Categories
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.

Categories
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
Body Image Eating Disorders Mental Health Recovery

Eating Disorders: Recovery and Service

Eating disorders can breed contempt or denial in those that don’t understand them while feeding the silent devastation and fear in those who have them. This is an inherently challenging situation. Types of eating disorders vary but we are most familiar with Anorexia and Bulimia or a variation of the two. Still, there are some who suffer from disordered eating. I’ve heard it said that disordered eating is not an “actual eating disorder,” but rather a “phase” of bad eating behaviors.  However, the DSM and professionals in the field of addiction and mental illness have proven that not to be the case. For example, disordered eating has now earned the diagnostic term Eating Disorder Not Otherwise Specified or EDNOS.

For real clarification, the DSM descriptions of the various criteria for Anorexia, Bulimia, and EDNOS can be found below:

Eating disorder not otherwise specified includes disorders of eating that do not meet the criteria for any specific eating disorder.

  1. For female patients, all of the criteria for anorexia nervosa are met except that the patient has regular menses.
  2. All of the criteria for anorexia nervosa are met except that, despite significant weight loss, the patient’s current weight is in the normal range.
  3. All of the criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur less than twice a week or for less than 3 months.
  4. The patient has normal body weight and regularly uses inappropriate compensatory behavior after eating small amounts of food (e.g., self-induced vomiting after consuming two cookies).
  5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.

The criteria for Anorexia Nervosa is:

  • Refusal to maintain body weight at or above a minimally normal weight for age and height: Weight loss leading to maintenance of body weight <85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected.
  • Intense fear of gaining weight or becoming fat, even though under weight.
  • Disturbance in the way one’s body weight or shape are experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
  • Amenorrhea (at least three consecutive cycles) in postmenarchal girls and women. Amenorrhea is defined as periods occurring only following hormone (e.g., estrogen) administration.

And the criteria for Bulimia Nervosa:

  • Recurrent episodes of binge eating characterized by both:
  1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
  2. A sense of lack of control over eating during the episode, defined by a feeling that one cannot stop eating or control what or how much one is eating
  3. Self-induced vomiting
  4. Misuse of laxatives, diuretics, enemas, or other medications
  5. Fasting
  6. Excessive exercise
  • Recurrent inappropriate compensatory behavior to prevent weight gain
  • The binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of anorexia nervosa

Recovering from any of these eating disorders is hard work. We have to learn to navigate the food playing field with healthy awareness. One of the interesting things I’ve learned about recovering from my own eating disorder is that food is merely a symptomatic component of the greater problem: low self-esteem, an out of control environment, poor body image, fear, control. Not eating was always a way to control the chaos around me. What I was clueless about was the fact that I was created chaos within. The more out of control the outside environment is, the more control someone struggling with an eating disorder requires to simply survive. Yes, there’s deep irony in the use of “survive” here, because the end result of some severe eating disorders is ultimately death.

Chelsea Roff, a recovering anorexic, yoga teacher, speaker, and author, has come out publically with her story of recovery. Chelsea suffered from a stroke when she was 15 and ended up in a hospital for 18 months under constant care. Her essay, bravely discussing her story first appeared in the book 21st Century Yoga: Culture, Politics, & Practice. From there, she was swept into the fray of instant publicity and exposure, ranging from the Huffington Post to Dr. Sanjay Gupta on CNN. While being in recovery isn’t about celebrity, there’s something to be said for a young girl who is taking this exposure and using it for good. There’s something deeply inspiring about someone who came from near death and is now thriving and being of service. In the end, being of service is what it’s about.

Eating disorders have their way of creeping back in when we least expect it. When we are of service and helping others, our own transparency is paramount to that process. In other words, being of service helps keep us honest. We have to eat. We have to learn to develop healthy relationships with our bodies and with food. Here, instead of vigilantly controlling our intake of calories, we can direct our vigilance to being of service. I look to Voice in Recovery and Chelsea Roff as young women who give back what was so freely given to them. I look to Melanie Klein (also a contributor in 21st Century Yoga) and Claire Mysko to provide the education and passion for body image advocacy in order to help young people gain a better understanding of the deeply rooted, media-infused sources of poor body image and eating disorders.

Kindness starts from within. We can and will recover.

RESOURCES:

NEDA

NIMH

Proud2BMe

Voice in Recovery (ViR)

 

Categories
Body Image Eating Disorders Mental Health

Graduation: Europe or Lipo?

“Kid, you’ll move mountains!
So…be your name Buxbaum or Bixby or Bray or Mordecai Ale Van Allen O’Shea, 
You’re off to Great Places!
Today is your day!
Your mountain is waiting.
So…get on your way!” – Dr. Seuss
Image by MarinaCr via Flickr

Certainly, for some teens, plastic surgery can be positively life-changing. For example: a child who’s subject to excessive teasing because of an inordinately large nose may positively benefit from rhinoplasty; a burn victim can return to relative normalcy with appropriate plastic surgery; a breast reduction can allow a young girl to exercise without neck and back pain. On the other hand, what lies beyond what’s necessary for some is the skewed perceptions of beauty and perceived normalcy inadvertently thrust upon teens through social and mainstream media.  The innate dissatisfaction with how we look contributes to how we meet the world. To really illustrate this, we can look at the recent uproar that came about when a mother defended her decision to give her 8-year-old daughter Botox injections. Makes you wonder: What 8-year-old has wrinkles? Better yet, what 8-year-old is even aware of wrinkles?


 
“Statistics gathered over the last several years indicate a decrease in the overall number of cosmetic (aesthetic) surgeries of teenagers (those 18 and younger) having cosmetic surgery, with nonsurgical procedures including laser hair removal and chemical peels being the most popular in 2010.”

These statistics are both good and bad. I mean, the fact that less invasive surgeries are on the decline is certainly positive, but I am concerned about the remaining high numbers of girls seeking these procedures.  We know teens are up against extraordinary pressure to look and be a certain way–some of it is normal adolescence–but when parents start giving their kids gift certificates for a new nose or new breasts, the lesson becomes less about self-esteem and more about trying to attain the pop-culture paradigm of perfection.

So, what does this mean from a recovery standpoint?  Well, if we start by parenting our children with this idea that they aren’t enough, we end up sowing the seeds of self-hatred and dissatisfaction. Instead of laying a foundation of confidence and positive self-esteem, we end up paving a rocky road to addictive behaviors, which inevitably contributes to disordered eating and eating disorders alike. There’s no reason why this can’t be a springboard to have a heart-to-heart with your teen. It’s also an opportunity to look at what messages we are trying to give our kids. Being a teen is tough; let’s not contribute to the social tyranny by fanning the fires of social awkwardness. This too shall pass.

Bottom line? There are far more appropriate gifts for your teen than going under anesthesia and accumulating scars, no matter how small they are.  

Links that may be of interest:
Categories
Body Image Eating Disorders Mental Health Recovery Therapy

Starving at 8

image © sarit photography

I know an 8-year-old who’s been known to choose an outfit specifically because it makes her “look thin.” This same 8-year-old often doesn’t finish meals because she thinks she’s fat. She’s the same 8-year-old that has begun to develop food rituals, often leaving the table with a reorganized plate full of uneaten food. Simply put, she already has an irrational fear of getting fat.
It’s hard being a girl. It’s hard to find a way to look at your unique self without comparing it with images of Barbie or Bratz. It’s hard to accept that  the beauty standard set by Cinderella or Sleeping Beauty isn’t actually real. But children, whose minds are filled with wonderful imagination and fantasy, aren’t going to cognitively recognize images that are potentially harmful. Instead, many will attempt to achieve the pink, thin, fluffiness of a Disney princess, or the skinny sass of a Bratz doll. Often times, even when parents are encouraging a healthy body image, the education on the school yard has a dramatically different lesson plan than the one from home. I’ve overheard conversations on the school yard that have made me pause – -it’s clear that body-image issues are in abundance and the pressure to look thin and svelte is invasive and intense.

So what can parents do? Start with eliminating the shame game. This might mean letting your daughter dump that maple syrup on her pancakes or having a cupcake at a birthday party. It’s a treat, not a vehicle for punishment!  Encourage healthy eating, but can you do it with compassion rather than the mallet of criticism?  Eliminate “fat talk”: your kids don’t need to hear it and frankly, it’s not good for you either. Stop trying to control what those around you eat. It’s not your job!  I’ve seen dads controlling the food intake of their wives and daughters to the point of devastating eating disorders (my dad was one!); and I’ve seen moms spewing “fat talk” or signing up for any and every diet fad while their daughters learn to eat in secret or restrict because they’re terrified of the incendiary reaction of their parental food monitors. These behaviors certainly don’t encourage self-love. If anything, they sow the seeds of self-destruction.

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.

Some helpful links:

NEDA
WebMD
Voice in Recovery
Peggy Orenstein
maudsleyparents.org
Also, check out “Brave Girl Eating: A Family’s Struggle With Anorexia” By Harriet Brown