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Recovery from an Eating Disorder: A Journey

Recovery from an eating disorder is possible!Recovery from an eating disorder, like life itself, isn’t a race. As long as you look at recovery as a continuum, rather than a single destination or a cure, there is plenty of reason to hope. Recovery’s leap of faith eventually blossoms into a willingness to explore new places in yourself, relationships, and your world. Some steps on the journey are slow and tentative, others come more easily-but each can be taken only one step at a time. Recovery is progress, not perfection, and that is the formula that holds the real promise of peace. Recovery is hindered when you judge yourself harshly by someone else’s progress; your problems are the only ones you can ever fully understand- and that itself is a challenge. On the other hand, a healthy comparison with someone doing well in recovery can inspire you and show you that recovery is achievable.

Recovery is not a result of choices among alternative paths offered by the present, but a path that is created -created first in the mind and will, and created next in behaviors. The path to recovery is not some place you are going to eventually reach, but one you are creating with each step you take. The paths are not to be found, but made, and the activity of making them changes both the maker and the destination.

There are often times in the process of recovery when you may tell yourself you have had a “bad” day after one single incident or event. This negative thought leads you into a cycle of self-defeating thoughts and behaviors, which transform the “bad” incident into a bad hour, day, or even week. Try to look at your slips in recovery as bad moments, not bad days. For every bad moment you have during the day, think of a positive moment you had during the day. You will find that you may not have really had a bad day at all, just a day filled with good and “not so good” moments.

Time Management in Eating Disorder Treatment

The Monday Morning Blahs and the Sunday Night Blues

Do you ever have the “Sunday Night Blues” or the “Monday Morning Blahs?” Do you find yourself living and working for the weekends? It is important to find joy in the journey and incorporate some pleasurable activities, such as enjoyable hobbies during your weekdays, so that you can mange your stress. Pick up a copy of your favorite author’s new book on a Tuesday evening or spend the evening browsing the bookstore and buy yourself a latte and a  biscotti. Establish a movie night where you watch movies and order take-out and lounge in your pajamas.  Thus, improving your time management and scheduled events improves your stress management.

time-managementIndividuals who know they have some control over their time management usually have less stress. One way to be in control is to incorporate more Type B personality traits into your lifestyle. Incorporating a more laid-back attitude will help safeguard your mental and physical health as well as replenishing yourself with leisure time such as taking time for yourself each day. Plan an occasional mental health day, such as a day of vacation during which you pamper yourself with a long walks, a facial, a massage, or playing with your frisky kitten, or just relaxing in your robe and slippers all day and watching old movies.

Identify your personal stressors by completing a stress inventory such as the Stress Map by Essi Systems. An inventory will pinpoint areas that are creating stress and will educate you on how to manage your stress more effectively. Examine your assessments and the charts. Identify areas that are particularly stressful for you and design a plan on how you will introduce change and be proactive. Learn to become more assertive and less aggressive in your communication style.

When people are assertive, they usually get their requests and needs met more often than when they are aggressive. One becomes assertive when one stands up for their rights in such a way that the rights of others are not violated. Eleanor Roosevelt once said, “No one can make you feel inferior without your consent.” Assertiveness implies that one can state their preferences without using accusatory statements that may be interpreted as blaming the other party. “I” statements such as “I would prefer to see the comedy instead of the drama. Assertive people express themselves without being self-conscious, accept compliments in a comfortable manner, and respectfully disagree with someone regarding an issue. Learning to say no and clarifying issues is also another manifestation of being assertive. WOMEN QUOTE: “The sign of a true lady is learning how to decline a dinner invitation without making an excuse.” One can be very gracious and say something along the lines of  “thanking for thinking of me, but unfortunately, I will not be able to join you” instead of “ I have to wash my hair and do my nails on Saturday.”

There are four basic interpersonal styles of relating to others:

  • aggressive style
  • passive style
  • passive-aggressive style
  • assertive style

The aggressive style is where one may raise their voice inflection and make demands and accusatory statements and the individual often does not consider the feelings of others. This particular interpersonal style often alienates others and is counterproductive. The passive style is where one does not communicate their needs or preferences and will often times acquiescence to avoid making waves. Girls who develop anorexia nervosa are often times very passive because they want to please others and do not want to ruffle anyone’s feathers by being assertive. Lastly, passive-aggressive is a style of relating in interpersonal relationships whereby one attempts to induce guilt or “pay back” another person by passively doing something to hurt that other person. An example would be to give someone the silent treatment because you are angry with them but you cannot find a way to express your anger in a direct manner.

Change stressors, such as moving across the country, starting a new job, or building a new home, are extremely challenging. Remember to allow yourself time to adjust to the changes, and try not to introduce too much change at one time. For instance, do not change to a new school system, train a new puppy and experience a breakup in a relationship in the same month.

Kindness and Self-Respect

Loving kindness: genuine care and appreciation for the well being of another; a respect for everyone’s values. This is a worthy concept and also one that seems almost impossible at times. For people struggling with eating disorders, personal loving kindness is almost non-existent. That’s why it is so important to initiate this practice toward others so we can learn to translate it to ourselves. But practicing loving kindness should not just be saved for our favorite people. The true practice is offering this to those who irritate, frustrate and anger us—the people we have the most difficulty loving. Having patience with others allows space for separating people from their actions. Loving someone for who they are rather than what they do means honoring a person’s strengths and forgiving his or her weaknesses. By doing this we start to accept that we are all human, and it is this alone that makes us deserving of love. Once people struggling with eating disorders have mastered loving kindness toward others in their lives, it will be easier to practice the same self-respect. If we can recognize other peoples’ soul selves, we will then have the tools to recognize our own. We will start to understand that even though we have flaws, make mistakes, and aren’t perfect, we are lovable and worthy. We will know that souls have worth, not bodies. When we begin to shower ourselves with loving thoughts, kind and loving actions will follow.

Practice Kindness in Eating Disorder Recovery

One concept is called truth without judgment, and loving kindness speaks to this idea. Separating judgment from our true feelings and thoughts allows for deeper respect and more honest communication, which in turn, makes room for more love. When we are able to speak our truth in a kind manner, we can honor all people for their being and not their doing. We can value someone for their own sake regardless of how they are or aren’t towards us. And for those struggling with eating disorders, we can show that truth without judgment and true loving kindness begins in our relationships with ourselves. As we love ourselves, we can resolve personal conflicts and make way for global respect.

Narrative Therapy

Narrative therapy involves exploring the shaping moments of a person’s life, the turning points, the key relationships, and those particular memories not dimmed by time. Focus is drawn to the intentions, dreams, and values that have guided a person’s life despite the set backs. Often times, the process brings back stories that have been overlooked–surprising stories that speak of forgotten competence and heroism.narrative-therapy

Narrative therapy consists of understanding the stories or themes that have shaped a person’s life. Out of all the experiences a person has lived, what has held the most meaning? What choices, intentions, relationships have been most important? Narrative therapy proposes that only those experiences which are part of a larger story will have significant impact on a person’s lived experience. Therefore, narrative therapy focuses on building the plot which connects a person’s life together.

Here are some basic principles of Narrative Therapy:

•    The primary focus is on people’s expressions/stories of their experiences of life.  People have the ability of telling and re-telling their personal preferred stories.
•    Expressions are in a constant state of production, and these productions are transformative of life.
•    Stories guide how people act, think, feel, and make sense of new experience. Stories organize the information from a person’s life. Narrative therapy focuses on how these important stories can get written and rewritten.
•    If narrative therapy had one slogan it would be: “The person is never the problem, the problem is the problem.”
•    Finally, the most important principle is that a person’s life story is a “work in progress” full of the multiplicity of possible answers.

Quotes:

“We are all in the process of becoming.”  -Audre Lorde  (1934-1992); Writer, Poet, Activist

“There is no greater agony than bearing an untold story inside you.” – Maya Angelou

“Your living is determined not so much by what life brings to you as by the attitude you bring to life; not so much by what happens to you as by the way your mind looks at what happens.”
-Kahlil Gibran, (1883-1931); Artist, Poet, And Writer

“The unexamined life is not worth living.”  -Socrates

Healthy Beginnings Have Happy Endings

“There is more difference within the sexes than between them.” Ivy Compton-Burnett

The objective will be to focus on relationships or Eating Disorder Inventory III scales for this chapter such as fear of intimacy, body dissatisfaction, binging episodes, and drive for thinness. Both men and women have a strong need for an intimate relationship and longevity through partnership. When people have intimacy in their relationships they feel less alone and more secure and confident. Knowing you have a strong support system to turn to in times of need provides important feelings of security, optimism, and hope, all of which are great antidotes to stress.

Healthy RelationshipsHowever, one of the most profound relationships an individual can develop is the relationship with oneself. Most individuals begin a relationship without examining their own values, ethics, and ideas. If an individual brings too many emotional needs or
baggage to the relationship it could be overwhelming for the other person. Consequently, the emotional dependency could result in emotional distance in the relationship.

More specifically, many patients who develop a formal eating disorder often socially isolate from others and they are dissatisfied with their interpersonal relationships. In addition, building intimacy is very challenging and may create emotional distancing. Furthermore, one may often avoid important events such as high school reunions due to their shame and embarrassment about their body image. Similarly, one may avoid becoming sexually active with their partner due to body shame. This chapter encourages readers to adopt personal autonomy and to build positive self-esteem prior to the commencement of any type of a relationship.

Initially, if one partner fosters positive self-esteem it attracts another partner who also has positive self-esteem. However, if one partner has low self-esteem they may also attract a partner who has low self-esteem.  Once the relationship has developed and one partner begins to build their self-esteem, it often threatens the other partner and results in conflict. Moreover, self-esteem and body image are strongly correlated for women. For example, the higher one’s self-esteem, the more accepting one is of their body image. Therefore, if one day your jeans are too tight or your weight goes up on the scales, it does not affect your self-esteem as much if you have positive self-esteem.

Is It Worth Dying For?

A recent commercial including all males portrays an interesting perspective on how obsessed Americans have become with their body image. In essence, it conveys the message that one’s clothing size will not determine one’s self-worth. Americans in general long for a healthier and improved body image. As an example, a recent study showed that 56 percent of women and 43 percent of men were dissatisfied with their overall appearance, and two-thirds of the women and over half of the men were dissatisfied with their weight. Empirical research indicates that males have a more positive body image than females.  Adolescents were especially uncomfortable with their body image and as many as 62 percent of this population expressed body image dissatisfaction.

Moreover, women expressed the most dislike for their hips and abdomen; for men, their chest and abdomen. However, the number one concern was their weight. In fact, weight was so closely linked to personal happiness that when asked if they would trade years off their lives to be thinner, 24 percent of women and 17 percent of men said they would give up more than three years.

Psychopathological concerns with body image or becoming obsessed with one’s body, weight, or image may result in a formal eating disorder. Clearly, body image distortion or a drive for thinness are symptoms that develop with eating disorders such as anorexia nervosa or bulimia nervosa which are both recognized as psychological disorders in the Diagnostic and Statistical Manual  (DSM-1V), published by the American Psychiatric Association.

The diagnostic criteria for anorexia nervosa is as follows: a refusal to maintain body weight at or above a minimally normal weight for age and height, intense fear of gaining weight or becoming fat, even though underweight, disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight, and in postmenarcheal female, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles.

The diagnostic criteria for bulimia nervosa is as follows: recurrent episodes of binge eating which is characterized by  eating in a discrete period of time an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances or a sense of lack of control over eating during the episode, recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. In addition, the binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

Self-evaluation is unduly influenced by body shape and weight and the disturbance does not occur exclusively during episodes of Anorexia Nervosa.

More recently the research criteria for binge-eating disorder has been addressed as well. The following issues are being explored as a diagnostic criteria: recurrent episodes of binge eating as described previously with bulimia nervosa, however, the binge-eating episodes are associated with three or more of the following:  eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of being embarrassed by how much one is eating, and feeling disgusted with oneself, depressed, or very guilty after overeating. A marked distress regarding binge eating is present. Lastly, the binge eating occurs, on average, at least two days a week for six months and is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of Anorexia Nervosa and Bulimia Nervosa.

Clearly, the aforementioned clinical diagnoses are more common in women than in men and at least 90 percent of the occurrences are actually in the female population. Death most commonly results from starvation, suicide, or electrolyte imbalance. In conclusion, would you actually die to have the perfect body? Get help for anorexia, bulimia and binge eating disorder. Call Walker Wellness today at 877-899-7254 to start your journey to wholeness.

Eating Disorders and Middle-Age

Eating Disorders in Middle Aged WomenEating disorders are typically considered an illness that affects young women in their teens and early twenties but in recent years, there has been an increase of eating disorder cases, particularly Bulimia Nervosa, among middle-aged women.  Bulimia nervosa, which is defined DSM-IV, is characterized by recurrent episodes of binge eating, and recurrent inappropriate compensatory behavior in order to prevent weight gain. Binge eating is the consumption of a large amount of food in a short period of time. The binge is associated with a feeling of loss of control and it is often followed by the compensatory behavior of purging. Classically, purging is considered to be vomiting; however, it may take the form of laxative, ipecac, diuretic, or enema abuse, excessive exercise, or periods of fasting. The binging and purging behaviors must occur twice weekly for 3 months to meet diagnostic criteria. Preoccupation with body shape and size accompanies the disease. Like anorexia nervosa, bulimia nervosa is also divided into 2 subtypes: (1) the purging type, in which the patient uses laxatives, diuretics, and/or vomiting to empty herself of the food, and (2) the non-purging type, in which she follows her binge with excessive exercise and/or fasting.

According to an article from the International Journal of Eating Disorders (1998), which surveyed 1,053 women ages 30-74, found that 71% in this general population sample expressed dissatisfaction about their weight. In a similar study, The Journal of Women & Aging (2004) surveyed over a thousand women aged 54 and found that 80% of them had body dissatisfaction. Nationally, eating disorder treatment centers are reporting an increased incidence of middle-aged women patients. Experts estimate that in this past decade, there has been a 40% increase in admissions for women over 40 in facilities nationwide.

There are several possible explainations for the increase in cases, which include increased awareness of eating disorder symptomology and more accurate diagnostic criteria. Additionally, certain life events that are specific to middle-aged women such as death of a loved one, divorce, loss of a job compounded by the natural changes to an aging woman’s body could be triggers to the onset or recurrence of an eating disorder.

The treatment for eating disorders in middle age must be tailored to the patient’s specific life circumstances and challenges. At the Walker Wellness Clinic, we incorporate a comprehensive team approach in working with psychologists, licensed professional counselors, clinical dietitians, adjunct therapist (i.e., art, music or sand-tray therapist), and exercise physiologist. Our mental health professionals also incorporate Psychological Testing, Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and a Family Systems Approach to treatment. Our eating disorder treatment program is clinically tailored to meet individual needs and provide patients with the skills that they need to lead more healthy, productive lives.

Psychological Testing in the Treatment of Individuals with Eating Disorders

By: Susan E. Justitz, Ph.D.

What is the clinical rationale, purpose, and importance for using assessments with those with a formal eating disorder?

Psychological Testing and Eating Disorder TreatmentPsychological testing can be extremely valuable during all phases of psychotherapy. Psychological testing first off allows for us to realize the patient’s baseline psychological functioning. It further allows for us to periodically measure traits and see the progression of these traits throughout the course of therapy.

In addition to helping monitor progress, personality testing also allows for us to identify common features or characteristics that patients with an eating disorder tend to struggle with. Identifying personality traits that might be making treatment or recovery more difficult are discovered and analyzed. Awareness is brought to the patients’ attention so they may be conscious of when these traits are interfering with recovery. Further, highlighting aspects of their personality that can be heightened and help with recovery are noted and patients are encouraged to rely heavily on those traits.

What personality traits do you typically see in the results for those with an eating disorder?

Those with an eating disorder tend to have a high degree of perfectionist traits. They typically are very rigid in their thinking. They also tend to isolate and withdraw when struggling with their eating disorder. They may at times show passive aggressive characteristics and they are frequently very non-confrontational. Being driven by a need to please is also another common characteristic. Patient’s personalities can heighten some of these traits and thus affect their mood. For example, a patient may naturally be very extroverted but their eating disorder is making them want to isolate and withdraw. Once pointed out to a patient that some of their unhappiness is simply missing time with friends, patients may focus on regaining that aspect of their personality, which often does not seem as overwhelming of a task as other things.

What type of clinical diagnosis or co morbidity diagnoses do we find for patients with an eating disorder?

It is very common for those with a formal eating disorder to also have coexisting issues with depression, anxiety, and obsessive compulsive traits. Obtaining a grasp of the degree one is struggling with obsessive compulsive disorder, for example, can help us tailor their treatment program in such a way that helps reduce or eliminate their obsessive thinking. Learning stress management techniques is another vital component of treatment for our patients, and even more so for someone presenting with a high degree of anxiety. We understand that many people turn to an eating disorder as a means of coping with anxiety. If we assess anxiety and eating disorder symptoms separately, we obtain a clearer understanding of how treatment is progressing. Similarly, depression symptoms vary greatly yet some are directly related to an eating disorder. Acquiring insight as to how depressive symptoms and eating disorder symptoms coexist can provide vital information as well and help direct specific treatment interventions.

Why does WWC offer learning disability, ADHD, and ADD testing for those with an eating disorder?

In addition to standard personality testing, Walker Wellness Clinic also offers testing in the areas of learning disability identification and attention deficient hyperactivity disorder. These services are available to our patients with formal eating disorders, but they are also available to the general community. We often find many individuals struggle with the transition from middle school to high school or high school to college. In some instances an undiagnosed learning disability or issues with ADHD is the culprit. Without formal diagnosis, individuals’ self esteem and academic performance suffers. We find that early detection of these areas along with academic modifications can help individuals stay positive, motivated, and successful in the scholastic endeavors.

 

Eating Disorders – It’s a Family Affair

Over 24 million individuals struggle with disordered eating; of those, about 8 million have a formal eating disorder. Ninety percent of them will never seek treatment. And of all mental illnesses, eating disorders have the highest mortality rate. Eating disorders are a growing area of concern, maybe in part because there is more media attention or more research dollars, but treatment options are still hard to come by.

Eating disorders are very complicated to understand and no one ever faces an eating disorder alone. Although individuals struggling with eating disorders tend to isolate, they are very much part of a family system that, knowingly or not, affects the patient’s recovery.  Because those struggling with an eating disorder tend to feel a lot of shame and guilt, it is often challenging for them to talk about this problem. Asking them to invite their family in for a session is even less appealing. I find of all treatment modalities, family therapy is often met with the most resistance – by the patient and by the family. Understandably, it can be an incredibly anxiety-provoking experience, but yet we know that family therapy is an integral part of one’s recovery from an eating disorder.   In fact, a recent study by Stanford University’s School of Medicine reported that family based therapy can be as much as two times as effective as individual therapy alone.

Family Therapy in the Recovery of an Eating DisorderA family system is fluid and dynamic and ever-changing. Understanding one’s role in the family and one’s relationship to others in the family can be a critical component in the healing of the family. Family therapy can help identify negative aspects of relationships that may be contributing to the individual’s eating issues. Families are not in attendance to be blamed for the patient’s problems, but rather to help the therapist understand how the family operates, communicates, and faces adversity. It allows them to gain much needed skills to better recognize and communicate with the patient. Family sessions focusing specifically on cognitive distortions of the patient can leave the family members feeling empowered and more skilled at recognizing when the patient may be in crisis or in need of support.

Family therapy can also help educate family members on specific triggers being faced by the patient. While there may be some commonalities among patients, most individuals have different triggers, different distortions and different reactions to stressors. Helping the family understand the eating disorder that is specific to their family member is incredibly helpful. After family therapy sessions, I feel families are more likely to try to discuss what each other is thinking and feeling. Through family therapy sessions, all members gain valuable skills to help express what they are thinking and feeling. Communication lines are opened rather than shut down. The feeling of ‘walking on eggshells’ is dispelled.

Family therapy can also provide a much needed venue for the family members to realize and express how the patient’s eating disorder has affected their lives and their mental health. Family therapy can provide a safe environment for families to understand that they are all likely sharing the same fears, concerns, and worries even though they may be expressing them differently. When family members feel heard and validated, they are more likely to want to be involved in the process.

Another great outcome of family therapy can be educating the family on the stages and requirements of recovery. Many areas associated with recovery, for example nutrition and exercise, have many myths associated with them. Family therapy can help extinguish some of those myths and puts the family in line with the treatment team members. Once everyone has the same information and is on board with treatment expectations, the patient feels more consistent support.

In summary, recovery from an eating disorder is not an easy process. Every tool in the toolbox needs to accessed. Family therapy is just one of those tools, but it is an incredibly necessary part of the process. Every family will have different family therapy needs and therefore the process will look different for each family. However, if the family approaches the patient’s eating disorder recovery with an open mind and a willingness to participate, recovery is much more likely.

Cool As A Cucumber!

Career issues create stress for both genders. Women are currently forming small businesses at twice the rate of men, which is good news for women’s career development. The bad news may be that women are faced with more stressors at home and work. Women may often feel they have a second job that begins when they arrive home from work. A Swedish study of men and women automobile plant managers between the ages of 30 and 50 showed that the blood pressure and levels of stress hormones went up for everyone during the workday. Interestingly enough, at the end of the day blood pressure and stress readings dropped dramatically for men, while the women, who reported more tasks to perform at the end of the day, still had high readings, even at home. Women report they are more sleep deprived than ever before, because they cannot complete all of their chores and commitments. In summary, is a woman’s work is ever done?

Stress often creates medical problems for men, simply because they wait too long to address the issue. Only 20 percent of the people enrolled in stress management programs are males. The major health problems facing men today, such as heart disease, high blood pressure, stroke, cancer and even impotence have all been linked to stress. However, studies are showing that personality traits play a major role in one’s stress level whether you are a female or a male. More women are starting to wear many hats and assume new roles in their personal and professional life such as becoming a chief executive officer of a company or adopting children as a single mother.

The majority of men and women have either Type A or Type B personalities. Type A personalities are more prone to heart disease. They have higher stress levels, are more obsessive-compulsive, and are more easily provoked to anger and hostility. On the other hand, Type B personalities are laid back and are not as likely to have heart disease. They exercise better anger control. Perhaps because men tend to see relaxing as a time-waster, many of them are overachievers and highly competitive, all characteristics of Type A personality, and Type A personalities are more likely to have higher stress levels. In fact, women who develop an eating disorder typically have a higher IQ than the general population and they are more genetically predisposed to be more achievement oriented, and perfectionist. Therefore, they are more at risk to have higher levels of stress, anxiety, and depression.  A winning solution would be to develop a Type C personality, where you incorporate the best of both Type A and Type B, but you learn to relax and maintain a balanced lifestyle. You can learn to work hard, reach high levels of achievement, and also feel laid back and as cool as a cucumber!

 

 
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