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How Does Stress Affect Your Metabolism?

Brooke

Did you know that your metabolism can be affected by stress? Most people think that their metabolism increases during stressful times, but actually it has the opposite effect for most people.

Some amount of stress is “normal”, and actually encourages your body to produce the appropriate amounts and types of chemicals to keep in a state of equilibrium. When your body is in balance, you will occasionally produce stress chemicals (hormones) to handle the stress and then your body goes back to normal. This level of physiological stress is typical, and one’s metabolism isn’t greatly impacted for any length of time.

The state that many of you find yourself in, however, is not a “normal” amount of stress. You may experience heightened stressors in your home environment and/or work or school environment. These stressors are ongoing and unfortunately, some of them aren’t controllable by you. Added to the outside stressors are the ones that are controllable by you, but often are the worst offenders when it comes to the amount of stress chemicals you produce. Why are they the worst offenders? Because they are happening all the time, instead of occasionally. If stress chemicals slow down your metabolism, wouldn’t you want to lessen them if you could?

A quick lesson in physiology:

As humans, we have an autonomic nervous system (beyond our conscious control) that regulates our internal organ system (heartbeat, lung function, brain, etc). The two sub-parts of this autonomic nervous system are the sympathetic nervous system and the parasympathetic nervous system. In very general terms, the sympathetic one causes us to “act” where the parasympathetic one causes us to “relax”. Another way to look at them is “quick response” and “slow response”.

Stress activates the sympathetic nervous system and our “fight or flight” response. Stress de-activates our parasympathetic (relaxation) nervous system. It makes sense, for example, if you are being chased by a saber-tooth tiger, you would want your “fight or flight” response to kick in to save you from being eaten.

During “fight or flight”, your body produces a surge of cortisol, a stress hormone, as well as insulin. Both of these hormones accelerate fat storage. The movement in your intestines slows down (your body isn’t interested in digestion when a saber tooth tiger is after you). Blood flow to your gastrointestinal tract drastically slows down. There is a significant decrease in your digestive enzyme production, as well as a decrease in thyroid hormone production. Healthy gut bacteria die off, and you excrete essential minerals and vitamins. There’s an increase in inflammation and a decrease in oxygen. In a nutshell, when you are in a constant state of stress, or “fight or flight”, your metabolism slows down.

What does all this mean for you?

Ask yourself 2 questions:

1.      Where am I creating my own unnecessary stress?

2.      How can I lower the stress that I have created?

Are you too hard on yourself? Are you taking on too many responsibilities that you don’t need to? Are you not speaking up for yourself? Are you taking on others’ stresses as well as your own? Are you speaking negatively to yourself?

Studies show that NEGATIVE SELF-TALK is a tremendous controllable stressor. This is an unnecessary stress that will have an enormous negative effect on how you digest and assimilate your food. If you are “trash talking” yourself all day long, beating yourself up for anything and everything that you do, you are hurting yourself in an unconscious physiological way, and slowing down your metabolism.  How many of you say things like:

·        I’ll only be happy when I lose weight.

·        I am disgusting.

·        I hate my body.

·        Everyone else is skinnier than me.

·        I suck.

·        I’m worthless.

·        I’m a loser.

YOU ARE SLOWING DOWN YOUR METABOLISM EVERY TIME YOU SAY THESE COMMENTS TO YOURSELF.

On the other hand, if you REDUCE OR STOP some of your controllable stressors and trash self-talk, AND attempt to add pleasurable things into your life like:

·        sense of purpose

·        healthy connections/relationships

·        sense of belonging

·        spirituality

·        healthy hobbies

·        relaxation

·        quality, enjoyable food and drink

·        sunshine

·        POSITIVE (or neutral) SELF TALK

You will have a positive effect on your overall well-being, you will dramatically reduce your physiological level of stress, and you will effectively increase your metabolism.

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Thank you!

heart-handsThis post is a follow-up of sorts to a Facebook thread that I accidentally started yesterday. What prompted the thread was an article that was sent to me written by a nutritionist who treated people for years for weight loss. It was an apology letter of sorts. The article really resonated with me because in the work that I do, I see many clients who, over the years, have been counseled by “professionals” about how to lose weight and have been harmed physically and emotionally by the advice. These professionals did nothing intentionally to harm their clients. In fact, I’m certain that they thought they were performing a valuable service or dispensing sound advice. But, an essential component to counseling an individual about food, nutrition, and their relationship with their body, is the human factor. It is essential to help the client see what is behind their struggles with food and weight. Their struggle is RARELY about the food or weight. It is OFTEN about other things. Trying to “fix” their weight in the hope of creating a happier life is missing the most essential information about the client. It is, essentially, missing the point. Helping the person to heal their life is where the real work lies. If someone is given nutrition information, factoids to help them become a smaller size, without addressing the underlying issues, it is like placing a Band-Aid on a gaping wound. It will cover up the problem, and provide a distraction from the issues for a period of time, but eventually it will backfire and the problems will persist. Not only will the problems persist, but then they will search frantically for the next diet to embark upon, and start the cycle all over again, shoving all the underlying issues further and further into the recesses of their mind and body.

I have a client who has worked for several years to heal her relationship with her food and body. She had anorexia as a child and now, as an adult, she suffers with emotional eating, and binge eating. As a result of her “use of food” as a coping mechanism, she has gained weight. Thankfully she didn’t come to see me with the sole intent to lose weight, because I wouldn’t have been able to treat her. In fact, I tell all my clients who want to be in a smaller body thinking that their lives will drastically improve when their weight goes down, that I will help them to improve their lives and, if their weight goes down as a side effect of improving their life, then their weight is supposed to go down. We will never intentionally do anything together as a deliberate attempt to lose weight. Over time, this particular client was tremendously successful in making changes in her life, putting her needs on the list of importance. She was able to prioritize her mental health for the first time in her life. She took the time that was needed to listen to, and attend to her needs in multiple areas of her life – private, social, physical, psychological etc.

In the past, she used to exercise purely as a way to lose weight. She was the “cardio queen”, focused purely on how many calories she could burn, and how that translated into what she could eat for the day. It was all a mathematical equation. Food became both her friend as well as her enemy. There were good foods, bad foods. Food was never eaten in a pleasurable way. Getting pleasure from food was “bad”. The moment she put something “pleasurable” in her mouth and swallowed it, she would feel guilt and remorse, swearing she would never touch that food ever again. She wanted to need only the bare minimum of food, but her needs were consistently higher than she wanted them to be. She wanted to restrict and control her body, but her body told her otherwise. She restricted and craved what she wouldn’t allow herself, and then restricted harder and craved more and more till she would “break” and give into the cravings, gaining weight in a rapid fashion.

When this client finally gave up the quest to focus all her attention on calories, fat grams, carbohydrate grams, calories burned, and cardio, and turned her attention to what the issues really were (by the way, this takes an enormous amount of courage and fortitude. It is much harder than focusing on calories and fat grams), she began to lead a much fuller and rewarding life. In fact, the rewards she achieved were FAR BETTER than anything she ever felt by fitting into a smaller pair of jeans for the brief moments that she did.

Currently, as a result of living a fuller life, and not using food as a reward or punishment, a distraction or a drug, she has been able to eat a variety of foods and enjoy every morsel with NO GUILT. The only problem that occurs now is when a “professional” tells her to stop eating this, or eat more of that. Only now, the problem is not HER problem, it is theirs, because she will tell them point blank “Don’t tell me what to eat! I’ll eat what I want to.” It’s amazing the response she receives when she tells people that she never diets and she eats whatever she wants. Now, of course, she doesn’t eat whatever she wants in the quantities that defy her body’s needs. She eats when she is hungry (which took a long time to discover), she stops when she is full (most of the time), and she pays attention to the messages and information that her body and mind give her. She eats foods that provide her with nourishment, and she eats foods that are just for pleasure and don’t provide nourishment. She has the wisdom to know what she needs.

There is no weight loss information, fact, knowledge or instruction that could have “fixed” this client’s issues. There is no diet or subsequent jeans size that could have replaced the healing that she achieved. There is no amount of information that could been better than the wisdom she discovered she had all along, that just needed to be tapped into and unveiled. There certainly would never have been ANY judgment or shaming about her size that could even remotely done anything beneficial to help her along her journey.

So, it is the amazing healing journey of clients like this one that enable me to say that I am so eternally grateful that I have not been a weight-loss professional. I did not write this post to criticize those who want to focus on weight loss as a profession. There is no “one size fits all” approach that works for everyone. I am certain that there are numerous professionals who, with integrity, are helping many people with body image and weight issues.

My advice is simply this:

I would encourage all of you to find the approach that truly “works” for you, not only in the short term, but in the long run.

Don’t blindly take any advice from a professional, simply because they hold themselves up as an expert. If it doesn’t feel right, question it. If a professional doesn’t want to explain their reasons or philosophies, ask yourself why.

Do your own research, not only on the internet or in magazines.There is a lot of misinformation and bias out there.

Find what resonates with you.Discover your own inner wisdom. It’s in there, even if it is buried.

Challenge the notion that weight loss at any and all costs, is healthy. A jeans size cannot determine health or happiness.

Challenge any and all of your toxic dietary beliefs (those that may not be true or are hurting you).

Invest time and energy NOW in finding non-weight related things that can enrich your life. Experiment with different things. You may not enjoy the first, second, or third thing you try.

My approach is not perfect and isn’t right for everyone. I am very fortunate however, to do the work I do and work with the most remarkable clients who have searched for an alternative approach to their food/body issues.  We are on a shared journey. I am grateful for you! Thank you!

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Perspective

Have you ever had an experience where something relatively small set off a firestorm of catastrophic thoughts, to the point where the thoughts and feelings that were created were so much larger, deeper and distorted than the event that started it all in the first place? This is how cognitive distortions can hurt us more than we could imagine, and why we need to continuously work on staying in the present and focusing on what’s “real”, not what’s a product of our wild and distorted imagination (by the way, our imaginations are often driven by our eating disorder and critical voice).

An example of this phenomenon happened while I was in session this week with a client. Several weeks ago Katie was truly taking in the fruits of all her efforts in recovery. She was feeling very accepting of her body, her eating was much less “rocky”, she was able to see life in a more positive way, and she was able to set some short term employment and academic goals for the next few weeks/months. Overall, her thoughts were clear and she was very self-nurturing. This week, she came in saying that she was not going anywhere in life, she was a failure, her eating was “crazy”, she hated her body, and that her whole recovery was completely back to the drawing board. Whoa!!!!! Could that possibly be true? Could she have possibly done a complete 180 degree turn in three weeks, after feeling completely different the last time I saw her? Of course not. The only things that changed were her feelings, which were ignited by distorted negative thoughts, and her loss of healthy perspective. The event that started the cascade of distorted thoughts and loss of perspective was a conversation that her father had with her about going back to college in the fall, in which he put pressure on her to pick a major and get the ball rolling for re-admission. She felt overwhelmed and, instead of trying to talk things through with her father and hold onto perspective, she shut down from the conversation, and indulged numerous catastrophic thoughts that carried her right back to her eating disorder behaviors and negative self-talk.

Other examples of these distortions of thought are:

Maggie got an 82 on her math test. She is normally an A student. She immediately said to herself “I’m a complete failure. I should have studied more. I’ll never get into college. I’ll never be able to have a career. I’m such a loser.” And, what do you think Maggie wanted to do to make herself “feel better”? She wanted to use her eating disorder. And what would that have accomplished? Absolutely nothing. What Maggie needed to do after getting the 82 on her math test was to feel whatever feelings bubbled up…sadness, disappointment, confusion, and a little anxiety? Then, Maggie needed to gain perspective instead of letting her critical inner voice run wild. The best thing for her to do next would have been to reflect objectively on the situation and think to herself “Well, the material on this test was super hard. I really studied as much as I could have. One test won’t ruin my entire GPA, my ability to get into college, or my life’s goals. If I need extra help in math for the rest of the marking period, I’ll ask my math teacher for the help.” If Maggie followed this type of thinking, she would feel a bit less upset, and she wouldn’t have such strong urges to use her eating disorder. Feeling negative feelings associated with a situation like Maggie’s is normal, but letting her thoughts become catastrophic is not. The distorted thoughts are a byproduct of negative self-esteem, and her eating disordered self-critical voice. They are the thoughts that will instantaneously drive the “need” to run to her eating disorder for numbing out, distraction, self-soothing, etc.

Jen had been dating a guy for about 6 months. Things were going well, when without any notice, he told her that he wasn’t “feeling it” and didn’t want to go out with her anymore. He said it was nothing personal but he wanted to move on. Of course she was hurt, sad, confused, and a bit angry. The news took her by surprise because she thought the relationship was going smoothly. Her thoughts went wild. Instead of calling a friend, crying, or talking it through with the guy, she immediately thought “I’ll never find love. I’ll never have a boyfriend again. I’ll be alone the rest of my life. I’m always going to be alone. I am unlovable. It must be because I have a F-A-T stomach.” Wow! Jen jumped to a millions and one conclusions, none of which had any basis in the truth. They were all manifestations of her strong negative feelings and her low sense of self. It is true that the breakup was very painful, but her mind took the situation and created one distortion after another, making her feel one hundred times worse than she would have if she tried to maintain perspective and looked at the situation as it really was. The truth was that she was getting hints for a few weeks that he wasn’t happy. She wasn’t completely happy with the relationship either. Their goals were very different and, in fact, she was questioning if she really liked him. She was contemplating talking with him about taking a break from the relationship but hadn’t wanted to hurt his feelings. But, since he confronted her and told her he wasn’t “feeling it”, she lost perspective and her distorted thoughts escalated, causing her to feel terrible about herself. Then, she wanted to use her eating disordered behaviors to “show him” that she didn’t care about him. In reality, he didn’t see any of what she was trying to tell him. Instead, he just moved on with his life.

The distorted thoughts (not the healthy ones) that we create are the ones that keep us SICK. Distorted thoughts are not about the truth. They are not based in fact. They are often gross exaggerations or completely false. For more information and specific examples of cognitive distortions, there are numerous sites on the internet. For example http://en.wikipedia.org/wiki/Cognitive_distortion

Never judge your life, your future, or your recovery when you have just been triggered by a situation that evoked strong feelings. Try to regain perspective with the help of support people – family, friends, and professionals. Try not to indulge those cognitive distortions that you create. And, above all else, refrain from using eating disordered behaviors as an attempt to self-soothe, communicate, distract, or give up. Take a deep breath, regroup, and reset! You know you can!

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Books are Ready!

It’s a self-help book with a twist!

Books are officially ready for purchase! My first shipment arrived today! If you know any adult woman (30s-60s) who struggles with disordered eating – primarily binge eating, emotional eating, and/or yo-yo dieting, please send her to the link below:

Behind the Mask: Our Secret Battle: Adult Women End Their Lifetime War with Food and Weight, Find Their Voice and Learn Self-Acceptance

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Three Wise Monkeys

You may have seen pictures, or miniature statues of the three wise monkeys. These monkeys date back to 17th century Japanese carvings.  Mahatma Gandhi, the leader of Indian Independence Movement who also influenced non-violence and civil rights movements around the world, had a statue of these three monkeys.

The three monkeys are Mizaru (see no evil) covering his eyes, Kikazaru (hear no evil) covering his ears, and Iwazaru (speak no evil) covering his mouth. Sometimes there is a fourth monkey, Shizaru (do no evil) crossing his arms. How do these wise monkeys relate to eating disorders??? Simply stated, in order to be free of your eating disorder, you must block out any negativity or “evil” that your eating disorder tries to impose on you, and replace the negativity with positivity. You must also take action and do the work that is necessary for your recovery.

 

In order to “see no evil”, you must not compare yourself physically to others. When you have an eating disorder, you are most likely comparing yourself to other people in your daily life, while watching TV, reading magazines, walking through the mall etc. Your eating disorder uses other people as well as your own body image distortion as a means to make you feel bad about yourself. Also, when you look in the mirror or try get dressed, your eating disorder will make you “see evil” by distorting your body image. To avoid it, you may need to choose your clothes in advance (the night before) to hasten the time it takes to get dressed, choose clothes that you feel physically comfortable in (nothing that’s too tight), shower and get dressed in dimmer lighting so that you don’t feel like you are in a dressing room at a clothing store (we all know how awful the lighting is in dressing rooms). Additionally, try to see yourself through the eyes of those who love you. They don’t see the “flaws” that you see. They don’t judge you by your imperfections, like you do. Remember that your eating disorder wants you to see yourself in a negative light so that it can keep control over you. Overall, you need to try to not let your eating disorder distort your vision of yourself.

 

Your eating disorder tries to fill your mind with vicious, self-critical, false, “evil” thoughts. They may sound like this: “You are disgusting.” “You need to lose weight or your life is worthless.” “You are unlovable because of your body.” “You better not eat that or you will go out of control.” “If you take one bite of that food, you will never stop.” “If you eat that food, it proves that you are weak.” “If you lose me, you will stop caring about yourself.” “If you get better, your life will be miserable.”

You probably hear “evil” thoughts like these, loudly and persistently, every waking moment. You may even dream negative dreams that your eating disorder has concocted. Your eating disorder fills your head with “evil” thoughts and you listen to them because you are scared, and the thoughts sound convincing. In order to recover, you must know that ALL thoughts coming from your eating disorder are FALSE. They are ALL DISTORTIONS. They are ALL designed to make you SICK and keep you SICK. During recovery, you need to first recognize the thoughts that are originating from your eating disorder. You need to differentiate the eating disordered thoughts from any non-eating disordered healthy thoughts. The eating disordered ones may be louder and more persistent and the healthy ones may be quieter and less frequent, but the eating disordered ones will always be FALSE. Once you can differentiate between the two, you must either ignore the eating disordered ones, or challenge them and replace them with positive or neutral thoughts. Ultimately, you need to pump up the volume of your own healthy thoughts and extinguishing the eating disordered “evil” ones.

 

“Speak no evil” has a few meanings when it comes to your recovery. First, speak no evil about yourself. When you have an eating disorder, you become so used to speaking negatively about yourself; you may not even know you are doing it. It’s automatic. But during recovery, you need to learn how to speak more positively about yourself and your recovery path. For example, let’s say you messed up at work, or got a bad grade on an exam, or put on an article of clothing that doesn’t fit, or said something during an argument that you didn’t mean, or had a slip in recovery. Instead of beating yourself up for it and saying things like “I’m so stupid.” “I’m ugly.” “I’m such a loser.” “I’ll never get it right.” “People hate me,” try saying “I did the best I could.” “These pants need to be put away because I don’t want to wear them and trigger myself.” “I’m working hard on my recovery and it won’t be perfect.” “It’s normal to make mistakes.” “No one’s perfect.”

The second meaning that “speak no evil” has in recovery is when it comes to honesty. People with eating disorders often keep things to themselves or don’t speak honestly to others for fear of displeasing them or not being liked by them. By being dishonest, you are giving your eating disorder strength to be used against you and to reinforce its own evil agenda. The goal is to speak openly and honestly. Honesty is not evil, it is truth…and truth truly sets you free from your eating disorder.

 

“Do no evil” refers to taking positive recovery action each and every day. Every action that you take that your disorder tells you to take, is self-harming in the short and long term. Your eating disorder ultimately wants to harm you, not help you. Although you may not be capable of acting opposite of every single thing that your eating disorder wants you to do, you can do the very best job you are capable of doing to act in a positive, recovery-focused way. You know better than anyone when you are engaging in eating disordered behaviors and when you are not. Each time you eat a strong meal, you are doing a good job. Each time you reach out for a healthy coping mechanism instead of bingeing, you are doing a good job. Each time you resist purging, you are doing a good job. Each time you do the very best you can do, in any area of recovery, you are doing a good job. Each and every time you do what you need to do to be true to yourself and take care of yourself, you are doing a good job in recovery.

 

As the wise monkeys say “see no evil”, “hear no evil”, “speak no evil”, and “do no evil”. The translation, simply, and concisely is:

See, listen, speak, and do all that is necessary to live free from your eating disorder and create the life you deserve.

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Taking Risks

A week ago I attended a memorial service for a very dear friend who passed away at a young age from a terrible disease. She was 55 years old. She was a wife, mother, grandmother, daughter, sister, and friend. She was full of life until her disease took her. As I sat in the church and witnessed the wonderful tribute to her life, I thought “I know she had a wonderful life and took advantage of all the fantastic opportunities she could. She died way too young, but she was loved immensely and lived life to its fullest.”

My friend’s death prompted this post.

Too many of us live life in a safe, predictable way. We don’t take risks because they are scary and we fear that we won’t be able to control all the circumstances around them. We don’t challenge our food behaviors beyond a safe amount because it is very hard to take the risks we know will make us “feel” uncomfortable – physically and/or emotionally. We don’t take the risk to speak up for our needs because we are afraid that others will get angry or upset with us and because we are people pleasers. We don’t take the risk to be vulnerable with others because we want to “fix” everything ourselves and not burden others. We don’t like to be vulnerable because it is terrifying to open up, so we don’t take risks and ask for help. We are so afraid to be “needy” that we pretend we are “fine.” Sometimes we are so tired from working hard at playing it safe and avoiding risks, that we isolate ourselves and our worlds become smaller and smaller. We devote a tremendous amount of effort in attempts to avoid risks and have a safe, predictable life.

Taking risks is scary, but we cannot allow fear to be an obstacle to emotional growth and well-being. Obviously I am not encouraging people to put themselves in unsafe circumstances where their safety and well-being are jeopardized. I am suggesting that we all evaluate our commitment to ourselves and the recovery process and determine which risks are necessary to further recovery and overall physical and emotional health and well-being.

If you are struggling with an eating disorder, what are some risks that you are avoiding taking? Are you avoiding adding food to your meal plan because you are afraid of feeling full or because you know your eating disorder voice will make you feel guilty? Are you avoiding giving yourself more self-care time because it is too hard to figure out how to make it work or worried that it will necessitate other people’s help? Are you avoiding reaching out for others’ help because you don’t want to “burden” others or because you simply want your eating disorder more than you want to be free of it and you can use the excuse that you don’t want to bother others as a way to stay stuck? Are you avoiding going out with friends because it requires you to go outside of your emotional and eating comfort zones? Are you avoiding reaching for your dreams because you have convinced yourself that you will never get there or that you will fail once you do?

Try to evaluate how your recovery is going and understand which risks are needed to move forward. Once you do this, choose to take one “risky” step at a time. Understand that you will be scared. You will have doubt. That doesn’t mean it is a bad idea. It means that it is worth doing! There is no better feeling than to look back at the risks in recovery and in life that have paid off! I have never met someone who has taken risks to recover and has regretted the process. And, if by taking a risk, it fails, try again or try a different one. There is no magic pill you can take or magic wand that you can wave to make a full recovery or enrich your life. It is all hard work that eventually pays off.

Below are some quotes I found that may help you take some risks…

Yes, risk taking is inherently failure-prone.  Otherwise, it would be called sure-thing-taking.  ~Tim McMahon

A ship in harbor is safe – but that is not what ships are for.  ~John A. Shedd, Salt from My Attic

The torment of precautions often exceeds the dangers to be avoided.  It is sometimes better to abandon one’s self to destiny.  ~Napoleon Bonaparte

Of all the people I have ever known, those who have pursued their dreams and failed have lived a much more fulfilling life than those who have put their dreams on a shelf for fear of failure.  ~Author Unknown

Often we… expect and want every day to be just like today.  Even though we’re not satisfied with today, we settle for security instead of discovery.  ~Stephen G. Scalese, The Whisper in Your Heart

Courage is not the absence of fear, but rather the judgement that something else is more important than fear.  ~Ambrose Redmoon

Courage is doing what you’re afraid to do.  There can be no courage unless you’re scared.  ~Edward Vernon Rickenbacker

 

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Grief and Healing

Grief: deep or intense sorrow or distress, especially at the death of someone

 

Dealing with grief as a result of losing someone is something most people have to experience sometime in their lives. Feelings of sorrow are natural. They result from losing someone meaningful in our lives through death, the loss a pet, a job, or a home. Grieving, or feeling loss, may happen after a divorce, a move, or loved ones moving away. Each of us copes with loss and grief in our own personal way, but there are healthy ways and unhealthy ways of coping.

 

If you try to ignore your pain or make all sorts of efforts to keep it from bubbling up, you will make it worse in the long run. In order to genuinely heal from any type of grief or loss, you have to face it head on and deal with it. Pain never goes away if you actively ignore it.

Having feelings of sadness, fear, overwhelm, or loneliness is a normal reaction to loss. Crying is a “normal” expression of these feelings. Crying is healthy. It is not a sign of weakness. It is a sign of genuine feelings. It is always better to cry than to try to put on a “happy face”. You are not helping your grieving process or helping anyone else by being “brave”.

Although crying is a natural response to grief, some people don’t cry in the face of loss. That doesn’t mean they don’t feel the pain. There is no one specific way to grieve. People express pain in different ways.  There is also no specific time frame for grief to be expressed.

Healthy coping mechanisms help with the grieving process, while unhealthy ones impair the process. For those of you who have experienced loss and used your eating disorder to cope, this post may be helpful for you.

There are several things that are necessary to cope with grief. They are: (1) acceptance and expression of grief, (2) time, (3) self care, and (4) support. Through these key components, you will be able to mourn your loss and heal from it.

Expression of grief has been outlined in the “stages of grief”: Denial, Anger, Bargaining, Depression and Acceptance. Remember, there is no time frame for these stages but it is important to fully experience them.

  • Denial, numbness, and shock: This stage serves to protect the individual from experiencing the intensity of the loss. It may be useful when the grieving person must take action (for example, making funeral arrangements). Numbness is a normal reaction to an immediate loss and should not be confused with “lack of caring.” As the individual slowly acknowledges the impact of the loss, denial and disbelief will diminish.
  •  Anger: This reaction usually occurs when an individual feels helpless and powerless. Anger can stem from a feeling of abandonment through a loved one’s death. An individual may be angry at a higher power or toward life in general.
  •  Bargaining: This stage may involve persistent thoughts about what could have been done to prevent the loss. People can become preoccupied about ways that things could have been better. If this stage is not properly resolved, intense feelings of remorse or guilt may interfere with the healing process.
  •  Depression: This stage of grief occurs in some people after they realize the true extent of the loss. Signs of depression may include sleep and appetite disturbances, a lack of energy and concentration, and crying spells. A person may feel loneliness, emptiness, isolation, and self-pity.
  • Acceptance: In time, an individual may be able to come to terms with various feelings and accept the fact that the loss has occurred. Healing can begin once the loss becomes integrated into the individual’s set of life experiences. (reprinted from WebMD)

During a time of loss, you may be triggered to use eating disordered behaviors to “feel better”. Although using eating disordered behaviors may cause you to feel numb or distracted, it will inevitably cause more pain and suffering. There are several good ways to express your grief, instead of using eating disordered behaviors. It is also very important for you to take good care of yourself during a time of loss. Although using eating disordered behaviors may initially feel like a way to take care of yourself, it actually causes you to become more depleted physically and emotionally.

Accept and face your feelings head on. You can try to suppress your painful emotions using eating disordered behaviors, but you can’t avoid them forever. In order to heal from your loss, you have to acknowledge and accept the pain. This may sound like an awful plan to you, but avoiding your feelings of sadness and loss prolongs the grieving process. If your grief is left unresolved, it may lead to depression, anxiety, and the use of other “substances” or maladaptive coping mechanisms. How do you face your feelings? The following are a few suggestions: Express your feelings in a concrete or artistic way. Write about your feelings in a journal or on your computer.  If you’ve lost someone you love, write a letter to them saying the things you wanted them to know. Make a scrapbook or photo album of the person and the memories you have shared.

Take good care of yourself physically. Try to get enough sleep. Follow the nutrition guidelines designed by your nutritionist to the best of your ability. Although movement can help you feel better, only do it if it is safe for you to do so. Check with your treatment team for appropriate movement guidelines.

Take care of yourself spiritually. If you are a member of a church, you may find that your religious leader or members of the congregation can provide you comfort. If you have a different type of spiritual leader or healer, perhaps you could reach out for him/her.

Reach out for support in other ways – from your treatment team, friends, family, and other loved ones. Perhaps a support group might help as well. Although you may need some time alone, you don’t want to completely isolate yourself and use eating disordered behaviors in place of real suppor

There may be times when others don’t know how to help, or what to say. There often doesn’t even seem like any words can help during a time of loss. People may say things that don’t help, or seem insensitive because they are uncomfortable with their own feelings or don’t have the ability to express empathy effectively.  Try not to shut down if you have received bad advice or insensitive comments. Reach out to others who you trust. Let yourself feel whatever feelings come up without worrying about what others may say. You may also notice that your feelings change and evolve. You may feel moments of extreme sadness or anger, followed by moments of happiness. This is normal.

There may be times of more intense grief – like holidays, times of year, anniversaries, and places, etc. It’s normal to feel more powerful feelings when you are triggered by certain events. If you can prepare for these events in advance by discussing them with a loved one or trusted professional, you may get through them without being vulnerable  to using eating disordered behaviors, or avoiding the event altogether.

Below are a few quotes I found to be helpful during times of grief and sorrow:

“There is sacredness in tears. They are not the mark of weakness, but of power. They speak more eloquently than ten thousand tongues. They are the messengers of overwhelming grief, of deep contrition, and of unspeakable love.” – Washington Irving

“To spare oneself from grief at all cost can be achieved only at the price of total detachment, which excludes the ability to experience happiness. “ – Erich Fromm

“Grief is not a disorder, a disease or a sign of weakness. It is an emotional, physical and spiritual necessity, the price you pay for love. The only cure for grief is to grieve.” – Earl Grollman

“What we have once enjoyed deeply we can never lose. All that we love deeply becomes a part of us.” – Helen Keller

“You give yourself permission to grieve by recognizing the need for grieving. Grieving is the natural way of working through the loss of a love. Grieving is not weakness or absence of faith. Grieving is as natural as crying when you are hurt, sleeping when you are tired or sneezing when your nose itches. It is nature’s way of healing a broken heart.” – Doug Manning

“When we honestly ask ourselves which person in our lives means the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing and face with us the reality of our powerlessness, that is a friend who cares.”  -Henri Nouwen

 

We Remember Them…

In the rising of the sun and in its going down,

We remember them;

In the blowing of the wind and in the chill of winter,

We remember them;

In the opening of buds and in the warmth of summer,

We remember them;

In the rustling of leaves and the beauty of autumn,

We remember them;

In the beginning of the year and when it ends,

We remember them;

When we are weary and in need of strength,

We remember them;

When we are lost and sick at heart,

We remember them;

When we have joys we yearn to share,

We remember them;

So long as we live, they too shall live

For they are now a part of us as

We remember them.

-from Gates of Prayer,

Judaism Prayerbook

 

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Tips for “Normal” Eating

The following information is the best I’ve seen, as a basic model for trying to normalize disordered eating. It is especially geared for those individuals who have been chronic dieters. 

No matter how many years or decades you have overeaten or how many diets have failed you, you still can learn how to become a “normal” eater—eating when you are hungry, choosing satisfying foods, remaining aware while eating and enjoying food, and stopping when you are full or satisfied.

 

Note: You did not fail on these diets. These diets failed you.

To succeed at eating “normally”, you will need to:

  • Focus like a laser on eating “normally”
  • Stay persistent like a dog digging for a bone
  • Not expect overnight success
  • Switch your attention from the scale to your appetite
  • Learn effective life skills to manage stress and internal distress

Disregulated eaters can learn how to eat “normally.” Here are some tips to speed you on your way.

Using self-talk

Learn “normal” eating skills: Look in the mirror daily and tell yourself you can learn the skills of “normal” eating.

Think of foods as nutritional and non-nutritional: Instead of thinking of foods as “good” or “bad,” consider them as nutritional or non-nutritional. “Good” and “bad” are moral terms that are best avoided in the food arena.

Give yourself praise: Do not put yourself down for the mistakes you make with food. Instead, lavishly praise yourself for your successes, even the tiniest ones.

Try a different approach: If experience tells you that diets do not keep your weight off, do not try to convince yourself that you should diet. Instead, give yourself points for trying a different approach.

Become your own cheerleader: Never say anything to yourself that you would not say to a young child you love, including calling yourself stupid, hopeless, bad, a failure, or worthless. Become your own cheerleader by generating positive thoughts about yourself and your progress.

Avoid all-or-nothing thinking: Do not use words like “never” and “always.” Remind yourself that most of life is not black and white, but gray. Think incrementally.

Do not dwell on untrue comments: Detoxify negative things people say about or to you that are untrue, rather than repeating them to yourself. Remember that what people say belongs to them, not to you, even if your name is attached to their words.

Connect to your emotions: Ask yourself often how you are feeling, so you can connect more easily to your emotions, but explore only with curiosity, not condemnation.

Stop judging yourself harshly: Develop self-compassion. Treat yourself lovingly. Practice speaking to yourself with extreme esteem.

Keep a positive attitude: Do not keep telling yourself that learning to become a “normal” eater is hard, because saying so only programs you to find the work more difficult. Instead, substitute words like challenging or doable.

 

Recognizing hunger

Rate your hunger: Check in with yourself often to see how hungry you are by using descriptions such as “not hungry,” “moderate,” “very,” and “famished” or a 1-10 scale.

Evaluate if you are hungry: Every time you think about food, ask yourself if you really are hungry enough to eat or if you actually need something else.

Consider having smaller meals: Experiment with eating smaller meals more frequently.

Think about hunger as a signal: It means that you need fuel, not that you have to go out and seek the most fantastic eating experience of your life.

Know what hunger means: Practice believing that hunger is for fuel and pleasure, not for meeting emotional needs.

 

Choosing satisfying foods

Choose for yourself: Do not get hung up on what other people are eating. Instead, ask yourself what you would like to eat.

Forget about good and bad: Remind yourself that foods fall on a nutritional continuum (high value/low value), not on a moral continuum (good/bad).

Make a satisfying choice: Never eat without first stopping to consider what you want. Spend time making your decision by tuning into your appetite.

Stay clear of guilt or shame: Refrain from allowing guilt or shame to contaminate your eating decisions. Avoid secret eating.

Choose foods that you like: Do not eat foods that you do not find satisfying or enjoyable. Eating them will make you think that you are on a diet.

 

Eating with awareness and enjoyment

Look before you eat: Before you eat, look at your food, its portion size, and presentation. Breathe deeply. Look again before taking a mouthful.

Chew every mouthful thoroughly: Chewing a lot helps to thoroughly release the flavor of foods.

Let food sit on your tongue: This allows your taste buds to absorb the flavor and transmit messages about your appetite to your brain.

Talk or eat: When you are talking, stop eating. When you are eating, stop talking.

Stay connected: Pay attention to your body’s appetite signals while you are eating.

Forget about guilt and shame: Push away guilt and shame while you are eating. Focus only on sensory pleasure.

Pause while you are eating: Think about how you are feeling about your food in terms of quality and quantity.

Know when to stop eating: Stop eating when flavor intensity declines, as it is bound to do. Do not try to polish off all of the food in front of you. Instead, aim for the moment when flavor peaks and you feel an internal “ah” of satisfaction—then stop.

Evaluate how full you are: Keep asking yourself while you are eating, “Am I still hungry?” and “Am I satisfied?”

 

Stopping when you are full or satisfied

Know the definitions: Think of “full” as having enough food (fuel) in your stomach and “satisfied” as reaching thehigh point of pleasure.

Quantify fullness and satisfaction: Use words, such as “nearly full,” “too full,” or “just right,” or a 1-10 scale to rate fullness and satisfaction.

Tell your body: When you feel full or satisfied, focus on that sensation, and broadcast it to your whole body.

Disconnect from food: When you are done eating, put down your utensils, push away your plate, and get up, if possible. At least mentally move on. Do whatever you need to do to disconnect yourself from the food.

Decide when enough is enough: Make sure you do not focus on food that is left in front of you. Recognize that you do not have to finish it or clean your plate.

Changing your beliefs:

 

From: To:
“I need to diet to lose weight.” “Diets do not work long term.”
“This is too hard.” “I can learn to do this over time.”
“This will take too long.” “If I do not change now, I will only end up back in this same place again, so I might as well get going on it.”
“Losing weight is the most important thing.” “I will lose weight if I honor my appetite and learn to eat ‘normally.’”
“I am bad/worthless/ugly if I am overweight.” “I accept my body as it is and still will try to improve it.”

 

Stopping emotional eating

Consider your feelings: If you have the urge to eat when you are not hungry, identify the emotion you are feeling.

Think of a different response: Remind yourself that feelings need an appropriate response—not food.

Know the emotions that trigger unwanted eating: Boredom, loneliness, anxiety, shame, guilt, disappointment, confusion, and helplessness can trigger unwanted eating. Look for more effective ways of dealing with these feelings.

Keep a feelings log: This will help you keep track of what is going on inside of yourself all day long.

Reduce stress: This will lessen frustration, helplessness, and the overwhelmed feeling you sometimes have that may drive you to eat.

Take care of yourself: Make sure you are taking care of yourself (with rest, sleep, hobbies, and fun) at least as well as you take care of others.

Learn from your behavior: If you find yourself eating when you are upset, do not take it out on yourself. Treat yourself with compassion and curiosity. Think about your behavior as a learning experience.

Find help: If you have a history of trauma or abuse, get help through therapy. A strong correlation exists between such a history and emotional eating and weight gain.

Take responsibility for yourself: Do not blame others for your emotional eating. Take accountability for your actions.

Build emotional muscle: Tell yourself that you can bear any emotion and practice doing so. You will find that the emotional muscle you build is amazingly strong and enduring.

 

References and recommended readings

Koenig KR. Nice Girls Finish Fat: Put Yourself First and Change Your Eating Forever.New York,NY: Fireside/Simon and Schuster; 2009.

Koenig KR. The Food and Feelings Workbook: A Full Course Meal on Emotional Health.Carlsbad,CA: Gürze Books; 2007.

Koenig KR. The Rules of “Normal” Eating: A Commonsense Approach for Dieters, Overeaters, Undereaters, Emotional Eaters, and Everyone in Between!Carlsbad,CA: Gürze Books; 2005.

Koenig KR. What Every Therapist Needs to Know About Treating Eating and Weight Issues.New York,NY: WW Norton and Co; 2008.

Contributed by Karen R. Koenig, LCSW, MEd

 

 

 

 

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First Days of School and Body Image

For many school-aged kids (preschool through senior year in high school), “back to school” shopping is fun. They love buying new outfits and shoes and backpacks and school supplies. With every item they buy, they get more excited to get back to school. They happily try on their new clothes. They stuff their new backpacks with all the pens, pencils, notebooks, and planners. The night before school starts, they feel a mixture of excitement, anticipation and a little anxiety.  The first days back to school, they put their new outfits on, head out to school, and experience all the first days activities. They may have ups and downs. They may like some teachers, and dislike others. They may have difficulty figuring out where to sit in the classroom, or in the lunch room. They may be a little anxious about finding their classrooms or getting there on time. They also may be excited to reacquaint with friends. This is all normal.

For those school-aged kids with eating disorders, a different experience is felt altogether. Although there are no universal experiences, I’ve seen enough eating disordered kids to know there is an element of difficulty that accompanies the “back to school” transition. They may experience all the same activities as non-disordered kids, but they also may experience a multitude of inner thoughts and heightened anxieties that non-disordered kids don’t experience. Many of these thoughts are negative and distorted. Many of them are body related.

Shopping for clothes to go back to school in can be a very upsetting endeavor. When one’s body has changed, there can be both physical and emotional discomfort. Looking for sizes, trying on multiple articles of clothing in various sizes, experiencing physical sensations associated with the way clothes fit, and standing in front of mirrors in the dressing room can trigger all sorts of thoughts and feelings.  These thoughts and feelings can taint the experience, and can trigger urges to use eating disordered behaviors. It is always best for the individual to shop with a compassionate friend or family member who understands the sensitivity of the individual and can offer support if needed.

If the eating disordered student’s body has changed over the summer, due to recovery related goals or as a result of the eating disorder itself, he/she has tremendous fear that others will comment about his/her body. “Wow! You look so much better than you did last year!” “You gained weight. You look great!” “You lost weight. I wish I was as skinny as you!” “Did you put on a few pounds over the summer?”

Any comments regarding one’s body can trigger someone with an eating disorder. Comments can be well-intentioned but may still be perceived as triggering. I tell my clients over and over that they cannot control the comments made by others. All they can control is their reaction to the comments. Comments about one’s body also exacerbate the body image distortion that the person already feels because they draw unwanted attention to the body. I usually advise my clients to either change the subject or try to walk away from the conversation. Then, they need to talk to a good friend to get the support and distraction they need, in order to move on with their day.

Getting dressed in the morning before school is also challenging. When someone has an eating disorder, he/she is uncomfortable in his/her own body. He/she experiences it in a distorted way. He/she does not necessarily have the ability to see him/herself objectively.

Below is an example of what someone with an eating disorder may experience in the morning, before the school day begins:

Allyson has set out her clothes the night before the school day. She wakes up in the morning already a little anxious for the school day ahead. She’s worried about a test she has to take, and she’s overwhelmed by the amount of school work she faces in her AP classes. She puts on the clothes she had picked out, but they just don’t feel “right”. They feel tight this morning. They didn’t feel tight when she tried them on yesterday. But this morning, she feels like she will burst at the seams. She begins to feel more anxious than she felt when she woke up. She convinces herself that she absolutely cannot wear the outfit. She tears it off and throws it on the floor of her room. She urgently searches through her closet and pulls out another pair of jeans and another top. These jeans feel too tight and the shirt looks “ugly”.   Off they go, onto the pile of clothes that are on the floor. She grabs a skirt, tries it on, and doesn’t like the way her legs look in the mirror. It goes onto the pile. Her anxiety escalates. The amount of time she is taking to pick out something to wear is cutting into the time she needs to devote to the rest of the morning activities, including eating breakfast. Her mother reminds her that she will be late if she doesn’t hurry up. Her anxiety is mounting. She grabs a dress out of her closet. She doesn’t like the way her arms look. She throws a sweater on over it. It just doesn’t feel or look the way she wants it to. She throws it on the top of the heap of clothes. Her time to get ready is significantly dwindling. She digs through the clothes and finds the original pair of jeans. She puts them on, pulls them up, buttons them, and throws a sweatshirt on. She feels “gross” and defeated. She heads to the kitchen where she has to figure out what to eat. Due to her anxiety and subsequent loss of appetite, as well as her “gross feeling”, she has urges to skip breakfast altogether. Her mother is watching though, so she eats part of her breakfast and promises her mother she will make up for it later. The school bus comes and she races out. On the way to school, she can’t get her body off her mind. She still feels “gross” in her body and she’s worried about the test and all the other stresses of the day ahead. From the outside, Allyson appears “fine”. She’s friendly but a little quieter than usual. On the inside, she’s suffering. She’s worried. She’s conflicted. She wants to be “in recovery”, but at the same time, she’s desperate to use eating disordered behaviors to make herself “feel better.”  The best strategy for her to follow to “get out of her head”, is to distract herself with friends or find a friend to voice her struggle to. Communication of her feelings may lessen the power they have over her. Also, if she shares her feelings, her friends may help to “normalize” them. If she has a treatment team, she might want to discuss this with them during her next session to help strategize for these types of situations, as well as to get help gain a more positive perspective on recovery.

The experiences outlined above are only a few examples of the types of situations that may trigger a student with an eating disorder. Situations that intensify negative body image are challenging but do not have to derail recovery!  It is his/her responsibility to work through these difficulties using the coping mechanisms he/she has learned and practiced so that he/she does not use any type of eating disordered behavior. Using his/her voice to express feelings is a key coping mechanism. Having an understanding circle of friends and family is also essential.

It is important to remember that negative or distorted body image is a byproduct of low self-esteem, stress, anxiety, negative feelings, life experiences, messages from others, distorted beliefs that are exacerbated by the media, societal pressures and other personal issues. Distorted body image is NOT about the weight, size, or shape of one’s body.

If you or a loved one experiences distorted negative body image issues, the National Eating Disorders Association says it best when they say “We all may have our days when we feel awkward or uncomfortable in our bodies, but the key to developing positive body image is to recognize and respect our natural shape and learn to overpower those negative thoughts and feelings with positive, affirming, and accepting ones.”  It is also vital for recovery to learn to separate your feelings from your body, and take care of your body as best you can through satisfying balanced eating and the types of pleasurable movement that energize and strengthen your body.

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Back to School: Recovery Focused!

For all of you who are going back to school – middle school, high school, college – there are some challenges that you may face. You want to be “armed” for these challenges and not let them hurt your recovery. For those of you who are parents of children, adolescents, or young adults with eating disorders, the following information will be helpful for you as well.

Summer, for many individuals, is a time of less structure, less pressure, and less exposure to the stress from peers. For students, it may involve a summer job, camp, vacation, a summer class or two, or just relaxing with friends and family.  Then, toward the end of August and the beginning of September, all that swiftly changes. Academic and social pressures begin again. Perhaps there is a change of school entirely, such as the change from middle school to high school, or high school to college. College students may leave home for the first time or begin living in an apartment, dorm, fraternity or sorority house.

Whichever the case is, transition back to school is a time of challenges for many students. It is especially challenging for those with eating disorders.

Structure, on the one hand, is very good for people with eating disorders. Getting back to the structure of a school day where there are specific times for specific academic and extracurricular activities, can be very comforting. The distractions that school provides, as well as the focus on new subjects, sports, and other skills, can also take the focus off the eating disorder and provide the sufferer with some relief.

On the other hand, going back to school can elicit some unforeseen stressors that can exacerbate an existing eating disorder. First and foremost, the anticipation of school (or leaving home to go away to college) will undoubtedly create anxiety. The fear of the unknown is a powerful source of anxiety. Social anxiety can also escalate. Anxiety can also relate to academics, lockers, teachers, making friends, and  living arrangements (at college). And, of course, there is tremendous anxiety related to body image, clothing, and food. I’ll highlight some of the specific stressors in my next few posts, and try to offer some solutions. Ultimately, it is important to be acutely aware that “back to school” time is a transition that individuals with eating disorders may struggle with. The issues are very real and must be handled with care and sensitivity.

The first topic I will discuss is “the lunch table” at school.

A number of my student clients are fearful of the lunch table. If you are a parent, you may be thinking “What types of stress could the lunch table create?”

Stressors that middle school and high school clients experience at the lunch table are:

  1. What should they put their lunch in – paper bag or lunch box (more typical in middle school)? Believe it or not, this decision causes an enormous amount of stress. They fear that if they put their lunch in the “wrong” container, they will get made fun of.
  2. Should they bring lunch, or buy lunch? This decision is stressful because they want to feel comfortable with what they eat for lunch, yet if their friends are buying lunch, they want to fit in. Also, there are usually lines of students waiting to buy lunch. Standing on line may be uncomfortable for the eating disordered student, as well as waiting on line creates a shorter amount of actual eating time. This can be challenging for the student who takes a bit longer to eat.
  3. If they bring lunch, what should it be and how much should they bring? Many individuals in recovery are on a meal plan that requires specific amounts of food that must be eaten at each meal. There is an enormous amount of conversation that occurs at the lunch table regarding what everyone eats. When a student eats anything that appears “different” in the eyes of anyone else at the lunch table, there is the potential for unwelcomed attention on the sufferer and their food choices. This is especially challenging when the sufferer is eating “more” than the others at the table.
  4. For female students especially, there is excessive “diet talk” at the lunch table. Comments such as “I am not eating carbs anymore.” Or “I only eat XX amount of calories a day.” Or “I have to lose XX pounds by Thanksgiving.” Or “I only eat pretzels at lunch.” This talk can trigger someone with an eating disorder, even when they are doing well.
  5. During the first few days of school, one of the biggest stressors my student clients experience regarding the lunch table is “where do I sit?” When an individual with an eating disorder has social anxiety and/or has only a few friends, and there is no comfortable person for him/her to sit with at lunch, he/she may experience an enormous amount of anxiety and may try to skip the lunch room altogether.

What are the ways to cope with these lunch table stressors?

  1. As far as the container you bring your food in, for the first few days, bring it in a paper bag (unless you know that the other students are using lunch boxes). Look around and see what everyone else brings their lunch in, and then you can re-assess whether the bag is the best choice or a lunch box. I’ve never heard of anyone getting teased about bringing lunch in a plain brown bag. Remember though, if you don’t have an ice pack in the bag, you shouldn’t bring anything that is perishable (lunch meats, fish, dairy, etc).
  2. Regarding bringing or buying lunch is concerned, keep your recovery at the top of your priority list when making this decision. If you feel most comfortable bringing lunch in order to meet your recovery goals, then bring lunch. As time goes by, and you can see what is on the school lunch menu, and you have seen how long it takes other students to get their lunch, then you can decide if you want to change your mind and buy lunch.
  3. You need to bring to lunch the amount of food that will carry you through until the next time you can eat (after school snack), or the amount of food that you and your treatment team have deemed necessary for your recovery. If you bring too little, you may struggle later, as you will be too hungry. This is true, no matter what type of eating disorder you have. In terms of what to bring for lunch, you want to bring the types of food that meet your nutritional requirements and foods that you like. If you need a supplement at lunch, you can bring it in a sports-type of bottle so that it appears like a sports drink. Try to bring foods that are “common” so as not to draw attention to your eating. I want to add here, that I understand this advice may cause some controversy. I’d love to say to my student clients to bring whatever they want to the lunch room regardless of what anyone might say, but I also want to protect them from any unwanted attention and comments. I had a male middle school client who brought tuna for lunch once and everyone at the table said “Ewww! That smells!” He threw his lunch away and ate none of it. A female high school client brought stuffed grape leaves to lunch and the others at the table commented on how “gross” they looked. She didn’t eat them and was too uncomfortable to sit at the lunch table again. Instead she ate in the nurse’s office.  You have to bring foods you like, but if there are foods that are pretty common looking, you will go unnoticed. These might be foods like peanut butter and jelly sandwiches or other sandwiches, yogurt, cheese sticks, pretzels, fruit, cookies, salads with chicken and cheese, granola bars, etc.
  4. When other girls start talking about their diets, you can try your best to ignore the conversation, start a separate conversation with the person sitting next to you, or change the topic altogether. Try to sit next to a “safe” person that you can rely on to help you out. If you are being too triggered, find an excuse to leave the lunch table (and take your remaining food with you). Unfortunately, diet talk is a pastime for so many people. You will likely not be able to escape it very easily. Also, many teens “talk” about their latest and greatest diets, but most of them don’t act on them. You must do your best to tune the “diet talk” out. Remember, in recovery, you have to stay focused on your needs, not the behaviors of others.
  5. Get as much information as possible in advance of the first day of school about who you know that will be in your lunch period. Ask them to meet you outside the lunch room before lunch starts so you can walk in together. Ask them to sit next to you as well. If you don’t know who will be in your lunch period, try to find a fairly empty table and bring a book with you. If you have a book to read, you might feel a bit more comfortable. While you are sitting there, try to look around for someone you know and then move to their table if there are empty seats. If there is someone else in the lunch room that seems like they are sitting by him/herself, you could try sitting at that table. He/she might be relieved to have someone sit with him/her. Or, if you are feeling courageous, you might try to use the lunch period to meet new people and sit with people you don’t know.

Remember also to talk to your family, friends, and/or treatment team about the anxiety you might feel about “back to school”. They will surely understand and might offer some great support.

Stay tuned for more posts regarding “back to school.”

 

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Why Can’t I Just Stop?

 

“When I’m having a bad day at work, I fantasize about the food I have at home.”

“When I’m making dinner for my kids after a long day of doing a million things for them, I can’t wait till I put them to bed so I can be by myself and eat all the leftovers.”

“I look forward to the times my husband goes away on business so I can do whatever I want with food.”

“The split second I am upset, I race into the kitchen and eat, eat, eat, as though my life depends on it.”

“As I feel the anger start to bubble up, I race to the box of xxx and crunch until I feel calm.”

“On Sundays, I feel so lonely I can’t wait to dive into the xxx to feel better. Then afterwards, I feel even worse. I also feel defeated, like I will never get better.”

“I feel so overwhelmed at times, I just can’t stop eating. I’m not sure whether I am overwhelmed and then can’t stop eating or if I can’t stop eating which causes me to feel overwhelmed, or both.”

“As I am jamming my hand into the package for another mouthful, I am promising myself that this will be the last bite but I can’t stop until it’s all gone.”

The above quotes from some of my clients illustrate that an eating disorder is not about the food. It is about the “state of mind” or “state of being” that the food and food behavior accomplishes. These quotes also illustrate the urgency these clients experience when thinking about getting to use the food behavior, as well as the helplessness that they feel.

I consistently try to help my clients see the relationship between their food behavior and what they are trying to “accomplish” by engaging in that behavior. Look at the words highlighted in the quotes above:

Bad day>>>fantasize

Doing a million things>>>be by myself

Look forward>>>do whatever I want

Upset>>>my life depends on it

Anger>>>feel calm

Lonely>>>feel better>>>defeated

Overwhelmed>>>can’t stop eating

Can’t stop until it’s gone

 

If an eating disorder were just about food, these clients would be able to “just stop” doing these types of behaviors and eat without all the urgency and subsequent remorse. But, an eating disorder is a complex combination of brain “hardwiring” and chemistry, environmental and familial issues and traumas, inability to communicate and feel authentically and effectively, etc. These food behaviors are an adaptation to many things.

If you are suffering from the type of eating disorder that causes any circumstances similar to the types of scenarios mentioned above, you personally know how hard you have tried to “just stop”. It doesn’t work that way. It’s not that simple.

But, there is hope.

First off, you have to try to understand that you have a complex history of underlying issues, combined with a brain that is genuinely trying to make you feel better.  It’s not your fault that you have found a food behavior that “works” in the moment to calm you down, numb you out, or wash away the thoughts and feelings that are painful to you. If it weren’t such an “effective solution”, you wouldn’t be so urgently seeking it out. You wouldn’t obsess or fantasize about it. You would be able to “just stop.”

Second, you must be willing and able to be kinder to yourself. If a loved one were going through the same pain and suffering you were going through, you would have compassion for them. Give yourself the same compassion. Tough love or self-criticism is not only ineffective; it worsens the behaviors every single time.

Third, without judgment, you have to be willing to self-reflect about what the food behaviors are trying to “tell you”. What are they accomplishing? Insight is essential. Without it, you will continue to beat yourself up and try to “fix” the problem behaviorally. It never works.

Fourth, you have to be willing to discover and tolerate the feelings you are attempting to numb out from, without the fear that you can’t do it. This is an area where clients often ask me “how do I feel my feelings? I don’t know how to do that.” The answer is simple and complex at the same time. We know that the food behavior is designed to numb out the feelings, so by delaying using the food behavior, you will feel something. You most likely won’t be able to do this for more than a few minutes at a time. During the few minutes you are trying to be abstinent from using the behavior, you may only feel anxious and obsessed about wanting to use the food behavior, but use the time wisely to gain information about the function of the food behavior. You may want to say to yourself, “I want to eat xxx so badly right now, but I’m going to hold off for 15 minutes to try to learn something about myself. During these 15 minutes, I’m going to journal whatever I am thinking or feeling. Then after 15 minutes, if I want to eat xxx food, I will.” By doing this through repetition over time, you may get some answers and may elongate the time during which you can be abstinent from the behavior.

Fifth, take the information you have gathered and try to make some life changes with it. For example, the woman who found that she fantasized about being by herself with food, after a long day with her children, used the information she gathered to try to make more time for herself  during the day. This way, she wasn’t in such need for it at night. The client who experienced loneliness every Sunday, decided to plan an activity with a friend or at least reach out and talk to one or two people every Sunday to feel connected. By realizing what the food behavior is “telling” you, you can work on improving the quality of your life.

Lastly, seek support. Both professional and personal support will help you make the changes you are seeking. You truly cannot do this work alone.

By no means does this process change your food behaviors in a day, or week, or month. You didn’t get to where you are in a day and it will take some time to make lasting changes. It can be done though…one baby step at a time.

Through (1) understanding, (2) kindness, (3) insight and self-reflection, (4) taking time to feel, (5) making slow life changes, and (6) getting support, you will heal…

 

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Transitions

A transition is movement, passage, or change from one position, state, stage, subject, concept, etc., to another;  change

Transitions are challenging for those with eating disorders and need to be respected as such. Examples of transitions are:

  • Going from one job to the next
  • Transitioning from adolescence to adulthood
  • Transitioning from being enrolled in one school to another
  • Season changes – Summer to fall, spring to summer, etc
  • Going from being in a relationship to being single, or the other way around
  • Graduating from college and working on a post-college plan
  • Going from being employed to being unemployed
  • Going from living in one type of body to another
  • Experiencing the sickness and death of a loved one

 

There are numerous examples of transitions. Some are less anxiety provoking but others can evoke high levels of anxiety, insecurity, sadness and fear. When an individual with an eating disorder faces a transition, leaving the familiar and moving toward the unknown, they often have increased urges to use eating disordered behaviors as a way to feel “safe”, distracted, numb, or less anxious and fearful. This occurs even when the familiar situation is not a positive one. For example, if someone is transitioning from an unhealthy relationship to being single, and the change is for the better, it is still unfamiliar and will evoke uncomfortable feelings.

If you have an eating disorder and are in the midst of a transition, or if you are the loved one of someone with an eating disorder who is facing a transition, the first thing you need to understand is that increased negative feelings and urges to use eating disordered behaviors during this time are normal. Individuals with eating disorders like to feel in control and “comfortable”, and there are less feelings of control and comfort during transitions.

If you have an eating disorder, don’t set your recovery back by using eating disordered behaviors to feel better. Use the transition to practice your skills of feelings expression and communication. If you use eating disordered behaviors to feel better, the transition will still be a part of your life and you will be making it much worse by not facing your feelings associated with it, communicating your feelings and needs, and dealing with the necessary steps to help you authentically deal with the transition and feel stronger when it is over.  If you were to look at your transition objectively (not emotionally), how do you want to feel when it is over? Do you want to feel strong, empowered, and proud of yourself, or do you want to feel  worse physically and psychologically than you did before it started?

Many of my clients this time of year have finished school and are in the beginning of their summer vacation. Some of them are going to college in the fall. They have just left the familiar surroundings of friends they have spent years with, teachers and coaches they knew what to expect from, and a variety of other expectations they knew how to navigate through. As time gets closer to starting a new school, the anxiety of new friends, classes, and moving away from home may escalate.  If they want to have a successful transition to college, they have to stay healthy over the summer and strengthen their recovery skills so that in the fall, they are as prepared as they can be to navigate the new circumstances they will encounter.

A client I met with this week is transitioning from a residential treatment center to a lower level of care closer to home. Stepping down from the intensity of treatment in a residential facility to having only a few one hour appointments a week can cause heightened feelings of uncertainty as well as additional responsibility. This is a transition that often results in lapses in recovery if it isn’t well planned and structured.

Two of my clients are pregnant and not only working through the transitions that they are experiencing with their bodies but anticipating the transitions that will occur after the baby is born – additional body transitions, changes in family life, responsibilities etc. This transition brings up feelings of fear and inadequacy, body image issues, and others. Pregnancy is an especially important time to work through the associated transition issues in a healthy, recovery-focused way so as not to harm the pregnancy itself.

Another client experienced a death in her family. She experienced the transition associated with the onset of the sickness and rapid deterioration of the family member’s health, and then his subsequent death. Her situation is an especially strong example of successfully experiencing transition because she was able to verbalize how challenging it was to abstain from using eating disordered behaviors to “help her” through the difficult time she faced and continues to face. She expressed how in the past, when faced with such uncertainty and then ultimately a grave loss, she would have engaged in eating disordered behaviors from the time she woke up until she went to bed, day after day, week after week, month after month, with the sole intention of numbing out all feelings. During this recent extraordinarily difficult circumstance, she was able to express her pain genuinely, and she was honest in talking with her family and friends about what she was going through. She is currently continuing to experience this transition in a healthy way, even though it is terribly painful.

The healthy way to experience a transition in your life is to face and discuss your fears and anxieties with loved ones. Share your thoughts with family and friends who may also be experiencing the same feelings. Don’t try to deal with it all alone. There is nothing worse than keeping thoughts and worries to yourself because if you do, your eating disorder voice will blow everything out of proportion and make everything seem destined to appear unmanageable, and destined to fail. Try not to let your eating disordered voice create negative or distorted scenarios about the future. Eating disordered voices are prone to creating fearful “worst case scenarios” to ignite worry and anxiety. Try not to focus on things you can’t control. Focus on the things you can control. Stay grounded and focus on what’s real, not what isn’t. Remember that every transition you get through in a healthy way will make you stronger and prepare you for future transitions. Life is full of transitions. They present themselves often, sometimes unpredictably. You can’t escape them, but you can use them as times to strengthen your recovery and your life as a whole.

 

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Vacations

When you go on vacation, wouldn’t it be nice to take a vacation from your eating disorder instead of having your eating disorder travel with you?

I’m sure some of you are not even able to go on a vacation because it so stressful that is sets back your recovery. I wanted to write this post because so many people will be embarking on vacations over the next couple weeks due to the spring break from schools. Also, summer is on its way and people often take vacations in the summer. This post is designed to provide you and your loved ones with insight into the challenges faced on vacations and strategies for working through them.

I recently got back from a vacation and realized how nice it was to not have my eating disorder tagging along. In the past, it would involve itself in every move I made, ruining the trip to the point where I was desperate to be back in the safety of my routine, the sameness, the disordered prison I called “home”.

Why is going away so challenging when you have an eating disorder?

No matter what type of disorder you struggle with, there are issues that you face that non-disordered people simply don’t worry about.

The following are some quotes from some of my clients regarding their challenging experiences on recent vacations, due to their eating disorders.

“I don’t remember anything fun about my family vacation. The months prior to the trip, I spent endless hours trying to buy clothes that fit and wouldn’t make me feel enormous. All this clothes shopping made me obsess even more about my body and reinforced to me how abnormal I feel. As the trip got closer, I pulled out all the stops and used every disordered behavior in my arsenal, somehow thinking this would make me feel better before I got there. So, by the time the day arrived when we left, I felt horrible, washed out and more obsessed than ever.

All I remember about the resort was scoping out every single bathroom there that I could escape to in order to use my behaviors. I spent the entire trip pretending to be normal and eating normally. Then when no one was looking, I would bolt to the least conspicuous bathroom. I was exhausted, bloated and depressed. I snapped at my kids and my husband because I couldn’t enjoy all the fun events we were partaking in.”

_____________

“I show up at a tropical resort after weeks or possibly months of anticipation. I’ve probably spent those weeks or months dieting and exercising because I need to look semi-acceptable in ‘resort-clothing’. Chances are that I have failed to lose any weight, so that weighs heavily on me causing me to be cranky.  Part of me says, ‘It’s not over. Try again.’ So, I decide to eat only one meal while I’m there. In fact, I even select cocktails that aren’t high in calories.

The attractive, thin, people around me make me self-conscious.  I feel awkward when I have to talk to them because I think they think, ‘She’s way too fat to be here.’ I decline when they out of pure politeness invite me to 8am yoga.

I try to make healthy food choices, but it’s hard because I am limited to what it available.  Depending on where I am, there may be a plethora of food, but the quality or the preparation may be bad, so I end up feeling unsatisfied, causing me to eat excess Carbs.  (Lots of Carbs at resorts!)  If the quality is great, then I probably indulge and feel guilty after.

Needless to say, at some point in my vacation, I snap and become super-bitch.   After I snap, I hate myself for starting a petty argument and that blows up to hating myself for EVERYTHING bad that I am and have including my body.”

_____________

“My family looks forward to this family reunion on a cruise every year. We all go away for a week where all there is to do is eat, eat, eat. For the months prior to the cruise, I agonize over wearing a bathing suit. I feel so awkward showing my body but I know it would be weird to not wear one. I find myself body checking more and more the closer the trip approaches. I strategize for weeks about how I will handle all the food. I devise a great plan to eat only three small meals, lots of fruit and vegetables, walk around the deck for exercise and drink alcohol minimally.

I am with extended family all the time. There’s no escaping them. The drinks are pouring. They are all feasting at every chance they can get. They stay up till all hours of the night at the clubs drinking and then binge at the midnight buffet.

I usually last about two days with my plan of restricting myself till on about the third day, I can’t take it anymore and a switch is flipped. I go wild. I begin eating like a crazy person. I gorge myself at every chance I get. I spend the next 5 days bingeing and purging over and over and over…usually at least 4 or more times a day. I keep trying to get myself back on track but I don’t have the energy to do it. I just resign myself to being disordered for the rest of the trip.

My personality changes too. I drink and become a ‘party animal’, so everyone thinks I am having a ball. Little do they know I am screaming at myself behind the scenes.”

_____________

“We usually go on a big trip, often to Europe, in the summer. Last year it was to Italy and France. The thought of going somewhere this summer sends chills up my spine. I have such a hard time breaking out of my routine of safe foods and my exercise plan. Everyone tells me that I will do a lot of walking on my trip but it doesn’t feel the same. I end up with strong urges to compensate for the lack of regular exercise. I also have a really hard time eating in restaurants and when we go away, we eat all our meals out. I just get so scared about all the changes and things I can’t control, I do terribly while we are away.

My family ends up getting furious with me because I can’t enjoy the food like they do. I end up ruining all the meals because I always let them down by ordering the safest food on the menu. My parents get in arguments over my eating and then their trip is terrible. I feel like a burden.

When we get back from our trip, my parents get even angrier with me because my weight will be affected and then they are scrambling to get me to eat more to get back on track. It’s a disaster all around.”

_____________

Well…these four stories of vacations are all too real for those who struggle with these illnesses. So, what do you do? How can you go on vacation and keep your eating disorder from ruining it?

First, you need to understand that you have a psychological illness that has been used as a coping mechanism and it doesn’t just vanish because you decide to go away. (Wouldn’t that be nice if it did???) Depending where you are in your recovery, a vacation can be a positive experience or a negative one.

I have treated many clients who have had fabulous vacations, ones when their eating disorders haven’t ruined the trip for them. Those clients were either fairly far along in recovery and/or strategized for the trip so that they felt as comfortable as possible.

Some strategies for your vacation:

  • Accommodate the Time Difference: First, if you are going to fly, plan for your flight and the times changes if there are any. Often, when you are gaining time or getting up extra early, there may be some challenges with figuring out your meals. In my opinion, if you are awake for extra hours, you will need to have an additional meal or snack to accommodate the extra time. Plan for this “extra” and have something comfortable to add in for the day.

 

  • Bring Food:  If you are flying, bring food with you on the plane. You can either buy things at most any airport, or take food from home. Think about in what time frames you will be flying and what meals and/or snacks you would be consuming if you were home…if you weren’t flying. I have been to numerous airports and I have found the packaged foods to be quite universal. I usually bring protein bars, nuts, and dried fruits for snacks. Depending on what time my flight is, I will perhaps buy a sandwich or a salad at the airport if my flight will be during a meal time. I always buy a beverage after I go through the security gate so that I have a drink on the plane. If you are lucky, you might be offered something on the plane, but lately, you have to buy the food. Plus, plane food often sucks. Always be prepared. You never want to be left with no food choices while traveling. Always pack food in your suitcase. Plan to bring enough snacks for every day you will be gone, at every snack time. Worst case scenario, you can bring them home with you. I look at food as important as medicine, and you would never forget to take your medicine on a trip. If you have favorite foods (obviously they cannot be perishable if you are flying), bring them – cereal, peanut butter, crackers, bars, nuts, etc. 
     
    If you are going to a destination and staying in a house or condo, hopefully you will have access to a grocery store once you get there and you might want to go to the store within a short period of time after you arrive so you have all the food you need. You will most likely have some meals in the house/condo which will provide you with structure and familiarity.If you are traveling somewhere by car, bring food as well. The good thing about traveling in a car is that you can bring perishable food with you like yogurt, cheese, sandwiches, etc. If you like to make stops periodically to get food along the way, you will have a choice of either getting something at the restaurant or “rest stop” or eat what you have brought with you. This would be a good time to challenge yourself if the restaurant or ”rest stop” has comfortable food. Most restaurants have a variety of options for a variety of needs. Get as much information about where you will be stopping before you stop so that you have a good game plan.

 

  • Add Structure to Your Meals:  You may need to be flexible if traveling with several people because everyone’s needs will vary, but try to get as much structure in your meals as possible on travel days as well as on vacation days. When you know where you will be going, make a “healthy” mental game plan for your meals and snacks. The last thing you want to do is plan to use behaviors while you are away. That will certainly ruin your trip.  Try to make sure your plan is to eat as recovery-focused, comfortable, and satisfying as possible. Planning to restrict, binge or purge will put your eating disorder in charge from the start and you will not enjoy yourself.

 

  • Try to Avoid Catastrophizing Things:  No matter how long or short your trip is, don’t let the time you are away overshadow the work you have done the other days, weeks and months of the year. Remember, it’s a vacation – a reprieve from the stresses of life.

 

  • Try Not to Compare Yourself to Other People:  You don’t want to ruin your trip by making comparisons that will only serve to make your eating disorder stronger. If you are feeling awkward, remember that people don’t really care what you are doing. They are more interested in what they are doing. On my recent vacation, we were on the beach every day. It was so freeing to just enjoy the sun and the water without feeling the awkwardness that my eating disorder used to inflict upon me. There was the momentary discomfort of walking across the beach into the water but the water felt so good and I am sure no one cared what I wore or what I looked like. Even if they did, I didn’t know any of them and I will never see any of them again.

 

  • Keep Your Food Expectations Realistic:   No matter what eating disorder you struggle with, the food will NOT be the same as it is at home. It most likely will elicit some challenging thoughts and feelings. Your eating won’t be perfect. It’s not supposed to be. This goes back to what I said previously. Go into the trip with a “healthy” positive, recovery-focused game plan and expect that you can’t control everything. On my vacation, the food was not that good. I was in an all-inclusive resort. Frankly, the food was disappointing. But, I ate what I liked, felt excited about a few things and was disappointed by a number of things. The food is a big part of what I look forward to on a trip, but although I was a little disappointed overall, I tried to maintain perspective and for me, perspective is key! If I look too much toward the food as the “make or break” aspect of the trip, I am often let down.

 

  • Get Support:  If you are traveling with family or other people, find someone who will support you when things are difficult. Maybe this will be a parent, friend, sibling, or significant other. Reach out and speak up about what your worries are. They may not “get” it but they can help support you through a rough patch, it can help prevent a disastrous trip.

 

  • Change Your Movement Expectations:  If you worry about movement during your trip, remember, once again, you are on vacation. Things will most likely not be the same as they are at home. Try to change your expectations about movement. If you follow an exercise routine at home and you won’t be able to do the same routine while you are away, use the trip as a time to practice flexibility in your routine. Please try not to catastrophize the change. Change is often very challenging for some people with eating disorders. Sameness is so safe, but once again, try to keep your expectations realistic. I find vacations to be a good opportunity to recharge myself, not to put pressure on myself to do everything the same.  The more pressure you put on yourself about all the things you “should” do on vacation, the more “guilt” your eating disorder will make you feel.

 

  • Stay OUT of Your Head!!! If you start going into eating disorder mode, press your mental “reset” button and try to challenge any negative thoughts and behaviors before they take over.

Remember, there are 365 days a year and your vacation is a small period of time within that year. Try to make the most of it. Try NOT to let your eating disorder and all the associated obsessions and compulsions ruin what could be a fun-filled break from the stressors you experience during the rest of the year.

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Adult Women: You are Not Alone!

When I first started treating people with eating disorders, the average aged client was between 17 and the mid-twenties. Now, I am seeing eating disordered clients as young as 5 years old and as old as in their 70s.

The focus of today’s post will be the “over 35” population. I will spotlight the issues that women face.

 

In my experience, adult women who struggle with eating disorders have struggled with some form of food issues, disordered eating, or eating disorder for a long time. Many times women can trace their struggle back to early childhood. Often they have either lived under the radar, never thought they had a “real problem”, or didn’t want to work on their issues. Then there comes a time in a woman’s life when there is a “perfect storm” of conditions and stressors that manifest into full blown eating disorder symptoms and cause her to seek treatment.

Let’s start with the obvious stressor that we all face; a society obsessed with youth, dieting, and thinness. Although an eating disorder is not about food, dieting, and weight per se, food, dieting, and weight are an integral part of the problem as well as the recovery process. As a woman ages, there are natural and inevitable changes that she experiences. Also, as a result of bearing children, the body experiences changes. In a world obsessed with having the “perfect” body, if an adult woman compulsively attempts to achieve the “perfect” body and uses young airbrushed teenagers as her frame of reference, she will always feel inadequate. Women also play “the comparison game”. It goes like this:

She’s smaller than I am. She’s on XXX diet. She looks happy. She must really have her act together. I bet she has no problems. I’m sure she can go into any store she wants and buy anything she wants and looks fabulous in it. I’ll never look like her. I need to lose weight. I can’t even shop for anything because nothing looks good on me.  I am disgusting. I am so unhappy. Tomorrow, I will not eat any XXX food. Tomorrow I will start being “good”. Yes…tomorrow I will start on the road to happiness. So, today I will eat whatever I want.

The natural changes a woman faces in her body, the comparisons and competitiveness, and the constant barrage of diet and weight loss talk contribute to an ingrained mindset of negativity and lack of self worth. Logically, we all hopefully know that our weight and clothing size do not create our self worth, but our society drills that very concept into our consciousness. It’s hard to escape. So, over the course of a lifetime, many women spend countless hours manipulating their food choices and intake in search of the elusive “perfect” body. Her eating and thinking become increasingly disordered.

Our ability to assess and validate our needs and to communicate them effectively is another stressor that adult women face each day. When a woman has a family for example, it is common for her to put the needs of the family in front of her own. If she has never been “good” at taking care of her emotional needs, she may fall further behind in this area once she has children. Putting herself first is not at all easy, and sometimes by default, she completely neglects her own needs and cannot communicate them effectively. The eating disorder becomes an adaptive form of “self care”. She can take care of everyone else at “take care” of herself simultaneously, without asking anyone for anything. Think of it as “maladaptive multitasking”. This can sometimes take on the form of bingeing at the end of the day or when the kids are at school, eating the kids’ leftovers, restricting, compulsively overexercising etc.

Changing roles within the family as well as outside the family and experiencing loss, can add to the “perfect storm” of stressors. Going from being a single woman to a married one, having the responsibility of a young family or struggling to have children, having an empty nest, watching aging parents deteriorate, experiencing death of a loved one or divorce, living an adult single life, are all extremely life altering events and necessitate big adjustments. They can potentially evoke tremendous anxiety and depression. An eating disorder can become a maladaptive “distraction” from these life altering situations as well as a self-soother, a way to reduce anxiety.

The lack of development of a healthy identity and passion for something (other than her body) is a huge trigger for the development of an eating disorder as an adult woman. Many adult women I see have very little idea of what they truly like and who they truly are. I often ask my clients: “Outside of your family (or your job), what do you like to do? What makes you happy? What are you passionate about?” Very rarely do they have the answer to this. They have often spent so much of their energy devoted to others that they haven’t thought about what they like separate from the interests and needs of their family or work. Therefore, to fill the void, the eating disorder develops as an alternate identity, a distraction from seeking passion, or a way to feel unique.

Women who had suffered various psychological and physical traumas or neglect when they were young, but didn’t have the opportunity to address them with a trusted safe professional, or who additionally suffer from trauma as an adult, may develop an eating disorder to suppress, numb out or cope with the myriad of feelings she may experience and choices she may face.

There are numerous other triggers that, in combination with fragile self esteem, anxiety and/or depression, genetic predisposition, personality type, society’s obsession with appearance and youth etc, provide a toxic recipe for an eating disorder.

The good news is that treatment is available for all those who suffer and adult women who are willing to do the necessary work can make a full and complete recovery. If you are an adult woman and are suffering, or can offer words of hope and encouragement for other women, please comment below. I want all women who suffer to know that they are not alone and that they can get better!

 

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The “Other” Victims

Eating disorders don’t discriminate, as we all know. They cross the age, gender, socioeconomic barriers. I was asked recently to give a presentation regarding the school-age victims of these illnesses that are in the minority, but unfortunately growing in numbers. These include the bullied, the younger victims, men, and members of the LGBTQ community.

First of all, eating disorders are not a choice. They are not a lifestyle. They are not a diet gone awry. They are not teenage girls’ diseases. They are not vanity-driven. They are mental illnesses that rob their victims of a full and vibrant life.

 

 

Some functions of eating disorders are:

  • coping
  • control
  • distraction and avoidance
  • expression and communication
  • self esteem
 
 

The Bullied

About 5.7 million children are bullied annually. Children who are overweight are targeted by bullies.

In a recent survey, 91% of youth with EDs had been bullied and 46% believed this contributed to their ED.  These children often stand out as different in some way because of appearance, sexual orientation, intellect, and socio-economic background, cultural or religious background. All bullying lowers self-esteem, and low self-esteem is proven to raise the risk of eating disorders. Bullying about size, weight and shape is particularly toxic. Size, weight and shape are the last personal domain where stigmatizing behavior goes unchallenged and where derogatory comments go unremarked.

Fat teasing should become as socially unacceptable as negative comments about race, ethnicity, sexuality or religion.

Some teens find that eating disordered behaviors such as binging and purging provide a sense of relief from the stress and anxiety of being bullied. In these situations, eating disorders become a type of coping mechanism rather than an fixation with appearance or an issue of body image. Other teens find that eating disorders give them a sense of control at a time when life is spiraling downward. When bullies are threatening, attacking, spreading rumors online or engaging in other harassing behaviors, an eating disorder makes some teens feel empowered in one area of their lives.

Younger Victims

A 2009 analysis found that in the last decade, hospitalizations for eating disorders more than doubled among children under twelve and now account for four percent of all such hospitalizations.

Disordered eating is now established as the third most prevalent chronic health condition among adolescent females; only asthma and obesity occur more frequently.

Children are exposed to more commercials for junk food and more ‘super-thin’ images and characters. They are being encouraged to eat high fat food and be thin – both at the same time! Magazines geared toward young teens and “tweens” utilize abnormally thin fashion models. The message is clear: “thin is beautiful”.

Lack of parental control, guidance and example are contributors as well. When Mom and Dad are overweight and/or constantly dieting or using laxatives, diet pills and so on, it’s difficult for teens to avoid copying their parents disordered eating and dieting habits.

More Moms and Dads are working. More kids eat and/or watch TV in their own rooms. These factors may diminish parental control over their kids eating habits. They may even weaken relationships between parent and child and may indirectly lead to increased psychological stress which is an important underlying cause of eating disorders.

In terms of interest in appearance, clothing, social behavior and sexualization, girls at twelve are experiencing what girls at fourteen were experiencing just a decade ago. Culturally, the messages to be concerned with appearance are being delivered to girls at younger and younger ages.

Males

1 in 10 cases of eating disorders involve males. While it’s true that men and boys develop eating disorders for the same reasons women will — genetics, low self-esteem, trauma, and cultural influences, ED’s in males are harder to diagnose. It can be easier to diagnose females with eating disorders because their obsession with weight results in recognizable symptoms such as not eating, purging, and dramatic weight loss. With men it’s a different story. Men’s obsession with weight usually manifests itself in “normal male behavior” such as excessive exercise and/or steroid use. Instead of striving to be super thin, men will often strive to appear lean and muscular by dramatically decreasing their percentage of body fat.

Males may diet to avoid being teased about being overweight or to improve athletic performance in wrestling, track, swimming, and other sports. Males often try to achieve a better body image through shaping-bodybuilding, weightlifting, and muscle toning-in response to social norms for males, which emphasize strength and athleticism.

Certain risk factors for developing an eating disorder are specific to boys. Boys who were teased as children for being overweight and athletes who must maintain a certain weight for enhanced performance are more at risk for developing eating disorders.

LGBTQ Adolescents

LGBTQ adolescents are especially at risk for eating disorders, as they often struggle with accepting their identity, coming out, and fitting in with peers who can be blatantly cruel. LGBTQ people experience unique contributing factors such as trauma in the form of gay-bashing or harassment, losing social support, family, and potentially their home as a result of coming out (up to 42% of homeless youth are LGBTQ), or extreme anxiety or depression associated with their sexuality or gender expression.

While the data showed a strong association between gay teenagers and eating disorders, the cause of these eating disorders isn’t sexual orientation, but rather the pervasive societal rejection and abuse faced by lesbian, gay, bisexual and transgender teenagers. This kind of isolation and victimization can take its toll on a young person. The emotional stress of this repeated victimization – a stress that is often accompanied by less-than-supportive home environments and social circles – can inflict significant lasting emotional damage that can manifest as depression, anger, self-hatred and disordered eating. Transgender individuals often feel tremendous body dissatisfaction. They often feel like they were born into completely the wrong body.

What needs to be done about this ever-increasing “epidemic” of eating disorders?

  • Schools need to have a “zero tolerance” for bullying of any kind.
  • We need to continually educate parents, educators, coaches, and other professionals about the signs of eating disorders and associated mental health issues like depression and anxiety in all students, no matter what their age or gender.
  • We need to educate individuals about diversity –in all areas, but especially in sexual preference and gender identity. Pervasive ignorance drives discrimination.
  • Educational and treatment resources need to be readily available online and in other environments like schools and workplaces, and quality treatment needs to be provided for those in need.

There is so much more that needs to be done to create awareness and provide treatment for all those who suffer with eating disorders. We can all do our part by being supportive to all people and especially sensitive to the needs of those who may be different.

 

 

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