Loneliness and eating disorders

This article examines the link between loneliness and eating disorders. This concept is evaluated through a systematic review of the literature that links loneliness and eating disorders and through a survey of themes connecting the 2 conditions. Eating disorders-including anorexia nervosa, bulimia nervosa, and eating disorders that are not otherwise specified, which include binge eating disorder-are challenging health issues. Each of these diagnoses specifically relates to loneliness. This negative emotion contributes to and fuels eating disorder symptoms. Negative interpersonal relationships, both real experiences and individuals’ skewed perceptions, exacerbate eating disorders and feelings of loneliness. Characteristics that have been associated with loneliness clearly relate to eating disorders. Understanding this relationship is vital, so that we can appreciate our patients’ struggles and work to target these intense emotions within the treatment setting. We need to be aware of the power of loneliness as it applies to individuals in general and specifically to those struggling with disordered eating.

(Source: ncbi.nlm.nih.gov)



What’s Behind the Dramatic Rise in Childhood Eating Disorder Hospitalizations?

One shocking recent statistic, released by the American Academy of Pediatrics in fall 2010, is that from 1999 to 2006, hospitalizations for eating disorders increased sharply - 119% - for children younger than 12 years old. The academy also noted significant increases in prevalence of eating disorders among minorities and males.

I spoke to Ovidio Bermudez, MD, medical director of child and adolescent services at Denver’s Eating Recovery Center and a board member of The National Eating Disorders Association(NEDA). The 119 percent rise in hospitalizations for such young children, Dr. Bermudez said, is “likely to be a good proxy for a rise in incidence,” meaning that as incredible as it sounds, it probably accurately reflects the increase in the number of kids under 12 who are suffering from eating disorders, especially, as Dr. Bermudez points out, when you consider how carefully third-party reimbursing organizations scrutinize hospital stays, and how reluctant they are to okay them.

The reasons for this scary rise in children’s hospitalizations, says Dr. Bermudez, are complex, the result of a variety of forces that have created a “perfect storm very likely related to changes in the environment and changes in people’s experience.”

Here’s how Dr. Bermudez believes this “perfect storm” has taken shape: Imagine that we can divide children our society into two groups, one that is genetically protected from eating disorders (meaning they have no family history of them), and another that is “genetically vulnerable” (meaning there is a family history of such disorders). Suppose a child in the latter group grows up in a “protective environment,” let’s say where there is no dieting peer group, no obsession with fashion and popular culture, or perhaps no obsessively dieting parents. Such a child is not likely to develop an eating disorder. “If that environment is altered and becomes a ‘promotive environment,’” explains Dr. Bermudez, “even someone who is more genetically protected” might be affected. The child who is really going to be adversely affected, though, and who is most likely to develop an eating disorder is the genetically vulnerable child exposed to the promotive environment.

Dr. Bermudez speculates that what we’re seeing now is a cultural shift from a “protected” environment to a “promotive” environment and notes, “in a lot of ways we’re seeing the same thing in other areas: childhood obesity, diabetes, and respiratory illnesses. My sense is that we are changing, the earth is supporting seven billion of us and that brings all kinds of added challenges, not only from a physical, and environment standpoint, but from an emotional and socio-cultural point of view.”

Dr. Bermudez cited 2010 findings from the American Psychological Association’s annual Stress in America, survey, which found that the number one stressor on families is their financial situations, and that nearly half of all children reported feeling saddened or worried about family problems. He calls it “stress by proxy,” meaning that kids “are not living the financial difficulties to the extent that their parents are, “but they were picking up the stress because we don’t live in isolation.” He adds, “the world in general, is becoming a more stressful place to grow up, in. Everyone has access to mass media and there are things being promoted that aren’t healthy, about body image, fitness, about the tolerance of violence…..and we know that exposure matters.”

In addition to be bombarded by potentially triggering mass media messages, kids face other challenges: “social competition, pressure to perform, to be multitalented, and engaged in so many things,” adds Dr. Bermudez. The pace of change and the level of tension in our society, he believes, are creating a culture that’s very difficult for our kids to get a stake in.” The message: “If you’re not a super go-getter, you may not make it,” and not everybody takes that message well.

So what can parents do? “First of all,” says Dr. Bermudez, “alleviate stress for yourself, and for your family. Maybe you do with less: work two jobs instead of three, and take care of yourself in appropriate ways.” (The American Psychological Association Stress in America report notes that managing stress levels, eating right, and getting enough sleep and exercise are key.)

Another thing: “Without kind of pushing your kid outside of the space within the bell curve, you want your kid to skew toward the side of less intensity, and fewer expectations of immediate performance.” When he speaks, Dr. Bermudez tells audiences, “I’m so grateful that a good chunk of my childhood was in Cuba, playing in the streets and flying kites…I didn’t take any lessons…now kids take everything, and if they’re not doing that, they’re out of the mix.”Instead of trying to cram in sports, arts, academic and enrichment programs all at once, Dr. Bermudez suggests rotating them “rather than all of them all the time at all costs.”

Another way you can help counteract an increasingly “promotive” environment is to, as Marcia and I advise in our book, model healthy attitudes and behaviors when it comes to food, eating, shape and size, and make exercise an enjoyable and regular part of your lives.

(Source: psychologytoday.com)



Dopamine and its effects on hunger

Dopamine deficiency tends to suppress hunger, and not spur motivation to eat, according to this interesting paper.

Is overeating due to too much dopamine or to too little? The dopamine deficiency hypothesis of obesity and drug addiction posits that suppression in dopamine signals (such as from D2 receptor downregulation) reduces reward pleasure and hence drives an addict or obese person to overconsume in order to chase normal levels of hedonic reward. However, alternatively, the incentive salience hypothesis suggests that dopamine mediates reward ‘wanting’ but not ‘liking’, and that overconsumption is more likely to be driven by dopamine sensitization. That idea suggests that dopamine reduction will usually suppress motivation, not enhance motivation (and that D2 downregulation observed in obese or in addicts might be usually the consequence of overconsumption rather than its cause). 

Here, Hardman and colleagues tested these two ideas by suppressing dopamine in normal men and observing whether it enhanced consumption (consistent with reward deficiency hypothesis) or reduced the desire to eat (incentive salience hypothesis). Relative dopamine levels were suppressed via acute tyrosine/phenylalanine depletion (ATPD), which means administering a dietary amino acid cocktail that produces relative reduction in dopamine synthesis compared to other neurotransmitters. Dietary dopamine depletion reduced hunger ratings in the participants and produced a marginal decline in intake (effects that are the opposite of those predicted by the reward deficiency hypothesis but consistent with the incentive salience hypothesis). Liking and monetary value ratings for foods were not changed. Hardman and colleagues suggest their “findings are consistent with the notion that dopamine mediates wanting (i.e. appetite/incentive motivation), and that this is a distinct neural mechanism relative to systems that underlie liking”.

(Source: f1000.com)



Red flags: How to spot ineffective eating disorder therapy

I have blogged before about how to choose a good therapist. In this post, I will approach the therapist selection / retention issue from the opposite side – how to spot a bad therapist. Please note that many bad therapists are very good people with good intentions. People do not become therapists for money, fame, or the recognition – most of them genuinely care about people and want to help them. By “bad therapist” I mean “ineffective therapist.”

It seems that there are quite a few ineffective therapists who treat eating disorders (ED’s), and this is particularly dangerous given thatEDs have such a high mortality rate and are associated with many medical and psychiatric complications.

I have had the privilege of working with many ED patients and families who have received ineffective or actively harmful treatment in the past. In talking with these patients and families about their prior treatment experiences, I have come to recognize many red flags that are very commonly associated with ineffective or harmful ED treatment.

Red Flags re: Etiology
1.) The professional informs the patient or family that the ED is “not about the food.”
2.) The professional informs the patient or family that the ED “is about control.”
3.) The professional is not knowledgeable about
 recent science regarding the etiology of EDs.
4.) The professional emphasizes psychosocial “causes” of EDs (e.g., family dynamics, societal pressures, identity issues) while ignoring, discounting, or minimizing the genetic and biological underpinnings.

Red Flags re: Family
1.) The professional blames the parents (either subtly or overtly) for causing or “contributing to the development of” the patient’s ED.
2.) The professional advises the parents: “Don’t be the food police.”
3.) The professional does not keep parents of minor patients (< 18 years) fully informed and actively involved in their child’s treatment.
4.) The professional views parents with suspicion or keeps them at arm’s length, without reasonable cause.

Red Flags re: Treatment
1.) The professional is not knowledgeable about evidence-based treatment for EDs.
2.) The professional cannot, or does not, explain the treatment method she uses and / or the rationale behind it.
3.) The professional recommends or allows individual psychotherapy without ongoing nutritional restoration, weight restoration, and medical monitoring.
4.) The professional is very interested in exploring “underlying issues” in an acutely symptomatic patient.
5.) The professional insists on addressing the patient’s co-morbid conditions without also (either first or simultaneously) addressing the ED symptoms.
6.) The professional has never heard of
 Maudsley / Family-Based Treatment (FBT), or has heard the term but knows nothing about it.
7.) The professional asserts that Maudsley / FBT “will not work” for this particular patient, without giving a convincing explanation for this assertion.
8.) The professional blames the patient (either subtly or overtly) for having an ED.
9.) The professional advises parents to send their child or adolescent away to a residential treatment center without first trying Maudsley / FBT, unless it is clearly contraindicated.

Red Flags re: Recovery
1.) The professional asserts that the acutely ill patient “has to want to eat” or “has to want to recover.”
2.) The professional emphasizes the adolescent or young adult patient’s need for control and independence as more important than her recovery from ED.
3.) The professional sets or allows a
 target weight range based on population indices (e.g., BMI of 18.5) or percentiles (e.g., 50th percentile for age/height) without consideration of the individual patient’s build, weight history, or optimal weight.
4.) The professional declares the patient “recovered” based on weight alone, without regard for her behavior or mental state.
5.) The professional asserts that one never recovers from an eating disorder.

This list of red flags may be useful when you are looking for or ruling out a professional or treatment program based on information on their website; it may also be useful in interviewing potential new therapists. If you or your loved one have been in treatment for a while without making progress, you can also use these red flags to help you assess the situation and determine whether to go elsewhere for a second opinion.

My advice? If you see one or two of these red flags in your therapist or treatment program, investigate and proceed with caution. If you see three or more, find a new therapist.

(Source: blog.drsarahravin.com)



Help for friends and family

People can, and do, recover from eating disorders, but professional help is almost always required. Unfortunately, the longer symptoms are denied or ignored, the more difficult recovery will be. If you or someone you know suffers from a possible eating disorder, it’s important to seek help immediately. Family members and friends can also benefit from information and help.

You may find it difficult and stressful to approach someone you care about who has an eating disorder. You may wonder what to say, or be worried about what will happen as a result. These are legitimate fears. Rest assured, however, there are things you can do to offer support.

Be Patient
When you approach the individual for the first time, do not be surprised if they reject your expression of concern. They may even react with anger and denial. There is a lot of shame and pain that goes along with having an eating disorder. It’s also important not to rush the person, and instead recognize that it will take time for the person to make changes.

Be Knowledgeable
It’s important to understand that an eating disorder is a coping strategy that the individual uses to deal with deeper problems - problems may be too painful or difficult to deal with directly. Remember: Eating disorders are not simply about not eating or vanity! This website can provide you with additional information that is worth learning, information you may also want to offer to your family member or friend. Whether they act on it immediately or need more time to think is their decision to make.

Be Compassionate
Eating disorders are a complex problem, and food and weight issues are only the symptoms of a deeper problem. It’s important to understand that the person would prefer to have healthier coping mechanisms and is doing the best they can at the moment. Show compassion for the pain and confusion that the individual is experiencing.

Be Encouraging
Encourage the person to see themselves as more than their eating disorder. Do this by talking about other aspects of your lives, and of life more generally. Affirm their strengths and interests that are unrelated to food or physical appearance.

Be Non-Judgmental
It’s important to express your own needs in the relationship, without blaming or shaming the other person. Remember that the individual with the eating disorder will have to decide on when and how to get help, and what kind. Support them by validating the healthy changes that the person does makes, however small they may be.

Conversation Guide

  • Focus on feelings and relationships, not on weight and food.
  • Tell them you are concerned about their health, but respect their privacy. Eating disorders are often a cry for help, and the individual will appreciate knowing that you are concerned.
  • Do not comment on how they look. The person is already too aware of their body. Even if you are trying to compliment them, comments about weight or appearance only reinforce their obsession with body image and weight.
  • Try to be positive. Find neutral, comfortable places and times to discuss the issues. Try to focus on the main reasons you are concerned or in conflict. Try not to be negative.

For example:

Instead of saying, “Why are you doing this to me?”

Say, “This is difficult for both of us, so let’s try to discuss it.”

Instead of saying, “You could control/stop this if you wanted to.”

Say, “I know how hard it is for you. Let’s talk about how we can both find ways to make things better.”

  • Find ways to keep calm, focused and respectful during difficult conversations.
  • Set caring and reasonable limits. Be firm and consistent. For example, know how you will respond when the affected person wants to skip meals or eat alone, or when they get angry if someone eats their “special” food.
  • Avoid power struggles about eating. Do not demand that they change. Do not criticize their eating habits. People with eating disorders are trying to be in control. They don’t feel in control of their life. Trying to trick or force them to eat can make things worse.
  • Examine your own attitudes about food, weight, body image and body size. Think about the way you personally are affected by body-image pressures, and share these with the person.
  • Make sure you do not convey any fat prejudice, or reinforce their desire to be thin. If they say they feel fat or want to lose weight, don’t say “You’re not fat.” Instead, suggest they explore their fears about being fat, and what they think they can achieve by being thin. Encourage them to reflect on how people are pressured to look a certain way, and how this makes us feel bad about ourselves.
  • When the individual with an eating disorder is a child or minor, more direct action and guidance may be required. However, always respect the rights and feelings of the individual.

Take Care of Yourself

Seeing someone you love struggling with an eating disorder might make you feel very scared, angry, frustrated and helpless. However, be careful not to blame them. Try to understand that eating problems are a coping strategy for dealing with painful emotions or experiences. The person with an eating disorder may know that their condition is upsetting other people, but may not be able to change.

  • Do not take on the role of a therapist. Do only what you feel capable of. Try to get some support for yourself. You need to take care of yourself while dealing with your friend/family member and might want to speak to a counsellor or health professional.
  • Make sure you continue to take care of you own physical, emotional and spiritual needs.

Remember that they can only get better at their own pace. You can be supportive and gently give them information. You can help them to see and consider alternatives. You cannot make them get better. Consult with professionals when a child is concerned.

(Source: nedic.ca)



Jenni Shafer: The Eating Disorder Time Suck

Thirteen years ago, when I was 22-years-old, if I wasn’t sleeping, I was with Ed. I am not talking about a guy, but my eating disorder. In therapy, I was taught to treat anorexia/bulimia like a relationship — naming it Ed, short for “eating disorder” — rather than an illness or a condition.

Think of the most time consuming relationship you’ve ever had. Imagine it was with the most demanding person you’d ever met. That was life with Ed.

A typical day went like this: Ed talked, and I listened. Since I only slept for about three hours a night, I heard his self-destructive voice saying, “You aren’t good enough,” for at least 21 hours a day. When you hear something that often, you start to believe it, and pretty soon you start to live it.

My eating disorder was as much about limiting my life as limiting my intake. I starved off fun by overworking and people by isolating. Obviously, I limited sleep as well. As for many women with anorexia, a key issue underlying my eating disorder was perfectionism, which caused me to falsely believe, among other things, that sleeping is a waste of time and that I should always be working. If I wasn’t at my real job, which varied from being a waitress to a security guard (not the best occupations for someone with anorexia), I manically found something to do to keep myself busy. I reorganized my apartment, mailed birthday cards to every person I’d ever met, and strategized new ways to decline dinner invitations. I did anything to stay out of the present moment — a scary place to be back then. I worked like this about 20 hours a day, which meant my work week was 140 hours long.

During those few hours at night when I actually rested, I noticed that my heart would beat erratically. I knew that people with eating disorders could die from cardiac arrest, and I distinctly remember thinking that I might not wake up in the morning. The most terrifying thing for me was that I felt like I couldn’t do anything about it. I was paralyzed, as if Ed was literally holding me down. It was one of those nights that finally pushed me to seek help.

Recovery, which took time and professional support, actually forced me to be a healthier person with food and weight than I ever would have been without it. I noticed that the less I obsessed about what I ate and how I looked, the more energy I had for pursuing dreams I’d put aside, discovering new passions, and even falling in love (not with a guy named Ed, I hoped). The part of my life that Ed consumed was slowly becoming mine again.

One of my dreams had been to become a professional writer and singer. I actually turned down an acceptance to medical school in Dallas, Texas and moved across the country to Nashville, Tennessee to pursue music. The problem was that Ed drove the U-Haul. I didn’t have the strength to sing or play guitar in Music City, and I couldn’t think straight enough to write a song. I did go to weekly vocal lessons but couldn’t truly connect with the music. When I recovered from my eating disorder, I got my life back and then some. Today, I perform songs as part of my career, and I get to write books and speak professionally, too.

As I travel across the country sharing my recovery journey, I no longer spend my time in airports worrying about the food on offer around every corner. When my body was malnourished, I literally could not walk past all of that food without bingeing on it. Not to mention, traveling is stressful, and bingeing relieved that stress. In an unfamiliar city in a hurried airport, no one ever noticed when I rushed from one fast food restaurant to the next eating uncontrollably. If you spot me in the airport today (I am traveling to Utah for a gig … as well as somesnowboarding), you won’t see me carrying lots of binge food. What you will see is someone who looks grateful that she is toting around a guitar — an instrument I never believed I could play. Letting go of Ed meant I had the time and energy — and belief in myself — to pick up my guitar and actually make music.

In my work, I am surprised over and over again by how many people hear Ed’s voice. Not everyone has a clinical eating disorder, but no one is immune to society’s message that says, “to eat less and to be thinner is to be better.” In my latest book, Goodbye Ed, Hello Me, I named this voice — Societal Ed.

According to the National Eating Disorders Association, a staggering 80 percent of American women are dissatisfied with their appearance. Countless moments are wasted worrying about how small our waists are and making sure that our coffee drink begins with just the right prefix. That will be a nonfat, sugar-free, no whip latte, please.

What would happen if we stopped being so preoccupied with whether or not our thighs touched at the top and obsessed about life instead? We could spend more quality time with our families. Or we could change careers, go speed dating, and even take trapeze lessons. We could experience more joy.

Societal Ed says if we reach the lowest number on the scale and wear the smallest size jeans (if we become less), we will finally be happy. But that’s a lie. At my lowest weight, I was unhappier than ever.

By the time I reached my healthy, ideal weight in recovery, I had not only added physical mass to my body but, more importantly, I was well on my way to gaining what I like to call “pounds” of joy and peace in my life. It’s important to note that our ideal weight has nothing to do with the bathroom scale, but rather it is the size we are when we can think best, have the most energy, and feel whole. When you put on weight like that, you get things like being able to write a song, ride a motorcycle, and enjoy every savory moment of your favorite food.

The body truly is a vehicle for life rather than something to be controlled. I’ve heard it said that our bodies are our Earth suits — simply what we wear on this planet in order to get around. We must nourish this gift in a balanced way.

As part of my continued effort to do that, I recently went zip-lining in Alaska. (I actually do things like zip-lining in Alaska now — most days Ed wouldn’t even let me leave my apartment). When I was flying through that rain forest strapped to a single cable, I wasn’t concerned — for even a single second — about how my backside looked in the harness. Instead I was a little scared and focused on not falling. But even more than that, I was exhilarated, suspended in the moment. And that’s time I wouldn’t trade for anything.

(Source: The Huffington Post)



Anti-Obesity Program Horrors: Do They Trigger Eating Disorders?

A new poll says 30% of parents have seen at least one worrisome behavior in their children that could be associated with an eating disorder—and they’re blaming it on school-based anti-obesity programs. Of course, lowering childhood obesity rates is a good thing, but it seems a lot of school programs are taking a dangerous approach: Instead of teaching kids how to life a happy, healthy lifestyle through positive role models, they teach them how not to be obese. The difference—inspiration vs. fear—makes all the difference between controlling obesity and, it appears, eating disorders.

According to a new report from the C.S. Mott Children’s Hospital, their national poll on children’s health examined the possible association between obesity prevention programs at the schools and an increase in eating disorders among young children and teens. What they discovered was many of the parents were worried about these programs actually back-firing and having the opposite effect that they were intended to.

Overall, 82% of parents said there was at least one school-based childhood obesity intervention program taking place in their child’s school. This included programs on nutrition education, limiting sweets or “junk food” in the classroom, height and weight measurements, and incentives for physical activity. All of which is fine, assuming it’s presented in the right way. But apparently it’s not, according to one-third of the parents who say they have noticed at least one behavior in their kids that could be related to developing an eating disorder. This included inappropriate dieting, excessive worry about fat in foods, being preoccupied with food content or labels, refusing to eat family meals and exercising too much.

Just as troubling is that 7% of parents also reported that their children have been made to feel bad at school about what or how much they were eating.

In a statement, Dr. David Rosen, Clinical Professor of Pediatrics, Internal Medicine, and Psychiatry at the University of Michigan Medical School and Chief of Teenage and Young Adult Medicine in the Department of Pediatrics agreed that this trend of putting too much emphasis on healthy behaviors could have a negative impact:

When obesity interventions are put in place without understanding how they work and what the risks are, there can be unintended consequences. Well-intentioned efforts can go awry when children misinterpret the information they’re given.

He went on to say that parents–and schools–should not overlook these warning signs:

Many of these behaviors are often dismissed as a phase. But given what we know about the association of these behaviors with the development of eating disorders and knowing that eating disorders are increasing in prevalence, they should be taken very seriously.

So in a society where one out of every three kids is overweight or obese, what’s the answer?

Based on my experience with my own kids and working with hundreds of others over the years, I think it lies in something much less obvious. Meaning, we don’t have to be so in-your-face with anti-obesity messages all the time. Yes, health education and P.E. are definitely necessary, but what happened to just making these programs fun and informative, like we had during our youth? Now, instead of simply teaching kids about the food groups and the rules of basketball, they are bombarded with messages about their weight and what they put in their mouths. They are criticized and made to feel self-conscious. And, in some instance, they are weighed and labeled.

Kids don’t need to constantly hear the warnings about getting fat, eating the wrong foods or not exercising enough. They are more vulnerable and impressionable than we think. Instead, what they need are simply healthy, positive role models to exhibit healthy behaviors. They need parents and teachers who are training for marathons or triathlons, eating a peanut butter sandwich on wheat bread with a salad for lunch, snacking on an apple, riding their bikes to work, playing a round of kickball with the kids simply because it’s fun, etc.

Don’t get me wrong, healthy living programs are definitely needed in schools, but it’s the approach of them that makes all the difference. That, and who is delivering the messages. Kids need to be inspired to live healthy, not scared into it.

(Source: blisstree.com)



Teen Power Struggles and Eating Disorders

The teenage years typically bring on feelings of separation and autonomy, often leading to a power struggle between a teen and his or her parents. Keeping an open line of communication between parents and teens is difficult, but integral to their development and growth. Power struggles, however, can be especially difficult—and frightening—for families who have a teenager suffering from an eating disorder.

Yet in truth, most people with eating disorders have a difficult time experiencing and expressing emotions. Symptoms are a behavioral way to express what cannot, or is not, being expressed emotionally. So, a typical child who is angry at a parent may slam their door, sulk, avoid contact, or not follow through on household chores. A child with an eating disorder might choose to not eat or vomit.

  It is easier to have consequences for the power struggle that ensues when a child won’t take out the garbage; but it is painfully sensitive and scary to have consequences for the child who chooses not to eat as a way to express their dissatisfaction or wish for autonomy.

  Either way, my advice for families is the same. Helping a teen find an emotional—not a behavioral—voice is key in dismantling power struggles. For families who have a child with an eating disorder, this is paramount. Words need to replace destructive or life-threatening behaviors. Here are things to consider for families struggling with their child’s eating disorder:

  • Separation and autonomy are inevitable and necessary tasks of adolescence. Supporting healthy separation of a child with an eating disorder is a key in recovery.
  • Children with an eating disorder have an increased difficulty in working out these tasks and expressing their feelings, especially anger. Understand that their eating disorder is not a willful act, but one of helplessness and pain. Their attempt is ultimately not to thwart you, but to hurt themselves.
  • There are many reasons why an eating disorder develops in teenagers. One of which is that eating disorders serve as a way to express feelings and behaviors that can’t necessarily be verbalized.  Internally handling issues and problems a teen is facing is quite common, yet when teens express these issues through the language of an eating disorder, it can become a very unhealthy and self-destructive form of communication.
  • Teens with an eating disorder need your voice of understanding, sensible limit setting and compromise. Talking about what they are—or are not—eating is typically not helpful and often provokes the power struggle. Point out when you see your child using their symptoms as a weapon, and ask whether they can share in words what they are feeling.
  • A parent’s anxiety is likely to be understandably escalated during the course of their child’s illness. Keeping your anxiety in check will help with rational thinking in your responses, particularly when your child’s behavior is provocative and scary.
  • Most importantly, seek the help of professionals. Solid family therapy can teach all members how to understand and interpret power struggles and how to dismantle them so that eating disorder behaviors are replaced by communication and appropriate teenage rebelliousness

(Source: psychologytoday.com)



10 ways to recover from a food binge and help yourself heal

After you’ve binged on sugar or food, you usually feel terrible:   bloated, overly full, gassy, and irritable. You may have a headache; feel a sugar rush or buzz, be wired or alternatively tired. You’ll probably have strong sugar cravings (learn how I kindly, and gently stopped eating sugar here) later that day or the next.

How can you love, nurture and care for yourself in this space?

1.    Don’t starve yourself. Eat. I know it sounds counterintuitive, but fasting after a binge will only make you severely hungry, which can easily lead to another binge, decimating your self-esteem. When you’re hungry again, eat. If you binged at night, start fresh by giving yourself a healthy breakfast. Stick to clean, whole foods (sugar free if you can) and drink lots of water. Lots of veggies and lean protein works best for me. You can’t change the past, but you can prepare for your present and future by feeding yourself whole, healthy foods to prevent a future binge.

Starving ourselves is a subtle form of punishment – “I was so bad yesterday I don’t deserve to eat today.” By contrast, feeding ourselves when we’re hungry again is a tangible way of saying, “I forgive you. You don’t have to suffer because you made a mistake.”

2.    Forgive yourself. Trying to starve yourself the next day is a sneaky way to try and get away with bingeing, to “make up” for your slip – “I’m going to make up for yesterday by not eating today.” Instead, admit you made a mistake. Forgive yourself. Be very, very kind to yourself:  Beating yourself up or criticizing yourself won’t make you change. Compassion and regret (not shame – there is a difference!) can. I talk more about self forgiveness hereand here.

One of the ways we can forgive ourselves is by recognizing that we don’t binge because we’re terrible, horrible people. We binge because we’re trying to meet a need. We’re trying to care for ourselves – as messy as it is. Learn more about why we binge here.

When we stop judging our bingeing and listen to it, we touch our unmet needs – all the hurts and wounds inside, all the things that aren’t working. By caring for these needs with understanding and compassion, we find the ability to care for ourselves without bingeing.

3.    Move the emotions through your body. A walk after a binge is a great way to move the painful regret, sadness, frustration and loathing I feel through my body. A good cry also helps. I always feel better crying my tears, as if I were cleansed. Other ways to move the emotions:  gentle yoga, stretching, deep breathing, rocking in a rocking chair or swing, meditation and dancing. I call this practice flowing – one of the 6 core practices of mycompassion based approach to healing food stuff, growing human(kind)ness.

4.    Detox. To help my body detox from so much food and sugar, I often take a bath or shower after a walk and cleansing my tears. I make my own bath salts with Epsom salts and essential oils; soaking in them helps me feel better both mentally and physically. I also make myself a large pot of Celestial Seasonings’ Tummy Mint tea. It soothes my digestion. That and a good book or a phone call with a friend boost my spirits and helps me move from regret to reconciliation:  How can I do this differently next time?

5.    Have a starting over ritual. Showering, bathing, walking, brushing your teeth:  any thing that signals to you that you are starting over, starting afresh or anew is helpful after a slip. Writing out my feelings is part of my ritual. I get out my notebook and write down:  “I am angry…,” “I am sad/regretful…”, “I am frustrated…” This emotional housecleaning feels so good. Then I offer myself compassion and forgiveness:  I love you so much even though you slipped up. I am proud of you for getting back on track. I am hopeful that you can love and care for yourself. I also have several photos of myself as a young child in my home. Looking at these pictures reminds me that I still carry that child with me, and reconnects me to my goodness. I’m not a horrible person because I messed up; I’m merely human.

Learn more here about reconnecting with your goodness (healing the shame and “I’m a terrible person voice) and what to do when you’re really, really stuck.

6.    Get back on track as soon as you can. When you slip up with a sugar binge, you usually have terrible sugar cravings for the next 3 or 4 days. If you are trying to get back on track, do what you need to do to support yourself through the sugar cravings. Outside support is often crucial. I would tell my family, “Mommy slipped up and had some granola last night. Can you help me by hiding it again and encouraging me over the next few days? I’ll be craving sugar and could use some extra help.”

I’d also go back to grounding (another core practice of growing human(kind)ness) and give myself lots and lots of structure. The more the better, as it made getting back on track easier. Another note on getting back to your sugar abstinence:  I wouldn’t wait too long.  As more time passes, you’ll retrain your sugar habit, the brain will want its sugar hit, and it will be harder to go back to not eating it. For me, when I spent more than a few days in, “what the hell, I’ve slipped up, I might as well stay here a while and enjoy it” mode, it always turned into several months of sugar bingeing.

Learn more about grounding here in 5 ways to stop a relapse and Help! I’m gaining weight and bingeing again.

7. Offer yourself comfort. When you’re feeling remorseful about overeating, you don’t need to berate yourself any further. You already feel badly enough about bingeing. What you need is comfort, compassion and kindness so that you can objectively look at what happened and find ways to act differently the next time. In my experience, this is the difference between blame and learning.

Comfort yourself just as you would comfort a small child:  cuddle in bed with a pillow or stuffed animal and cry, talk to yourself in reassuring tones, “It’s okay, honey. You’re going to be okay.” Or try picturing someone from your childhood who gave you unconditional love – a grandma, for example – and visualize her comforting you in the present moment. All of these things help ease the sting.

When your inner critic goes haywire, beating you up for your mistake, and you find yourself in a mental spin cycle of racing thoughts, I find it helpful to use these phrases:  “Come back.” This reminds me to get out of my head and ground myself in my immediate physical experience. I also like the phrase, “Feel your feet on the floor” to reconnect with my body, the ground, the earth, my physical home.

“Just breathe” helps too!

To promote self acceptance, I love saying this phrase aloud, borrowed from a dear friend:  “I love all of me.” It’s particularly helpful for me when the voice of, “Why can’t you be different?” starts its chorus. Try it. Take a moment and whisper to yourself, “I love *all* of me.” Doesn’t that feel soothing?

8. Move out of your head and get support. We tend to distance ourselves from friends and loved ones when we’re overeating or when we’ve made a mistake. We feel ashamed for being imperfect, so we try and hide it. However, when we break through this barrier, and share our pain with a compassionate listener, we find immediate relief. When you’ve been overeating, share on the free forums and reach out for support so that you don’t feel alone. Talk to a friend. Move the energy with expression.

It’s easy to delve into overthinking, where you get trapped into a mental rut, going over and over something in your mind. Telling your story stops the spin cycle and enables you to find the exit ramp.

You can also offer yourself compassion and empathy. Listening to our own hearts and caring for our feelings can even prevent a binge, a process I describe in the post, Stop a binge in its tracks with empathy.

9. Give yourself self acceptance. It’s easy to offer yourself approval when you’re on your “best” behavior. But what about when you’ve been overeating? Do you offer yourself love and support at those times, as well?

It’s ironic that these low times are when we need our approval the most. Without our approval, we feel bereft, judged, unacceptable. We feel unlovable and not okay.

When we’re in this space, it’s very easy to go back to overeating because we’re feeling so badly about ourselves. Self-acceptance is what breaks the chain, so that you stop after one mistake, instead of piling them up, one after the other, until you hit rock bottom. Your unconditional love creates a safe container for you to change. It is what enables you to put the fork down and ask yourself, “What is really going on here?” and shift.

10.    When you’re ready, examine what happened. Binges are fabulous learning opportunities. Try and examine what was going on:  how were you feeling beforehand? What thoughts were running through your head? What expectations or shoulds ran the show? Write about the event and see if you can make sense of it. This can help you prepare for the next time. Think of how you can support yourself next time so that you can act differently. As psychologist Rollo May said, “Nature does not require that we be perfect, it requires only that we grow, and we can do this as well from a mistake as from a success.”

My free Binge Rescue worksheet offers a map to unlock the source of the binge and prevent it in the future. You may also enjoy this post on how to prevent a binge.



5 Reasons I Chose to Fight My Eating Disorder… and won.

Looking back at my descent into, and out of, anorexia, I feel that there were a few key realizations that, together, were enough to shift my paradigm out of the eating disorder mentality and into one that fostered recovery. I credit these realizations with my healthy life today, and I hope they’re as meaningful for you as they were for me.

1. I didn’t see a light at the end of the tunnel.

It’s easy to fall into the eating disorder trap by focusing on one “diet” after another. I always thought that the next diet, or the next 5 pounds, would be the solution that would lead to “happiness” and “then” I could start living.

Well, guess what? That light at the end of the tunnel never came. It was always another 5 pounds, another diet, another imperfection to conquer. I began looking back at my life and realized how many things I had missed out on — special dinners, a nice glass of wine at night, sleeping in and lazy mornings — and wondered if I was going to spend this whole precious life focusing on how I looked.

Suddenly, I realized that the eating disorder was never going to go away.  It was a game that I was never going to win, and it was stripping away thousands of irreplaceable experiences along with it.

I truly believe that it took recognizing what I was giving up, and then accepting that it’s alright to want some of those luxuries in my life, that set the wheels in motion for my recovery.

Suddenly I was able to honestly question my investments and returns in this endless battle with my body that I had embarked on.

2. My body, for all of the work and attention it was demanding, looked surprisingly awkward. 

We can prod, pinch, and starve, but that doesn’t mean we’re going to look like Adriana Lima. Why would we want to? Sometimes I think we can focus on a superficial, aesthetic goal without taking the time to question whether or not it’s as relevant to our personal bodies and success as we believe it is.

Eating disorders, although not voluntary, are often supported and fueled by messages sent by the media and our surroundings that the thinner we are, the happier and more successful we will be. The images in magazines, movies, and television seem to often imply that slender is equated with sexy, lovable, or powerful – when often it’s quite the contrary. Health and energy are incredibly powerful in relationships, the workforce, and our own happiness.

The truth of the matter is, a healthy weight helps our bodies look the way they’re designed to look — which is far more balanced and, in my opinion, more attractive, than their starved counterparts.

Once I took the time to nourish my body and let it fill out naturally, I was astounded at how unique my figure is for me. There really is a reason that it’s my body, and I have started to learn that I have my own unique beauty — and that’s a very exciting, and authentic, feeling.

3. The chance for a future.

You’ve heard it before and I’ll say it again: an eating disorder is an incredibly dangerous thing. Now, as someone that’s been there, I’m aware that saying this to someone with an eating disorder is like telling a smoker that cigarettes cause cancer.

Nonetheless, I don’t do well with boundaries, and I will continue to bring this point into play until the cows come home. I truly believe that once these dangers are fully realized and internalized they will have the power to make a difference. The human mind has an astounding ability to dissociate what we know rationally from what we can accept, especially when we’re addicted to or otherwise dependent on something harmful to us.

At the time of my eating disorder I was smack dab in the threshold of adolescence, a time notorious for the infamous invincibility fallacy and, as a result, far too much self-abuse.

At a certain point, I grew up a bit and began to recognize that I am not invincible and that these things could happen to me. I began to regret the damage I had already done. As life began to surprise me with wonderful things I had never anticipated, I began accepting the power and potential of the unknown.

I realized that I might fall in love one day and wish I hadn’t destroyed my bones and longevity, or even worse, that I might be infertile the day that that man and I want to have a baby. I realized I couldn’t undo the damage I had already done, but I began to fight back to protect the health, time, and future that I still had before me.

4.  I was socially isolated and, well, downright boring to be around.

There’s no way around it — an eating disorder will cramp your style when it comes to quality of life. Over time, living on the routines and neurosis required to maintain overly strict eating and exercise habits, one will become increasingly uninteresting. Vapid. Dull. Insipid.

The truth of the matter is, people eventually become tired of it. My family became tired of going to a fancy dinner on vacation with me when all I would order is a diet coke and steamed veggies (and then would become bloated and agitated from pure fiber, caffeine, and bubbles).

Friends became tired of me canceling on evening plans because I was too tired (eating disorders are exhausting), or too anxious about how I looked, or what food I would be faced with if we went out, or how late I’d be up and if I’d be able to make my workout in the morning.

Slowly I became incredibly lonely, and I also became boring. I realized that when I was on a date, or meeting a new person, I hadn’t had the energy or time for the humor, experiences, and hobbies that make a person someone you want to spend time with.

The truth of the matter is that I was downright boring. And, over time, I was alone.

5. I had insurmountable barriers to intimacy.

One of the things that suffers most during the course of an eating disorder is that individual’s capacity for intimate relationships. It wasn’t just that I was always bloated and uncomfortable from subsisting on vegetables, or that I was energy-less and depressed from avoiding carbs for 10 years, or that no sane man would tolerate my aforementioned regimes and schedules, no — it was that the longer I starved the more I distanced myself from my physical being, creating a chasm where there should be unity between my mind, body, and heart.

The deeper I went into anorexia, the more I physically rejected my body and any sort of physical experience. Further, over time, being so hard on my body and myself made me increasingly hard on others.

It was hard to be patient and forgiving with another person (a fundamental part of a healthy, loving relationship) when I was spending huge amounts of time and energy repressing my true, healthy, imperfect self.

At a certain point, I wanted kindness. I wanted to learn to flow with the imperfections of myself, others, and life. I wanted to eat cake at my wedding.

At a certain point, I wanted to fight. And once I sat down and looked at these reasons, and truly understood them and their implications, for the first time I saw a way out.

(Source: blogs.psychcentral.com)