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???

"I FEEL FAT"

I recently attended a conference where psychologist Ann Kearney-Cooke gave a fantastic lecture about body image and decoding the language of I feel fat. Her philosophy is that a situation occurs--it could be you just tried on a pair of jeans that were tight or something completely unrelated, like you got angry with your sister--which then triggers you to become negatively focused on your body image in some way. Suddenly you are aware of this body part or that body part, and end up "feeling" fat.

This feeling distracts you from an emotion, thought, or belief you had (have) about yourself regarding the situation that occurred just before you had the negative body image thought. It may sound confusing, but think about it the next time you start body checking or focusing on negative body image thoughts. What prompts you to start focusing on your body image? Many of you might say that it just "happens" and is automatic.

While that might be true because body checking and the hyper focus on body image becomes habitual, I challenge you to start being mindful of specific situations that trigger body image thoughts. Just what are you distracting yourself from? It is often much easier to focus on body image than to face the deeper implications of your emotional/mental/cognitive state.

For instance, if you pass another woman on the street, make a comparison (and subsequent judgment on yourself), and suddenly "feel" fat, then maybe you are distracting yourself from your belief that you just don't feel good enough. This might lead to the fact that you're single, which then could lead to the feeling that you will never be in a relationship because you don't feel good enough or pretty enough, which could then trigger your ultimate fear of being alone and abandoned. After that takes place in a millisecond (perhaps on a less conscious or subconscious level), you suddenly look down at your thighs and believe they are so much larger than they were 30 seconds ago. Pardon my long example, but this is how it can happen.

Maybe it is completely unrelated to body image, like, you are worried about getting into graduate school or are procrastinating about studying for a test. It is much easier to focus on body image, as well as engage in ED behaviors than to face potential failure or to have to buckle down and face the dread of doing something you don't want to do.

I think it is common to think of ED symptom use as what you actually do with food. But, body checking and focusing on body image is also an eating disorder symptom. Whether it is the food or the body image, all of it serves as a distraction to a larger issue. So, as you go through your day today and catch yourself body checking or focusing negatively on some part of yourself, ask yourself the question, "How is my body image distracting me from being present?"

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!

Eating Disorder Recovery Milestones

One major milestone in ED recovery is when time passes and you don't think about your eating disorder. What I mean is that you don't wonder about or entertain the thoughts of purging after a meal, or restricting until dinner. You don't have to exercise to burn calories. You can wear clothes even if they might make you look heavier than you are. More importantly, you can go out in public on a "fat" day. Most importantly, your "fat" days are fewer and farther in between.

While I have been in recovery for a long time, my eating disorder was a treacherous battle that lasted for nearly half of my life. The eating disorder voice, though much quieter, can still be present. When this happens, it is an indication that something else is going on.

Given that it is a holiday weekend, I have an extra day off. In the past, I would cherish a day off to rest, only to ruin it with a weekend of bingeing and purging--which would make me needing a vacation by the time I returned to work.

I woke up today, however, and realized that I haven't been obsessing or thinking about food at all, really. One early in recovery or a person without having an eating disorder might think that it is odd that after all of these years I can still think of food. Given our culture, it is nearly impossible NOT to think of food, weight, body image, etc. What can I say? When you come from a place of purging 20-30 times a day for half of your life, you are bound to hear ED thoughts, even years later. That is just a reality. It isn't everyone's--especially when EDs come in all forms, with different levels of severity and chronicity--but it is mine.

Does that mean I am imprisoned by it still? NO. For many years in my recovery, I still had a notion of "getting back" to that "perfect" weight again, or thinking that I could use the ED to fall back on if I needed to from time to time. But then, I got to a place where I JUST DON'T CARE. While the ED voice sometimes try to entice me, trying to engage me and reminisce about days when I was thinner (and miserable), I don't care about it enough to do anything about it.

The message.... LIFE is so much more than the ED--REALLY. Yes, it serves as a nice distraction and gives one a false sense of security and protection. But that is just a cruel ruse. EDs waste time and waste lives. For those struggling and reading this--YOU can recover!!!!

Eating Disorder Transitional Living...Bridging the Gap

In an article published on May 7th, the Kansas City Star announced the opening of Thalia House, a transitional living house for women recovering from eating disorders. Given that I grew up in KC, and also the place where my eating disorder came alive, I am so excited for Thalia House's presence in the area.

When I lived in Kansas City, I had two stints at Baptist Memorial Hospital, in the eating disorder unit. The first was a 30-day stint, and the second was a 60-day stint. While I learned many tools and did not binge, purge, or starve while in the hospital, I relapsed within a couple days of discharge. The reason was not because I didn't know what I needed to do. It wasn't because I was a horrible person. It was because eating disorders are a BEAST. To go from 24-hour care to being thrown back in your old environment equates to relapse, in many cases.

What I needed was a step-down, or transitional, program. Of course, a place like Thalia House did not exist at that time. Even the few 12-Step OA meetings in the area did not really address anorexia and bulimia.

When I finally went to Sierra Tucson, a 28-day program in Arizona, they shed light on the need of the continuation of treatment. From there, I went to Turning Point of Tampa for 3 months, which was a step-down from Tucson. At Turning Point, I learned accountability for my actions and practiced being abstinent. Even after my discharge from Turning Point, I had some relapses. Eating disorders are tough. But, I practiced new behaviors, and my recovery time grew.

The person struggling with an eating disorder, family members, and even professionals often lack the knowledge or discount the power of the disease. Anyone who thinks that if you just eat X, Y, and Z three times a day then the eating disorder will go away is sorely mistaken. We don't want to admit it, face it, deal with it. But recovery requires a lot of work and SUPPORT. In this case, Ignorance is NOT Bliss.

While "sober" living houses have been around forever, primarily located near treatment centers, it's nice to see that eating disorder group homes popping up in more places. It is so needed! The ED epidemic continues to grow, and I'm guessing ED transitional living will grow, too. 'Hope so!

Eating Disorders: The Dis-ease of Never Having Enough and Wanting More

Eating disorders are complex in that a myriad of issues can trigger them. It isn't as if it is just one struggle. It is biopsychosocial, meaning, one's biology, psychological state, and social environment can create the perfect recipe for an eating disorder.

While there are many characteristics, one ED theme seems to be the thought of never having (or being) enough, and always striving for more. Maybe there's not enough love, or you feel you aren't enough. In any case, it can drive one (us) to constantly seek perfection through achievements or become people-pleasers--trying to overcompensate for our innate defects as human beings. If we can have enough or be enough, then we are okay. The problem is that we are left always wanting more. If our want is unfilled, then we are back to feeling not enough.

For many with eating disorders, this translates into our relationship with food and our bodies. We try to get to the perfect weight, the perfect pant size. Even if we know we aren't fat, we'd still like to be a little smaller; just to feel more comfortable. Some of us push away food, while many of us crave more, long after we've met our daily caloric intake.

What I have learned throughout the years, is that I may always want more... of everything. What I try to practice daily, and imperfectly, is sitting with the uncomfortable feeling of wanting more and not acting on it with a late-night snack. I'm not always successful, but I get more successful as the years go by. I still can comfort myself with food from time to time; my abstinence will never be that black-and-white perfection. But, I stick to my bottom lines. For me, that is what "normal" eating is. Some days you may not eat quite enough, some days a little too much. And other days, just the perfect amount. I will probably always strive for perfection, but that doesn't mean I have to be perfect.