Tag Archive | Bulimia

Book Release!

My book, Behind the Mask: Our Secret Battle, is in production and will be ready for purchase late November or early December 2012. Women in their 30s, 40s, 50s, and 60s who have suffered with lifelong low self-esteem, disordered eating, and body image issues, who have defined themselves by their weight, and experienced the relentless psychological “tug of war” that accompanies these issues, will relish this book as a means to help them deeply understand and appreciate their eating behaviors as a coping mechanism that no longer “serves” them, and as a hands-on skill-building tool.

Behind the Mask first details specific issues that many women struggle with during various stages of life that play an integral role in their disordered relationship with food, through the voices of two adult women with lifelong eating issues and the connections they have made along the way. It then provides my professional detailed three-phase approach to acquire the skills necessary to eat in a more peaceful way, find one’s voice, and practice self-acceptance and self-care. It is a book of connection, hope and tools for recovery.


Stay tuned for more specific information on how to purchase the book!


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Is Recovery Worth It?

“Is recovery worth it?” After you have answered the following questions, you will have a better idea for yourself if recovery is worth it?

Is it worth living a life that isn’t governed by unfair negative punitive thoughts?

Is it worth fighting to eat something, without doubting each and every bite and torturing yourself with catastrophic judgments surrounding a meal?

Is it worth being able to go to an event, party, wedding without obsessing about what you are wearing, or worrying if anyone is looking at you,  or panicking about what food will be served and when it will be served?

Is it worth trying to seek a passion, hobby, or career that fulfills you and makes you want to wake up every day in anticipation of the potential good that can come from the day?

Is it worth communicating effectively, and defending your wants and needs?

Is it worth feeling all your feelings, both positive and negative because it makes your life “real”?

Is it worth placing your energy and time on things that enrich your life, instead of the investment of time that your eating disorder behaviors take up?

Is it worth being free of the physical and emotional pain that your eating disorder inflicts upon you?

Is it worth eating foods that nourish your body and satisfy your appetite instead of eating foods you have convinced yourself you like but you really hate, just because they are “safe” and you incorrectly believe that they prevent you from going out of control?

Is it worth moving your body (if that is your choice) because it makes you feel strong and flexible, instead of hurting your body by exercising because a voice in your head says you need to in order to be “worthy” for the day?

Is it worth taking the risk of exploring who you really are beneath the cloak of the illness that you call your “friend”?

Is it worth really looking at your illness as a coping mechanism that no longer serves you and turning toward healthy coping mechanisms that are as effective as they are unfamiliar?

Is it worth trying not to be perfect as perfection is unattainable, but striving to simply do your best?

Is it worth waking up each day and saying positive things to yourself to start your day?

Is it worth looking back at some point and saying “wow, I am so much happier now than I was while I was in my eating disorder”?


I have never, ever met someone who after having recovered, has said that recovery wasn’t worth the time and effort. Everyone has the power and strength to recover. If you want to recover or even if you think you want to recover but you aren’t positive or don’t have the tools yet, keep moving in that direction and have the faith that you will get there. Step #1 is to make sure you strive for positive thoughts and shut down the negative ones. The positive ones are your foundation…the stepping stones on your personal path to recovery.


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What Does Recovery Look Like?

The second in the series of three questions I am asked the most is:

“What does recovery look like?”

Answer: Wow! I have changed my answer to this question over the years. In my opinion, recovery is a highly personal “picture”. Recovery to one person will look differently than to another. I’d love your answers, in addition to my own!

In my opinion, recovery doesn’t mean being a perfect eater. Recovery doesn’t mean having a preconceived body size. Recovery doesn’t mean eating to be a certain weight or size.

Recovery means consistently not using food behaviors to cope and communicate your needs and desires, because you have developed more effective healthy ways to cope and express yourself.

Recovery means never dieting.  That’s right! You can never diet again. This is such a challenging area for many people. So very often, clients say to me “Normal people diet. Normal people manipulate their bodies. Normal people overexercise. Normal people use diet pills. How come they can do these things and I can’t?”

“Normal” people don’t have a mental illness where any or all of these behaviors are symptoms of the illness, and when engaging in these behaviors are expressing symptoms of the illness and thus making it worse.

It is not “normal” to do any of those things. Just because something is common, doesn’t mean it is “normal” and it definitely doesn’t make it good or right or healthy or something to aspire to. In my opinion, recovery means not restricting, bingeing and purging, using other substances (diet pills etc), compulsive exercise behaviors, or any type of harmful behavior (even “mildly”).

Once you have an eating disorder, you are VULNERABLE to all things that “normal” people engage in related to food/exercise. That isn’t your fault. It is simply a side effect of having an eating disorder.

Even when you are in a healthy place in your recovery, certain behaviors will still put you at risk. Dieting, for example, is the number one behavior that triggers eating disordered thoughts and can be a catalyst sending you right back into your illness. So you can never diet again…ever. Recovery means redefining “normal”.

How does exercise fit into recovery? Again, remember that you are vulnerable. Exercise (even if it has never been a part of your illness) can be tricky. Everyone knows that movement is good for people. When you have a history of an eating disorder, you have to be attentive to the purpose behind the desire to exercise. If you are healthy and you exercise, you have to be cautious that the purpose doesn’t switch from being healthy to “feeding” your illness. Be honest with yourself and set healthy goals for your exercise. Make sure it doesn’t take on a level of importance where it becomes a “job” or a “behavior”.

Recovery means having a peaceful relationship with food. Food is an essential part of life, but when you are in recovery, food doesn’t occupy all your thoughts. In recovery, you think about food in a neutral or positive way. You don’t have strict black and white rules regarding food, unless medically necessary.

Recovery doesn’t mean having a perfectly happy existence. But, your worst day well will still be better than your best day sick because you won’t be sick and your life will be REAL. Life has ups and downs. Life is difficult at times and joyous at times. Your eating disorder just makes life more difficult on every level, in every way. So, without it, your life ultimately will be less difficult. You will also feel all your feelings – the positive ones and the negative ones. Your feelings are essential, and feeling themwon’t kill you!

Think of all the things you cannot do because of your illness. You will have the opportunity to do any of these things, if you choose, when you are in recovery.  It is freedom.

Recovery means practicing different forms of regular, consistent self-care. Everyone has different ideas of how they can practice this. For some, self care involves having hobbies like reading, blogging, knitting, or doing crossword puzzles. Others like to have creative outlets like singing, painting, playing a musical instrument, or other art forms. Some like listening to inspirational music every day. Whatever you consider self-care, you need to do it regularly.

Recovery is whatever you want it to be. It’s your life. Define it. You only get one life, make it the best one it can be! It’s worth going for!!!


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Can I Recover?

Many clients have been asking me lately:

“Do you think I can fully recover?”

“What does recovery look like?”

“Is recovery worth it?”

It is normal to be asking these types of questions. In my experience treating numerous people who have been and are continuing to go through the process, these questions come up often.

So, I’d like to answer them to the best of my ability in three separate posts. The answers are my professional opinions, based on my experiences.

Question one: Do you think I can recover?

Answer: I wouldn’t be working in the field of eating disorders if I didn’t think it was possible for everyone who has these illnesses to recover. But, what many people don’t often realize is that recovery takes an enormous amount of fortitude, time, insight, skill-building, and hope.

Fortitude during the good times is easier to attain. Fortitude when things are rough is much harder. It is during the roughest times that your fortitude will be tested, but will need to be an essential ingredient in the recovery process so that you don’t regress or relapse.

The time recovery takes varies person to person. I have never seen any individual recover in a short period of time though. You need to change your expectations if you thought recovery was going to be a “quick-fix.” Most estimates are between 4 and 7 years for the process. Some people make a quicker recovery and some take much longer.

Having insight into the origins of the illness as well as insight regarding it’s ongoing purposes is not only a gift, it is a necessity. If you know what your eating disorder’s functions are, you will be able to find better solutions for those issues.

Skill-building is the process during which you will need to practice using healthy coping mechanisms and communication skills in place of using eating disordered behavior. This new way of living is very challenging. It is uncomfortable. Resorting to comfortable eating disordered behaviors instead of healthy coping mechanisms is, in part, what causes the process to take time.

Recovery also takes support – in various ways – professional support, support groups, support of loved ones, friends, family, and peers. That doesn’t mean that you need to have full disclosure to everyone in your life, but seeking support in various ways from others is key.  Financially speaking, seeking the right type of professional support can be challenging, sometimes impossible. There are services that are free (some support groups and other group meetings). Finances may necessitate you being more creative in the types of support you can receive. There are also organizations like NEDA that have mentoring programs and group support via the internet. Project Heal offers treatment scholarships for people through an application process.

Resources are available. Support is available.

The question I often ask my clients when they ask me if they can recover is “Do you think you can recover? I believe in you, but you have to believe in you!” Often when people are in the throes of these illnesses, they truly don’t know the answer to this question.  They are unsure, scared, and haven’t build the confidence necessary to truly know. If you don’t know the answer to the question for yourself, you need to trust that others have gotten better and with time, strength, and practice, you can too.

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Your Teen May Be Headed For Trouble

Your teenage girl appears to have it all together.  She is bright, pretty, has good friendships, and is athletic.  She develops an eating disorder…what happened?  When a teenager feels out of balance, when the things she feels she CAN control are out of balance with the things she feels she CAN’T control, she feels uncomfortable.  For instance, she can’t control that school pressures are enormous and she studied as hard as she could for an exam and got a 92 instead of a 98.  She can’t control that her parents argue.  She can’t control that her boyfriend isn’t ready for a serious relationship and wants to break up with her.  If she is a perfectionist, these out of control situations may even make her feel like a failure.  She is vulnerable.  She decides to go on a “simple diet” to lose 5 pounds to feel better about herself (because she has been taught by the media that thinness = happiness).  On this diet, she realizes that her weight and the amount and types of food she puts into her body, are things she can control when other things in her life she can’t always control.  The more out of control her life feels, the more important it becomes to control her weight and her eating.  If she is vulnerable enough, the dieting could lead to an eating disorder.

The media, in all forms, sends messages to teenagers that in order to be happy, you must be thin and beautiful.  A teenager is bombarded by these messages in magazines portraying waif thin computer altered models.   Television is sending us messages that if dieting doesn’t work, you can even have an extreme makeover to fix your appearance flaws.  Life-threatening surgeries are portrayed as a brilliant quick-fix.

Teenagers also are living in a diet-obsessed environment.  65% of our country is overweight yet, if you’re not on the latest diet – South Beach, Atkins – something is wrong with you.  Everywhere you turn, in magazines, on TV, every news program, online advertisements,  you are bombarded with messages about how to lose weight.

Imagine being a vulnerable teenager, perhaps of normal or slightly above normal weight, struggling with all types of issues, and then having to sit at a lunch table trying to eat a sandwich where no one would eat a “carb” if their life depended on it.  Everyone is talking about how “fattening” bread is.  The peer pressure to diet is extraordinary.

So, you have this vulnerable teenager, feeling out of control, unable to communicate her feelings, experiencing academic and societal pressures, and peer pressure to be thin, and you have the perfect storm… a scenario that can create disordered eating and eating disorders – anorexia, bulimia, binge-eating disorder.

What behavioral signs should a parent look for?

Behaviors vary according to the type and severity of the disorder.

  • If your teen talks more about her weight in a negative way
  • If she asks often “do I look fat?”
  • If she starts cutting out things in her diet such as foods that were once her favorite foods, such as desserts, and says she doesn’t like them anymore
  • If she exhibits rituals around her foods like cutting it up into small pieces, measuring foods, or pushing things around on the plate
  • If her clothes appear looser
  • If she avoids social situations where food is involved or makes excuses not to eat
  • If she has become a vegetarian but will not eat fats and oils or higher fat vegetarian foods
  • If she grocery shops or prepares food for the family but refuses to eat it
  • If she goes to the bathroom often after eating (to purge)
  • If she begins to exercise compulsively, doing excessive amounts of cardiovascular exercise, sit-ups, jumping jacks, leg lifts, push-ups
  • If she is using diet pills or laxatives on a regular basis
  • If, in secret, she binges on high calorie foods
  • If you see empty food packages in her room or in the garbage
  • If she avoids food at holidays


What strategies can a parent employ to help your teen avoid dieting/disordered eating?

  • Don’t diet – healthy weight can be achieved through normal eating and changes in lifestyle.  Be a healthy eating role model.  The “do as I say, not as I do” philosophy doesn’t work with food
  • Don’t discuss weight at home, yours or your teenager’s (especially dad)
  • Never criticize your own body
  • Get rid of your scale
  • Don’t criticize your teenager at mealtime; don’t engage in power struggles over food
  • Be a critic of the media
  • Encourage size diversity
  • Encourage your teen to appreciate her qualities other than her weight to help boost her self-esteem
  • Encourage your teen to express all of her positive and negative feelings with you
  • Have structured meals as often as you can to create a normal eating environment – if a teenager who wants to diet has an unstructured or chaotic eating environment at home, it makes it easier for her to diet and get away with it


If you see any of the above “red flags” or have any concerns about your teen, call a professional who is trained in the detection and treatment of eating disorders.





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Jellyfish and the Boat

A colleague and I were talking the other day and were trying to find an analogy for the recovery process. I’ve heard a lot of analogies but I loved her latest one!


Let’s say that you’ve capsized off a boat in the middle of the ocean and all you have is your life preserver to keep you afloat. You see a boat in the near distance that you know will save your life but in order to be saved, you have to swim to it. You aren’t an expert swimmer and the water is full of jellyfish. You know you can’t just stay where you are forever because you will eventually drown. The journey toward the boat for safety will be terribly uncomfortable and scary. You will have to struggle to swim amidst the jellyfish. It is the only way you will be saved. You need to muster up an enormous amount of courage, hope, faith, and stamina. Then, you need to plow through those jellyfish one stroke at a time. Eventually you will be pulled out of the water, onto the boat and be led to dry land.


The only things that would hold you back are fear and lack of the essential ingredients of faith, hope, stamina and courage. Recovery is the same type of process. There is fear of the unknown, insecurity about the ability to do it, and desire to stay where it is familiar, even though it is a struggle in itself.


What enables some people to plow through the jellyfish, and swim to safety? Sometimes it is sheer will. Sometimes it is intrinsic strength. Sometimes it is hitting rock bottom. Sometimes it is the strong desire to have a fulfilling life. Whatever it is, it can be done. You can swim through the jellyfish. You can recover. Muster up the courage, strength, hope, faith and stamina, and move toward recovery!


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Are You a Casualty of Dieting? Tips for “Normal” Eating

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 weight management, 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, or nutritional or “fun”. “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 the high 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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What Are You Addicted To???

Disordered habits are addictive. Healthy non-disordered habits are difficult to adopt, let alone adhere to. So many times, clients will say to me:

“I didn’t think it was a big deal to skip that one snack.”

“I only wanted to binge once. I figured then I could give it up.”

“I promised myself that after this binge/purge, I’d never do it again.”

“I wanted to push myself to do more exercise just once, to see if I could do it.”

Eating disordered behaviors are addictive. You NEVER want to engage in them “just once”. Once you engage in them one time…just one time, you CRAVE them. You may not like them, they may be painful, they make you feel terrible about yourself, but you become addicted to the “high”, the relief, the numbness you get from them. Unfortunately, each time you use eating disordered behaviors in order to numb out, avoid, distract or lower your anxiety, you set yourself up for having a more difficult time stopping them and finding new “healthy habits” such as effective communication, feelings and needs identification and coping mechanisms.

Don’t fool yourself into believing that if you engage in an eating disordered behavior today that you will “want” to give it up tomorrow or that it will be easier to give it up at a time in the future. It is HARD giving up disordered behaviors. It will bring up anxiety and discomfort when you resist using disordered behaviors. It is hard finding healthy behaviors in place of disordered ones. That’s why recovery is arduous and using eating disordered behaviors is more comfortable (even though they are painful). Each day you engage in disordered behaviors like restriction, bingeing, purging, overexercising, use of other addictive substances like laxatives, diet pills etc, you are making it more difficult to live without them.

The “high” isn’t worth it when it sets up an addiction that is so difficult to break and prevents you from leading a healthier life and learning healthy habits. You must resist the instant gratification of the addictive behavior. You must try to look beyond it, and think of how you want to feel in the long run. What is your choice…short-term gratification for long-term pain and suffering OR short-term discomfort for long-term health and recovery? It is ALWAYS a choice!

I found three quotes that I felt accurately illustrate this topic!

Habit, if not resisted, soon becomes necessity.  ~St. Augustine

Habits are at first cobwebs, then cables.  ~Spanish Proverb

Bad habits are easier to abandon today than tomorrow.  ~Yiddish Proverb

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Q&A with Donna

Tiffany Asks: I’m doing well in recovery, but I was wondering how much involvement with food is ok. Is it ok to work a food / nutrition related job? Is it ok to watch Food Network? Or are these signs of obsession?

Great question! As a person who has a lot of experience in the world of food, I can tell you that many of my clients have been very involved in food-related jobs, interests, and hobbies while in the throws of their eating disorders, only to find out that when they get better, they lose many of these interests. Some of them have actually studied it in college but then switched majors when they realized they really didn’t enjoy it as much as they had thought they would. Others have continued to study it and enjoy it, long after they had been doing well in recovery. It’s very hard to know whether it is a true pleasure or if it is an obsession as a result of your eating disorder until you are very far into the process of recovery, or dare I say, recovered.

If you are currently doing well in recovery, try to ask yourself “will this food involvement trigger me to get worse, help me get better or have no effect on my recovery?” If you think it is triggering you or contributing to making you worse, it is not a good idea to invest energy into it. If is not triggering you to get worse or actually feels like it is helping you get better, then it’s probably just fine. Many of my clients have found that working in a food environment is the most challenging and triggering.

Anonymous Asks: Ever heard of on-demand eating? What is it?

On-demand eating is intuitive eating, which means eating what you want to eat when you are hungry and stopping when you are full. It is the kind of eating that many non-disordered people do with ease. It does not involve counting calories, fat grams, carbohydrate grams, or exchanges. It does not include weighing or measuring food, or rigid food rules. It absolutely does not involve dieting. If you have suffered from an eating disorder, it requires a significant amount of mindfulness, being very attuned to your emotions and trust in the process. It is imperfect. Mistakes are made when you may overeat or undereat. It has quite a learning curve so you need to be patient and hopeful!

Maria asks: How am I supposed to know if a craving that I am experiencing is based on nutritional needs or emotional needs?

It’s often extremely difficult to determine whether a craving is nutritional or emotional. You have to practice being in tune with your hunger, fullness, appetite and emotions to really gain a full understanding of your cravings.

Many people have cravings. Most “normal” cravings vary. They may be one type of food on one day and a completely different type of food on another day. One day you might crave ice cream, the next day, steak, and salad on another day.

If you have consistently deprived yourself of a particular food or food category (like bread, for example), you most definitely will crave this food. You may be able to suppress it for a period of time, but it will most likely unleash itself at some point. It will be powerful and difficult to fight, the more you avoid this food. This would not necessarily be a nutritional craving, but a deprivation-driven craving.

If you give yourself a variety of foods on a regular basis so that you are not depriving yourself, and you find yourself craving something, ask yourself first “when was the last time I ate?” If the last time you ate was a while ago (let’s say 3 or 4 hours), then your craving may just be hunger-driven. Your brain will picture a food that gives you pleasure and you will want to eat it.
If, on the other hand, you have eaten recently and it was a good amount for you, then you can most likely rule out a nutritional or deprivation-driven craving. You then need to ask yourself “where is this craving coming from?” Your craving may definitely be emotional. You can be fairly certain that you are craving something other than food. The food is what your brain is making you think of and obsess over so that you don’t have to think about what’s really going on inside your head. The food becomes an emotional salve or a temporary means of distraction.

Sometimes there is more than one type of craving at work. The most powerful cravings are those that combine hunger, deprivation-driven and emotional cravings. So if you restrict amounts and types of food, go long periods without food and you are going through a stressful time, be aware that these types of cravings will be stronger.

Stephanie asks:How do you find treatment that is affordable??

Great resources for services and other information on eating disorders are the NEDA website http://www.nationaleatingdisorders.org/ and the something fishy website http://www.something-fishy.org/.
You can locate services in the area where you live on both of these websites. NEDA sponsors web chats and can put you in contact with a NEDA Navigator.
There are also free support groups in many areas for people in recovery.

Elizabeth asks:Should I tell my nutritionist I used to chew/spit if I havent done it in years? Now i just restrict.

It is not essential to tell your nutritionist about a past eating disordered behavior, but I believe that it is important for you to be as honest with your treatment professionals as possible. If you had a past eating disordered behavior like chewing and spitting, it might be helpful to discuss the circumstances surrounding the behavior, the triggers, emotions etc. Remember that eating disordered behaviors are all symptoms/clues of underlying issues. The more your treatment professionals know, the better equipped they are to help you get to the root of the illness and help you get better.

Brooke asks: I am ready to recover from bulimia, I don’t want to tell others can I do this on my own?

Bulimia is an illness and as such, in order to recover, it is important to receive treatment from professionals that are experts in eating disorders and will treat you with the compassion and respect you deserve. You don’t have to tell other people unless you can seek their support as well. Most importantly, you need to be medically stable and gain the tools you will need to recover from your illness. Good luck, Brooke!

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Dieting Linked To Eating Disorders


The above article in Medical News Today discusses some of the findings of research done in England by the British Association for Counseling & Psychotherapy on the effects of dieting on the development of an eating disorder.

“Findings indicate that many clients who do/have dieted solely to lose weight have low self-esteem, and that once dieting starts the clients’ psychological issues become more profoundly associated with their physical appearance. Emphasis then becomes increasingly centered on losing weight rather than addressing the underlying self-esteem issues and a strong link between such clients’ low self-esteem/confidence and body image emerges; it also seems that many such clients primarily tend to use dieting in an attempt to control/improve their lives.”

Also noteworthy is how, since dieting is “normalized” in western societies, many individuals who diet regularly may actually suffer from an eating disorder and go undiagnosed.

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Vic Avon on FOX Focus: Male eating disorders

Click below to read the story on Fox 23 News
FOX Focus: Male eating disorders

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Health at Every Size from NYTimes.com

Health at Every Size, an article in Wednesday’s NYTimes.com, discusses how Lent can be another time for people who are discontent with their bodies to give up certain foods in an attempt to lose weight (a diet in disguise, perhaps?).

The article goes on to discuss the ineffectiveness of dieting for long-term weight loss.  “…a weight-focused approach geared toward losing weight is — surprise! — not especially effective in either reducing the weight or creating healthier bodies. In fact, they say, such an approach can unintentionally lead to weight gain and worse health.”

Instead of using this time as one to restrict, why not use it as a time to make peace with the body you have?


If you are already suffering from an eating disorder, restriction of any kind at any time of the year is dangerous and may potentially exacerbate your illness.

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Donna’s Top Ten Reasons Not to Diet

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Ten Most Pervasive Myths about Eating Disorders

The following is an excellent resource for people who want to educate themselves about eating disorders. Not only is the article Ten Most Pervasive Myths about Eating Disorders well-written and informative but when you scroll over each myth topic, you will find additional enlightening videos and articles. Thanks to Radiology Technicians Schools for producing such an exceptional resource.


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“With self-compassion, if you care about yourself, you do what’s healthy for you rather than what’s harmful to you.”  

This is the last line from a quote in a New York Times article that discusses a new area of psychological research called “self-compassion” and a new book on the topic by Kristin Neff, Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind.

The first thing I tell a client that comes into my office with an eating disorder is “This illness is not your fault.” The second thing I tell my clients is that “You need to be kind to yourself in order to heal from this illness.”

People who suffer from eating disorders – anorexia, bulimia and binge-eating disorder, are extraordinarily sensitive, kind-hearted individuals. They are the types of people who make others feel good about themselves with their compliments, love, unending ability to listen and empathize.  Unfortunately, these sufferers reserve their adoring ways for others, and when it comes to themselves, they are self-critical, self-loathing, unforgiving, and merciless. They overinflate their flaws and minimize their attributes. They beat themselves up for the most insignificant “mistakes” and struggle to see their strengths and successes – in the food arena as well as in other areas.

This article emphasizes that negativity and self-criticism are not motivators for change, whether they come from others or from within. These tactics breed negativity and helplessness, two states of being that reinforce sickness, depression and lack of motivation for positive change. 

Self-compassion is not only the first step in healing, it is an essential step. If you suffer from an eating disorder, remember to treat yourself with the same kindness and respect you would bestow upon your friends, family and other loved ones. You will be pleasantly surprised at the power a little compassion can have in the recovery process.

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