Tag Archive | Control

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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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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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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Stuck and Powerless

How many times have you felt stuck in your recovery or in other areas of your life? Have you ever felt powerless against your eating disorder or powerless in areas of your life making you want your eating disorder even more?

These two states of being are extremely powerful forces in one’s recovery, and in life as a whole. You can either allow them to debilitate you, or help move you to a better place.

In the past month or so, I have felt these two states of being particularly powerfully, not in my eating disorder recovery because I have achieved a recovery that is sacred and won’t be damaged by these states of being, but in several areas of life. It made me think of how difficult life is for my clients when they feel “stuck” and/or “powerless” and how often we experience this in life, and in recovery. Feeling stuck and powerless also forced me to make some decisions. The first decision I had to make was based on one question? “Do I FEEL stuck and powerless, or AM I actually stuck and powerless?” The first part of the question indicates that the way that I feel doesn’t necessarily reflect reality. The other reflects a different scenario entirely. In either case, something needed to be addressed. Through my process, I was much more clearly able to see my clients’ difficulties and thus hopefully enable me to help them more effectively.

Three clients come to mind when I think of being “stuck and powerless”. One is stuck in a few areas of life and therefore feels somewhat powerless. The second is stuck at a place in recovery, is tempted to not push to go further, and is having urges to go back to using eating disordered behaviors to “feel” more “powerful”.  The third feels powerless in her life, and historically turns to eating disordered behaviors to distract herself from the issues in life and when she feels badly about herself, thus perpetuating the feelings of powerlessness.  All three feel a bit defeated, and I can understand why.

Mirriam Webster defines powerless as:

1. Devoid of strength or resources

2. Lacking the authority or capacity to act

Stuck means “firmly positioned in place and difficult to dislodge”. Related words are: bonded, cemented, glued, anchored, clamped, embedded, entrenched, impacted, implanted, attached, bound, fastened, secured, immovable, unyielding.

No wonder these two states of being are difficult to manage.

If you are experiencing these issues, first stop to think and reflect on the first definition of powerless. Are you truly devoid of strength or resources?  Do you completely lack the authority or capacity to act?

Often individuals feel a sense of powerlessness as a result of events of the past. Many individuals learned early on that speaking up for what they needed would be met with negative consequences. This learned helplessness or powerlessness is often perpetuated through adulthood, even when the events are in the past.

You may often think you have no strength left, and your resources aren’t plentiful, BUT dig deeper than you ever have before and look for even the teeniest bit of strength to help you through. It is in there. It may be hidden, but it is inside you and you can find it. You also may need to look even harder for resources and “safe” people. They are out there in all sorts of places – in friends, acquaintances, organizations, religious and other spiritual leaders, therapists, teachers, family members, online resources. If you feel you have exhausted all your resources, begin a new search. Remember also, that YOU are your biggest resource. If you think you lack the capacity to act, reflect on the reasons you think that way. Are you basing your reasons on your past experiences or cognitive distortions (distortions of truth), or are you basing them on facts. Ask someone you trust to help you. Maybe you are unable to “see” ways you can act because you are deeply entrenched in the negative feelings that you have lost healthy perspective. Maybe you cannot act now, because of certain circumstances that are beyond your control, but perhaps you can come up with a plan to act within a certain time frame.  You need to continue to search and search for ways to improve your situation.

 

During the times when you are “stuck” at a place in recovery or in life – firmly positioned in place, embedded or entrenched, try to imagine it as an opportunity.  Being stuck is a clue that perhaps you aren’t ready for the next step. What is the next step? Is it too big? Have you not prepared well enough for it? Are you scared? What is expected of you if you take that step? Is it too unfamiliar? Do you need more time? Do you need to strategize more? Are you afraid of you take that step, there’s no turning back? Are you afraid to trust the process and take the leap of faith? Do you not have the confidence that you will be successful? Pay attention to the thoughts and feelings that are coming up, the powerful thoughts and feelings as well as the subtle ones. Also pay attention to your eating disordered thoughts. When we are stuck, we often revert back to wanting our eating disordered behaviors as a distraction or to sabotage our progress. In my opinion, being stuck is progress in itself, if you use it wisely.

Below are a few quotes that I thought might help you get “unstuck” and reclaim your power!

The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. –  Martin Luther King, Jr.

You can be absolutely certain that when you feel you are being most unfairly tested, you are being prepared for great achievement. – Napoleon Hill

Your vision will become clear only when you can look into your own heart…. Who looks outside, dreams; who looks inside, awakes. – Carl Jung

All growth is a leap in the dark, a spontaneous unpremeditated act without benefit of experience. – Henry Miller

 

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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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Is It Possible to Lose Weight ?

Many of my clients ask this question, whether their body has
changed as a result of their eating disorder or as a result of the recovery
process itself. Weight, size and body image are such sensitive subjects. They
are intricately woven into the complexities of eating disorders and must be
dealt with very carefully.

After gaining some weight, many of my clients want to revert
back to some type of restrictive eating in order to change their weight/lose
weight. This type of restrictive eating may be as simple as eating foods they
“know” are low-calorie foods but that the individual hates or reminds them of
their disordered/dieting days. Restriction can also crop up in subtle ways,
like the following:

  • Convincing yourself you like a food because it is healthy when you really don’t like it and have never liked it.
  • Trying to eat a smaller portion size than youknow will fill you because you’ve gained weight and think a smaller portion“should” fill you.
  • Trying to eat a volume of low-calorie foods to fill you up, hoping it will prevent you from eating what you really want.
  • Setting any unrealistic goal that you know deep inside goes against what your “inner eater” wants.

 

The following vignette is an example of this
phenomenon…inevitably slowing down recovery, giving power to the eating disorder,
and causing the exact behaviors one is trying to alter:

A client came in for a session last week. She has been on
both ends of the eating pendulum. During her restrictive days, she would limit
herself to very few foods as a means to an end (weight loss). Then she went
through a period of rebound bingeing that lasted for an extended period of time
causing some subsequent weight gain. She currently doesn’t want to restrict or
binge but she feels confused about what to do. She feels she is in a body that
is not her “normal” one but knows she can’t restrict to get back to normal. She
is repulsed by the foods she ate while restricting but desires to eat them
again because they are “healthy”. The thought of eating these foods again also
causes her to “rebel” and binge.

She’s trying to eat whatever she is in the mood to eat, but
gets frustrated because her choices are often “unhealthy” and are not leading
to weight loss. It seems though, whenever she tries to negate her intuitive
appetite, she eats more than she initially wanted to, she feels more out of
control, her weight goes up, and she wants to give up.

Not only are there psychological dynamics going on in this
situation, but physiological ones as well. When the body is deprived of food,
there are many complex physical/hormonal/brain side effects that occur as a
result that will ultimately create a temporary heightened hunger and appetite.
These chemical changes cannot be “willed away”. They need to be attended to and
understood. There is no specific time frame for these effects.

I also want to mention, as we all know, an eating disorder
and recovery from an eating disorder are not about the food itself. Recovery is
about achieving other healthy coping mechanisms so that food isn’t the ONLY one
used. Continually placing all the emphasis in treatment on the eating patterns
and the food choices themselves, will take the individual further away from the
ultimate goal…trying to understand what the food is being “used” for, and
reducing the need for food (in any way, shape or form) as the only coping
mechanism. Ultimately, when someone who has an eating disorder is using a
multitude of other coping mechanisms, effective communication skills, and
healthy forms of self-care, as well as experiencing and tolerating all of their
feelings, food can begin to be “just food”.

The following was written by Karin Kratina, a pioneer in the
field of eating disorders. It truly exemplifies this process.

Sometimes recovery from eating issues involves weight loss.
Sometimes it does not. Regardless, any focus on weight is a potential danger
zone since a focus on weight loss can cause a return to the eating behaviors
you are trying to change. If you are above your body’s set point weight range,
it is possible that with intuitive eating, your weight will slowly shift until
you are back at your set point range. But you need to first be doing the
following to heal eating issues (it does not work to try to lose weight then
heal eating issues).

 

Place a check mark next to the thoughts/behaviors that you practice on a consistent basis:

□   I know how to keep a food journal recording food, feelings and hunger/satiety.

□   I usually keep a food journal when I’m having a hard time with my food/weight.

□   I am in tune with my hunger and am comfortable beginning most of my meals hungry.

□   I am able to stop eating when physically satisfied, usually with no problem.

□  I am able to eat almost any food without beating myself up or feeling guilty.

□  I almost always take action to handle feelings and situations that trigger me to eat by:

□  making a choice between feeling uncomfortable or addressing the issue

□  making effective changes on my own when possible

□  reaching out for appropriate support from family and friends

□  engaging in counseling if I see my reaction to triggers not changing

□   My attitude towards my body is “if you can’t be with the one you love, love the
one you’re with.”

□   I practice numerous nurturing behaviors to fill myself so that I don’t need to turn to
food.

□   I usually know what my needs are and how to get them met by setting limits and
communicating directly.

□   I usually assert myself and rarely have to resort to yelling, arguing or withdrawing when
feeling frustrated with others around me.

□   I like my body most of the time.

□   I realize when I feel fat, an issue other than weight needs to be addressed.

□   I know that if I lose weight to feel better, that ‘feeling better’ is almost
always transient since it is not the weight loss that makes me feel better, but
what I think about the weight loss. I can feel better right now by changing the
way I think.

□   I have changed the way I think and feel content with myself most of the time.

 

If you are consistently practicing the behaviors above, some
weight loss may be possible. Make note of any thoughts/behaviors that you are
not able to do consistently and make them a priority. You may want to enlist
the help of a professional. Remember, never diet, it is the quickest
prescription to weight gain.

© Copyright 1999 Karin Kratina, MA, RD

Adapted from the unpublished work of Peggy DeMars, MS, RD

Download at www.NutritionTherapy.org Also visit www.NourishingConnections.com

 

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Energy vs. Effort

How much energy do you put into your eating disorder recovery?

I bet many of you think about your eating disorder 24/7. I also imagine that it takes an enormous amount of energy to get through every day with your illness, whether you are fighting to get better or fighting just to get through a day co-existing with it.

Many of my clients say to me “I wish more than anything that I didn’t have this illness. I want to just wake up one day and be normal.”

Unfortunately it doesn’t work that way. Recovering from an eating disorder not only takes an enormous amount of energy, but it takes even more effort.

A patient of mine comes to her sessions once a week every week. She never misses. Even during the blizzards we have had, she drives her SUV to the office to have her weekly sessions. She works on trying to follow the goals we set each week. She puts an enormous amount of “energy” into her recovery. What she continually struggles with is the “effort” part of recovery. She does the work she needs to do until the work gets anxiety provoking or fearful, and/or until her eating disordered voice gets its way and wins. Then she backs down and quits. She has said to me during almost every one of our sessions “I want to get better so badly. I really tried, but I got so scared I couldn’t do it.” I believe every passionate word she says. It breaks my heart that she struggles so much. But, this illustrates what I mean by effort.

Recovery steps are NOT EASY. They will not be devoid of anxiety or fear. When you defy your eating disorder, you will feel like you may lose the (fake) control you get from your illness. You may feel like you won’t know who you are or how to live without your eating disorder.

Your eating disorder will not relinquish control over you without a fight. It will not quiet down when you have a healthy thought or healthy behavior. It will challenge you, create fear and anxiety. It wants to remain in your head, like the opportunistic “parasite” that it is. What you need to do though, at the exact moment that you feel the most scared or anxious, is push through it. You need to experience and tolerate the fear and the anxiety. You do this by staying positive, doing the “healthy” behavior and feeling whatever emotional discomfort that emerges. You don’t quit once the discomfort comes up. All that does is strengthen the fear, makes it just as hard to do the “healthy” behavior again, and makes you feel defeated. Once you can experience the discomfort and survive, you will begin to build your confidence and will be able to repeat the process again and again and again. This is true effort…sitting with the feelings and anxiety that your eating disordered voice stirs up, doing the healthy behavior and not backing down. Then, repeat.

Energy must be matched by effort. Wanting desperately to get better combined with unending effort will create the shift in power from your eating disorder to the authentic person inside you who is desperately searching to emerge!

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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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Awake and Alive

Originally posted on 11/17/2010

The following post is from a client of mine who is an extremely courageous, warm, loving human being, who is finally discovering herself separated from her eating disorder. I’m proud of you, PR!

Lately, I’ve been pinching myself to see if I’m really awake and alive.  I’m so afraid that it’s all a dream, a mirage, and that soon I’ll wake up and my recovery from my eating disorder will fade away and I’ll be sick once more.

It’s just that for the first time in my life, I thank God when I wake up in the morning and face the day with joy.  For the first time, I’m loving life and laughing with pure happiness untainted by obsessions and illness.  For the first time in my life, I see a future bright with sunshine and rainbows.  Oh, I know there will be hard times ahead and there will be days when the familiar feelings of self-hate and depression will come back.  I know there will be days when the black cloud descends and I may feel like I’ve fallen off the cliff again.  But I also know that when that time comes, I will be able to recognize the pit that lies ahead and use the skills I’ve learned over years of therapy to keep my head above the water until the waves pass.

I know I will be able to do that because for the first time, I believe in myself and in the strength I possess and in the potential for greatness which lies within me.  I know this sounds idealistic and “honeymoonish”, almost like my head is inside a pink cloud which will soon evaporate.  I know some people would read this and be cynical about my seemingly shallow understanding of what recovery is about.  But that would be because they don’t know my story.  They don’t know the story of suicide attempts, hospitalization, weight gains and weight losses, severe depression and a difficult, sometimes impossible climb through mountain ranges before I reached this peak.  In either case, I’d rather be in a pink cloud, which may soon disappear, than back in my eating disorder where I’m stuck inside a black cloud which never goes away.  Besides, during this time that I’m in the pink cloud I’m slowly building a fence around myself which will protect me during those times when I get too close to the edge of the cliff.  And during this time, I am reinforcing that fence every time I win over my eating disorder.  So I’m glad to be inside a pink cloud right now.

I’m finally standing on my own two feet; something I never dreamed was possible.  I never could imagine what life would be like when I no longer listened to my eating disorder and followed its directions.  I wondered how I would manage without the support I received through intensive, weekly therapy.  And that’s why I keep pinching myself.  Because I’m finally basking in the sunlight which for so long seemed totally out of reach.  I’ve finally exited the narrow tunnel of my eating disorder.  I’m finally awake and I’m finally alive.

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The Diet Nightmare!

When was the last time you can remember being in the company of other  women (and often men) without the conversation inevitably evolving into the latest “remarkable” diet someone is on, how carbohydrates are “fattening” or fats are “fattening”, how a low-carbohydrate diet is the way to stop “bloat” or how a lemonade fast is the best way to drop quick pounds, what the new secret is to drop weight while you sleep, what new-fangled pills are the latest weight loss magic that melt away the fat?

Someone will inevitably be compelled to argue how bagels are the devil, how she hasn’t eaten bread in years, how butter “sticks” to her hips like glue, how much weight she lost and then gained back, what body parts she gained it in, what times of the day she allows herself to eat, how much exercise she has to do or how much exercise she’s not doing and feels guilty about, why her thighs keep growing, where she has the most cellulite, how she can’t control the size of her  stomach? These conversations are epidemic! The irony is that these women don’t see this way of life as unusual or obsessive in the least, nor do they realize that their eating is not intuitive or healthy. If they didn’t discuss their dieting life with other women, they would have little to keep each others’ interest. Unfortunately, diet and weight topics of conversation are the common ground on which women reside. They seem to have lost touch with the other aspects of themselves and the other things in life that are more important than their dress size or the number they see on the bathroom scale.

This phenomenon is especially prevalent between January 1st and February 15th. During the first days of every year, many people embark on their “New Year’s Diet”, forgetting that last year, each and every single other time they embarked on one diet or another, the diet failed because diets always fail. It’s as if all the bad memories of all these failed diets were erased from their memory and they decided this time would be different. It WON’T be different. It NEVER is different. It CAN’T be different because it’s still a diet. It still isn’t normal or sustainable. It is rule-driven restriction, and it will fail.

The definition of insanity is doing the same thing and expecting different results. Just because a new diet seems different because it subscribes to eating certain different combinations of foods at certain times of day or eliminates certain “fattening” foods, or because a celebrity or doctor tried it and lost weight (temporary weight, I’m certain), it is still a diet and will inevitably come to an end and any weight lost will be regained. That’s how diets work.

But, because people get so excited just before and in the early stages of embarking on their latest, newest diet, they make you feel like they’ve “got it” this time. They surely have the secret. This time, they will keep the weight off. They are certain of it!

A few weeks or months later (if it even takes that long), they will be off their diet, and they will no longer be excited. In fact, they will not be talking about that specific diet because it will have failed. They will only complain about how much weight they have regained. The irony is though, that they won’t blame the diet for failing them. No, that’s not the way it works. They will inevitably blame themselves, saying they can’t “stick” to a diet, or they are weak, or some other derogatory self-critical comment. This negative self-talk will further exacerbate their rebound overeating, subsequent weight gain and quest for a new and better diet. PEOPLE DON’T FAIL DIETS. DIETS FAIL PEOPLE!

Dieting like this is a cycle that never ends. It’s like being a hamster running on a wheel. The hamster keeps on going and going and going, getting absolutely no where, until he finally decides to jump off or falls off (or dies, trying to get somewhere he can’t get to).

For those of you who are “enlightened” and have given up the dieting nightmare, good for you!!!!!  For those of you who keep thinking that there is a “good” diet out there, get off the darn hamster wheel! Please work with a trusted professional to learn how to eat more intuitively, stop the endless diet cycle, learn self-trust and heal your relationship with food, yourself, and your world! It is a slow process, but at least you are off the wheel and really getting someplace worth fighting to get to!

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Expectations

Do you ever have a stretch of time when you feel you “got it”, when you can feel recovery is going well, you are putting the pieces together, and your eating disorder voice is NOT dictating your behaviors with food?  Then, almost without warning, you find yourself in the eating disorder “pit” again??? 

If this happens to you, try not to get discouraged. I know…easier said than done. If you have suffered for a long time with your eating disorder, it will take a while for you to put the pieces together, keep them together, and not have slips. Sometimes the power of your urges, or emotional “need” for an eating disordered behavior is stronger than you would expect in view of all the insight and tools you have developed during your recovery.

I had an adult client a couple weeks ago who was going through this exact type of issue. She had a really good period of putting all the pieces of her recovery together. She had worked really hard at eating well, taking care of her emotional needs, and communicating effectively. Then, she broke up with her significant other. Although she knew the breakup was the right thing to do, she didn’t expect the intensity of the pain and loss she would feel. She went on a two week self-described “eating disorder behavior fest” that was one of the worst she had ever experienced in all the years she had had her eating disorder. She used all the eating disordered behaviors she hadn’t used in years. She said that by using all these behaviors, she wanted to numb out from all her negative feelings and she wanted to inflict physical pain on herself (with pain from behaviors) so she didn’t have to feel the emotional pain. It doesn’t matter which specific behaviors she used for the purpose of this story. In my opinion, all behaviors are painful. Wow…my heart broke for her. The situation she was in appeared to be extraordinarily triggering. When we spoke about it, she realized that the breakup brought up so many feelings she hadn’t experienced for a long time, feelings of worthlessness, loneliness, fear of being alone forever.

I tell this story because she had been free of her eating disorder behaviors but was unprepared for the breakup and subsequent feelings. She wasn’t emotionally prepared and she didn’t think she would actively need to use her healthy tools, coping mechanisms and resources. She immediately resorted to her eating disorder to cope.

This story is not designed to make you feel like recovery is not possible. It is designed to help you see that when you go through very challenging times, you need to be especially vigilant, mindful and use all your healthy tools, coping mechanisms and resources or you will be susceptible to resorting to your eating disorder.

The good news with this client is that through this rough period, she learned a tremendous amount about herself and her needs in a relationship. She learned the feelings that were extremely powerful triggers, and she learned that she needs to be very actively and regularly using her healthy coping mechanisms to prevent herself from falling into the eating disorder “pit” again. She left the appointment not only feeling relieved, but optimistic!

So why does this type of “setback” happen? Well, the answers obviously will vary person to person but there are some common threads. One reason is that when you are doing well, you may lower your defenses and take some “chances” that you wouldn’t normally take. These chances may come in the form of a challenging food situation or in the form of a challenging emotional situation. It’s during challenging times that you will be “tested” and the urges to use eating disordered behaviors may increase. Also, sometimes you may get “hit” blindsided by a situation that is beyond your control and then you find yourself unprepared. Again, this is a trigger that is very powerful and can cause you to use behaviors when you haven’t used them in a while. I also look at triggers in degrees of severity. By this I mean that when triggers are mild to moderate, perhaps you can navigate through them with relative ease and use healthy coping mechanisms, but when the triggers are moderate to severe, you may have increased urges and difficulty refraining from using an eating disordered behavior or behaviors. Specific emotions may also trigger you more than others. For example, when you are overwhelmed or lonely you may be triggered more than when you are sad or angry or frustrated.

I could go on and on about why you might be susceptible to having a setback but the important thing to remember is that recovery is a process that is like traveling on a winding road. It is not a straight line. You will have periods when you feel you are totally “fine” and then times when you struggle more. Just try to gain as much insight as you can about the circumstances surrounding a setback so that you can help prevent it from happening over and over again. A setback doesn’t mean you have to have a “fall back” or relapse.

If your expectations are that you “should” be free of behaviors after a certain period of time and effort, remember that your behaviors have been an adaptive coping mechanism that you needed when you didn’t have the healthy alternatives. Throughout the recovery process, you may have developed a tremendous amount of insight about yourself and your eating disorder but insight is only part of the solution. You will need to actively resist using eating disordered behaviors until the time when you have put all the pieces together and your healthy coping mechanisms come more naturally. Then, you need to use your new found coping mechanisms actively whenever you need them!

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Restriction vs Restraint

A client recently asked me what the difference between restriction and healthy restraint was. She suffers from an eating disorder where her eating behaviors range from severe restriction to binge eating. She rarely experiences times where her eating is comfortable, easy and pleasurable. I’ve been working with her on understanding that the periods of restriction are often followed by periods of bingeing and in order to reach the comfortable eating place, she cannot continue to give herself permission to restrict. She revealed to me that she knows no other way to avoid bingeing except to restrict. It’s “all or nothing” with her eating she says. She says sometimes it’s easier to not eat at all because once she eats she has strong urges to binge and finds it impossible to resist them.  Wow. This is such a powerful statement, yet one I have heard numerous times in the treatment of people with binge eating disorder. So, I have said to her on a few occasions that she may practice “healthy restraint” at times, because it has less of a chance of causing binge eating than restriction does. So…what exactly is healthy restraint vs restriction?

Restriction, in my opinion, is rule-driven deprivation of food that overrides the body’s natural intuitive hunger, its “starting point” for eating. It is a deliberate withholding of food despite the desire or appetite for it. It may include the withholding of overall food intake, of specific nutrients, food groups, times of day, time periods, etc. It is often painful and creates heightened obsessive thoughts of food. Restriction is quite common with individuals with anorexia, bulimia and binge eating disorder. Also there are numerous individuals who don’t have a diagnosed eating disorder who restrict their food in order to be a specific weight or size. It is not a matter of “will-power” or strength. Restriction is unnatural. It doesn’t make someone more powerful or “in control”.  It is counter-intuitive and often backfires.

“Healthy restraint” is different. It is a behavior that many healthy people engage in every day in choosing what and how much to eat. Restraint is not about rigid rules, but more about choice. It is flexible, based on the body’s intuitive cues of hunger, appetite and fullness. Restraint is a mixture of intuitiveness and choice. It is knowing you are full or you’ve had enough and then telling yourself it’s ok to stop now because you are satisfied and you can eat more later if you want to.

By giving you a couple examples, it might illustrate the difference better. Allison has an eating disorder. She fears losing control over her intake of food time and time again. She has convinced herself that she overeats every time she is in the presence of a food she likes. She has told herself that if she doesn’t limit herself from all pleasurable foods, she will overeat. She avoids numerous foods, opportunities to eat out with friends and family because she doesn’t want to binge. She keeps a very limited array of foods in her house. She has developed very strong negative feelings and opinions regarding foods other than the very select few she deems “safe” or “good”. If she eats a food that isn’t on her safe list, she is convinced she will binge. She inevitably does binge on these foods and then restricts them once again, making her theory that she can’t eat them even stronger.  On a weekend night, Allison goes out to dinner with her family. Her family orders a variety of choices off the menu. Allison orders a salad with grilled chicken, dressing on the side. She says she doesn’t like anything else on the menu. She refuses the bread that’s on the table, she doesn’t eat a dessert.  She orders a diet soda to drink. She spends the meal making small talk meanwhile she is preoccupied with all the foods everyone else is eating, telling herself they are crazy for eating those foods, the foods are horrible, if she ate one of the entrees everyone else chose, she’d go out of control, gain tons of weight and her life would be miserable. She tells herself she is much better off only eating her “safe” “healthy” salad. Yet, all the while, she really knows she loves the other foods. She wishes she could let herself have them and eat them in the amounts that “normal” people do.   When dinner is over, she feels sad, angry and deprived. Somehow she convinces herself that it was the right thing to do. A few days later, in a “moment of weakness” while at the grocery store, she buys a box of cookies along with the other groceries. She barely gets the car door closed when she rips into the bag of cookies and eats half the box before she makes it home. Clearly, in this instance, Allison experienced restriction which led her, in part, to rebound binge on cookies. Not to say that restriction always leads to bingeing or that there aren’t multiple causes for bingeing but restriction is NOT a positive or natural behavior.

Robin also has an eating disorder. She has spent months trying to achieve structure in her eating by eating three solid meals a day and eating exactly what she desires at each of these three meals. Her breakfasts are not the traditional breakfasts. She prefers dinner foods for breakfast. She no longer follows her old restrictive rules. She listens to her intuitive side and eats well. On an occasion recently, she was invited out to lunch with several friends. As they were ordering, she listened to the women all speaking about what foods they wouldn’t order off the menu, how they would never eat “this or that”. They all ordered salads. When it was her time to order, she ordered a hamburger and fries. They all looked at her like she was crazy. She told them she wanted the burger. She had to listen them all comment how bad her choice was. Lunch arrived and she proceeded to eat her burger and fries with gusto. About ¾ of the way through her meal, she was comfortably full. It tasted delicious and she told herself that she could have eaten the whole burger and all the fries, but she decided that she had eaten enough to satisfy her and if she wanted a burger and fries again for dinner or the next day for any of her three meals, she would have it. There was no “need” to eat it all at lunch and push past the feeling of being satisfied into feeling “overfull”. She was exhibiting healthy restraint because she offered herself the choice to have it all or have it again whenever she wanted it next. This took the power away from the food and enabled her to use her intuitive skills to determine when to stop.

Now, some people truly don’t have intact intuitive skills like this so they must look at their plate of food and make sure they don’t stop prematurely, before they feel they are truly satisfied or eat it all simply because it is there. They want to go into the meal with an open mind instead of a restrictive, diet mindset or a “rebound” mindset. If they aren’t mindful, they may end up eating less than they need or more than their body wants them to.

Just recently a mom came in with her teenage son (who was not diagnosed with an eating disorder) to my office. She wanted to discuss why her son gained a significant amount of weight in only six months. I asked her what the food was like in her house. She said that she never keeps “junk food” in the house because every time she does, her son eats it all and exhibits no control over it. Also, whenever he’s at his friends’ houses, he overeats on cookies and soda. I asked him if he felt deprived of these foods so whenever he got the chance, he would take the opportunity to overindulge on them? He looked at me with a sigh of relief and  began to cry because I had said exactly how he felt. He was restricted from having these foods at home and that set him up for craving them all the time. His mother agreed to have an abundance of these foods at home from now on and to never let them run out. He agreed that he would try to take the power away from these foods. I have seen examples of this type of power struggle over food many, many times. The people who have had foods withheld from them are those who often have strong cravings for them. On the other hand, it’s those who have abundance and variety of foods to choose from who are often those who do not feel deprived and therefore can choose foods without the emotional “tug of war”. In time, this teenage boy will be able to have a wider variety of food preferences. He will most likey choose “junk foods” sometimes and other types of foods sometimes. He will be able to exhibit healthy restraint because his preferences will change and be based on intuitiveness and choice rather than restriction and rebound craving.

Note:  I want to emphasize that many individuals who are in the throws of their illness or who are in early stages of recovery may not be able to differentiate between restriction and healthy restraint and therefore must ask their treatment professionals if it is a skill they can work on together. It is easy to convince yourself you are exhibiting restraint when in actuality, you are restricting. This especially would not be a skill that would be appropriate for the early stages of recovery from anorexia.

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Commitment

You may have noticed I haven’t posted anything in a few days. I was trying to understand why I haven’t been inspired for a few days and I just realized that I have been overwhelmed by work and holiday preparations. What I also realized is that I have made a personal commitment to you all to support you through this blog and I will not let you down!

So, this post is about commitment…I am committed to you, but I also want you to be committed to you!

What does it mean to commit?

According to the dictionary, to commit is:

1. to give in trust or charge.

2. to consign for preservation: to commit ideas to writing; to commit a poem to memory.

3. to pledge (oneself) to a position on an issue or question; express (one’s intention, feeling, etc.)

4. to commit oneself to a promise; to be committed to a course of action.

5. to entrust, esp. for safekeeping; commend: to commit one’s soul to god.

Many of you are committed to your work, your studies, your family or friends. But, are you committed to yourself and your recovery? Are you committed to your goals to stay healthy in mind and body? I want you all to commit with the utmost pride to yourself, and never ever give up on yourself or your recovery! Get the support you need, write your recovery goals down and look at them every day! When you have a bad day, pick yourself up and start again. When you are struggling, ask for help! When you are doing well, celebrate! Each and every one of you deserves to be well and to see the life you are meant to have, free of your illness!

The person who makes a success of living is the one who sees his goal steadily and aims for it unswervingly. That is dedication.  ~ Cecil B. DeMille

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Holiday Parties with ED

Holiday parties can be stressful for people who suffer from eating disorders. Below are my top 10 ideas to help you negotiate through some of the difficulties you may face. Ultimately, it’s important to prioritize your self-care during the holiday season and try to make it as stress-free as possible.

  1. Try to stick with a routine of eating as often as you can. This doesn’t mean restriction; it means a comfortable yet structured way of eating…a routine. If you need to attend a party or family function, eat as normally before it as possible so that you stay as “regulated” as possible.
  2.  Before you go to any type of party, get as much information about it in a advance as possible, including what will be served, how it will be served (ie: buffet or sit down dinner) and when. This way, you can mentally prepare yourself for the food aspects.
  3. If need be, bring something with you that you are comfortable eating. Bring enough for others to share with you. It could be an appetizer, side dish, or comfortable dessert. The hostess will think you are very thoughtful and you will be more comfortable with that particular food.
  4. Inform a trusted person in advance that you may need their help during the party. Ask them to help you if you need it. Develop a “signal” that only the two of you know that means you need them. It may be that you need their help in an awkward social situation or with a food issue.
  5. Never go to a party or event overly hungry. Excessive hunger will heighten obsessions about the food and may cause you to feel “out of control”.  Again, eat on a regular schedule the day of the party.
  6. In terms of the food, do the best you can at the party. Remember, it is one meal of one day. Try not to catastrophize what you eat or how much you do or don’t eat while at the event. Once you leave the party, move past it. Try not to dwell on what you did or didn’t eat.  Once it’s over, it’s over.
  7. Spend as much or as little time at a party as you feel comfortable with. Because social events can cause anxiety for numerous reasons, plan your time according to your comfort level.  Also, try to have flexibility built into your plan in case you want to stay longer or shorter than initially planned.  
  8. Try to remember that the food is only one aspect of a party. There are other aspects that you may want to focus on. There may be one or more people there that you’d love to catch up with. There may be kids who you can play with to give their parents a break. There may be elders there who would love to share stories with you. 
  9. If someone comments to you about your eating, weight or size, try to immediately change the subject to something related to them. People like to talk about themselves. Take the focus off of you and put it onto them. For example, if someone says “Wow! You look like you lost (or gained) weight.” You could say “More importantly, how are you doing? What’s new in your life?” Also, try to realize that people who don’t understand eating disorders don’t realize that discussions about food and weight are very personal. They are usually just curious. Put a mental “protective barrier” around yourself and don’t let comments penetrate it.
  10. After a party is over, get back to your routine. End the day on a positive note. Give yourself a “pat on the back” for doing the best you could.

 

These are just some of the things you could do to make holday parties less stressful for yourself. Do you have any tips and tricks on coping with stressful holiday functions?  I’d love to hear your suggestions.

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