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???

Opening a Window of Opportunity

Countless number of times when active in the eating disorder, I'd have a thought to use an eating disorder symptom and, before I knew it, I'd be standing in a grocery store buying binge food or find myself in a bathroom, unable to account for the time that lapsed between the thought of using the eating disorder and the action. As if I'd had tunnel vision, my consciousness only able to see the option of using eating disorder symptoms for dealing with my emotions.

Working as a psychotherapist, I hear this story day after day from clients. I often will retrace the steps of a client's slip, only to hear her unclear as to how she arrived at her symptomatic state, which seems to create an added layer of guilt and hopelessness much of the time. As if it was just something that "happened" to her and all of a sudden she was in relapsive behavior. I truly empathize with my clients in these moments, as it can feel like such a state of self-defeat.

Perhaps the most important thing I learned in early recovery was that my thought did not have to lead to an action. I learned that I needed to create a window of space, an opportunity that gave me time to collect my often-irrational and emotionally-charged thoughts and actually CHOOSE a way to deal with the situation, urge, or feeling with adaptive coping skills instead of self-destructive behaviors.

In order to do this I had to:

1. Be mindful of what was happening with me internally.
2. I had to literally stop and become conscious of the here-and-now and acknowledge my eating disordered urges.
3. I also had to remind myself that a thought is just a thought. I am going to have these thoughts, but that does not mean I have to act on them.
4. Next, I had to make a decision and not keep entertaining the urge to use ED symptoms. A symptom cannot thrive without attending to it.
5. Once I made my decision, I then had to create a plan for what I was going to do instead of use ED symptoms. This came in the form of using healthy distractions, leaving my environment, reaching out for support, etc.
6. Finally, I had to take action and remind myself that the urge will pass, if I let it.

In order to break the eating disorder cycle, you have to be able to tolerate your emotions long enough to get to the other side of them. To know that you CAN tolerate any emotion, no matter how uncomfortable. Today, think about and write down ways you can create distance between your thoughts and actions when an urge strikes. Come up with a list of coping skills (self-talk, playing the tape through, reaching out to others, meditation, taking a gentle walk, etc.) you feel you could actually use in the moment.

As an experiment, the next time you have an urge to use ED symptoms, put your plan into action and give yourself a real window of opportunity for recovery. The window may appear to be jammed, locked, or hard to open. But you have the power to open it and create a different outcome. Eating disorders are deadly, and you never know if you will have a tomorrow to start over for. Start today--you deserve it!

NYC Ballet Dancer Jenifer Ringer Criticized for Being "Overweight"

NY Times dance critic Alastair Macaulay probably should've completed one more revision of his choreographed commentary for NYC Ballet's production of "The Nutcracker." Perhaps if he'd chosen to edit his harsh view of the Sugar Plum Fairy--played by Jenifer Ringer--whom he stated "looked as if she'd eaten one too many sugar plums," there wouldn't be so many tutus and ballet pink tights in a wad.

As a therapist, recovering bulimic, and former dancer, I have mixed thoughts about the NY Times article. My therapist and recovering self is outraged by such insincerity; especially when Ms. Ringer has talked about her issues with eating and self-esteem, which were perpetuated by the ballet world. As a former dancer, albeit not primarily classical ballet, I was never told I was fat. However, there were a couple of times when I was told that my body would be perfect if I'd just "tone up" a little. What was difficult for me was living in LA and being criticized by agents or choreographers about my look or style, and the constant type-casting. The message was clear: You aren't good enough. Period.

While it hurts to be judged in the dance world, it wasn't unexpected. My years of taking classes daily, spending hours scrutinizing every movement, every body line, every inch of my body--while trying to get the ballet mistress' attention and stand out more than your classmates--prepared me for the professional world of dance. I knew what I was getting into. It fed right into my naturally masochistic nature. Home sweet home.

Getting back to the article, though ... I do find it RIDICULOUS that, of all things, knowing that Jenifer has had past ED and self-esteem issues, Macaulay had to comment on her body. Wasn't it enough that he said she didn't dance with adult depth or complexity? Tsk, tsk Macaulay.

As a therapist who wants to help those who struggle with food and body images issues, I can't help but wonder how many more young girls and women will be triggered by his critique. So, he's getting a lot of flack for his comments--the message is on point: You need to be THINNER.

Ms. Ringer responded on the Today Show about being criticized, stating that because of where she is in her life now, she can move forward from it. Here are some of her comments below.

"I was 16 when I became professional and I think I wasn’t prepared to cope with just being in an adult performing world, and so I think my coping mechanisms kind of turned into eating disorders and body image issues."

"As a dancer I do put myself out there to be criticized and my body is part of my art form. At the same time I’m not overweight. I do have I guess a more womanly body type than the stereotypical ballerina."

I agree with her comments. It's clear that she has Grand Jete'd from her past insecurities to a life of health and sanity. BRAVO!

"HOW" EDs change

As a person in recovery from a long struggle with bulimia, as well as a person studying to be an addiction specialist, I often ask myself, HOW do eating disordered persons change. I know from my own experience, it has been a long process of small changes over time, which has eventually led to large life changes. But I have to wonder, when, what was it, and how did that switch go off in my brain that said, "Okay, now you are ready to take action and change." Ya know, that paradigm shift that occurs that makes one realize that they want more out of life than the ED.

Everyone has there own process, clearly. As one who wants to be an ED therapist, I have to wonder (because of my own recovery), how much does therapy actually influence that moment when people decide to take that courageous leap of faith into recovery?

When I think of my own experience, I spent many years in therapy with no real behavioral changes. Not because my therapists weren't great, but rather because I had to hold on so tightly to the false sense of control/other benefits of the eating disorder. I'm wondering if there is a therapeutic way to "speed up" the process, allowing people to see that they don't need to hang on to the ED so long. To some extent, I think it's possible--by strengthening the rational self and helping one to create a sense of self outside of the ED. Most importantly, helping one create a support system. Without a support system, we are all pretty much screwed.

On the other hand, because we are dealing with a mental disorder, which comes with firmly planted irrationalities, maybe a therapist's job is to be there to plant therapeutic seeds, so that when one is ready, then they will be able to tap into that information and use it as a tool for change.

What prompted these thoughts, I guess, is that when I see friends who are completely entrenched in this disease, I wish I could say or do something to help them get out of their own way and experience life! It's so much better than the isolation of the ED!!!! Yes, I know... I'm powerless over people, places and things.