The Abyss of Bad Body Image...Don't Get Sucked Under!

How many times in your life have you been having a perfectly pleasant day and then suddenly find yourself drowning in negative body image? In an instant, you feel like X body part has tripled in size even though, rationally, you know that is not possible. Over the course of my life, throughout relapse and recovery, I have had countless moments like this. Every therapist I have gone to throughout my life told me that "body image is the last thing to go" in ED recovery. As a therapist working with ED clients, I endorse this train of thought as well.

Given our culture, I don't know that body image ever fully dissipates. The notion that in order to be successful and beautiful you must be skinny penetrates every media outlet. So, everywhere you go, watch, and read the message is clear. Plenty of women without EDs have moments of "feeling fat" or thinking their quality of life would improve if their pants were just a bit looser. Rationally we know that this is not true, but our minds--ED or not--are not always rational. So, even after years in recovery or being fully recovered, there may be momentary flashes of negative body images.

I would be misrepresenting myself if I said that I don't ever experience body image issues. However, the major difference today is HOW I CHOOSE TO RESPOND. Today when that negative voice tries to disrupt my happiness, I realize that I have a choice. I can choose to listen to it and really get into self-hatred. Or, I can choose to not listen, knowing that nothing good can come out of it. If it pervades and tries to lure me further by giving me a sudden awareness of a certain body part, I have to really ask myself what else is going on? If I am okay with my body one minute, but having issues the next, then, clearly, this is not about body image.

My clients often ask me, so HOW do you choose not to engage in negative body image??? Here are a few actions that work for me:
1.) I recognize that I am having negative thoughts about my body.
2.) I explore possible explanations as to why the thoughts are occurring at this particular moment. Many might think that there are no explanations, and that it "just happens." I encourage you to dig a bit deeper with this. Even if it is ED talking and thus doesn't need explanations, ED is not a separate entity that lives in your brain. It may feel like that, however, you are the only person that is actually thinking and listening to your thoughts.

3.) I MAKE A DECISION NOT TO ENGAGE. More than that, I have to ask myself, DO I WANT TO ENGAGE IN SELF-LOVE OR SELF-HATRED TODAY??? This is what it really comes down to. It might feel like you haven't any choice, but YOU DO!!! I'm not saying it is easy, but you can do this. It is difficult to want to choose self-love when it is so comfortable to emotionally beat yourself up. Recovery from negative body image is hard work, but it is far from impossible!

THOUGHT FOR THE DAY: FOR THIS MOMENT, I HAVE THE ABILITY TO THINK POSITIVELY ABOUT MYSELF. :)

Dis-Ease or Disease?

At least two times a week, my clients at Renfrew will inquire about whether an eating disorder is a disease, like in alcoholism, or if this is a disorder one can fully recover from and never have to think about again. Looking into their eyes, eyes that reflect a desperate desire to know that they can fully recover, I want to tell all of them that full recovery is possible for everyone. However, that is not my immediate answer.

First, I have to define how I'm defining "fully recovered." I think of recovered as no longer relating to having an eating disorder, not using eating disorder symptoms as maladaptive coping mechanisms, not being plagued by the ED voice, not concerned with weight/body image issues, not struggling with wanting to use symptoms, and not engaging in symptom use. Now I know there are others to add to this list, but you get the picture.

I believe that some will fully recovery while others will be in recovery for the rest of their lives. I think are a variety of variables that determine whether one will have a period of dis-ease with an eating disorder, or will have a disease that will have to be managed for the rest of one's life. Some variables could be developmental stage, age of onset, age of first intervention, number of years in ED before entering treatment, ability to restore weight, chronicity, level of support structure, family history of mental illness, co-occurring disorders, trauma, external antecedents, inability to alter worldview and belief system, etc. And there are so many more. I think the closest answer to the truth is that we don't really have much evidenced based knowledge what makes someone fully recover. I think of it similarly to having siblings who grow up where their parents are alcoholics--one sibling becomes an alcoholic later in life, and the other is, seemingly, without pathology. Why is that?

If eating disorders were reduced to issues of weight restoration and symptom management, my guess is that it would be much easier to have evidence based predictors of full recovery. But, as we know, the food and juxtaposed behaviors are merely a symptom. Can we predict that the prognosis for a 14 year-old who goes into treatment after a 6-month period of anorexia nervosa with no co-morbidity will be better than the 25 year-old anorexic with a history of trauma and substance abuse? Probably--but not absolutely.

I think that many can fully recover from an eating disorder. I just don't how realistic it is to claim that everyone can fully recover. In the last decade, I have had hundreds of interactions with women (not adolescents) who feel that they will be in recovery for the rest of their lives. It doesn't mean that they are imprisoned by an eating disorder and are actively using symptoms. It simply means there is some level of daily maintenance to sustain long-term recovery. Even if one can't be "fully recovered" and are in recovery, is that really such a bad thing???