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???

Natalie Portman and the Black Swan: A Perfect Performance of Insanity

Recently I saw the movie Black Swan. Besides the buzz around it, because I’m a former professional dancer, in recovery for eating disorders, and a therapist, I thought it would be the perfect movie for me to see. Yes, there was a slue of self-destruction. Yes, it portrayed the perfection requisite to a ballet career. So what?

Well, what I thought was kind of genius about the movie was how the director eternally depicted what goes on inside the unbalanced, perfectionist, eating-disordered mind. The duality of the White Swan and Black Swan characters Natalie Portman played in The Black Swan symbolized an exaggeration of the “good” and “bad” mindset I spoke about in my first post.

What I liked is that it gave the audience a real look into the mindset of self-destruction. While not everyone can relate to such a severe level of self-hatred and insanity, people do have internal battles to a lesser degree, which makes Portman’s character all the more relatable. The timing of the movie is interesting. Like the many reality shows concerning addiction and mental health on TV today, I think the fact that a movie (even if not in reality) is portraying the complete mental insanity that occurs in the perfect world of ballet, illustrates that the stigma around mental health issues are slowing diminishing. All of which is refreshing.

I’m going to see the movie again to completely wrap my brain around it.

Daily Reminders

While I have been free from bingeing and purging for some time now, my eating disorder still tries to lure me into playing its dangerous games. Almost daily, it's as if I hear a voice that says, "Hello? Remember me? I have some new games for you when you're ready to play."

Sorry, I don't play those types of games anymore. On occasion, however, I find myself gambling on the Russian Roulette of abstinence to see how far chance, luck, and strategy will take me without falling into the red zone.

For instance, the other night as I drove home from work, I felt thirsty, so I thought I'd make a pit stop and get a Diet Coke. It was after ten at night and I don't live in the safest of neighborhoods, so instead of getting out of my car, I decide, brilliantly, to cruise through the drive-thru at McDonald's. To people who aren't addicted to food, this may seem like a viable, innocent option. Although I can eat anything abstinently, for a person like me, who used to have McDonald's bags adorning the front and back seats of my car, quenching my thirst at a fast food chain is never a smart option.

Of course, I already knew this, but did it anyway.

A few seconds after I tentatively inch my way up to the drive-thru, a familiar phrase comes blaring through the raspy speaker.
"Welcome to McDonald's, would you like to try an Extra Value Meal today?" Would I? Of course. Will I? Of course not.
"Just a second," I reply. "I'm not quite ready." I should have been ready. After all, I knew what I came for--one Diet Coke, nothing more.
Enticed by the entertaining pictures of fast food that scream at me--"Pick me, pick me!"--my mind begins to flounder.
"Are you ready to order?" the voice asks. Feeling like I've already wasted at least three minutes of her time, I decide that it would be rude to order just a Diet Coke. Pressure corrupts my head as I deliberate my options.
"Yes, I'll have a medium Diet Coke...and an Apple Pie."

Seconds after leaving the drive-thru, I take a bite of the pie. It tasted delicious, but I knew if I ate another bite, then I'd spend the rest of the evening feeling guilty and performing fat checks to see if I any evidence of apple pie clung to my stomach. With that, I put the pie down.

The reality is that I am capable of eating anything from any menu without resorting to bingeing and purging--but that doesn't mean that I should. I know that bingeing and purging is absolutely not an option--which means that whatever I choose to eat, I have to live with the consequences.

The difference between me now and when I engaged in bulimia is that today I believe that 1.) eating one bite will not physically change my body, and 2.) what's is becoming more important to me is eating things that won't produce guilt. At times, as in the above scenario, I tend to deny and forget certain truths for myself, which is why I still get into sticky situations.

Cliche for the day: Progress, not perfection.