1/19/17

The Path through Body Image in Recovery

Body image thoughts constitute the most stubborn and tenacious symptom of an eating disorder. For most people, the ultimate goal of the illness is to lose weight and reclaim their body in an idealized form. The result is a wish, a panacea. Life will be wonderful and the world will somehow be good once the magic weight is attained. 

When a fantasy is imbued with an overarching expectation, the desire is doomed to fail. Logically, no weight can fix an entire life. No body shape solves all of one's problems. But the most common implied thought of an eating disorder is just that. 

Two realities ensue from this eating disorder thought. First, no one wants to give up the goal of weight and body because it means giving up the wish for an easy fix to life. Second, negative body image thoughts have little to do with body, as shown in the study from the last post. When a supposed visual about one's body actually reflects all the ills of one's life, there is no negotiating with the power of these thoughts. Moreover, if body image reflects the negative feelings about oneself, those thoughts have no chance of a fix in the eating disorder paradigm. They will remain forever elusive and only cause misery. 

Healing from these critical, negative thoughts means engaging with the actual issues in life. The negative thoughts stem from feelings about life, relationships and emotions. The supposed easy fix of the body image thoughts is to translate the negative emotions about external realities into negative thoughts about body. Then trying to fix one's body stands in for trying to handle the emotions of life, to no avail. 


It is a tough sell to help people face those feelings. The emotions are scary, and the automatic reaction is to turn to the eating disorder for help. Acknowledging and experiencing the feelings is challenging and unpredictable. Each person needs help to manage the intensity and confusion of the emotions and to know things will turn out ok in the end. This process can be very effective. The hard part is helping someone see the value in ignoring the body image thoughts and instead facing the emotions of life.

1/12/17

Connecting with Body in Recovery

People with eating disorders focus relentlessly on body and weight. This focus may be common in today's world, but the level of obsession in these illnesses is significantly more consuming. The thoughts stop reflecting reality and instead become a powerful internal dialogue that goes beyond just the simple wish to lose weight. For instance, how else can an emaciated person still feel she needs to lose weight?

Outside of illness, others often interpret these eating disorder obsessions as they would the normal wish to lose weight. Without considering the overall pressure about body size in our society, it's crucial to realize the stark difference between this common wish and the eating disorder thoughts. 

Often the obsessions about body and weight in an eating disorder actually has little to do with one's body. Research reflects this quite clearly. In one study, patients with and without anorexia were asked to reflect on their own self image during an MRI. The results for people with anorexia, unlike the others tested, showed that in processing their own body, they did not activate the visual center of their brain. In other words, self-image for people with anorexia did not reflect the actual, visual representation of themselves. 

This information is very helpful in recovery. It's easy to extrapolate from this study that recovery needs to involve connecting with one's body again. An eating disorder separates self-image from the body itself. So recovery means learning to feel, process and experience the feelings in your body. This may not be intuitive about eating disorders but is critical to understand the process of getting well. 


Accordingly, inpatient and outpatient programs often include yoga, walks and various other forms of treatment that involve movement. Therapy must regularly recognize how people experience their lives and emotions in their body, not just in their minds. Recovery is not just an intellectual or even an emotional process but also a physical one. Wresting a life back from an eating disorder involves transforming all components of the human existence.

1/5/17

Food Villains in our Culture

Media coverage of nutrition is based largely on the need for more readers. The public appetite for nutrition advice, news and suggestions is insatiable. Despite the overwhelming evidence that diets don't work, reputable news outlets can't help but report on new diet fads. Nutrition experts all agree that eating advice needs to be very simple, yet the media jumps on the newest nutritional bandwagon for fears of losing ground in the marketplace. 

To clarify for readers of this blog, when research shows that diets don't work, the conclusion isn't that weight loss is impossible. It means that low calorie, short-term diets ignore medical knowledge about weight and set point ranges. Successful weight loss means slow, steady changes in what someone eats combined with regular activity. These steady changes lead to overall health improvement and a shift in one's weight range downward and allows one's actual weight to decrease as well. 

With regards to the newest media trend, it appears that a new generation of food villain has officially arrived. In the eighties, the first official villain was fat, largely propagated by fear of cardiac problems. The nineties and into the aughts left behind fat for carbs, in large part because of the media powerhouse Atkins diet. Currently, the newest villain is sugar based on newfangled information about glycemic index and medical research into gastrointestinal endocrinology. However, like the other villains, medicine is still struggling to prove what is actually true. 

The best way to approach these fads is to acknowledge that food is best eaten in a  large variety and primarily whole foods. Our bodies are designed to eat this way and function best when given food that match what humans have eaten for centuries. 

People with eating disorders or disordered eating tend to eat by strictly following the latest unsubstantiated guidelines and avoiding the newest fear foods. In extreme cases, people eat very strict and often unhealthy diets. Avoiding fat or carbs almost exclusively can cause significant health problems from malnutrition. For example, it is often shocking to someone with anorexia how much damage their body withstands from avoiding fat for years. 


The newest villain is likely to inspire similar unexpected medical effects from people who assiduously avoid sugar. There is no way to predict the effect other than to know that food is meant to be eaten and not overanalyzed. We are designed to eat a variety of food and to eat mostly regular food, not items made in factories. The more we ignore media coverage of the latest diet or food villain, the freer we all are to live our lives fully. 

12/28/16

Thoughts about Recovery during the Holiday Season

This season is meant to be one of joy and celebration, and for many there are moments that match the hopes with true sentiment. Even so, a time of year with so much riding on it can lead to disappointment or disagreement, argument or worse. It's a time of year when people come together and families or groups cope with a host of mixed, often intense feelings. 

For people in recovery from an eating disorder, this season brings a mixture of regret about the past and time lost and also hope for change in the future. Often surpassing the celebratory moments can be the extra pressure on recovery to somehow take a giant leap forward or even magically leave the struggle of the eating disorder thoughts and behaviors behind. 

Clearly, the nature of recovery is neither kind nor forgiving. Progress comes from hard and steady work. Changing ingrained thoughts and patterns around food, a necessary component of survival, involves refashioning behaviors deeply imprinted in our most basic brain function. It's almost like learning how to walk again when every ounce of your body wants to sit forever. No holiday or new year will speed the process. 

What this time can bring is the peace to find steady ground around those people closest to us. The antidote to an eating disorder is not strict rules or tough love but about connection, meaning and forgiving love. The way to find peace from an unrelenting eating disorder is to create a foundation of true connection and bonds. Those pillars limit the space for an eating disorder in one's life. 


Although there may be a desire to push people away, the real benefit comes from knowing people are on your side. Feeling as if there are people supporting the cause can galvanize recovery and strengthen the sense of a healthy future more than anything else.

12/15/16

Why Compulsory Eating Disorder Treatment Almost Always Backfires

A topic I have visited several times in this blog is forced treatment of adults with eating disorders. I have seen patients taken to treatment against their will improve their medical health many times, but rarely if ever does this approach lead to psychological and emotional wellness and recovery. 

It feels incomprehensible for families to watch a loved one suffer, become ill or even come close to death from any illness, let alone an eating disorder. And watching this process is excruciating. There is a point when severe medical compromise leads a family to take their loved one to the ER for emergency care in order to avoid permanent damage or death, and that step is as valid for an eating disorder patient as for anyone. 

However, compulsory residential treatment for months is another consideration. At this juncture, forcing someone into treatment involves confining them against their will and forcing them to eat and follow rules they never agreed to. The result is such a loss of autonomy and enormous fear of doing things that feel impossible and indeed traumatizing. From the patient's point of view, enforced eating doesn't feel kind or compassionate in any way but instead incomprehensibly cruel. 

This is hard for people with little knowledge of eating disorders to understand. Eating for most people is as simple as breathing and sleeping. It is one of the basic daily tasks we must do to survive. Even for people who ruminate about what to eat, they must eat. For people with eating disorders though, nothing could be more terrifying. 

But forcing people to eat is not the crux of eating disorder recovery. Successful treatment entails regular eating and health to be sure, but love and compassion combined with the growth of the individual outside the pervasive and punitive eating disorder thoughts create true health. 


The circumstances necessary for treatment must be voluntary. A patient needs to realize the need for help while also recognizes the limitations the eating disorder imposes on daily life. From that point of view, there is a purpose to the scary step of starting treatment. There is a reason to seek out extraordinary circumstances and to start down the path to creating a full and healthy life.

12/8/16

Overexercise, an Undertreated Part of Eating Disorders

Exercise is a relatively new concept in health. Only in recent decades, as a significant number of jobs have become sedentary, has the medical world realized the detriment of the lack of exercise to health. 

The health news media spread the word about the need for exercise and helped create a new part of the virtuous life. The well-rounded, healthy individual must incorporate exercise into any daily regimen, so the message goes. 

Although the concept has merit, the individual's well-being, in today's age, is always secondary to the power of the marketplace and money. Accordingly, business interests now dominate the exercise world, exploiting a medical recommendation into a guilt-inducing profit machine.

From over-priced gyms to exercise classes to communities proselytizing a new way of life, smart individuals created companies to manipulate people to spend money on exercise and to translate the modern need for an idealized version of health into monetary gain. 

For people with eating disorders, the effect of a powerful exercise industry is more nefarious. Since exercise remains an unquestioned positive in today's society, there is still no room for the message about overexercise. The gyms and classes have no way to manage the person who spends seven hours per day in the gym or goes to four, five or six classes per day. 

The medical effects of overexercise are cardiovascular problems, chronic dehydration, muscle breakdown and even kidney failure. Even for those whose symptoms aren't as severe, exercise dominates one's life and leaves no room for any other personal growth or relationships. 

The first step towards addressing overexercise is to call it a problem. Exercise is necessary for our bodies to function, but that can mean walking each day as much as going to a gym or class. The idea is that our bodies are not made to sit exclusively. Moreover, the human body needs food to function every day, no matter the amount of exercise. The industry has coopted the concept of calorie burning to mean one deserves food only after burning energy. Separating food from exercise is a crucial part of discounting eating disorder myths. 

Limiting exercise to a certain number of times per week and amount of time per day is also a way to recognize the potential detriment of overexercise. Without a way to acknowledge excess, the pervasive message that exercise is always good will triumph. 


Taking these initial steps will also open the eyes to the eating disorder community that exercise must play as large a role in the eating disorder symptomatology as starving, purging or laxative use. When we as clinicians take overexercise seriously and devise treatment aimed directly at these symptoms, people seeking treatment will hear the message much more clearly.

12/1/16

It's Time to Treat Eating Disorders as Both Psychological and Physical Diseases

What makes eating disorders unique in the scope of psychiatric illness is the fundamental medical nature of treatment. As such, the complete approach to recovery needs to include a medical sensibility as well as psychological one. 

However, artificially separating the psychological and physical tends to limit the effectiveness of care. The best plan must incorporate and weave together these two parts of eating disorder for truly comprehensive care. 

The clinical world tracks eating disorder providers into specialities: food, therapy and medical. Each provider is a crucial member of the treatment team but usually focuses their specific treatment on only one component of recovery. However, the individual's experience is a cohesive one, and separating out the different aspects of an eating disorder doesn't reflect the reality of having one. 

This problem begs for creativity on the part of the treatment team, something always called for in eating disorder treatment. The wisest clinicians have gleaned enough knowledge and experience to know that blending information from other parts of recovery, even when it's not one's specialty, makes for more complete care and an increased chance for recovery. 

For the therapist, this means referring regularly to the medical complications from an eating disorder and heeding the severity of the illness. For the physician, respecting the power of the eating disorder thought process rather than implying recovery is the same as willpower. For the nutritionist, recognizing food and nutrition education isn't really the cornerstone to treating someone with an eating disorder: the treatment is really food therapy. 


Each clinician may have a specialty; however, the team overall must focus on the psychological and physical components of an eating disorder as well. Each appointment is a way to call into question the dominant eating disorder thoughts and point out the fallacy of continuing the symptoms. A cohesive approach of each member of the team can acknowledge the realities of recovery and help the patient recognize how physical and psychological impairment limits their lives.