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Eating Disorders

Eating Disorders in Teens: How to Talk About It

Eating disorders refer to several mental health conditions revolving around the bingeing and purging of food, obsessions with weight, highly restrictive diets, and other requirements (including the compulsive ingestion of non-food items, known as pica). While eating disorders can, on the surface, sometimes be masked as a “healthy” concern for bodyweight, they are intensely physically and psychologically destructive and continue to have the highest mortality rate among all psychiatric conditions currently recognized by the Diagnostic and Statistical Manual of Mental Disorders.

Characterizing Eating Disorders in Teens

Eating disorders can have a long list of potential symptoms. While there are five major characterized eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, rumination disorder, and pica), there are also several behaviors that can be classified as “other specified feeding or eating disorders” (OSFED), as well as “avoidant/restrictive food intake disorders” (ARFID), which are separate but related to eating disorders.

Anorexia Nervosa

Intense fear of weight gain characterizes anorexia, specific “fear foods,” incredibly low daily caloric intake, low body weight, and severe body image issues, to the point that the patient doesn’t recognize their low body weight as being unhealthy or too low. At its worst, teens with anorexia may have various physical symptoms caused by their malnutrition and low body weight, including:

    • Loss of menstrual cycle
    • Dizziness
    • Brittle or thinning bones
    • Dangerous heart health issues
    • Lanugo-like body hair
    • Dental damage due to frequent purges

There is some overlap with obsessive-compulsive disorder (OCD). Teens with anorexia tend to set extreme rules for themselves surrounding food intake and body weight and may punish themselves for breaking these rules (through starvation and excessive exercise).

Bulimia Nervosa

Bulimia is characterized by frequent binge-eating behavior coupled with subsequent purging behavior. It is cyclical, in the sense that teens with bulimia will often obsess over certain foods and be obsessed with eating, binge heartily, then experience extreme guilt, leading to a purge. Purging behavior includes vomiting, taking laxatives, fasting, or excessive exercise.

Teens with bulimia are not usually underweight, but they may still be at risk of malnutrition and other physical ailments because of their frequent binging and purging, including swollen lymph nodes, a weakened immune system, and damage to the throat and teeth caused by stomach acid.

Binge Eating Disorder

Binge eating disorder is characterized by frequent binging and subsequent low mood, but not purging. Teens diagnosed with binge eating disorder will often feel incredibly guilty and self-conscious, reinforcing binging as a coping mechanism, starting a cycle. Unlike teens with anorexia or bulimia, teens with binge eating disorder may be overweight or obese.

Seek Guidance From Parents or Therapists

Eating disorders are severe, and many teens diagnosed with an eating disorder have a warped sense of what is and is not suitable for physical appearance and food. They may be sensitive to specific phrases and sentiments, such as seeing others comment about their health and appearance or seeing them pick up new diets or commit to new kinds of eating.

Start helping your friend by asking their parents or therapist how you can help by learning what sentences and actions to avoid or learning what you should do to model a healthier relationship with food. By better understanding your friend’s diagnosis, you will have an easier time knowing how your behavior and words might affect them emotionally.

Family Support and Care Is Vital

Family and friends can play a significant role in eating disorders in teens through the Maudsley approach. This family-based therapy emphasizes the importance of continuing to provide support outside of inpatient or hospital treatments. The Maudsley approach helps families play a role in the treatment of their teens by coordinating with a therapist providing individual or group therapy and by setting the foundation for healthful living through:

    • Weight restoration.
    • Modeling healthy eating habits.
    • Noting and tracking both physical and mental health improvements.
    • Slowly helping teens take control over their eating habits as they close in on a healthy weight and have made significant progress.

Family therapy may also play an essential role in helping families better understand their teen’s behavior and problems surrounding food and teaching them how to encourage better eating without placing pressure on the teen themselves and blaming them for their behavior. It emphasizes that the disorder is an external actor playing a role in their teen’s behavior and that the focus is on overcoming that disorder together. Therapists will ensure that parents do not criticize their teen’s behavior or make it “their fault.”

Help and Treatment for Eating Disorders in Teens

It is important not to encourage the behavior associated with your friend’s condition, such as skipping meals, exercising way past the point of physical recovery, avoiding certain foods, or obsessing over body image and thinness. Empathy and compassion are essential, recognizing that a friend’s self-image issues may continue to be a sensitive topic for them even after treatment.

They might not be ready to discuss certain things without triggering anxieties and worries about body image or food. Teens struggling with eating disorders often have a long and arduous treatment process ahead of them, one in which both their physical and mental health must be taken into consideration. Many teens with conditions such as anorexia nervosa are treated at the height of their malnourishment and near starvation.

Despite such consequences, many teens diagnosed with an eating disorder do not realize that they are actively harming themselves and harbor extreme and deep-seated fears regarding certain foods and weight gain. Long-term support from friends and family is essential to the proper treatment of eating disorders in teens. By assisting in the critical refeeding process, modeling healthy eating behaviors, working on beneficial coping mechanisms together, and keeping an eye on potential signs of relapse, a teen’s loved ones continue to play an important role long after the initial treatment process.

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Eating Disorders

Signs of Anorexia to Watch for in Teens

Anorexia nervosa is one of the most common eating disorders in teens, and a condition that has risen in prevalence over the last few decades. It’s largely characterized by unhealthy and unsustainable weight loss, a consistently below-average body mass index (BMI), and a very low body weight in the absence of any contributing diseases or conditions.

Anorexia is commonly mentioned in contrast to bulimia. Where bulimia is characterized by binge eating and purging behavior (i.e. laxative use, induced vomiting, etc.), anorexia is characterized by controlling and reducing body weight largely via exercise and self-induced starvation. Women are more often affected by anorexia nervosa, but men can also struggle with eating disorders and associated body image issues.

While eating disorders are most often diagnosed among teens and young adults, they can occur (or persist) later in life too. Because teens are learning to take care of themselves and taking concepts such as nutrition and healthy living into their own hands, it’s important for parents and educators to differentiate between healthy lifestyle changes and potential symptoms of an eating disorder.

A Key Characteristic of Anorexia Nervosa

There are several signs and symptoms for anorexia nervosa, the most important being self-induced starvation, physical symptoms of extreme malnutrition, and a fear of gaining weight, particularly fat. However, it often comes back to a central point: The need to always lose more weight.

Teens who struggle with anorexia nervosa constantly perceive themselves as fat in some way, and often suffer from symptoms of body dysmorphia, a compulsive mental health issue wherein someone constantly perceives flaws within themselves even when these flaws aren’t present. More than any other symptom, teens with anorexia nervosa will insist that they need to lose more weight even while they’re unhealthily underweight.

Other Warning Signs of Anorexia

Teens with anorexia nervosa will go through extreme lengths to avoid eating food or making up for meals with excessive and intense exercise. While there is certainly a benefit to intense exercise, the level of exercise that is characteristic for someone with anorexia is destructive and harmful, particularly in the absence of much needed nutrition and critical recovery.

At the very least, a growing teen body needs plenty of sleep and plenty of food. This is doubly important when undergoing training. If your teen is obsessed with sports alongside unrealistic calorie restrictions, they may be struggling with anorexia. Other important signs and symptoms include:

    • Denying hunger
    • Eating in secret to avoid being judged
    • Developing certain rituals during meals (centered around reducing intake, such as excessive chewing)
    • Extreme dietary rulesets (completely avoiding one type of food or nutrient)

Aside from behavioral symptoms, anorexia can lead to the development of serious physical symptoms because of malnutrition and intense physical stress. These symptoms include:

    • Amenorrhea, or the absence of menstruation
    • Signs of osteoporosis, or brittle bones
    • Abnormally dry and flaking skin
    • Acne
    • Hair loss
    • The development of very fine facial and body hair, known as lanugo
    • Frequent fainting spells
    • Low blood pressure

These are not surefire signs of anorexia, and any one of these symptoms should prompt a visit to a doctor. But in the absence of a different medical condition, they may be caused by malnutrition and stress because of an eating disorder – especially in combination with the aforementioned behavioral signs.

What Causes Anorexia?

The causes of anorexia are complex, consisting of both environmental triggers and potential heritable traits that overlap with symptoms of obsessive-compulsive disorder (eating disorders and OCD can cooccur), anxiety, and depression. Psychiatric causes, including abuse and exposure to certain media, also play a large role. Other identified causes range from genetics to bacterial infection.

Given that eating disorders are more common in developed or Western countries, and are rising in prevalence in developing or non-Western countries, one theory is that the growing rate of eating disorders among teens is at least partially a result of Western beauty standards, media, and advertising (from TV to Instagram).

In the age of fitness models and influencer culture, teens are more inundated with unrealistic bodies and beauty standards than ever and may adopt unhealthy diets or exercise regimens not understanding what goes on behind the scenes. They may not be aware of how dangerous it is to remain at a certain low bodyfat outside of competition or aren’t aware of the use of things like fake weights, imperceptible image manipulation, and performance-enhancing drugs.

However, whether these environmental factors simply trigger an innate potential for anorexia or contribute to its development is still unclear. Research into eating disorders has shed a lot of light on just how complex they are, as well as revealing the many internal and external factors that play a role in their origin.

Signs of Anorexia in Boys

When eating disorders are brought up in the context of boys and men, other body image issues – such as muscle dysmorphia – are more commonly talked about. Indeed, “bigorexia” is a more common issue among boys than girls. However, that doesn’t mean anorexia nervosa does not exist in men. An estimated 20 percent of anorexics are male, presenting with all the same symptoms – starvation, a heavily distorted body image, and extremely restrictive dietary habits.

Again, symptoms of anorexia in boys overlap with symptoms of anxiety, depression, and obsessive-compulsive behavior. It’s a disorder that claims lives across gender lines, and while women are more heavily affected than men, the cases of boys with anorexia are rising, or at least becoming more known to clinicians and researchers.

How Anorexia Is Treated?

Some cases are far more severe than others. Because anorexia nervosa can sometimes go untreated until hospitalization occurs (because many teens refuse treatment), one of the most important steps to treating anorexia is first ensuring an anorexic teen’s survival. Teens with anorexia are carefully monitored to ensure that their hydration and electrolyte levels are improved, that their heart health hasn’t deteriorated too much, and they may require a feeding tube if they can’t keep down solid food. In extreme cases, hospitalization plays a vital role in the long road towards recovery and improvement.

Because the causes for anorexia may be neurological as well, treatment differs from individual to individual depending on how effective certain approaches are deemed to be. Teens with anorexia will usually work with a therapist to overcome and deny delusions of fatness and accept that they need help to work towards a healthier bodyweight. Different types of behavioral therapy such as CBT may help teens with anorexia confront their own thought patterns and avoid re-engaging in self-induced starvation.

Sadly, anorexia has the highest mortality rate of any mental disorder, in large part because of the risk of cardiovascular failure and the effects of starvation. Treating this disorder can be difficult, and requires a holistic approach addressing a teen’s psychological and physical symptoms. Family members often work with specialists to provide critical support, and a registered dietitian will help a teen learn to rethink their eating habits and slowly return to a healthier weight.

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Eating Disorders

What Are Symptoms of an Eating Disorders?

One of the most common eating disorders we’ve all come to know is anorexia. Most of those accounts portraying anorexia are focused on women and young girls. There are also other eating disorders we may not be aware of looking at someone directly. Other eating disorders are harder to see on the surface, whereas anorexia is characterized by deficient weight that causes the person affected to waste away before our very eyes.

Conditions like these hurt families, and they often feel confused and helpless because they are unaware there’s an issue half of the time. At Visions, our parents and loved ones must learn a little something about every mental health and emotional condition so they can be ready, with eyes wide open, to see the signs. We hope to prepare families everywhere to care for each other, even when the person hurting can’t express themselves in words at that moment.

Most people don’t realize that eating disorders don’t just affect women and girls, unlike what the media continues to show us. Eating disorders affect everyone, no matter their gender. It’s known that over 10 million men in the United States are affected by eating disorders; this number is half of women and girls affected, but the point is that women are not the only people that struggle with weight and body image.

Most Common Eating Disorders

Anorexia Nervosa

As one of the leading, most common eating disorders, anorexia nervosa is a condition that begins with the complete cessation of eating or gaining any nutrition into the body at all. Adolescents affected by anorexia often lose weight rapidly to the point that it can cause serious health issues, possibly even death.

Symptoms of Anorexia

  • Depression
  • Thinning hair
  • Suicidal thoughts
  • Social withdrawal
  • Trouble with digestion
  • Wearing baggy clothes
  • Reduced periods in women
  • Acute fatigue and insomnia
  • Anxiety concerning weight gain
  • Dehydration Jaundice (yellowed skin)
  • Won’t eat in a group setting and often makeup excuses

Bulimia Nervosa

Those affected by bulimia eat, but they won’t allow the food to digest in their system. You’ll notice them take frequent bathroom breaks to vomit up their food to avoid absorption of nutrients so they can avoid gaining any weight. Bulimia is a serious condition that could cause deterioration of the esophagus and other tissues in the body. Those with bulimia could suffer from seizures and irregular heart rhythm.

Symptoms of Bulimia

  • Frequent mood changes
  • Depression and anxiety
  • Their breath will often have an obscure odor
  • Dental deterioration
  • Constipation or inflammation of the intestinal tract
  • Dry skin
  • Devour lots of food and excuse themselves
  • Critical of body weight and shape
  • Muscle cramping
  • Tremors
  • Social withdrawal
  • Fainting

Binge Eating Disorder

People eat with binge eating disorders, and they will eat regularly, but these abnormal eating behaviors occur when they’re alone. Bulimics have periods where they won’t eat, fast, then eat a high amount of food in one sitting. Those with bulimia will often eat fast food alone and hop from one restaurant to another to eat in isolation.

Symptoms of Binge Disorder

    • Lack of self-control
    • Eating significant amounts of food and hiding food away
    • Continually eating until it becomes uncomfortable
    • Social withdrawal
    • Weight gain
    • Feeling guilty eating
    • Excessive exercising
    • Can binge eat and then vomit their foods

Body Image Disorder or Body Dysmorphic Disorder (BDD)

A mental health condition that often comes from anorexia, bulimia, and binge eating disorder often comes from these disorders. It might be the case that your loved one started with a form of extreme dieting or became addicted to exercise, and this body dysmorphic disorder (BDD) manifested, or the other way around. These conditions work off one another.

At Visions, we work with our teens to help them realize the beauty within every one of them. If we’re aware of how our children feel about themselves and how we talk to them as a family or supportive unit, we might notice these changes in eating behaviors and their adverse effects. As always, pay attention and be attentive to your children. If your child or loved one develops an eating disorder, contact us today.

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Eating Disorders Mental Health Recovery

Eating Disorder Awareness Week: Insight From Michelle Gross, MA, LMFT

Continuing our week of honoring Eating Disorder Awareness Week, I spoke to Visions’ Michelle Gross, MA, LMFT who has specialized in the treatment of eating disorders for over 18 years. Her passion is in treating the eating disorder community both individuals, and their families. Eating Disorder Awareness is something we encourage and support via groups, individualized therapy, and nutritional support. I asked Michelle for some insight into what she tells families with a loved one who is suffering from an eating disorder or disordered eating behaviors. She says,

 

“When assisting a family who have just learned that their loved one is suffering from an eating disorder, I want them to know that eating disorders are a coping mechanism that tend to occur in individuals who suffer from anxiety and/or depression. Eating disorders numb pain (overeating), release feelings (purging), and create a feeling of control (counting calories). Eating disorders, although not always identical in form, tend to run in families. Family members need to know that the way in which they respond to their loved one is critical to the recovery process; however, they are not responsible for the development of the eating disorder itself. Eating disorders are an illness. Eating disorders are not about weight.”

 

Families who are confronted with this issue have to re-learn how to communicate with each other in a non-triggering way. I recently had to have a discussion with someone about their perpetual food talk and how triggering it was. Every meal was punctuated with negative commentary about weight gain, etc. So, eating with this person was becoming treacherous. Michelle Gross has wonderful insight and suggestions for situations just like this:

 

“It is important for family and friends to know how to be supportive. Unfortunately, the best of intentions to assist the eating disordered individual tend to backfire. Telling an anorexic that recently gained weight: ‘You look so much healthier,’ is easily misconstrued as being told one is ‘fat.’  Attempts to make sure an anorexic eats or a bulimic does not purge, create feelings of powerlessness that intensify the desire to feel in control by minimizing calories or purging.  Innocently mentioning one’s own need to lose weight or recently enjoying a vigorous workout, leave the eating disordered individual feeling inadequate and more dissatisfied with herself.  Loved one’s need to learn the ‘language’ spoken by the eating disordered individuals. Eating disorders are competitive.”

 

And what about triggers? Remember, what triggers one person may not trigger another, but some things are similar across the board. Michelle provides some salient advice here. If we begin to understand the psychological mechanisms of the eating disorder, our awareness and ability to support someone who is suffering increases. By opening our eyes, we can be supportive without judging the individual.

 

Michelle tells us that, “Family and friends also need to learn what triggers or intensifies eating disordered thoughts and behaviors.  Shopping for clothes, going to restaurants, exercising to reduce stress, can all intensify the eating disorder.  Eating disorders are reactive. The more one learns how their loved one’s eating triggers them, the more helpful one can be.”

 

Recovery is a family process, and that includes recovery from substance abuse, mental illness, eating disorders, or processing disorders. Treatment must include all facets of the family system. Learning how to do this is a process and a practice; and as Michelle illustrates, it is not one-sided affair:

 

“It is extremely valuable for family members to be part of the treatment.  Family sessions in addition to the individual therapy offers all members the opportunity to learn how to be supportive, to share concerns in a controlled environment, and gives the eating disordered individual an opportunity to express their feelings in an appropriate way vs. through the eating disordered behaviors.”

 

We need to unite as a recovery community, championing Eating Disorder Awareness Week and encouraging others to do the same. We can facilitate supportive environments and spaces for healing so those suffering from an eating disorder can begin to recover and find freedom from the devastating anguish caused by their eating disorders.

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Body Image Eating Disorders Events Mental Health Recovery Teen Activism

Eating Disorder Awareness Week: Visions’ Stefanie Boone, MS, RD Shares Insight

It’s National Eating Disorder Association‘s Eating Disorder Awareness Week

often referred to as EDAW. I asked Stefanie Boone, MS, RD, to provide some insights and tips on what an eating disorder is, what is is not, and ways in which you can be supportive. This year’s EDAW theme is “I had no idea.” We are grateful to have Stefanie as part of the Visions family:

When I see parents, friends, or significant others trying to support their loved one with an eating disorder, my heart goes out to them. Besides feeling guilty (is this my fault?), worried (will he or she be OK?), and overwhelmed, they are often at loss around how to be helpful. Friends, family, and community need education around the following concepts:

–       That an eating disorder is really a symptom of deeper underlying issues;

–       That their loved one cannot just simply stop the behavior;

–       Certain things you may think would be supportive can actually make things worse;

–       That their own talk and behavior around food, diet, and being dissatisfied with their own bodies have and will continue to affect  their children or loved one;

–       That the sports team their child is a part of may actually be feeding into their ED.

My top five tips for those who want to be supportive are:

1. If you are trying to get your loved one to seek help, take a loving and non-judgmental stance with your loved one. An eating disorder is a mental illness, and requires professional help. Express your concern from a loving place.  Share how the ED is impacting you and your family.

2. If you are supporting an adult (spouse, parent, adult child) – do not be the food police. This is usually not helpful. With children and teens parents may need to be more involved – your child’s treatment team will guide you.

3. Be a positive role model – even if you do have your own opinions about food and even if you think you are “fat”, you need to stop sharing these thoughts and comments with your loved one.
And NEVER comment on how your loved looks – this is a very sensitive area and often a completely innocent comment such as “you look great” can be twisted into “is she saying I look fat?”

4. If your child is on a team sport, contact the coach – get more information as to what he/she is advising your children around food and exercise. Your child will most likely need to discontinue this sport at least temporarily while in recovery.

5. If you are a teen and have a friend you are worried about, talk to an adult about it immediately– teacher, school counselor, parents. I know this may be hard, but you may be saving your friend’s life.

 

Eating Disorder Awareness Week begins TODAY: 2/23-3/1. Please share your experience, strength and hope this week, using the hashtag #EDAW14. You never know who you’re helping or who might “hear” you for the first time.

Links to Check out:

How much DO you know? Take the NEDA QUIZ.

Proud2BMe Teen activist guide

Download NEDA’s Key Messages HERE and let others know why you’re participating.

 

Categories
Eating Disorders Mental Health

Orthorexia: When Healthy Becomes an Obsession

Orthorexia Nervosa is a term coined by Dr. Steven Bratman in 1997 and refers to the obsession with the purity and healthfulness of food. Orthorexia hasn’t found its way into the DSM-V, but it is a very real disorder. It falls under the pretense that one is really eating healthfully.  However, the desire to eat well and purely can often provoke an environment of nutritional loss and poor health. Orthorexia presents a conundrum, because eating healthy is a positive attribute; where the issue arises is when eating healthy becomes an unhealthy obsession.

 

I sought deeper insight into this disorder, and spoke to our nutritionist Stefanie Boone, MS, RD, who frequently works with clients suffering from Orthorexia.  She says,

 

“When I see clients with orthorexia, what stands out most is the level of stress and anxiety they experience at the idea of eating something they deem as unhealthy, as well as the amount of time and energy spent around their healthy diet. Orthorexia is hard for people to understand as a type of eating disorder, because eating healthy is generally such a positive thing to do. But when it winds up being all-consuming, it is at the expense of other areas of their life (relationships, work, mental health). Health may be compromised if a person winds up eliminating too many foods. Weight can get dangerously low, though it doesn’t always.

With orthorexia, there is an exaggerated perception that eating one food or meal that is unhealthy will have unrealistically negative consequences (similar to Anorexia Nervosa where a person may fear one food or meal will cause them to ‘get fat’).  Sometimes, the person feels as if their goodness or worthiness as a person, or even their spiritual trajectory, depends on their eating.”

 

The National Eating Disorder Association (NEDA) provides these questions to consider. The more questions you respond to with a “yes,” increase the likelihood of orthorexia:

 

  • Do you wish that occasionally you could just eat and not worry about food quality?
  • Do you ever wish you could spend less time on food and more time living and loving?
  • Does it seem beyond your ability to eat a meal prepared with love by someone else – one single meal – and not try to control what is served?
  • Are you constantly looking for ways foods are unhealthy for you?
  • Do love, joy, play and creativity take a back seat to following the perfect diet?
  • Do you feel guilt or self-loathing when you stray from your diet?
  • Do you feel in control when you stick to the “correct” diet?
  • Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?

 

Orthorexics often become isolated, suffer from nutritional deficiencies, lose the ability to eat intuitively, and suffer from significant social issues. The fear of food becomes overwhelming. This is not a sustainable existence; it is one that requires professional help and support.

 

As a recovered orthorexic client describes, “I basically thought that the cleaner I ate, the better my closeness to the source would be from a spiritual perspective—that I would be able to see and think and feel more clearly. The problem was that at the end of it all when you cross reference the foods that are not OK to eat across the many different philosophies I was trying to follow (ayurveda, Chinese medicine, etc.), I was left with the reality that there was really nothing left I could eat.”

 

With professional help, a recovered orthorexic will learn to shift their paradigm around food. While they will continue to eat healthy foods, they will have redefined their relationship to it, freeing them to enjoy life more completely.  If you are suffering, please seek help. Recovery is possible.

Helpful sites and articles:
NEDA

Mayo Clinic

Academy of Nutrition and Diatetics

Orthorexia: Too Much of a Healthy Thing? (Huffington Post)

 

Categories
Eating Disorders Mental Health Recovery

Eating Disorders: Putting Ed in Time Out

It’s been a while since we’ve talked about Ed (Eating Disorders), but it’s summertime, and Ed likes to interject a lot now that it’s bikini season. Oh, and FYI, it’s not uncommon for those in recovery to refer to their eating disorder as Ed. Some may give it another name, but Ed always seems to fit the bill.

 

Eating disorders are tricky: they are not about food, but food is the weapon of choice. Ed is the one quietly whispering in your ear, nagging you about calories or telling you that you really shouldn’t eat this or that or encouraging you to binge. Frankly, he’s a jerk. He doesn’t have your best interests in mind. Part of recovery is learning how to talk back to Ed, but that is a process. We tend to get so caught up in the lies and dysfunction of the eating disorder itself, we get detached from reality. Ed is a magnificent manipulator and master of ceremonies, and he digs his role.

In the book “Life Without Ed,” Jenni Shaefer declares independence from her eating disorder. She does this after a lot of therapeutic work; so don’t get any crazy ideas! Jenni  Shaefer eventually wrote a declaration of independence from her eating disorder; I’ve shared a more general version with you which was sourced from here. It’s fantastic. Perhaps it will encourage you to talk back to your eating disorder. Perhaps it will encourage you to kick Ed to the curb and declare your own independence.  Enough is enough. There’s no reason to live under the tyranny of Ed any longer. Even when he rears his ugly head, we can talk back. And even if he gets the better of you for a day or two, perhaps you can look at this and know that you can dust off your knees and stand up again. Remember, “fall down seven, stand up eight.” To quote Jenni Shaefer, “Ironically, it is the not-so-fun part of recovery that actually enables life to be so much fun in the end.”

My Declaration of Independence 

When in the course of human events, it becomes necessary for a person to dissolve the bonds which have connected them to Ed, and to assume, among the powers of the earth, the separate and equal station to which the Laws of Nature entitle them, a decent respect to the opinions of humankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all persons are endowed upon birth with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of happiness.

That whenever Ed becomes destructive of these ends, it is right to abolish Ed and to institute Recovery, laying its foundation on such principles and in such form as shall seem the most likely to effect safety and happiness.

When a long train of abuses, pursuing invariably the same person evinces a design to reduce that person under absolute despotism, it is their right, it is their duty, to throw off Ed, and to provide recovery for their future security.

The history of Ed is a history of repeated absolute Tyranny over this man or woman. To prove this, let facts be submitted.

-Ed has refused for a long time to allow the individual to find happiness

-Ed has erected a multitude of binges and purges

-Ed has ravaged the individual’s life and harmed the lives of the people close to them

-Ed has cut off all emotions

-Ed has suspended the individual’s own mind and declared himself invested with the power to legislate the the individual’s world

-Ed has deprived the individual of food

-Ed has taken away the individual’s feelings, abolished his or her most valuable morals, and altered fundamentally his or her values.

Therefore, I solemnly declare that I am FREE and INDEPENDENT.

I am absolved from all allegiance to Ed.

Any connection between Ed and I will be completely dissolved, and as a free and independent individual, I have the power to eat, live in peace, and find happiness.

Categories
Addiction Eating Disorders Recovery Smoking

Eating Disorders: Using Smoking As Weight Control

Smoking cigarettes in adolescence has always been considered a pathway to coolness, or a way to fit in. For a time, smoking began to be considered passé, but amongst teens in recovery, it still holds the mythical status of cool and is often key to fitting in. So much so, kids who want to quit or who don’t really want to smoke may even start smoking E-cigarettes in an attempt to reach the same level of cool. (It is just vapor, right?). I digress. For girls who smoke, there may be another reason behind the nasty habit: presumed thinness, or a path to thinness. Some assume that smoking is also the answer to hunger pains and subconsciously satisfy (albeit temporarily) the desire for food.

 

In their working paper titled “The Demand for Cigarettes as Derived from the Demand for Weight Control,” Stephanie Von Kinke Kessler Scholder and John Cawley found that “among teenagers who smoke frequently, 46% of girls and 30% of boys are smoking in part to control their weight.” We see this behavior all the time within our recovery community, particular among those suffering from and beginning to recover from eating disorders. For some, the idea is that it’s far easier to go smoke than to eat lunch. We are highly aware of this predilection amongst our eating disorder population and we take great measures to stop these behaviors in their tracks. Some of which include supervised meals and several focus groups dedicated to eating disorder recovery.

 

But what about someone struggling with an eating disorder who is not in the safe, healing environment of a treatment facility? What if they are on their own, doing the dance of recovery solely through meetings and fellowship? Will they notice their use of cigarettes to stifle hunger pains? More than likely, they will not. I remember being new and bragging that I was surviving on a diet of coffee and cigarettes, ever chasing the goal of “perfection.” At the same time, I also had a raging eating disorder, consuming my thinking and vision. I was clueless. It took me years to learn to recognize that smoking was a key to assisting me in my process of acquiring thinness.  In fact, one of the fears when I quit smoking was the presumed assurance of weight gain.

 

As always, one of the first steps to recovery is asking for help. This is not a feat that comes naturally to an addict or alcoholic. We are accustomed to “doing it all ourselves.” Still, going to meetings, getting a sponsor, finding a therapist, all of these things can help us begin the healing process. Beginning the process of digging deeply and getting to the root cause of whatever is causing you to harm yourself with addiction, starvation or binging, or binging and purging is crucial. We cannot recover alone, nor can we stop the insanity of our addictions without asking for help.

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Body Image Eating Disorders Recovery

Body Image and You: Stand Up to Your Inner Voice

#EDAW13 #LoveMore

In honor of NEDA‘s annual Eating Disorder Awareness Week or EDAW, I had the opportunity to speak about body image and photography at Cal State Northridge. Conversation is a huge part of my photographic process and a key component in working with people.  It’s not uncommon for me to hear self-deprecating commentary from photography clients about their perceived weight issues, body expectations, body shape, size, imperfections, et cetera. We are never exactly where we think we should be, right? In those moments where we are particularly vulnerable (in front of a camera, for example), why wouldn’t we talk about how insecure we might feel? After all, we are inundated with manufactured “perfection” in advertising and media on a daily basis. I find it an honor and privilege to have the opportunity to use these moments to be of service as a body image advocate to honor whomever I’m photographing in order to create a creative partnership. In those moments, we can quiet that angry inner voice of delusion.

 

Recovery asks us to be of service. In my own recovery, I try and bring the energy of service work into everything I do: to love others, even when loving them is difficult. To love myself, regardless of my own perceived imperfections. Eating disorders and disordered eating both have this in common: body image issues. If anything, it is a side effect of being a human being in a visually saturated world, but it doesn’t have to become a necessary evil. There is a way to challenge the negative body image messages we encounter in our everyday lives. Changing your body image means changing the way you think about your body.

 

Start from within:

When you wake up, set an intention to say 3 nice things to yourself throughout the day. Write those things on post-its if you need to and stick them where you won’t miss them.

 

Change negative perceptions to those of acceptance and positivity

Silence your inner critic. Begin to recognize that A: you are not your thoughts,

and B: feelings aren’t facts.

When you hear that negative self-talk revving its engine, try and counteract it with a positive comment.

 

How do we learn to love ourselves when what we see is distorted?

We see reflections of ourselves wherever we go: shop windows, bathroom mirrors, dressing rooms, elevator doors, brass coverings, and random reflective surfaces. Our reflections are everywhere, but are they really a true reflection of us? Most often, they are not.  Many professionals are talking about “Mirror Fasting.” In this practice, you are asked to “fast” from looking at your reflection.

Try this: Make a decision to stop looking at your reflection for a day. See how you feel. Add another day. See how you feel. Women and men who do this tend to have an increase in self-esteem, and a more positive image of their bodies. What we see is not always reality when it comes to mirrors; when we suffer from body dysmorphia, what we see really becomes skewed. Kjerstin Gruys, a 29-year-old sociology graduate student documented her yearlong Mirror Fast in her blog, Mirror Mirror…Off the Wall. In that process, she learned to love her body. I’m not asking you to skip mirrors for a year, but perhaps trying it out for day or a week, noting the emotional effects would be beneficial.

 

Body image issues are something many of us face. Even in recovery, even knowing what we know about the negative factors behind a poor image of self, we struggle. But with what we know, we have to find the temerity to stand up to that inner bully and put a stop to the barrage of self-deprecating chatter. Today, I stood up to that voice and looked in the mirror and said, “You are magnificent.” It felt incredible.

Helpful reads:

How Yoga Changed My Mind (And My Relationship to my Body) by Melanie Klein

Starving for Connection by Chelsea Roff

Voice in Recovery

Categories
Eating Disorders Mental Health Parenting Recovery Treatment

Stress, an Eating Disorder, and Mental Health

…Eating Disorder… (Photo credit: ĐāżŦ {mostly absent})

A while back, I wrote about a child of 8 years old who was showing early signs of disordered eating behaviors. As noted at that time, the behavior was fueled by a father with his own poor relationship around food and a mother who is also victimized by his negative body and food talk. I’ve watching this child over the last year, hoping I was wrong, but knowing more and more that the signs I was seeing were none other than an eating disorder being nurtured and fed by self-hatred, stress, and a negative environment. Her organization of food has gotten more intense, as has her open disgust around whatever is on her plate. It’s not so much about being “fat” but more about her discernment around eating a growing number of “certain” foods.

There’s stress all around this kid: her father is impatient and fixated on his own weight and body image. Her mom is reacting to his actions by persistently apologizing when she eats, joining Weight Watchers, and choosing to ignore the cry for help at the dinner table. As a regular in their household, it’s been hard to watch and harder still not to say anything for fear of being shut out entirely. I’ve used my presence as an opportunity to change the dialogue when I can, but it’s hard speaking to a room full of deaf ears. I finally did say something when the negative talk was directed at me and as expected, my comment, despite coming from love, was met with a “Nah, I’m not worried about that.”

 

Stress is a huge culprit here. According to the Eating Recovery Center, “childhood stress is typically: personal, interpersonal, interfamilial, or global (a stress reaction to national or world news).”

  • Age is not a factor: Children of all ages experience stress, though they may express it differently.
  • Children are vulnerable.
  • Children respond differently to the stress in their environment.
  • Stress is cumulative. Adults aren’t the only one’s who can “only take so much.”
  • Change is stressful. Even positive change. I am reminded here of reorganizing a room in my house and my son getting utterly overwhelmed even though the change was positive. Our nervous systems are indifferent to our whims and desire to pile on more and more and the fact that we all may have a different response is something to be noted and respected.

Parents and adults alike would be wise to open a dialogue with their kids about stress and one’s perceptions of how things are. In the case of my young eating disorder study, dad is never around and only available on weekends; when he is there, he’s impatient and obsessively exercising or on his computer—detached from everyone. This provides a huge source of stress for her and for the rest of her family. Unfortunately, this has been weaved into her negative self talk and commentary about her family and hinders her relationships with others and with food. She’s angry, stressed out, and starving herself in response.

What can we do? We can start with the following:

  • Be an example of positive body talk.
  • Talk to our kids. Be open and honest, but be loving.
  • Eat mindfully. Turn off the TV. Make mealtime a place of solace and connection.
  • Don’t talk about stressful subjects at the dinner table. In other words: keep it light.
  • Don’t use food or eating as a means of punishment. (You’re going to bed without dinner).
  • Encourage self-care and self-love: At dinner, ask each person to express one thing they are grateful for.
  • Cook together. Show them that food isn’t the enemy.
  • Go on hikes or family walks.
  • Have family meetings. We do them council style in my house. It makes a world of difference.
  • Don’t be afraid to ask for professional help.
  • Be honest with your therapist. They can’t help you if you hold back.
  • Find a support group—being alone with your child or family is in crisis is too much for anyone.
  • Take care of yourself so you can take care of those around you.

If you’re worried that your son or daughter might be developing an eating disorder (note: boys are not immune to this!), look out for some of these signs.

(Please note, certain behaviors are warning signs, but in combination and over time, they can become quite serious):

Behaviors specific to anorexia:

  • Major weight loss (weighs 85% of normal weight for height or less)
  • Skips meals, always has an excuse for not eating (ill, just ate with a friend, stressed-out, not hungry).
  • Refuses to eat in front of others
  • Selects only low fat items with low nutrient levels, such as lettuce, tomatoes, and sprouts.
  • Reads food labels religiously; worried about calories and fat grams in foods.
  • Eats very small portions of foods
  • Becomes revolted by former favorite foods, such as desserts, red meats, potatoes
  • May help with meal shopping and preparation, but doesn’t eat with family
  • Eats in ritualistic ways, such as cutting food into small pieces or pushing food around plate
  • Lies about how much food was eaten
  • Has fears about weight gain and obesity, obsesses about clothing size. Complains about being fat, when in truth it is not so
  • Inspects image in mirror frequently, weighs self frequently
  • Exercises excessively and compulsively
  • May wear baggy clothing or many layers of clothing to hide weight loss and to stay warm
  • May become moody and irritable or have trouble concentrating. Denies that anything is wrong
  • May harm self with cutting or burning
  • Evidence of discarded packaging for diet pills, laxatives, or diuretics (water pills)
  • Stops menstruating
  • Has dry skin and hair, may have a growth of fine hair over body
  • May faint or feel dizzy frequently

Behaviors specific to bulimia

  • Preoccupation or anxiety about weight and shape
  • Disappearance of large quantities of food
  • Excuses self to go to the bathroom immediately after meals
  • Evidence of discarded packaging for laxatives, diuretics, enemas
  • May exercise compulsively
  • May skip meals at times
  • Teeth may develop cavities or enamel erosion
  • Broken blood vessels in the eyes from self-induced vomiting
  • Swollen salivary glands (swelling under the chin)
  • Calluses across the joints of the fingers from self-induced vomiting
  • May be evidence of alcohol or drug abuse, including steroid use
  • Possible self-harm behaviors, including cutting and burning

If you notice even one of these, it’s time to address it. Talk to your daughter or son, talk to your doctor. If necessary, elicit the help of a treatment facility. In other words: Get help. Showing our kids that we care and are willing to stop our own negative behaviors in order to help them is invaluable. It’s a family problem, not an individual one.