EDulting: Recent Episodes
Ryanne & Tara
EDulting is a podcast exploring the real life, every day struggles with eating disorder recovery while breaking down different recovery concepts and strategies for those struggling with (or loving someone with) an eating disorder.
PRESS RELEASE: 1/13/2019
Resilience Center is pleased to announce the beginning of an innovative new program: Resilience RecoverED: Intensive Outpatient Program for Disordered Eating, opening on January 17, 2019.
Resilience RecoverED is a program for adults who are at least 18 years old and who have a problematic relationship with food behaviors, which may include undereating, binging, purging, overexercise, to the point of interference with mental, physical, social, and/or economic health.
This intensive program is designed to help clients diagnosed with an eating disorder to gain insight into the neurobiological, emotional, and physical aspects of disordered eating, to change problematic behaviors, to build and strengthen a support system, and to learn to care for themselves in new, more resilient, ways.
The 6-week program includes weekly individual therapy, nutrition counseling, and both skills-based and process groups.
The first of its kind in Oklahoma, the program alternates between being offered on site at the Tulsa office of Resilience Center and online, using HIPAA compliant software.
“If someone can stream Netflix; has a computer, laptop, or tablet with a webcam; and a pair of headphones, then they have the technological capability to participate in Resilience RecoverED,” says co-owner and eating disorder therapist, Ryanne Mitchell, LPC.
This is the first telehealth intensive outpatient program for eating disorders in Oklahoma, and it is the hope of Resilience Center to be able to provide higher level, intensive services for individuals in need, regardless of proximity to Oklahoma City or Tulsa (the only two cities that currently offer this service).
For more information, call 918-861-4973 or visit www.resiliencecentertulsa.com/iop.
MEDIA CONTACT:
Ryanne Mitchell, MA, LPC
Resilience Center
rmitchell@resiliencecentertulsa.com
918-861-4973
I don’t flatter myself to think that there are readers who have noticed, “hey, Ryanne hasn’t blogged anything in a while,” but I’m giving you my explanation anyway!
There has been radio silence as I have furiously researched, written policies and procedures, scoured the best curriculum components, created forms and guides, marketed, and untold other tasks all in preparation for something super exciting…
(are you in suspense??)
Starting next month, Joleen and I are launching a telebehavioral health intensive outpatient program for eating disorders (THE FIRST OF IT’S KIND IN OKLAHOMA!). Using HIPAA-compliant telehealth software, participants will be able to access comprehensive, specialized eating disorder treatment from across the state.
To say I’m excited is an understatement. This has been a dream since I started working at the inpatient program at Brookhaven and realized there was a figurative treatment cliff I was pushing my patient’s off of upon discharge. There just are not many step-down treatment options (or step up if outpatient hasn’t been working for you) in Oklahoma for adults with eating disorders, and not many people can afford the high cost of private treatment programs out of state.
We are launching our first 6-week pilot program on November 6, although enrollment is rolling. The group will be limited to 2-6 participants, so if you, a loved one, or a client are in need of affordable, accessible specialized eating disorder treatment, please reach out! You can get more information about the program and admission criteria in the REGISTRATION GUIDE, emailing IOP@resiliencecentertulsa.com, or calling 918-861-4973.
Thin Bias in Eating Disorder Treamentby Joleen WIlson, RD
When you picture someone with anorexia nervosa, what comes to mind? For many people, it may be an emaciated white female whose in her early 20’s. She appears pale and disheveled, and may have a feeding tube in her nose. Not a lot of lay persons will say otherwise. More times than I care to count, I’ve had eating disorder clients tell me that they are not sick enough. Where the majority of this disillusionment stems from is the typical body type thought to be associated with anorexia nervosa. The aforementioned example is the traditional anorexia that many of us are familiar with. However, I’m here to say that anorexia (or any eating disorder for that matter) does not have a look. You cannot look at a person and determine whether or not they have a restrictive eating disorder. It takes some hard digging into their daily patterns and thoughts around food and exercise to diagnose that stuff. Eating disorders pop up across the board. I’ve seen men with eating disorders. I’ve seen black females with eating disorders. I’ve seen gay men with eating disorders. I’ve seen women in higher weight bodies with anorexia, which is the ED I’m discussing today. I’ve also seen (for another podcast) women and men in higher weight bodies who think they have binge eating disorder, when really they have a restrictive eating disorder that forces them to binge eat (as a response to restriction). More often than not, these are the patients that are falling through the cracks. These are the patients who aren’t getting diagnosed and aren’t getting sent to treatment until it’s too late. Even if they are sent to treatment, insurance companies will frequently cut their days short because they either weight restore or they were in a normative weight category to start with. For those of you out there who are reading this and have an active eating disorder and can identify with one of these groups I’ve mentioned, you ARE “sick enough”. Oftentimes, you are more sick and treatment resistant than those with the stereotypical body shape that anorexia is known for because of the constant battle in your head and the resistance to seek help. Please do not let this be a barrier for you. Find a clinician that “gets it” and is willing to work with you and your struggles around weight and food. Everyone deserves eating disorder care, regardless of their body size, gender, sexual orientation, or race. Eating disorders show up in a variety of marginalized populations. The reason we do not “see” them is because we aren’t looking for it. Doctors aren’t always looking for it. Dietitians aren’t always looking for it. Therapists don’t always see it. If you need help, be sure to reach out.Let’s get into eating disorder treatment as it exists today. Some of the above situations can be classified by the DSM-5 as “other specified feeding or eating disorder, OSFED”, previously known as atypical anorexia. Right now, there are few treatment programs and insurance agencies who sympathize with this diagnosis. In essence, they are colluding with the notion that you are, in fact, not sick enough. This is rubbish. BMI is rubbish. Anyone who is suppressing their natural body weight by restricting, overexercising, engaging in substance abuse or otherwise to suppress their appetite (regardless of BMI) is “sick enough”. This is what keeps many people from treatment that they need, or keeps them from going back to treatment. They are either told by their medical provider that they aren’t at a dangerously low weight, or they go to treatment and see others who are in fact at a dangerously low weight. And this further drives their “not sick enough” mentality! They believe that their weight holds value, and if it is higher, that they must diet harder. Wrong! They simply need a treatment paradigm that accounts for this. Unfortunately, many insurance reimbursements are driven by weight, NOT behaviors. If their weight is stable or restored, they’re typically discharged to a lower level of care despite their readiness to do so. This very fact is the reason why I see so many patients with anorexia on an outpatient basis who cannot completely buy into the fact that they have anorexia and that they are, IN FACT, very sick indeed. If you skip meals, feel dizzy, and/or have organ dysfunction that stem from an eating disorder (bradycardia/tachycardia, arrhythmia, low BP, slowed digestion, kidney failure, and others), then you ARE sick enough. F the labels. Get help today.
This month we chat about recovery in the postpartum period with Kylie Mitchell of www.immaEATthat.com.
It's that time of year. It seems you can't shake a sarong without hearing some diet culture BS around "swimsuit season." The unfortunately reality, is that often it's really "relapse season" for many who struggle with eating disorders/disordered eating.
EDulting is so very pleased to have Tracy Brown, RD as a guest this month. This episode looks at the process of becoming connected with your body as both a source of important information, of joy, and a way to live out body acceptance.
Many of us struggle to get any time outside of our homes, offices, or cars (I miss you, vitamin D!). We struggle to incorporate gentle movement into our day. Some people even struggle with the intensity of sitting across from someone in the office, or with the intensity of having to sit in general for an hour. Wouldn't it be great to have the option to be outside, enjoying nature and the physical and emotional benefits of movement?In my practice I frequently treat eating disorders and disordered eating. Thus, many of my clients have a punitive relationship with movement. They use it to punish themselves, "earn" calories and food, or in attempts to control body shape. Walk + Talk sessions are a way to introduce gentle, mindful (dare I say, joyful?) movement with support. Research also shows that physical movement can increase blood flow and access to different parts of the brain, which may offer a new perspective on old thinking. It also offers an experiential environment to learn new grounding techniques for anxiety and PTSD while building the mind/body connection.
I also work with new moms, and walk + talk sessions are well suited for moms, as mom can bring baby in a stroller or carrier and have 2 for 1 self care: therapy and a walk outside!
Heads up! Walk + Talk sessions may not be suited for everyone. Interested clients will be assessed for safety, confidentiality concerns, and medical stability prior to participation.
FAQ:Q: Where do walk and talk therapy sessions happen?A: My office is close to many local parks and trails. We would meet at the park of your choice, then head out for our walk.
Q: What should I wear?A: You should come dressed in comfortable clothing appropriate to the weather and shoes for walking.
Q: What about bad weather?A: We will discuss a back-up plan before scheduling our first walk & talk session. The back-up plan can include using my office or having an online session. If you prefer to walk outside, I am not bothered by light rain, but it will always be your choice!
Q: Is this a cardio workout?A: No! This is a leisurely walk and you can set the walking pace that allows you to comfortably talk. I am NOT a physical trainer and this is NOT an exercise plan. While we walk we stay focused on talking, but also reap the benefits of leisurely physical movement and being outside!
Q: Anything else I should know?A: These sessions are the same as typical office sessions as far as length, scheduling, and cost. The biggest difference is confidentiality. Since we are walking in public, I am unable to control what others can hear or who we see. Generally this is not a problem, as it is not obvious that I am your therapist. Prior to a walk & talk session, we will review an informed consent for walk & talk sessions and discuss how to handle possible scenarios. If you ever feel uncomfortable with walking for any reason, we will stop and resume in office or online sessions.
Ready to learn more? Call 918-861-4973.
What is the function of fitness?If you look at the cover of Shape Magazine or other so-called “fitness” publications, you would think the function of fitness is to burn fat, have a toned body, flat abs, lean legs, and a firm butt. Literally, one headline calls out “Look Hot!”
Women’s Health doesn’t fare much better. Headlines offer a ride on the “Hot Body Express,” promising you can slim down and firm up fast if you only follow this tear-out workout routine for 14 days.Beyond the disturbing message in all of these headlines that our bodies are mere sex-objects rather than the vehicle for our lives (one soapbox at a time, amiright?), we are totally missing the point of exercise and the function of fitness.
Here are some actual functions of fitness:* Lower blood pressure and heart rate * Strengthen muscles to improve chronic pain conditions * Increase bone density * Decrease harmful effects of stress hormones * Improved lung capacity and function * Increased endurance to chase toddlers * Better coordination, flexibility, and agility * Improved balance and spatial awareness (proprioception) * Better sleep * Stress management and improved mental health * Improved immune system functioning
Here’s the thing, though. Those benefits start to disappear if you are underfed (eating less than required) or over-exercising.So how do you know if you’re getting too much of a good thing?Normal exercise involves two critical behaviors:
- Adequate rest. Additional rest when injured to achieve full recovery.
- Taking in adequate energy in correctly timed intervals to stay strong and at peak performance at all times. Any accidental undernourishment is quickly rectified. “
Translation?If you are exercising every day for hours and/or not eating enough to sustain your activity (meaning, eating more than the bare minimum required, since you need the extra energy), then it may help to take a look at your relationship to exericise.
Below is an excerpt from an ED Institute article: Exercise as a Way to Restrict
Here are the six facets that are used to determine whether anything has become an addiction (including exercise):
- Salience: does the activity become the most important one in a person’s life? Do they think about it more than anything else? Do they crave it or feel they are suffering without it? As soon as they are not doing the activity are they planning when they can next do the activity? Do they forego other previously pleasant activities in their lives so they can do the activity in question?
- Mood modification: That’s the subjective feeling of the “high”. The feeling of “in the zone” or “meditative” or “calming”, “neutralizing other stresses”.
- Tolerance: Needing to increase the amount and time dedicated to the activity to get the same levels of mood modification.
- Withdrawal Symptoms: Irritability, short-tempered, jumpiness, anxiety when unable to do the activity in question.
- Conflict: Interpersonal issues arising with loved ones and friends as a result of the activity. Family and friends expressing their anxiety, concern or irritation with the person’s focus on the activity. Intrapersonal conflict where the person experiences guilt or anxiety that she is harming herself and others with her focus on the activity.
- Relapse: Attempts to avoid or moderate the involvement in the activity are punctuated with repeated returns to the activity at a quickly restored or even heightened level than before.
To recap:If you feel you can’t get through a day without exercise, you can’t manage your mood without it, you are exercising more and more, you get cranky when you can’t hit the gym, and you keep going even when you are tired or hurting, I have to question if what you’re doing is really about health. Because none of that sounds healthy.Now, I’m not anti-exercise. I just believe in finding exercise or movement that energizes you and compliments your unique health goals – both physical and emotional. You do not have to “earn” your food in the gym or punish yourself with exercise for eating. The goal of exercise, of fitness, is not to burn fat or have toned arms or to be sexy for anyone else, but to celebrate what your body is capable of and to provide it another tool to stay healthy.
For further inspiration, check out this video smashing body size/fitness stereotypes by REI.
We all drank the koolaid. It wasn’t our fault, really. We have grown up on decades of ever-evolving, ever-contradictory nutritional advice, all of it seemingly focused on controlling weight, with a touch of health thrown in for good measure. Even worse, weight has been sold to us as a synonym for health, and we bought it, hook, line, and sinker. What a tragedy.
Add up all the time, energy, and suffering you have given to this fallacy. The time spent planning exactly what you will eat and when, adding up calories you increasingly do not feel entitled to. The energy you've spent punishing your body. The suffering you have felt by measuring your worth by a number on the scale, feeling less-than, unworthy, or ashamed of your body for existing in its natural state.
I’m sucker for a redemption story, though, so the tragedies can end there, if you believe these magic words:Diets don’t work.You know that old tongue-in-cheek saying about insanity? Doing the same thing over again and expecting different results? I’m pretty sure they invented it in response to dieting. Maybe you already know this, but you keep dieting anyway, imagining the science couldn't possibly apply to you. I’m a former smoker, so I get it. I can’t tell you how many times people would say to me (utterly unsolicited), “you know that smoking will kill you right?” I never did this, but in my fantasies I would drop the cigarette like a snake bit me, stamp it out, frantically shake the person’s hand, thank them gratuitously for this new information, for saving my life, just to see what would happen. My point is, I KNEW smoking was harmful, but I did it anyway. Some of you have heard that dieting and restricting is harmful, and you do it anyway. If that is the case, I hope you don't mind one more pitch for camp non-diet.
I’m going to give you the benefit of the doubt, though. I think that most of you don’t know that diets don’t work. You think you don't work, that your body doesn't work, and you are broken in some way. I’m hoping to free you from that and from every New Year’s resolution to “lose weight” from now on.I’m going to tackle some of the common things I hear to justify dieting and break down why they don’t work. For the sake of mutual understanding, I’m defining dieting as taking in less energy than your body requires (roughly 2500 calories/day for women and 3000 calories/day for men) and/or restricting or eliminating entire food groups for no medical reason/for the primary purpose of weight loss or weight control.
You might do this by skipping meals, cutting down calories or portion sizes, using gum or distractions to ignore your hunger, using low calorie replacements, omitting nutrients (like carbs or fats), always choosing the "healthy" option when dining out, not eating after certain times, filling up on water before meals, and so on.
“2500 calories?! My body doesn’t need that much food.”Out of sheer curiosity, I looked up the recommended daily calories for my 4 year old. It was 1500-1700 calories. Why wouldn’t your body need more energy than a 4 year old’s??Let’s break down those calories.
Your brain uses roughly 700 calories/day alone. Its primary fuel source is glucose, aka carbs.
Your basic body functions that support staying alive (heart, lungs, etc.) take another 700-1000 calories/day.
The rest of those calories go to giving you energy to think, move, and get shiz done during the day. And yes, even your body needs them.
"Weight loss is calories in vs. calories out, so if I cut some calories, I'll lose weight."Not necessarily, and definitely not long term.
Our bodies are complex, dynamic creations, so why would something as important to sustaining life be a simple in/out equation of only one factor? In truth, the equation looks more like this:
Source: www.precisionnutrition.com
So what does all that mean? It means weight gained or lost is determined by these factors minimally (not to mention hormones and role of genetic expression):
Actual calories eaten: self explanatory
Calories not absorbed: Not everything we eat is absorbed. Additionally, some people engage in purging behaviors that decrease the number of calories absorbed. (Fun fact: Calorie absorption begins immediately in the digestive process. Even if you purge immediately after a meal, you still absorb about 50% of the calories. You absorb most calories eaten, if not all, even if you are misusing laxatives.)
Resting metabolic rate: This is the energy required for those "basic body functions that support staying alive."
Thermic effect of eating: Ever hear of the meat sweats? Eating and digesting energy takes energy.
Physical activity: Exercise and what not.
Non-exercise thermogenic activity: The energy your body uses daily getting shiz done.
All of these are interconnected, and changes to any part will affect the whole, a whole metabolic system designed to keep you around a "set point" weight where it functions optimally.
“I have a slow metabolism, so I need to eat less.”Or
“I hit a plateau, so I need to cut more calories.”In the words of Willie Wonka, strike that. Reverse it. You eat less, so you have a slow metabolism. You need to eat more calories.
Ever had that annoying experience of dieting super hard to only lose a few pounds, or, more infuriating, GAIN weight while dieting? Your body’s not flawed. It’s doing what it’s supposed to do.
Your body doesn’t know the difference between dieting and starving.Remember that metabolic equation? Here's what happens if you restrict:
Source: www.precisionnutrition.com
Restricting calories suppresses metabolism and thermogenesis ("burning" energy), so you don't necessarily lose weight (and may actually gain weight).
Even if you are "successful" at losing weight, your body will have suppressed your metabolism because it thinks you are in a famine, and it has utterly no awareness that you would like to fit into your skinny jeans. So, it does you this favor. Additionally, because your body loves you, it will stay suppressed for a bit causing you to put on weight once you stop dieting so that next time you’re faced with a famine, you can get through it. (Don't worry, your metabolism CAN recover after a period of eating sufficiently.) Bodies are pretty amazing. Why?
We have to eat to live.
This is a biological need. Wanting to eat more when dieting is not a lack of will power. It is not a failure. It is your brain and body doing what it is supposed to in response to the biological need to eat to live. It is not “bad” that you want to eat, that you need to eat. On top of this, when you are dieting/semi-starving, your body releases hormones designed to both drive you to eat AND make food taste better. Your body is all, “well, food’s not coming. Let’s make it taste even BETTER to eat, and maybe it will come.” This sets you up for overeating or binging while dieting. Your brain and body are pulling out all the stops, trying to get you to feed them.
Besides, dieting is stressful. So stressful that you will release cortisol in response to undereating, making you more irritable and (again) more likely overeat.
“What about ketogenic diets?”There is no reason for you to be on a ketogenic diet unless prescribed by a physician, and usually then only to treat seizure disorders.
See above re: brain fuel. You see, when the brain gets no energy (aka carbs) from your meals, it will switch into a process called ketosis. Long story short, it will convert fat in your body into something sort of like glucose that your brain can sort of use. Only, ketosis can only meet about 75% of your brain’s daily needs. Additionally, prolonged ketosis will break down not only fat, but your muscles, leaving you more prone to injury and breaks.
This means your memory will suffer, your sleep will suffer, and your mood will suffer.
Sounds totally healthy, huh?
“Then why do I feel so energetic when I cut out carbs?”I can’t say for sure. People with a genetic predisposition to eating disorders will often experience a calm or even ecstacy when restricting or eliminating food groups. If you experience this, you need to be extra vigilant in eating adequate amounts.
The opposite is more common, and there are TONS of articles out there on “how to overcome low energy when low carb.” Reframe this as “how to ignore the fact that your brain is starving when refusing to eat carbs because you want to lose weight,” and it starts to sound more and more questionable.“I'm not on a diet, it’s a lifestyle change.”Oh, ya’ll. This one really gets under my skin. In what life do you want to miss out on the glories of cheese, ice cream, melty pizza, or a perfect croissant?
Let me tell you about the lifestyle you have chosen.
You started X diet (excuse me, lifestyle) and you were committed. You counted calories or macros or exchanges. You took up spin classes. You lost weight, you met your goal, and you started to feel more comfortable with the occasional indulgence. You told yourself you “earned” it. Over time the constant need to meal prep and hit the gym every day became hard to sustain. The weight came back, and then some. You vowed to "get back on track" to lose the weight. You have repeated this cycle every few years (or months or less), each time blaming yourself for "falling off" the diet, when your body was never built to diet at all!
“I don’t feel hungry, so why should I eat more?”Dieting messes with your hunger and fullness hormones. For most people, dieting results in a drop in fullness hormones and a rise in hunger hormones (that whole your-body-doesn’t-want-you-to-undereat thing).
After long-term dieting and/or overeating (disordered eating), the signaling can be so damaged that you no longer feel hunger or fullness. The paradox here is that not having hunger is actually a sign that you need to eat more to repair those hormones.
(This may not hold true you eat often and don't allow yourself to feel hungry, in which case exploring any fears or feelings about hunger may be useful.)
“I’ll eat normally once I lose the weight.”I’m going to pick on religion for a second here. Does anyone else remember True Love Waits? Is it still a thing? When I was in high school, participants signed a pledge to remain sexually abstinent until marriage. Participants were frequently told that sexual desires are sinful and in need of control. What do you think happened once participants married and have sexual relationships? There are often years of association between sexual desire and shame to undo. (More on this in this month's podcast.)
Now, if you lose weight, your brain will not stop wanting to fix the malnourishment, and you will also need to undo years of association between eating and shame.“But what about all the negative health outcomes associated with obesity?”Did you know that people in BMI category 25-30 tend to live longer that those in BMI range 20-25? Weight is associated with some health outcomes, but I think/hope we all learned at some point that correlation does not equal causation.
We need to ask why the link exists, what are the contributing factors – like job type, diet, physical activity, the stress of stigma, and disparities in medical care that may all play a role in negative health outcomes. Regardless, dieting is known to end up in greater weight gain. Why risk more weight gain by dieting if weight IS the issue?“Okay, fine. What do I need to do?”Stop dieting. Seriously. ASAP. Stop counting calories, creating a meal schedule, leaving out food groups, “earning” calories, and on and on. Eat enough, eat from a variety of food groups, pay attention to how different foods make your body feel, eat foods you like, and let your emotions play a role in what you eat (they do anyway).
Easier said than done, right?
Start focusing on healthy habits that are related health goals. Things like:
___ Cut the time it takes me to walk a mile (or be able to run a mile)
___ Be able to touch my toes
___ Be able to keep up with my kids/grandkids without getting
completely winded
___Think about food less often
___ Balance my breakfast
___ Become more self-confident
___ Minimize the negative self-talk
___ Sleep better
___ Feel more energetic
___ Progress to using a heavier free weight
___ Cook at home more often
___ Manage my blood pressure
___ Find safe places to express myself
___ _________________(Fill in the blank.)
If weight loss happens as a result of these behaviors, it happens. It may not. Your weight may not change at all. If you were under your body's optimal weight, you will likely gain weight. Your healthiest self may not look or weigh what you hoped, but health is far more than weight.
Now, undoing years of nutritional misinformation and coming to terms with how you feel about allowing your body to do this is a longer post for another day soon!
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This month Tara and I are talking body image. We spend a good deal of talking talking about how body image develops and ways to challenge the thin ideal
"My eating disorder gives me a sense of control."
"I feel totally out of control around food."
Today I want to address some of the most common things I hear in eating disorder recovery: that the eating disorder has taken your control and used it against you, by giving you a sense of control or a sense that you have none. I also hear how powerless many of you feel to battle the eating disorder, and often power and control are muddled and confused as synonyms.
Let’s clarify. Power is your ability to act. Control is your ability to create or dictate outcomes. Control is a tool of power, but having power is not dependent on having control. You can’t use control, the same tool of the eating disorder, to gain power over it. You have to regain a sense of your inherent power.You were not powerless at birth. While it’s true you were dependent on others for survival, for comfort, and for love, you used what power you did have to get your needs met. You cried. You demanded attention. You definitely influenced the people caring for you. This was your power.
Whether you call it a need, drive, instinct, or even a value, we are wired to seek power, to be powerful. In our developing years, our power, our ability to act and to influence others, serves our survival. As you began to walk and talk, you exercised or practiced your power through tantrums, saying “no,” and through crying. Again, you did this to get your needs met, to get comfort and loving attention. This personal power becomes the basis of your autonomy. In fact, as adults, having more autonomy seems to satisfy this need for power. Studies have shown we actually seek less influence over others when we have more autonomy. I think this is because power needs an object, and in healthy power, the object is you.
Unfortunately, personal power can be abused and distorted in a myriad of ways. Maybe the grownups who were supposed to take care of you didn’t do such a great job. Maybe they ignored your needs, made fun of your needs, or met your basic needs but without any love or comfort. So many of you have grown up feeling powerless because those around you could not or would not meet your needs for love and belonging. So, you started to seek power through control: control over others, control over emotions, control over food and/or body, control over your home, your routine, you name it! Again, this is because power needs an object, and in unhealthy power, the object is control.
Let’s look at a few domains of power and their interplay with disordered eating (this by no means is a complete list):
OwnershipWhen you own something, you can do with it what you like. Some of you may not have ever felt like you own your body, like it truly belongs to you. Control over eating or body size can become a substitute for your true power to attend to and respond kindly to your body.
AttentionPower needs an object, but it also needs an audience. Sometimes these are one and the same. Sadly, all attention is not created equal. Punitive attention, violent attention, or no attention at all are forms of invalidation and can drain your personal power, giving you the message that your needs are foolish, an intrusion, wrong, or unimportant. Think of attention from its root, to attend. This means to be present, to be helpful, to look after, to manage (you get the drift). Maybe you didn’t have the best examples of healthy attention while growing up, and the eating disorder was there, was trying to help, and took on the management of your emotions (albeit in a way that has cost you your physical and emotional health).
PositionMost people see a position of authority as a position of power. These power positions include the ability to make a request knowing it will be respected and followed. Some power is clearly bestowed – like a job title of CEO in the work place – and some power positioning is more implicit or dictated by culture – like family and gender roles. When you encounter this form of power, you usually respond with deference or dominance. Yielding control, or attempting to yank it back. You may have given the eating disorder a position of authority on all things food and body, and you go back and forth between listening and following its orders and fighting for control. My answer is to unseat that eating disorder voice from the position of authority and give the power back to you.
GatekeepingAnother form of power is controlling access to something. Bouncers, receptionists, specialists, and librarians are all examples of roles involving control of access to something: the club, the manager, the knowledge. In healthy personal power, you are the gatekeeper to your body, your time, your energy, and your other resources. When this is abused, you instead become the gatekeeper of your secrets and of your vulnerability.
What is necessary for recovery is empowerment.
What you need isn’t more self-control, but more autonomy. More personal power. More freedom to discover your own values, to set your own boundaries, to make your own meaning, to respond to your body with kindness. Where you feel out of control, you need MORE autonomy, not less.I hope you are taking steps to increase your power.
For the record, getting help in your recovery is a major step in increasing your power.
Ready to feel more powerful? Contact us for more information about our services.
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So many of us have no idea what hunger really feels like. Above are some distinctions between physical and emotional hunger. This is very useful if you tend toward eating when struggling with a tough emotion. However, I think there is a third kind of hunger we don't give much lip service to. This is a type of hunger that occurs when you have been restricting.
"Wait!," you say, "My problem is binge eating! I don't restrict!" Not so fast. Do you swear off sweets (or chips) the day after a binge? Do you resolve to "eat right" and thus hardly eat at all? Are you eating fewer than 2000-2500 calories per day on a "good day?" Then you are restricting. In fact, this restriction (no matter how severe or mild) is what creates this third type of hunger.
I call it "Survivor Hunger." This is the hunger that flips on when you are around food or start eating after several hours (or days or weeks) of restricting. The tricky thing is, it ALSO can feel urgent and overwhelming and can leave you feeling guilty or out of control (even though it is your body kicking into survivor mode. "There's food! We're allowed to eat?! Eat it ALLLLLL, it may never come again!!")
The unfortunate reality is that many restrictive eaters and binge eaters alike will misinterpret this as "emotional hunger," ignore or otherwise distract themselves from it, shame themselves for it, and continue to deepen disordered eating.
The answer? Before you check for physical vs. emotional hunger, ask yourself if you're eating enough and eating regularly throughout the day. If not, fix that first. You won't be able to listen and follow your hunger cues any other way.
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It may not be a shocker for me to tell you that the holidays are a time of intense anxiety and stress for all of us, but particularly for those suffering from eating disorders. Work parties, family gatherings, and holidays traditions seem cruelly centered around food and eating, so it's not surprising that many people in recovery relapse during or immediately after the holidays.
For this month's podcast, Tara and I are tackling holiday survival: pet peeves, planning, and picking yourself back up.
In the throes of an eating disorder, the body gets both the blame and the abuse. Body becomes the scapegoat. Sometimes this happens at a level you’re not even aware of. If your body boundaries were violated at some point, through abuse or objectification, you can fall into the trap of thinking your body itself was to blame for the abuse or attack. On top of this, our bodies take much longer to process and heal than our minds. So when the body shows the aftereffects (startling easily, panic attacks, etc.), it can deepen the belief that the body is to blame. To try to “fix” this, you may try to control your body through any means available, including disordered eating, cutting, substance abuse, relentless work, excessive exercise, and more. These efforts, in effect, tell your body to “just get over it.” The thing is, your body can’t get over it. At least not like that.
Your body needs time to process what it’s been through. It’s on this journey with you. To do this, you need to find ways to integrate your experience, your consciousness, your insights with your body. Otherwise, you will remain in battle with your body instead of letting it guide your healing.
What if you struggle with a chronic ailment or illness? Does that mean you won’t find healing? Not at all! Health and healing are not the absence of illness, but a way of being in relationship with your body. None of the therapy in the world can free you from feeling, just like restricting didn’t free you from feeling. Binging didn’t free you from feeling. Drinking didn’t free you feeling. Becoming a marathon runner didn’t free you from feeling. Get my drift?
You will begin to heal when you begin to show your body the respect and care it deserves. When you allow it to be imperfect and respond with love anyway.
We tend to have this expectation that therapy or self-help will lead to insights that will then give the healing we need to change our behavior toward our bodies. I’m guessing you already have some insights about why you treat yourself the way you do. Did those epiphanies change your behavior? Maybe for a little while. Then you find yourself falling back into harmful patterns, now armed with the guilt that comes with the awareness of why you are doing it, the harm it will cause, and doing it anyway. The issue that knowledge not embodied is not yet learned. When you start serving your body, tending to your body, and caring for your body, healing will follow.
Are you ready to start?
You probably have a goal that is stopping your recovery in its tracks. This goal has probably disguised itself as something “healthy,” while in reality it is serving illness. In eating disorder recovery, this is your “goal weight," sometimes called "ideal weight."
I’ve heard patients in and out of treatment discuss their willingness to recover “but I don’t want to go above x pounds.” Or overweight patients viewing eating disorder treatment as yet another diet to follow to reach x pounds. Treatment team members themselves often perpetuate this stumbling block by asking the patient set this number, or setting it themselves, trying to appease the eating disorder to keep the patient in recovery. Not a fan. (Read an excellent blog on the topic here.)
See, I don’t care if your doctor/dietitian/therapist is cool with your goal weight because it squeaks you out of the dangerous BMI zone (BMI is BS, btw, but more on that later) or otherwise puts you into a healthy BMI. As long as you have a goal weight, you will relapse. I’ll say that again. As long as you have a goal weight, you will relapse. Here’s why:
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I’m guessing that you set that goal weight while you were still in the midst of disordered thinking. How are you sure it’s a realistic, healthy weight for you? (See more here)
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Let’s assume it is a realistic, healthy weight. What will happen if your body overshoots it? Sometimes in recovery from restricting, your body will go over its natural set point to repair and reset metabolic processes. If you are holding onto a goal weight, you will freak out when this happens. ED will shout “I told you they just wanted to make you fat!” You will fall back into thinking your body must be controlled instead of cared for.
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If you are currently over this goal weight, you will be tempted to dabble with restricting, purging, or other compensatory behaviors “until I lose the weight,” setting yourself up to further lower your set point and keep the cycle going. Or you believe that healing your relationship with food will finally result in that weight loss you’ve been chasing. It may not. You may gain health, vitality, and greater self-love, but there is no guarantee of weight loss. Because lower weight DOES NOT equal health. And visa versa. A higher weight does not equal poor health. There are waaaaay too many factors at play to reduce health to one number.
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If you are under this goal weight, there’s a very good chance that you have set a goal weight that is too low to sustain your body’s functions. Because lower weight DOES NOT equal health. Again, way too many factors to deduce your health from one number.
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Most importantly, all of your thoughts about ideal weight are meaningless when it comes to the body’s work of healing and recovery. The body will weigh what it weighs when you are consistently taking in adequate calories/exchanges for recovery, no longer doing any eating disorder behaviors, and moving/exercising for fun and function instead of punishment.
I wonder if there are other unrealistic goals that are sabotaging your recovery as well. Like goal weight, these are goals that look like they might be healthy, but in reality set us up to give up when the conditions we set aren’t met. Conditions we set in the midst of our disorder, be it an eating disorder, depression, anxiety, or PTSD. It’s time to put your goals to the test.
Is it realistic? Give me the evidence. I’m talking, “can hold up in a court of law” facts, not beliefs.
Is it tied to a value? Where is the meaning for me?
Do have the resources/support to meet this goal? How can I get there?
Hold your recovery goals up to the light, and if you find them lacking, make new ones. New ones like, “go camping and have enough energy to hike with my friends” or “feel comfortable enough in my body to dance it out with my toddler to her favorite song.” Create goals that are about the life you want to live, rather than another tether to the disorder that is taking your life.
That is recovery resilience.
Today I want to talk about partpartum body image and eating disorder recovery.I often say that recovery is a process, not a goal. My own history with disordered eating has taken me through restricting, purging, overeating and binging, fad diets, and fitness trends all in the futile attempt to control my body and my emotions. Over the last four years, I have considered myself in full remission. I even came to continuously respect, care for, and usually even like my body, even after my first child was born and I didn’t entirely “bounce back.” (For the record, I hate that term.)
But now…
My body is a stranger to me. After giving birth to twins, there are strange hills of rippled flesh hanging from displaced and damaged muscles. I am trying to be loving. I am trying to be kind. I am wondering when I will feel at home in this new body. I make myself look in the mirror, my own exposure therapy. I make myself touch my stomach softly while marveling at the two tiny humans that grew there. And I cycle through emotions I thought I had healed. I have a twinge of disgust for the woman who thought she might get out of this pregnancy unmarred. I try to replace that with compassion for her disappointed optimism.
I said to my husband last week, “I have National Geographic boobs now.” He wasn’t thrilled with my word choice. “Do you think you should be calling them that?,” he asked with a grimace. It took some reflection to figure out why this response stung. You see, this term was not meant to be entirely self-degrading. Sure, it was definitely said with sadness and mourning, and a hint of mean to it that anyone with an eating disorder history may recognize. The phrase “National Geographic boobs” calls to mind - and Google search results - native, tribal women with stretched, pendulous breasts. I suppose this is used as insult in our culture, as maidenhood, not motherhood, is celebrated as desirable. But I think it stung, because there was a quiet thought trying to bubble up saying, “and what would be wrong with having National Geographic boobs?” In that phrase is also a fair amount of awe and respect. There is a complete ownership of womanhood and motherhood in those images that feels primal and important. This is what breasts are SUPPOSED to look like after birthing and nursing children. This belly is the natural outcome of the gift of growing life. I don’t have to find any of those outcomes aesthetically pleasing... yet (still working on my own internalized messages), but I am trying my damnedest to keep this real beauty, the beauty of life, growth, transition, and motherhood in the forefront of my mind as far more important than whether my body meets any other standard of beauty. I’m trying my damnedest to remember that I can set my own standards of beauty that take into account my body as a whole, rather than the singular aspect of appearance.
Maybe one day in that striving, I will be home in this new body. I can feel it trying to welcome me. I can feel it asking for my care. I can feel the healing that is ongoing, the healing that is still to come. Until then, I can practice responding to my body with care. I can practice being patient and compassionate with my mourning, with my disgust, with myself. To do this, to make it to other side of this transition, I have to use all I have learned in recovery, all that I still teach about recovery.
Dear hearts, long term recovery is still hard some days, and is still worth it every day. This is the process of recovery.
In this month's podcast, Tara and I are talking calories. Your body needs energy to recover, and that energy doesn't come from yoga or rest or a great massage. It comes from food. From calories. Unfortunately, we live in a culture where dieting is so pervasive, we don't even know we're dieting. I had a client tell me yesterday, "I don't diet. I eat 1100 calories a day." You guys. Anything below your body's recovery/ongoing requirements (generally speaking, 2500/day for an adult 5' and taller) IS dieting and will only suppress your metabolism. Our bodies are far more complex than a simple equation of calories in vs. calories out. In this episode of EDulting, we attempt to explain this complexity, as well as the struggle to accept it in recovery.
Hosted by a licensed counselor and a recovering mom/author/student/badass, EDulting is a podcast exploring the real life, every day struggles with eating disorder recovery while breaking down different recovery concepts and strategies for those struggling with (or loving someone with) an eating disorder. This is the first episode.
Bear with me here. When I look back on the changes that have helped me become a better person (still a work in progress), nearly every period of growth was preceded by a period of despair. I'm using despair here as an umbrella term to cover a range from unpleasantness to utter destruction. That despair can manifest in a myriad of ways: a gnawing loneliness, existential anxiety, destructive relationships, disordered eating, overspending, or other self-harmful behaviors. These are the symptoms of despair, the ways it demands to be seen or, more often, attempts to relieve it. It was only in eventually turning to face the despair, to explore it, to excavate it that I was able to change. This is why one of my favorite quotes is from Carl Rogers, “The curious paradox is that when I accept myself as just I am, then I can change.”
The trick here is not to confuse acceptance with affinity. I can accept things I don’t like. When I accept my role in creating some sources of that despair as well as my role in rising above it (or at least learning to live with it more peacefully), then I can make steps toward change. I see this play out in big and small ways in my life and in the lives of the brave souls I have the privilege to explore this with. Despair, like pain in the body, is a signal, a helper, telling us things are not right. If we listen, we have an opportunity to give ourselves what we need to heal. Like knee pain can drive us to the couch to rest and avoid further injury, emotional pain can drive us to retreat, reduce stress, reevaluate, and repair.
As we surrender, whether willingly or kicking and screaming, to this process, despair can somewhat be welcomed as a friend, a signal to pause, to take stock, and empowers us to change. After all, if something caused me no distress or despair whatsoever, why would I be motivated to change? In this way, despair is a catalyst for growth and healing, a part of the process. Now, that’s not to say you will magically start loving being in despair or the unexpected destruction that befalls us all from time to time, but it can provide it some much needed balance. If in the midst of my lament I remember that I can grow grit, self knowledge, or have a chance to treat myself more kindly through it, then it is not all destruction.
In what ways have your struggles made you more resilient?