituals surrounding it that made this easier? Did you accept that you needed to eat? I’m thinking about it from terms of somebody trying to put this together for themselves or move forward. What would this look like for them? What did it look like for you?

Alex Carroll: To clarify, are you asking what the ritual is like now in recovery or what it was like before while I was sick?

Gabe Howard: So I guess that’s a very good question. I would say both. What was it like before and after and probably during? Because I imagine that it wasn’t like one day you were this way and the next day you were that. I imagine there was there is probably a learning curve.

Alex Carroll: Yeah, well, there was a completely different mindset shift too, between when I was sick before going to treatment and now. Before I knew that I needed to eat and I knew physically I would die if I didn’t get that in, yada, yada, yada. I knew the science behind it. Still didn’t care, but knew I had to do something. My strategy at that point, I was just seeing food as what is the least amount that I can eat and still be alive? Now, the way that I look at my meals in the way that I view food is how can I eat these meals in a way that lets me live the life that I want to? If I wasn’t eating, I couldn’t go dancing with my friends and I couldn’t go on hikes. I couldn’t do anything. So each time that I sit down before meals now, I like to remind myself of the amazing things that come with having this delicious food in front of me. I try to be mindful and when I take the first bite, I try to really focus on the flavors of the food that I’m eating and enjoy the experience. Again, I have to remind myself, a lot of the times is food is fuel. It’s not a number, it’s not the enemy. It’s something that will help me live the life that I want to live. And I still have this part of me that is terrified of food, but that part of me is much quieter.

Gabe Howard: What advice do you have for somebody who suspects that they might have an eating disorder or that somebody that they love, a friend or a family member might have an eating disorder?

Alex Carroll: For both of those, I would say speak up. If you think that you have an eating disorder and you’re questioning yourself, you probably do. Speak up and reach out to somebody, anybody. If you can see a therapist, a dietician, even talking to your best friend. If you are somebody that is close to somebody that you think is struggling, speak up, because when I was struggling, I was dying for somebody to just validate what I was going through and put a name to it and felt like people kept ignoring it, but it’s because people were uncomfortable talking about it. So I would say make sure you bring it up and lean into that discomfort because it could save their life.

Gabe Howard: Is recovery possible?

Alex Carroll: Recovery is possible. I’ve seen it, I have lived it, and I also know how tempting it can be to not be recovery focused. There are times in my life where recovery has not been at the forefront and my eating disorder, has taken control again. But at the end of the day, I know that I’ve gone through it before and I know that I can beat it. I’m not fully recovered. I don’t know when that happens. Recovery doesn’t have to be perfection. It has to be you committing to being better and taking the steps every day to be better and to fight your illness. Not everybody has the same recovery journey. Some people will go to treatment multiple times.

Alex Carroll: The biggest thing is that nobody wants to have an eating disorder. I think that there’s always this notion that eating disorders come from a place of vanity. It might start that way as a diet, but it becomes something much more severe. It’s more than just someone being stubborn or somebody eating too much or somebody having this as a choice. It’s very much not a choice. And eating disorders don’t discriminate. It doesn’t matter if you are white, black, Asian, gay, straight, trans. It does not matter because eating disorders affect people of all walks of life. It’s the mother of three. It’s the athlete. It’s the friend of your brother. It’s all these different people that you might not see. There are over 30 million people in America living with an eating disorder. Just because they’re not walking around looking emaciated, that doesn’t mean they’re not there. And that doesn’t mean that their battle is any less severe. So that is one thing that I really want to make sure that people know is that it’s not a choice and people of all different backgrounds will struggle, And it’s not just the blond, petite college girl like me.

Gabe Howard: Ms. Carroll, thank you so much for being here. We really appreciate your time.

Alex Carroll: Absolutely. I really enjoyed talking, Gabe, and anybody out there listening who is either struggling with an eating disorder or worrying about somebody in their life that might be living with one, I hope that they found this helpful.

Gabe Howard: My name is Gabe Howard and I am the author of the book Mental Illness Is an Asshole, as well as a nationally recognized public speaker who is available to speak at your next event. You can, of course, get my book on Amazon or you can get a signed copy with free swag by heading over to my website, gabehoward.com. Wherever you downloaded this podcast, please take a moment to rate, rank and review. Also follow or subscribe. It’s absolutely free, and that way you won’t miss any future episodes. Thank you for listening and I will see everybody next Thursday here on Inside Mental Health.

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