Eating Disorders Today

I've Moved!

I'd like to welcome you to come visit my new blog at www.stopeatingdisorders.com  I feel this move to a new home will help me better serve my readers, friends and clients.

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Best regards,

Joanna Poppink

Eating Disorders: Reversing Short or Long Relapse

      

       I'm in the middle of attending a great conference at UCLA this week end. It's "Adult Attachment in Clinical Context: Applications of the Adult Attachment Interview." Superb and gifted researchers and clinicians are gathered to discuss and share information on the latest neuroscience findings, the reasons why humans bond or do not bond well with each other, how human relationships can harm and heal, and the powerful healing force of human love, compassion, stability, flexibility and reliability.

       As I participate in this conference, surrounded by clinicians dedicated to learning and fostering healing, I feel richly held.  I am free to let my mind relate what I'm hearing and learning to people who, in some way, live with the experience of eating disorders.

       Here's what I've come up with after two days of the conference.  Perhaps more will emerge after tomorrow, the last day.

       The joyous or painful or frustrating reality is that we humans can destroy, create, and change neural functioning in our brains. In other words, we can improve. We can deteriorate.  We can change – for better or worse.

       The research coming out of neuroscience provides evidence that particular circumstances over time can alter brain activity and even brain structure. See Dan Siegel’s work and Alan Schore’s writings.

       The good news is that a durable, kind and informed relationship with a trustworthy and stable person over a considerable period of time will actually create conditions where a person’s brain can change for the better. This is one of the great and wonderful powers of long term, in depth psychotherapy with a trustworthy and focused psychotherapist.

        This is also why loving, trustworthy, stable, reliable and empathic parents produce secure, loving and self confident children.

       This is also why a loving, trustworthy, stable, reliable and empathic aunt or uncle or grandparent or teacher or neighbor can contribute to building a secure base in a child who has problematic parents.

       Love and kindness as well as focused attention and knowledge creates an environment in which new ways of seeing the world can become permanent.  The developing child or the adult patient not only develops trust for the parents or the therapist.  She actually develops the capacity to trust, to be more optimistic, to recognize good opportunities and act on them.

      We can also put ourselves in circumstances that destroy trust, not only in a relationships but in the brain’s  ability to trust at all.  One of the tenets of 12 step programs is: stay away from lower companions. The people around us affect our sense of ourselves and our brain functioning.

        In a stressful environment where fear, pain, ridicule, shame and unpleasant surprise are continual, we will adapt in ways to care for ourselves. For the person who has a history of an eating disorder this can mean going back to old coping mechanisms like binging, purging, “spacing out” and hiding.

       She can also reinforce this negative condition herself by pummeling her mind with negative
critical judgments on herself.  This too affects neural pathways, synaptic connections and her view of the world and reinforces the eating disorder thinking and behaviors.

      In such a state she will find great difficulty in recognizing opportunities for help. Even if she does recognize such opportunities she may lack the trust and self esteem to reach out and ask for help. The longer this situation lasts the more ingrained her eating disorder style of living will become.

       The return of eating disorder behaviors or feelings or both signal that either new growth is necessary or achieved progress is undermined. 

      This is a time for her to look for relationships, behaviors and circumstances around her which are negative, isolating, critical, demanding, frightening or composed of unrelenting stress. The return of the eating disorder is an attempt to cope with these circumstances. Noticing them is the beginning of restoring her recovery path. 

       If she experiences harsh negative circumstances momentarily genuine recovery will stand. If
she experiences such circumstances for a longer period, she will be stressed but can most likely rely on her newly internalized strengths and self confidence powered by her more developed neural mechanisms.

       But, if she experiences such circumstances as part of a new normal routine in her life, regular and unrelenting, her brain can adapt to the situation and create entrenched patterns. What begins as a temporary state can become a permanent trait. Here we have the relapse stretching out into what seems an intractable way of living and being.

       However, even if this happens she can still take action to put herself in a loving, kind, healing environment where she can once again allow her heart, mind and  brain circuitry to heal and develop along the pathway to health. Yes, a relapse, even a long relapse, can be reversed.

       It’s truly amazing and wonderful how putting ourselves in relationships filled with love, compassion, empathy and focused attention will not only allow us to build good feelings but actually change ingrained patterns of negative feelings thoughts and action.  We can actually help each other evolve, even at the neural level, toward health.

       Who would have thought neuroscience would bring such a message, backed by scientific evidence, of hope and loving direction?

(In addition to Siegel and Schore’s work, I recommend, for those who are up for some heavy reading, The Development of the Person. When Drs June and Alan Sroufe discuss their research following individuals from before birth to To their 30’s I'm always inspired and find myself filled with teary heart felt appreciation for them and their work.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Bias Confession from an Eating Disorders Specialist

       My patients and readers live their own lives with their own agendas and values leading the way.

       However, I am not neutral. I want, with all my heart, for them to live long healthy lives.  I want them to be well, to have love, joy, satisfaction, confidence and a genuine liking for themselves as they proceed onward to a feisty, interesting and healthy old age.

       I especially do not want anyone to break her own heart.

       People who come to my psychotherapy practice or writings need a reason to make that entry. Primarily, they come because they have an eating disorder. They also come because a person with an eating disorder is in their intimate circle.  They also come because they know someone who benefited from my work and want the same benefits.

       Mostly, they come because they experience emotional pain and frustration in their lives and have a spark of hope that maybe another way to live exists.

       Ending an eating disorder is a step, a major step granted, but still a step toward creating and living a better life. 

       In my practice, my focus is on the whole person sitting in front of me. I see the energy poured into the eating disorder.  I get a glimpse of what might be possible for this person if that energy were directed toward living a more full life.  When we share that glimpse we become a team of two with the goal being to send life energy to life.  That means dismantling the eating disorder mechanism and removing the need for the protection given by the eating disorder.

       Our mutual goal becomes creating a psychological, emotional and spiritual normal that allows a person’s genuine life potential to unfold.

       My job, as I see it, requires me to state my bias and let the person know that her best choice is one that comes from her beliefs, not mine. She also needs to know that I will support her  living based on her values, not mine.

       A free and healthy person will face difficult choices in life.  If an eating disorder doesn’t exist, then an automatic and artificial guiding system doesn’t take over the decision making by default. 

       For example, someone doesn’t stay home and binge instead of meeting with friends.  Or someone doesn’t binge and throw up before meeting a potential employer and therefore meet that person in a partially numbed condition.

       If an eating disorder isn’t there then decisions about school applications, career choices, pregnancy (to conceive or terminate), relationship choices (positive or negative), commitments of any kind,  are based on personal agenda and personal values.  These must belong to the individual, not me.

       I do my best to make my bias clear so that the person is free of any sense of obligation to please me. More importantly, my stating my bias helps the individual sort out what she thinks she is supposed to choose based on the agenda and values of others, including the entire culture, as opposed to what she deeply values. 

       After all, in the end, she lives her life.  And a satisfying life is one that is based on living according to her own true agenda and values.

       Sometimes self sacrifice is based on deeply held and honored values known and appreciated by the individual alone.  I believe a person needs to be free to make such a choice.

       However, if an eating disorder is in the way, choices involving self sacrifice can be blurred or seen as required with no possibility of flexibility, change or even a vague sense of the option to say, “No.”

       If she is oblivious to her own values she can make a choice that will immediately or eventually break her own heart. 

       While an eating disorder fades the person is challenged more and more to listen and learn her own truth.  Whether her truth is mine is not the issue.  I stand for her listening and honoring her own unbuffered self, mind, spirit, body and heart.  When she can do that, she is on her way to
living her real life, and that is a joyous and satisfying way to live.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Things to Do During National Eating Disorders Awareness Week (or Anytime!)

􀂐       Sign the National Eating Disorders Association’s Declaration of Independence from a Weight-    Obsessed World to free yourself from the three D’s: Dieting, Drive for Thinness, and Body Dissatisfaction.
 
􀂐       Celebrate Fearless Friday - A Day Without Dieting - and feel how empowering a diet-free day of self-acceptance can be!

􀂐       Attend a workshop, presentation, lecture, or meeting in your community that will help you feel better about yourself. See the National Eating Disorders Association’s website, your local newspaper or campus calendar for events.

􀂐       Use your voice to effect change: join the National Eating Disorders Association’s national media advocacy campaign to write letters of protest and praise to media, corporations and advertisers who promote negative or positive messages concerning body size, weight, dieting and eating disorders. Sign up via the web at www.NationalEatingDisorders.org.

􀂐       Consciously choose to avoid making comments about other people or yourself on the basis of body size or shape.

􀂐       Compliment someone else for a skill, talent, or characteristic they have that you appreciate. Remind yourself that a person’s value is not determined by their shape or size.

􀂐       Enjoy your favorite meal without feelings of guilt or anxiety over calories and fat grams.

􀂐       Donate your jeans and other old clothes that no longer fit your body comfortably to charity. Someone else will appreciate them, and you won’t have to worry about the way they fit anymore.

􀂐       Start each morning by looking in the mirror and saying something nice about yourself out loud.

􀂐       Put away or throw away your bathroom scale.

􀂐       Look through magazines and newspapers, ripping out advertisements, photos and articles that promote negative feelings about weight, body image and food. Talk back to the TV when you see or hear an ad that makes you feel dissatisfied with your body.

􀂐       Read a book that lifts your self-esteem, promotes positive body image, encourages healthy living or helps you overcome stereotypes about social standards of beauty.

􀂐       If you know someone who is struggling with an eating disorder, take the time to reassure them of your friendship and support for their recovery process.

􀂐       Throw out all of the diet products in your house.

􀂐       Remind yourself and others that It’s What’s Inside That Counts!

􀂐       Become a member of the National Eating Disorders Association and join the effort to create a world where self-esteem is not weighed in pounds on a scale. Visit www.NationalEatingDisorders.org or call (206) 382-3587 for more information.

       Challenge yourself to pick at least one of these easy-to-do tasks during each day of National Eating Disorders Awareness Week!

© 2004 National Eating Disorders Association. Permission is granted to copy and reprint materials for
educational purposes only. National Eating Disorders Association must be cited and web address listed.
www.NationalEatingDisorders.org 􀂎 Information and Referral Helpline: 800.931.2237

       By all means, share with us on this blog your experience when you do any of these activities.

       For me, and all of us in the eating disorder recovery professional community, every day is eating disorder awareness day.  I've been a member and supporter of NEDA since its inception. I support the recovery of others. I don't diet. I wear clothes that fit, and I have no diet products in the house. 

       Whoops. Last night I co-hosted a wonderful dinner party in my home for the UCLA program, Dinner with 12 Strangers. Undergraduates, graduate students and alumni (that's my category) met in my home for a terrific evening.  Somebody brought tall bottles of soda including a diet soda.  A left over half bottle full is in my kitchen but on its way out.

       These diet products do slip in, don't they?

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

 

National Eating Disorders Awareness Week Starts Today

National Eating Disorders Awareness Week
February 24 – March 8, 2008

Useful Resources for All Year

       Here's a list of what I consider useful and substantial resources related to eating disorder information and treatment opportunities. I've included two videos that impressed me.  And I'm including my list of eating disorder in-patient and residential programs (93 pages) available for free via my website.

1.          National Eating Disorders Awareness Week home page

2.          National Eating Disorder Awareness Week - IAEDP Southern California Event

3.          YouTube - Eating Disorder Awareness Week Video
             Powerful and sensitive visuals and rap music

4.          YouTube - National Eating Disorder Awareness Week Video
             Candid talk by young woman who restricts

5.          Gurze Books

             Specializes in publishing books about eating disorders

6.          Academy for Eating Disorders (AED)

             The Academy for Eating Disorders (AED) is a global,
             multidisciplinary professional organization that provides
             cutting-edge professional training and education, inspires
             new developments in eating disorders research, prevention,
             and clinical treatments, and is the international source
             for state-of-the-art information in the field of eating disorders.

7.          International Association of Eating Disorders Professionals (IAEDP)

8.          National Eating Disorders Association;

9.          Overeaters Anonymous

10.         Eating Disorder Information and Referral Center

11.         American Psychological Association Help Center for Eating Disorders

12.         ANRED

              a nonprofit organization providing information about eating disorders,
              recovery and prevention.

13.         Extensive list of in-patient and residential treatment programs - international

             Created by Joanna Poppink, MFT, the list is free and available to qualified
             individuals via e-mail attachment. Be advised, attachment is 93 pages long.

       This is the week to learn and share knowledge about helpful eating disorder recovery resources. It's a time to support all who are working for recovery for themselves or on behalf of others.

       Please let me know if you discover other valuable and useful resources you feel belong on this list.

Thank you.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Miss America, Anorexia, Fear: Hiding in Plain Sight?

       Carrie, on ED-Bites wrote an indignant response to what I consider a rather cavalier column about eating disorders in the New York Daily News.

       Carrie said her own anorexia was based not on controlling weight or the external world but on controlling fear.  I agree.  Controlling everything a person possibly can control in an attempt to control what is uncontrollable I feel is at the root of most eating disorders.

       When that point is acknowledged the discussion goes away from food, fashion, weight, appearance, and even beauty and sexuality. 

       The discussion then becomes centered around the questions, Why are growing numbers of women at increasingly younger ages afraid?  What are they afraid of?  Why do they feel that their fears are justified and that they have no way of protecting themselves except through eating disorders?

       Addressing those questions takes courage and honesty.  In my experience as a psychotherapist, the attempt at reaching answers to these questions is the beginning of genuine eating disorder recovery.

       Fitting into what our culture defines as beautiful, even if that definition encompasses an unhealthy and dangerous physical condition, may well be protection women seek from their fears. 

       The authors of the Daily News column, Dr. David Moore and Bill Manville, end their discussion on a victorious note.  They describe proof of Kirsten Haglund’s  victory over anorexia in terms of her becoming Miss America.  Good grief. The woman found a great hiding place.  She is the epitome of what our culture describes as beautiful. 

       I commend Miss Haglund for her industry, her hard work, her outspokenness in terms of eating disorder recovery. I wish her every success possible in living a long and healthy life. 

       I hope she and supportive loving people around her acknowledge that she is 19 years old, only four years away from her past experience of severe anorexia and that achieving a high cultural standard of beauty and acceptance – an anorexic’s dream – does not represent recovery. 

       I hope she is alert to her inner challenges and is prepared to cherish and honor her healthy emotional and psychological developmental needs as her term of Miss America fades and she continues.

       Thank you, Carrie, for bringing up this issue and for letting your honest sense of indignation come through to all of us.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Eating Disorders and Body Appreciation

       What if we step away from body appreciation as an aesthetic consideration that relates to weight and appearance?

       An exercise or meditation to open up communication between mind, heart and body is this:
       1.      Let the mind relax with all the judgments.
       2.      Let the heart be free to love.
       3.      Let the body be and discover how your body feels when it is appreciated.

       Give yourself from a half hour to an hour for this exercise.  Slowly walk around a large room or garden or around the block.  Be sure you find a safe place to walk.

       Starting from the top of your head, let your awareness move through your body slowly. Thank you body as you go.

       For example:

       Thank you, skull, for protecting my brains so I can function in this world.
       Thank you brains for allowing me to think and for keeping my body working.
       Thank you eyes for letting me see as much as I can of this world.

       Move through your entire body, covering your neck, shoulders, arms, hands, fingers, chest, back, spine, ribs, abdomen, stomach, genitals, legs, ankles, feet, toes,   Thank each part of your body for the work it does, and be specific about recognizing that work.

       If you do this on a regular basis you can go deeper.  You can thank specific organs, veins and nervous system. 

       You can thank your immune system for protecting you.  You can thank the mysterious and wonderful ability your body has for healing, for cell regrowth. You can thank your skin, the largest organ of all, for protecting you and providing you with sensations that warn you, sensations that bring you pleasure and sensations that connect you to other people.

       If you continue to do this exercise, over time you might feel that you want to do more than say thank you.  You might want to help your body with love and kindness to carry on all the taks that allow you to live in this world.

       This has little or nothing to do with weight or physical beauty.  It has everything to do with appreciation, health and love.

       Of course, some might believe that appreciation, health and love create beauty in this world.

       I do. 

       Do you?

Eating Disorders and Body Communication

       Much material I read and hear about eating disorders concerns how a person feels and thinks about her body.  But not much has come to my attention that relates to how the body thinks and feels.

      How the body thinks and feels may be a concept that requires a stretch for some or even many people until we open ourselves to understanding the language of the body.

       The body has no words.  Still, our bodies tell us when they need sleep or food or a change in external temperature.  Our bodies tell us when they need a more firm or cushioned bed or chair.  They certainly tell us when something is hurtful to them, like too much heat or cold or abrasion or puncture.

       Most of us have had a near miss when our eyelids blinked faster than thought to avoid a spec from flying into our eyes.

       Our bodies communicate potentially life saving information like when the hair on the back of the neck rises.  This is a primitive body warning of danger on a survival level.

       An aspect of eating disorder recovery involves giving respect to the body itself and learning not only its language but also how to heed what the body says.

       What if the anorexic woman listened to her endocrine system that cried out for nourishment as hormonal function shut down?

       What if the bulimic woman listened to her esophagus plead for a rest from the continuous flow of digestive acids?

       What if the compulsive eater or binge eater listened to a stomach that cried out for mercy and relief from the continuous need to stretch to the point of pain?

       What if, instead of war, we learned to make peace with our bodies?

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Imagery and Intuition regarding Eating Disorders

       The Marion Woodman three day Dreams workshop was warm, challenging and wonderful. I’ve been wondering what to share with you.  Dream work is so personal, but then, so is eating disorder recovery.

       The most powerful image I had, toward the end of the second day, my intuition tells me is relevant to all eating disorders.

       Marion is in her eighties.  Her body is disintegrating.  She uses and needs a cane.  She conserves her energy as best she can.  She survived and recovered from a serious bout with cancer.

       But, when she speaks, her spirit is fiery. Her eyes glow.  Her voice is strong.  She beams warmth and assertive direction that makes us forget her physical frailty as we become inspired by her wisdom and passion.

       The image came through to me of a candle, but not a candle with a wick that burns on top. This white luminous candle contains a wick in the center that burns all the way from top to bottom within the wax.

       The fire within sends out heat that melts the wax from within.  So, for Marion, the image was of her inner fire melting her body away.

       I stayed with this image since Marion inspired it but was not it.  The image went much farther.

       The length of interior burning wick, if too hot, melts the wax encasing.  The candle is gone leaving only a line of fire.  Well, that could mean that the spirit burns brightly but is without a body.  This is an anorexic dream.

       Another version is this:  The length of interior burning wick is hot and melts the wax encasing. But, more wax is added on a continual basis.  This makes the wax thick and forever thickening so the heat of the fire doesn’t penetrate through the wax and into living space.  The candle keepsg getting bigger and the light is continually less visible.  This is the experience of the binge eater or compulsive overeater.

      What about bulimia?  In terms of my image, bulimia is tormented in a different way. In this image the wholeness of the fire and the wax is aware.  The fire burns and the wax melts beginning to reveal the blazing wick.  But the feelings that go with that fire are too intense to bear. Then the wax builds up thickly to bury the flame.  The dullness of that burial is too lonely and terrifying, so the wax is allowed to melt away until the terror of exposure forces the build up again. This is the in and out, here and gone grueling and endless repetition that is unaddressed bulimia.

       These are powerful and helpful images for me. They hold intellectual, emotional and physical understandings in a way that only intuitive imagery can pull together and allow to develop simultaneously.

       Where do you go with these images? 

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Expect Some Dreamy Posts!

       “Dreams” is the title of the seminar I’ll be taking this week end in Santa Barbara with Marion Woodman (a talk) and Steve Aizenstat.

       Integrating a person’s inner life with her outer life in harmony and health has long been crucial, in my experience, for achieving eating disorder recovery.  Regardless of the specific diagnosis:  bulimia, anorexia, binge eating, compulsive overeating – and all the possible associated behaviors, like cutting, shoplifting, over exercising, over scheduling, under achieving, abusive and exploiting relationships greatly benefit from developing a healthy integration between mind, feelings and body.

       Marion Woodman is one of the early writers in the field of eating disorders.  She is a gifted Jungian analyst with a way of understanding and bringing healing opportunities to men and women and, from my perception of her, particularly to women with eating disorders. I listened to her audio tape, "Dreams" many times and often recommend it to patients. Marion Woodman understands women and the language of dreams!

       I plan to walk among the trees on the Pacifica campus, participated in the dream workshops throughout the days, speak and share with wonderful people, write down my own dreams, muse about the dreams of my patients and those collective dreams that speak for our culture.

       The nourishment from the people, place and theme I know will benefit my in mind, heart and soul.  From this will come new and surprising integrative thoughts and feelings that are bound to appear somehow in my blog posts as well as the rest of my personal and professional life.

       If you care to join me in this experience, take note of your dreams this weekend.  Write them down.  We can share them next week on this blog and see where our dreams lead us.

       Here’s a bit about the wonderful Marion Woodman (excerpt from the Marion Woodman Foundation website www.mwoodman.org

Marion Woodman, LLD, DHL, PhD, is a Jungian Analyst, teacher and author of The Owl Was a Baker's Daughter; Addiction to Perfection; The Pregnant Virgin; The Ravaged Bridegroom; Leaving My Father's House; Conscious Femininity; Dancing in the Flames (with Elinor Dickson); Coming Home to Myself (with Jill Mellick); The Forsaken Garden: Four Conversations on the Deep Meaning of Environmental Illness, Marion Woodman, Ross Woodman, Sir Laurens van der Post, and Thomas Berry, edited by Nancy Ryley; The Maiden King (with Robert Bly); and Bone-Dying Into Life. A visionary in her own right, Marion Woodman has worked with the analytical psychology of C.G. Jung in an original and creative way. She is the Chair of the Marion Woodman Foundation.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Awakening to Eating Disorder Recovery

       How does a person with an eating disorder take genuine action that will realistically create a solid recovery path?  How does she maintain her sense of purpose so she keeps to that path despite painful challenges?

       These are two of many vital questions I’m attempting to address in this blog. They are in the back of my mind always when I think about eating disorder recovery.

       I remember my first psychotherapy session with the psychotherapist who led me through the first years of my own recovery from bulimia.  She was the third person I ever told I was bulimic and the first who was not in a 12-step program. I was terrified. When I saw that she was still warm and interested in me and not overwhelmed by my revelation I thought I was free to breathe again.

       But then she said, “We’ll begin an interesting journey.”  I burst into tears.  She was surprised.  She wanted to know why I was crying.  Perhaps you who are reading eating disorder recovery blogs and websites will understand.

       My psychotherapist said we would begin a journey.  I told her, it had taken me years of hard work and despair to reach the point where I could sit before her.  And she called this the beginning.

       I cried because my beginning was such a long time ago.  I cried because I had come so far only to learn that this now was just the beginning.

       Of course, I didn’t have much recovery to work with then so I didn’t appreciate the concept of “new beginning.”  Now I realize that in recovery and in most or all areas of life, we always have an opportunity to see and live any and every moment as a new beginning. 

       But I was bulimic then.  I thought in terms of black and white, all or none, and I thought in a linear fashion.  I had no idea that my way of thinking was narrow and confining.

       Sometimes, on a dark night with heavy black clouds and pouring rain the world seems mysterious, powerful and almost invisible.  What you do see is distorted by slanting water, shadows and imagination.

       Then suddenly, from out of an unknown somewhere a bolt of lightning strikes out across the blackness.  The startling glare dispels shadows and brings the world up clear and vivid. The moment passes. The dark returns.  But your memory of the light remains. You got a glimpse of the presence beneath the cloak of darkness.

       Eating disorders are like that black stormy night, full of passion, fear and misguided distorted visions.  The stroke of lightning is the life force in us that gives us a glimpse of who and where we really are. We may not like what we see. 

       But if we can hold that awareness a little longer each time our inner lightning strikes, our awareness will grow. We can use it to build our way out of the darkness and into an opportunity of finding our healthy and distortion free life.

       What equips a person to get on and stay on her recovery path?  It has to do with keeping alive those many tiny glimpses of light and health that shoot through the eating disorder way of life. When you gather enough of those glimpses you have a compelling vision of a better life. 

       Lightning is raw energy.  A glimpse of the truth of your life comes from your inner life force.  That’s a kind of raw energy too.  The awareness leads you to your Recovery path.  The energy helps keep you on that path.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Does Advertising Affect Eating Disorders?

A recent Hubpages blog raised the question: Does advertising affect eating disorders?

In my opinion, much of current advertising promotes both tiny size fashion in clothes and huge portion size in food. It's an impossible combination many people strive to integrate. 

A person vulnerable to eating disorders will strive to come up with a solution that allows her (or him!) to fit into tiny clothes and eat huge portions of food at the same time.  This person can become terribly ensnared by an eating disorder. 

But something worse exists.  Advertising that pushes people to be small and eat large supports eating disorder thinking and behavior.  The continual onslaught of emaciation, body surgery, and diet publicity actually convinces many people that the lifestyle being portrayed is normal. 

Such media portrayal validates starvation, cutting behaviors and binge and purge cycles.  Plus, this portrayal can delay recovery work.  If a person with an eating disorder is subjected to a barrage of images and messages celebrating the symptoms of her illness, she may believe she is living well and wisely and will not seek treatment. 

This is a cultural phenomenon that is tragic.  It contributes to people taking pride in their illness, proselytizing eating disorders, destroying their health, ruining relationships and, in far too many cases, shortening their lives.

What kind of influence does advertising and media portrayal of fashion, beauty and diet have on you? I welcome your thoughts and feelings.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

How Long Does It Take to Recover from Bulimia or Anorexia? Part III

What does it take to Heal from Bulimia or Anorexia?

Healing from anorexia and bulimia requires development along all seven points I described in my last post.

But what does it take to actually heal? And why does this healing take a long time?

When I went back to college after a 13-year absence from academia, UCLA gave me a yellow piece of paper that listed my required courses.  When I completed everything on the list UCLA would grant me a degree in psychology.

The sheet was 81/2 x 11 inches.  I tacked it on the wall above my desk and set to work.  Every four months I checked off three classes.  It took me three years to work through that one sheet of paper and qualify for my first diploma.

Below is a short list of developmental that can take several or many years to move through.  Still, like my yellow sheet on the wall, the list can inspire a person to keep on keeping on.

Perhaps, most importantly, the list confronts a person with realistic goals when her mind starts making excuses and rationalizing false beliefs.

I’ll write some of the developmental tasks in affirmation form so even reading them is a beginning.

1. I tolerate my feelings.
2. I am realistically aware of what is going on outside and inside my own skin.
3. I know how to establish and honor personal boundaries
4. I know how to make myself safe.
5. I know how to recognize reasonable and honorable people.
6. I know how to enlist the help of reasonable and honorable people in a fair and honest way.
7. I know how to discriminate between healthy and unhealthy activities, environments and companions.
8. I know how to makes honest, self-caring and honorable choices based on healthy observation.
9. I know my own genuine weaknesses and strengths.
10. I take responsible action in the world.
11. I know when to say, “No.”
12. I am able to say, “No,” even if I am uncomfortable about saying so.
13. Regardless of the challenges life presents, I know and trust that I have what it takes to live a good life.

I created thirteen tasks in this list. The number thirteen has significance.  It means breaking an old pattern. It means emerging as something new or a new variation on an old theme.

Actually, as I write this I surprise myself because I began this post by revealing my thirteen-year hiatus from school.  I didn’t make the connection till just now. That’s how the psyche works.

After thirteen years out of school I returned to resume my education on a new path, build a career and create a new life that was and is much better than the life I had
completed.  Thirteen was the break the pattern signal.  And I didn’t know that consciously till just now.

When a person makes positive strides in the direction of achieving these developmental tasks, the eating disorder has less of a function in her life. The person discovers much better ways of taking care of her psychological and survival needs and expands her life into more enriching experiences.  The eating disorder is less or even no longer necessary. 

How long does this take?  It takes as long as it takes to accomplish these tasks. The actual time differs with each person. How each task is accomplished involves the work in psychotherapy that leads to the past, the present and the future.  It leads to new ways of thinking, feeling and responding. It leads to grand discoveries of where a person is truly interested and of how she wants to invest her life energies. 

Recovery doesn’t happen overnight and the work isn’t easy.  However, the good news is that you don’t have to wait for full recovery to reap benefits of healing.  Every step of the healing process allows the person to be more competent in the world, experience the joy of being more capable and especially, able to connect with other good people in a satisfying and healthy way.

By all means, let me know your thoughts about this.  I welcome your sharing.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

How Long Does It Take to Recover from Buliimia or Anorexia? Part II

       Why does recovery from anorexia or bulimia take years? Because vital developmental tasks must be addressed, and development takes time.

Let’s look at what needs to be accomplished in recovery.

       Eating disorders develop to serve a protective psychological function.

       1.      They protect a person from being aware of what they cannot bear to know or feel. 

       2.      They give a person a sense of control when the person has little real control over what's important to them. 

       3.      They give a person a private island of limited sensation and limited awareness. This is a defense that helps when a person is incapable of preventing physical, psychological or emotional boundary invasion.

       4.      They create an obsessive sense of entitlement to make up for the lack of boundary awareness or the lack of knowledge or skill in honoring personal boundaries or limits.

       5.      They protect a person through numbness and obsessive thinking from knowing what they feel such as anger, fear, disappointment, regret, guilt and shame. A person may even need to block feelings of love, passion and joy if knowledge of those feelings would disrupt the status quo of her environment.

       6.      Eating disorders allow limited but intense feelings to surge within the person and explode out as a form of relief from tension.  These episodes are often highly dramatic and can be both manipulative and destructive in relationships.

       7.      In many situations eating disorders protect a person from knowing she is competent, intelligent, capable and creative when such knowledge might be disruptive to her present life and the imagined (and sometimes real) consequences are intolerable.

       Healing from anorexia and bulimia requires deep, rich and healthy development along many layers of the personality.  When this is achieved the person can cope with the difficult ordinary and sometimes extraordinary challenges life presents without the protection of the eating disorder. Healing also frees a woman to be capable of giving and receiving honest emotions in worthwhile relationships.

       As a matter of fact, healing frees a woman to actually be a woman.

       I’d be glad to elaborate on any of these points.  Please feel free to ask questions and share your opinions and experiences in the comments.

       In the service of easy blog reading I’m trying to keep posts as short as I can while still giving you as much recovery information as possible.

      In my next post I’ll talk a little about some of the work required to heal from bulimia and anorexia.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

How Long Does it Take to Recover from Bulimia or Anorexia? Part I

       This is a reasonable question I'm often asked.  Not only can I not provide a specific time, but also I can't guarantee that someone will indeed recover.  And I certainly can't give the answer so many people want, which is days or a weekend or at most, a quick stay in a residential program.
 
       The question is complex with a different answer for every individual. 

       If you are still reading after this undesirable news, please let me talk a little about eating disorders and recovery.

       People develop eating disorders for a reason. Eating disorders help a person cope with living when the person has not developed other ways to successfully take care of herself. 

       Healing has to do with developing a competent, mature and aware sense of self and awareness in the world.  It has to do with restarting stalled emotional development so that the person can take care of herself realistically in the face of simple and complex life challenges.

       How long does it take to accomplish the required developmental tasks?  A substantial period of time from several years to many years, depending on the challenges of each individual.

       But please don’t despair at the thought of the time involved.  Recovery is a process. As you move through time and stages of recovery, you reap benefits as you go.  Your life improves as you gain more health.

       During the healing work, yes, you will need courage to face your pain.  But you will also experience joy as you discover the authentic worthwhile you.

       I’ll write more about the recovery process in my next post.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Professional Boundaries with Eating Disorder Patients: considering right brain studies and work of Dr. Allan Schore

  (elaborating on my comment in Eating Disorders for Professionals Blog)

       Today, happily, we have evidence based scientific research to back up the use of our humanity in our clinical work with patients.

       Appropriate boundaries between patient and psychotherapist are essential in any psychotherapy and particularly in the field of eating disorders.

       However, the topic is often discussed in terms of content:  e.g. a patient asks my age, if I'm married or divorced, if I have children, my religion, if I've ever had an eating disorder.

        I believe that when a patient wants to know about my private life or wants to include me in her private life (weddings, funerals, births, graduations, award events, etc.) that the patient wants and needs a particular psychological emotional experience from sharing the experience with me.

        In other words, its not the information or event that is the issue. The sharing of our humanity is the point. The patient wants to know that she will be understood and appreciated. She wants to know I have a history that will inform me in terms of being present and empathic with her.

       She wants to know that I can appreciate her pain and personal dilemmas. She also wants to know that I have survived my challenges and her stories will not shock me or cause me to judge her. Perhaps most of all, she hopes that I have healed from what she suffers and that if I have healed then she can heal too.

       The valuable experience between us is not content, but right brain to right brain communication.  We use words because we have to. We communicate far more than words, We need more than words to heal and be healed.

       Allan Schore, in his fantastic research on affect regulation, impacts many areas of social science and biology by showing that right brain communication is received by the right brain and actually changes brain structure to allow developmental progress. Developmental progress is exactly what is needed for eating disorder recovery.

       The discoveries revealed by the increased sensitivity of neuroimaging validates what many sensitive clinicians have known for a long time. Honesty, caring, empathy, sharing spontaneous imagery, acknowledging physical responses to clinical material makes for effective connection, growth and increase possibilities for healing.

       The key question I ask before I reveal personal information to a patient is this:  Will my answering this question burden the patient or will my answering support her healing?  Often, when I'm asked a personal question I will respond by saying, "I will answer your question.  But before I do, can you tell me why you want to know or what meaning this information has for you?"

       People suffering from eating disorders have rarely experienced a quality relationship where their boundaries were respected. In general, they know little about respecting boundaries.  Responding with respect and care to their questions helps begin the process of learning and appreciating what personal boundaries are - mine and theirs.

       This kind of communcation also shows a woman with bulimia or anorexia that she can meet limits and caring from a person at the same time. Such an experience is often new and always in the service of health and personal development.

       People recovering from eating disorders need the presence of honest, caring and respectful human beings in their lives.  I believe, with the backing of neuroscience, that we psychotherapists can’t keep true to our profession unless we are true to our humanness.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Death, Tragedy and the Wounded Soul

        A young anorexic woman died in Ireland because her psychiatrist mother drowned her daughter in the bath. It's a tragic story of Gothic proportions going back who knows how many generations. The mother couldn't bear the daughter's anorexia.  The daughter refused treatment.  The mother had an eating disorder.  The grandmother committed suicide.  The story in "This is London" stops there, but the human story has got to go back who knows how far.

       I'm haunted, as many people must be, by the horror, the extremity, the tragedy, the ignorance, the blindness, the waste and the ongoing and spreading suffering of this event.

       Eating disorders go deep into our souls.  Personally I think that they go deep into the souls of the individual with the disorder and also deep into the soul of our society.  Something powerful in our current human condition is bringing up a terrible despair that eating disorders are making public.

       If we can a bring thorough recovery to people with eating disorders, and embrace effective ways of preventing anorexia, bulimia, binge eating disorder and all the rest, we will also be finding a deep cure for the problems in our society that spawn eating disorders.

       I hope this sad and profound tragedy will spur people to look more deeply into both the psychological and cultural forces contributing to sustaining eating disorders in our midst.

       Wounds of the soul are showing.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Perspectives on Eating Disorder Recovery and Relapse

       A thirty-three year old man wrote to me saying he had been a binge eater most of his life and now was fully recovered because food has been a non issue for two years.

       Of course, I am glad he is happy with the strides he has made in his life.  But his post got me to thinking.

       I have been working since 1980 with people who have and who have had eating disorders.  I don't know what people mean by "fully recovered." 

       While it is possible that people can have two years or more of being in a state where food is a "non-issue" that doesn't necessarily mean they are "fully recovered."  By the same token, someone who has not binged or purged for some time and then begins again may actually be signaling growth rather than relapse (although, of course relapse is possible too.)

       As I see it, people develop eating disorders as a way of coping with what they cannot bear.  The people committed to getting well work in psychotherapy, 12 step programs, spiritual programs, nurture their creativity and gain education and skills necessary for them to function as they choose in this world.  As part of this life long process they feel their emotions, recognize and bond with trustworthy people, and develop a sense of self worth.  As they develop they learn and discover how to address their inner and outer life situations without the eating disorder.

       However, as they age, develop, mature, take on new challenges, are confronted with life's strong pleasant and unpleasant surprises, aspects of the eating disorder may return.  If it's not a relapse, (meaning collapse and surrender) it can be a signal that a new strength needs to be developed or that the person is overstretching his capabilities and needs to pace himself. 

       The eating disorder, a tried and true mechanism developed to a person survive, returns to some people not as an enemy but as a guide to teach the person about how they are feeling or not feeling.  The teaching occurs in a language the person understands perhaps better than any other.  TThis is the language of the eating disorder, which for many has been a life long companion.

       In my opinion the "recovered" person, is consciously aware of his or her liaison with the eating disorder.  It's as if the eating disorder were some kind of sleeping general or police force who, when the person takes on more than they can bear, rises up to alert, protect and defend the person using the old eating disorder methods.  This gets the person's attention dramatically.  The "recovered" person recognizes the return of the eating disorder urges or actual behavior as a signal to pay attention to something that is out of conscious awareness. 

       Past recovery work allows the person to reevaluate what's going on in his/her life knowing now that something is being denied. He or she can then do more inner work so they can be fully present for their experience without needing the numbing protection of the eating disorder.

       There can be gaps of five, ten even twenty years of no acting out and then the old faithful protector emerges to wake up a person who is involved in more than she/he can bear and doesn't know it.  The eating disorder lets them know it.  It can last for only a few days and be of tremendous value.

       I would not like people who have occasional psychological informative incidents of their eating disorder symptoms thinking they have lost their recovery.  Nor would I like people who have no symptoms for two years to think that their disorder is over.

       No one knows what challenges life will present in the future.  I doubt that any of us are fully equipped to deal with what the future will reveal.  We all need to keep learning and growing
to survive and thrive in this life.  And we all have signals that let us know we need to learn and grow beyond our current limitations.

       A return of eating disorder urges is one kind of signal that more growth and learning is required.The more recovery work the person has done the more capable he or she is of continuing the recovery work when those inevitable life challenges emerge. Those urges can help open a blind eye or a dulled psyche to a new challenging reality and help a person continue to live a full life.

       What are your perspectives on recovery and relapse?

       Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Boyfriend Wants to Help His Girlfriend Who Suffers from Anorexia

        A young man wrote asking how to help the woman he loves.  She is anorexic. They've been together for a little over a year. He says one good thing about the situation is that she is aware of her condition and has begun to talk with him about it.

        He is combing the Internet and bookstores reading hundreds of stories and medical write-ups about eating disorders and anorexia in particular. He says he feels that the more information he has the better he can behave toward his girl.

        I'm trying here to give you the message and the tone of his letter without giving you his exact words.  Those words belong to him.  But the message within his words applies to many young men (and not so young men) who are in a relationship with an anorexic woman.

        He says he and his girlfriend have begun to have wonderful conversations about her condition.  He feels these conversations are a good sign because she is not getting upset as they talk.  He wants to do the right thing, be supportive and help her get well. 

        He tells her that the two of them can get through this problem and that he will remain committed to her no matter what.  He says that he never has loved anyone as much as he loves her.

        He repeats throughout his letter in many ways that he feels good about her turning to him for help.  He wants to make sure he is doing everything possible for the woman he loves to help her get well. I am the only person he has spoken to about his girlfriend.  Her condition is private and he wants to honor that privacy as he helps her get well.

        My heart is touched by his plea for help. I only hope I can help you see what I see in his bittersweet request.

       At the end of this post is my answer to him.  I stand by what I said. What I didn't say is this:

       Anorexia is a profound illness that affects the mind and spirit as well as the body. A person who is anorexic denies herself in many ways.  She is often unreachable by any form of nourishment. 

       A person who is in the throes of anorexia is like a starving person standing before a feast, pleading for food.  Generous people offer her food,but the starving person pushes it away, throws it away, spills it, can't hold the plate, can't hold the fork, can't deal with the temperature or consistency, can't swallow properly, and on and on.

       The people at the feast, who do not understand her illness, will meet each problem as it comes with a solution.  They will hold the plate, change the temperature, provide more comfortable utensils, find
ways to help her throat function with massage or medicine or hospitalization, and on and on.

       Each attempted solution will have flaws that keep that starving person from taking any nourishment. She may cry, complain, suffer and plead for help.  But she cannot accept it.  Eventually she will be visibly angry and actively spurn attempts to help her or criticize the people trying to help her for being invasive, critical, bossy, controlling, selfish, and on and on.

       This is only part of the picture. I'll talk about more in future posts.  But this part of the picture is what concerns me regarding the young man's request for help.

       He sounds to me as if he feels that all his love, energy and intellectual prowess, if rallied properly, will save his beloved.

       He doesn't know that he can be drained while his efforts somehow continually fail to reach her in a healing, nourishing way.

       I hope you understand that I am describing the symptoms of an illness. This is not about the authentic woman living under the burden of the anorexia.  That authentic woman is barricaded within herself by the illness. The ardent boyfriend is confronted with more symptoms than he knows.

       I fear for both of them.

       Still, there is a way out.  Healing can happen if both people recognize that some of their feelings and behaviors are a direct consequence of the anorexia and must not be given power.

       Specific suggestions to the young man:

Dear Young Man,

1.      Encourage your girlfriend to work regularly with a mental health professional who has expertise in treating eating disorders.

2.      Go to Overeaters Anonymous meetings occasionally, and listen to people talk about their experience in suffering and recovering from eating disorders.

3.      Let your girlfriend know you are doing this and let her know you would go with her to an OA meeting or two to get her started if she were willing to go.

4.      Go to Al-anon meetings yourself and learn the basics about being in relationship with someone who has a disorder similar to addiction.

5.      Let your girlfriend know you are doing this because her being at risk from this illness causes you great concern, and you want to know how to help yourself deal with your own suffering as well as help her.

6.      Make sure you take care of yourself.  You might consider getting supportive counseling for yourself.  Getting too involved in her recovery can cause problems for you and your relationship.

       You need all the support, knowledge, patience, self respect and self-confidence you can rally and develop to see this relationship through. It takes skill and attention to boundaries and self care to learn how to be in relationship with the person you love and not be in relationship with the disorder.         

       Good luck!  You sound like you really care about her. She's fortunate to have you by her side.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Eating Disorders and the Challenge in Asking for Help: An Artist's Perspective

Eating Disorders Today Welcomes Guest Blogger, Janna Stern, Gifted Artist and Great Friend

       I'm an artist, an M.D., a wife, mother and grandmother with a passionate interest and concern for people who suffer from eating disorders. I feel honored to be asked to contribute some of my work as a guest on Joanna's blog as I find her dedication to the cause and her work to be on target.

       My painting: "In God's Ear." can be viewed at http://serendip.brynmawr.edu/exhibitions/stern/.

       My thoughts about how the image relates to eating disorders:

       People look for a savior. Both the afflicted and those who love them or are trying to help them cry out for help.

       They feel likes dolls at the mercy of some autocratic or whimsical owner. There is no clear path.

       Nearly everyone acknowledges a superior being and tries to reach out to a deity for solace and direction. The doll looks so weary and helpless, as if it has been cast aside several times in searching for a savior that never came.

       Most people with eating disorders only trust themselves and feel safe with their own system of maintaining control and order. When everything in the world is out of control, they ultimately are in control of what they do and where they seek comfort.

Janna Stern, M.D. artist
email: janna@jannastern.com
URL: http://www.jannastern.com

Recent Flurry of Blog Posts Regarding Family Dinner Research

Love is left out of the eating disorder prevention equation yet again.

       Eating disorder prevention does not mean following a check list of correct
behaviors at the dinner table.  It means behaving reasonably  and practically with
a powerful undertone of love, respect, a glad willingness to listen, honesty
confidence to passionately disagree and deep certainty that right or
wrong everyone in the family loves and will stand by everyone else.

       When that is brought to daily life in a family, including family
dinners, eating disorders don't have a chance to develop.

       Researchers have a tough time factoring love in their studies. I can
appreciate the difficulty.  I also am dismayed by research results
that do not consider the presence or absence of genuine love and
respect.

  Researchers say..."what happens at that table has an impact on teens
as well. Juggling schedules to make time for eating together,
creating healthy, nutritious dishes, and having positive interactions
at the table are all components of healthy family meals."
http://www.thatsfit.com/2008/01/14/family-meals-help-girls-avoid-eating-disorders/

       Yes, these are components. Please include love and respect, spacious
time, generous listening, appreciations of differences, honesty and room for laughter
and shared passions.

       Now we're talking about family meals that help prevent eating disorders.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Facing Unseen Physical Problems caused by Eating Disorders

* "Obviously, my body doesn't believe a word my brain is saying."  Calvin in Calvin and Hobbes Collection

       The osteoporosis aspect of eating disorders doesn't seem to be a concern to people in the throes of their eating disorder. 

       Osteoporosis doesn't hurt and doesn't show.  Tooth enamel loss, hair loss, weight gain or loss, skin eruptions all show. The visual is what gets a woman's attention. Unfortunately she tries to correct the  visual without addressing the deep cause of her troubles, her eating disorder.

       The unseen damage remains out of awareness for a while: osteoporosis, esophagus tearing, electrolyte imbalance, risk to heart, dizziness from blood sugar imbalance, organ damage, hormonal disruption and the impairment of judgment based on lack of sleep and lack of proper nourishment.

       The unpleasant reality is that reality won't go away.  Any acting out of any eating disorder serves to numb a person's  feelings and dim her awareness of what is going on around her.

       But turning off awareness does not mean turning off the fact.  Living in a state of oblivion doesn't halt the damage being done. 

        Oblivion needs to fail as soon as possible. 

       That failure and the vision of what is actually happening to her body is a terrible shock and brings up terrific anxiety.  The challenge is to not use that anxiety as a trigger to binge or purge or starve or exercise to bone breaking lengths.

       The challenge is to use that fear and anxiety, that glimpse of reality, to address the eating disorder realistically and start working with a mental health professional who specializes in eating disorder treatment. The challenge is to get even more awareness and get her healing work underway. 

* quote from Calvin and Hobbes, p. 7 Scientific Progress Goes "Boink", by Bill Watterson, Andrews and McMeel Press, 1991.

http://www.amazon.com/Scientific-Progress-Goes-Boink-Collection/dp/0836218787

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Helpful Quiz, Ability to Conceive, Osteoporosis

      

       Breaking the Mirror posted answers  http://www.breakingthemirror.com/  Quiz Answers!January 11, 2008 to a to a ten point eating disorder quiz posted on a teen fashion site. 

       Posting this quiz is a wonderful idea. It helps provide clear information that can combat prevalent and false ideas about eating disorders.

       I would add that while birth control is always a good practice when someone is sexually active and not prepared to conceive a child, it is also true that severe anorexia can seriously
limit a woman’s ability to conceive.

      Another point missing from the quiz relates to bone strength. Many young women with eating disorders develop osteoporosis. It doesn’t hurt, and it doesn’t show. Some anorexic women who are
only 17 years old have lace bones comperable to a very old and fragile woman.

       That said, stating health risks will not scare a person into recovery. But they might scare a person into treatment!

       I hope so. I’ve recovered from bulimia and have been a psychotherapist dedicated to eating disorder recovery for many years. It seems that girls and women need to notice that the eating
disorder eventually causes more pain than they can bear before they are willing to risk giving it up.

       This requires a desperate kind of courage because they genuinely face the unknown in the therapy work. It can be almost impossible to imagine a life without the eating disorder. Yet, a
glimmer of the freedom that might be possible if they were genuinely free of the behavior, the thoughts, the anxiety, the planning and strategizing, the need for the cover up lies
can keep a person on the recovery road.

       I'm glad to know that in the sea of high drama, repetition and hype on the internet relating to eating disorders, some realistic information is being offered that can be truly
helpful to people looking for solid recovery.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

What a Healthy Relationship with Food Looks Like - a lesson from children

            Two little girls, sisters, 5 and 7 years old, were spending the afternoon with me in my home.  We are great friends.

            We had been painting in my studio and running in the grass counting Buddhas (I have a lot of Buddhas in my garden).

            Suddenly the five year old announced, "I'm hungry!"
      
            The more demure seven year old gave her sister a look that said, not so loud and impolite, please while she looked at me and nodded, "Me, too."

      I said, "Well, let's go look in the refrigerator and see what I've got."

      They both grinned and ran into the house.  The content of other people's refrigerators is fascinating to children.

     We found a kind of apple they had never tasted, a fuji.  Five said "no.".  Seven said, "Try it.  It might be good."

     I peeled the apple.  This was a task so totally expected and assumed that no verbal request was given.  Five wordlessly handed me the apple with a most effective facial expression and automatic gesture that clearly informed me of my job.

     They decided the apple was good.  We also found some cottage cheese and carrots. So we peeled the carrots. I sliced the apple. We dished out the cottage cheese and sat in the dining room for lunch.

      I put on some Mozart because we had been discussing the theory that listening to Mozart made children smarter.

      The girls ate with gusto and no talking.  Then they started talking a little as they ate more slowly.  Then they talked even more and ate less.  At one point the seven year old described how she felt listening to the music and wondered if she were getting smarter. 

      She then got up and danced.  The five year old joined her.  The remaining food on the table was forgotten as the girls leped and jumped to Mozart's music.

      My experience?  My imagery saw each child with a transparent fuel tank on her chest. When the fuel tank was empty they immediately felt hunger and knew it.  The thought of food was exciting. Looking at the food, making decisions about it, preparing it was thrilling.  Eating it was glorious. 

      As the gauge on the fuel tank registered an increase, their eating slowed.  By the time the tank was full they had lost complete interest in the food.  Not only that, but the burning fuel released energy to their minds and bodies and that energy turned into joyous dance.

      I smiled at my cavorting little friends, thinking, This is what the absence of an eating disorder looks like.  This is what a healthy relationship with food looks like.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Eating Disorder In-patient and Residential Treatment

     A worried mother called me this morning, concerned that she had not yet received my eating disorder in-patient/residential treatment program list. http://www.poppink.com/list.html

     I was on vacation in Maui with my family and couldn't send the list until today.

     The mother, in the Midwest, is deeply concerned about her 25 year old daughter on the east coast who is a compulsive overeater and obese. They are both looking for an in-patient program that will get her started in recovery.  Well, actually, I think they hope that checking into the best program they can find will result in cure. 

     I'm always concerned when someone says that "some kind of support might be needed after" a residential treatment experience.  To me this phrase reflects a naive hope that a person can go away ill, come back cured and the burden of the illness will be lifted off everyone involved.

     This fantasy simply must be dispelled so that unnecessary disappointment and feelings of failure don't delay or even destroy positive moves toward recovery that are being made.  Residential treatment can help people get on the recovery path.  After residential treatment people with eating disorders still have to walk that path, or climb or crawl or, as 12-step says, "trudge" their way to recovery.

     When you know you are working toward progress, even when you are backsliding a bit, you can keep your energy directed on the healing task in front of you.  You might feel frustrated at times.  Who doesn't?  But you can handle feelings of frustration. We've all had lots of practice with that.

     When you know that in-patient is a first, not a last step you can be less hard on yourself.  You can ease into the program and do the best you can.  You don't have to feel a sense of failure at all.  By putting yourself in a healing environment you are making yourself a winner.  When that healing environment becomes your own inner self, your recovery becomes more solid. The transition between in-patient treatment and solid inner recovery is usually long term psychotherapy. 

     How long is long?  It's long enough to make that internal healing environment in you as solid as can be. It's long enough for you to have solid practice and experience in living a healthy life in a new way without needing bulimia or anorexia or a binge or a cutting or starving episode to get through. It's long enough to guide you, support you, ease you, escort you to a healthy life. 

           Please remember, the search for something "perfect", the desire to find the "perfect" program, the urge to reach the "perfect" size or be the "perfect" person in any way at all is a symptom of an eating disorder.  We humans are not designed to be "perfect".  Our design is that of a human being with all our flaws and contradictions. There's something wonderful about being like a kaleidoscope, an endless colorful variety of perspectives, intact and whole.

     I hope with all my heart that the woman who called this morning and her 25 year old daughter who is locked into her own mind and body by her eating disorder, can find the help and the direction they both need to get relief from their suffering and find their eating disorder recovery path.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA                       bulimia, anorexia, compulsive overeating recovery, www.poppink.com

    

Eating Disorder In-Patient Experience

     A wonderful, honest, detailed and accurate description of what it's like to go through an eating disorder in-patient experience is posted on: http://ballyhoo.typepad.com/mollyblog/eating_disorders/index.html

     Molly Freedenberg shared her eating disorder recovery viewpoint and by so doing, gave a gift to the eating disorder recovery community.

     Her post dispels myths and fantasies about early recovery. I'm especially glad that her vivid examples make clear that in-patient or residential treatment is the beginning, not the end of recovery.

     I've heard from too many people who believe that "going in-patient" is both a last resort and also a complete treatment experience after which a person with an eating disorder will be "cured."    

     Even in the news where celebrities with eating disorders are discussed, I see the idea expressed that the eating disorder in-patient programs "failed." 

     While it's true that some programs are better than others and some programs are more suited to an individual's needs than another, it's vital to remember - or learn for the first time - that in-patient treatment programs are the beginning and not the end of treatment.

     To request a list (free) of eating disorder in-patient programs, please go to www.poppink.com and click on "in-patient programs" in the sidebar. Be advised:  the list is international, comes as an attachment and is 94 pages long.  I've been building it for many years.

     Thank you again, Molly, for your generous and insightful post.  I hope many people who need to begin their eating disorder recovery will find your post and get an accurate and thorough snapshot of what in-patient eating disorder recovery programs can offer.

Joanna Poppink, MFT, psychotherapist, eating disorder recovery specialist, Los Angeles, CA

anorexia, bulimia, compulsive overeating, binge eating recovery; www.poppink.com

Emergency Hospitalization, Eating Disorder, Coming Home

       Yes, you can help your eating disorder recovery by ordering your environment. 

       Jeremy asks in his blog http://jeremygillitzer.blogspot.com/ if bringing his home into order will help him stabilize after his emergency six week hospitalization for eating disorder recovery.  To me, it sounds as if his emergency escort to the hospital was a rescue mission, and that he is lucky he got his life saved.

       Now it's time for him to take over and rescue his own life.  That's true for everyone with an eating disorder. The big questions are what to do? how to start? when to start?

       When to start? Answer: ASAP, with now being best.

       How to start?  Not as easy but the answer is usually right before our eyes.  As old school 12-step says, "Do what is in front of you to do."  Then follow it.  If it's a paper clip on the floor, pick it up and then see what's next.  If it's a phone call to make or hair to wash and comb, or a diaper to change, or a bed to make, or dishes to wash, or an appointment to keep, do it.  Then you'll see what comes next.

       If you can see what's in front of you to do and take healthy and practical action regardless of how you feel you are on a good road.  But maybe you can't see it.  Maybe you're so flooded with so many tasks and feelings that you are immobilized.  What then? That's when people ask, "What should I do?"

       Jeremy asks, should I clear out and organize my home?  I say, Yes!.

       Living with an eating disorder in control of your actions leads to chaos in your life and environment. Creating a healthy structure that will hold your life securely even when you feel insecure is the insurance you need to keep your life and your relationships intact.

       What's above reflects what's below and vice versa. Inner chaos creates outer chaos in your home, your file system, you closets, your kitchen cupboards, your closets, your work, your relationships. Everywhere you look you see the chaos theme reinforced.  That view goes in your psyche, and you feel hopeless and overwhelmed.

     You know where those feelings lead: binge, purge and more.

       So, by putting some order in your outer life you can give your psyche the signal of order and personal empowerment than can influence your state of mind.

       Yes, Jeremy. Clear the clutter out of your house.  It will help you clear out what's unnecessary in your mind. Get rid of what doesn't work for you, especially if it's broken.  That will help you get rid of your reliance on old ways of thinking that don't work for you. Put some beauty in your home.  That will help you smile and be more comfortable in your own skin.

       House organization is certainly not a substitute for ongoing and deep psychotherapy that is necessary for recovery. But, following the principles of Feng Shui in the home can help you bring more balance and health to your life and help your stabilize on your path to eating disorder recovery.

Joanna Poppink, MFT, psychotherapist, eating disorder recovery specialist, Los Angeles, CA   

bulimia, anorexia, binge eating, compulsive overeating recovery work. www.poppink.com

 

Coping with Feelings after New Years

A Nourishing Treat for Getting Through This Week Well

       As you move through this first week of the New
Year, I recommend that you read or re-read Joseph Campbell's
Hero with a Thousand Faces.

       This is the classic that can guide your through
your journey to eating disorder recovery.  Even if you
don't see the relevance, your unconscious will gladly take
in the healthy nourishment Campbell has to offer.

       I met Joe many years ago at an imagery conference
at UCLA.  We met in a big hall outside the workshops.
Many of the speakers and workshops were good, but at that
moment I was fleeing a bad one.  Joe was also in flight
from something he couldn't bear as well.

       We sat on a step at the bottom of the staircase and
talked for well over an hour.  The energy, honesty, humanity
and richness of the man came through so well I can feel him
today.  He also had a twinkle in his eye for attractive
young women which I enjoyed.  After all, he was a most popular
professor at Sarah Lawrence for many years.

       Many books came later.  His influence on the creation
of Star Wars came later yet. 

       But give yourself a gift and a boost into healing by
reading his first book, the book he wrote when he was a young
man starting his own journey.  Enjoy.  Please know that you
can be the heroine of your life.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA
bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Binge Eater Discovery

A post just came in to my eating disorder recovery discussion board on www.poppink.com.  The poster was shocked in her discovery that she is a binge eater.  She is now looking for help.

I hope you can appreciate my gladness at her discovery.  I'm not happy that someone has any form of an eating disorder.  But when a person discovers that she does have an eating disorder that discovery is good news.

Now she has an opportunity to stop criticizing herself about her weakness, bad character, and all the other horrible  and relentless judgments she makes about herself.  Once she knows she has an illness, a disorder with a name, she can begin to look for guidance in her recovery work.

She can stop the endless pain of trying to do what doesn't work and begin her path to health and freedom from those debilitating binges.

Joanna Poppink, MFT, psychotherapist, Los Angeles, CA eating disorder recovery specialist

bulimia, anorexia, binge eating recovery;  www.poppink.com

Hung Over or Exhausted or Frightened?

       The week after New Years can be tough.  Fantasies around
New Years may be more powerful than Christmas wishes.  New Years
is often a time of hope for the end of eating disorder symptoms.
You hope for the beginning of a new and true love. You hope that
at last, you can be your real self, be recognized as the quality
person you are and welcome peace and opportunity in your life.

       When all those wishes don't come true as the New Year opens
the disappointment can be intense.  That disappointment can bring on
a state of depression where you have low energy and just want to cry
alone with your best friend - bulimia.

Please, hold out.  You might be hung over from too much
of everything over the holiday.  You might be exhausted from
activity and tension.  You might be frightened because of the sudden
transition from holiday to quiet regular life.  Maybe you are
experiencing all three.

       Give yourself a chance to adapt to the shift your mind,
heart, body and emotions need to make after the holidays.

       A big tip that always needs reminding, that all of us
tend to forget:

Don't get too hungry.
Don't get too thirsty.
Don't get too tired.

Hunger, dehydration and fatigue will play havoc with
your emotions, your ability to think and your ability to
perceive realistically.

       Give yourself a few days of eating three healthy
meals a day, drinking 6 - 8 glasses of water a day and
getting eight hours of sleep at night. 

       You will be happily surprised at how much better
life looks. 

       This is not a cure for bulimia.  But it is a way
to catch hold of some health so you can take the steps
necessary for solid recovery.  And wouldn't that be a nice
way to start the New Year?

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA
bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Bulimia Emergency Tips for New Years

        When your gut trembles and aches with fear, when your upper arms
seem to vibrate on their own, when the back of your throat aches, when
what you see begins to have an unreal quality you are experiencing raw
vulnerability that is a prelude to a binge/purge episode.

       If you suffer from bulimia the end of a holiday season can leave
you in this fragile emotional condition.  You may attempt to use rage to
wipe out these feelings. You may try to control the people around you to
prove your power when deep down you feel powerless. You may want to hide
under the covers or throw a full on tantrum.  Please remember these are
symptoms of your illness.  You can get through this.

       After the holidays a quiet comes to town, which is difficult for
a person with bulimia to bear.  Generally people use the after holiday
time to rest, clean up, see how much money they’ve spent and get ready
to go back to school or work.

       A person with bulimia can’t move smoothly from high-energy conditions
to a calm and even state.  Other people relax after an intense time.  They
rest and regroup. The bulimic person crashes and feels frightened and unstable.

       This instability can set off one binge/purge episode or a series of
binges and purges that can last for days or weeks. 

       If you are near this state, please remember to be kind and giving to
yourself.  Try these simple tasks:

       1. Take a shower and wash your hair
       2. Make your bed
       3. Eat breakfast and immediately go for a walk
       4. Go to an OA meeting
       5. Call your therapist.  If you don’t have one, start looking for one.
       6. Go to an animal rescue shelter and volunteer to walk a dog
       7. Go to the library and write thank you notes to anyone you can think of
       8. Look at something you usually think is beautiful – even if nothing seems beautiful now.
       9. Postpone your binge or purge. Start thinking about what else can nourish you.
      10. Journal, journal, journal.
   
       Find ways to put yourself in environments that nurtures healing, creativity
and learning. Someday you will create that for yourself.  For now, stretch yourself
in that direction because every moment of your life can be the beginning of a New Year
for you.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA
bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Eating Disorder Recovery Tip: Greet the New Year with a Gratitude Journal

       Why not greet with New Year with a gratitude journal?

        You can start by putting a reminder note on your bathroom sink
mirror that says, "Add one item to your gratitude journal, no matter how small."

       (http://www.sleepydust.net/GRATITUDE-JOURNALS-what-is.html)

       The "no matter how small" is essential.  Looking in any mirror at any time for
an eating disorder person can be a trial.  Mirrors, like scales,
bring out the ferocious and unrelenting inner critic, merciless and condemning.

       Meeting that critic with a gratitude reminder can help prevent a person
from spiraling into a bleak emotional state that could well trigger an eating disorder
episode.

       A gratitude journal can help all of us open our minds and hearts to the positive
aspects of living and of our lives in particular. 

       You might think, "Well, I can't do that because I have nothing to be grateful for.
My life is a mess."

       If you are caught in that kind of downward thinking we need to find
a way to reverse the direction and bring you up, not to elation but to a normal
steady state that can perceive realistically.

       So we get very basic.  If you don't like your nose you can still be
grateful that you have a nose.  Some people don't.

       If you don't like your residence, you can still be grateful that you have
shelter.

       If you don't like your body you can still be grateful for having a body
that functions, even imperfectly.

       If you are isolated and alone you can still be grateful that telephones,
e-mail, pen and paper exist and you can make moves to connect with others
when you make that choice.

       Perhaps we could make a gratitude list on this blog with your comments.
That might help people who are stuck in bleakness to get out into new
and more happy possibilities.

       Right now, I'm grateful for the Internet and the development of the blog.
The blog gives me an opportunity to speak more directly to people with
eating disorders and share what I've been learning all my life about what
it takes to recover.

       We are right on time when we start our recovery work. Now
is always the right time. Gratitude can be the open door to a more
healthy and happy New Year.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA;
bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Coping with Family Visits over the Holidays

Most people with eating disorders have experienced strained relationships within their family with one or more family members. Creating distance from family is an attempt to create a safe barrier in order to avoid familiar emotional difficulties.

However, separation from family during a holiday season opens up an inner black hole of loneliness, abandonment, isolation and terrific grief. The ideal holiday celebration images streaming in through media, billboards, music, street corners, malls, shop windows is in extreme contrast to the real experience.

Yet, to be with family triggers floods of anxiety because the family will be the real family, not the media images of the holiday. If the person is in the early to mid stages of eating disorder recovery she does not yet have the ability to protect herself and stand firm in the presence of the people who remind her of the original stressful situations.

Early recovery from anorexia, bulimia or compulsive overeating is a sensitive and emotionally painful and frightening time. The person is quite vulnerable.

Here are some tips on coping with family visits.

1. Decide in advance what boundaries you need to keep yourself safe and secure. e.g. separate room for sleeping (i.e. no sleeping on the living room couch) or other public places.

2. Let people know in advance that you have a food plan you need to honor. Make arrangements for the food you need to be easily available.

3. Set up a phone support team in advance. You make calls at specific times to specific people who will listen to your stress and your achievements with understanding. These people can be from eating disorder support groups, your psychotherapist, Overeaters Anonymous members.

4. If your feelings get out of hand, if you are on the verge of being overwhelmed, make your outreach calls and find an OA meeting. Put yourself in an environment where the top priority for others is eating disorder recovery.

5. And always, always: Don t get too tired, too hungry or too thirsty. Keeping yourself well rested, well nourished and well hydrated not only helps keep you healthy. It also helps keep your blood sugar levels reasonable and your emotions more even and mellow.

Please remember, the greatest challenge in eating disorder recovery is to recognize that you suffer from an illness and that your recovery depends on your bearing your own feelings. We all must live in the world as it is.

When your feelings are unbearable, as they often are when you suffer from an eating disorder, your challenge is to find healthy ways to reduce the stress in your environment. At the same time, since isolation is tempting but not a good idea, you need to find ways to build your inner strength so that you can bear more of the stress of life.

All this may seem like an arduous task. But you will be surprised at the joy and satisfaction you experience as you discover your own creativity and new skills in caring for yourself well. You'll discover ways of being more at peace with your family. What's more, you will like yourself better.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA

bulimia, anorexia, compulsive overeating recovery:  www.poppink.com

Eating Disorders, Family Visits and the Holiday Season

          People with eating disorders or in early or mid recovery

from eating disorders call for help more often during the holidays

than any other time.

          If they are separated from family for any reason they feel

bereft.  At the same time, if they are going to be with family, they

are flooded with anxiety.

          The eating disorder behaviors, too much or too little, purge

via throwing up or exercise, are defenses against both real and

perceived dangers.  Unfortunately the person with an eating disorder

often cannot tell the difference.  She feels vulnerable and actually is

unable to take care of herself in many mild as well as severe stressful

situations that arise in family gatherings.

Options are:

          1.         avoid the family gatherings.  consequence: feels lonely and abandoned.

          2.         attend the family gatherings. consequence: feels rage, fear and attempts

                      to control others

          3.         act out her eating disorder, i.e. binge, purge, starve and do what she is told:

                      consequence: is numb to people and stress around her, feels isolated among

                      people, feels guilt, shame and lots of tension.

          4.         call for help and commit to recovery work.  consequence: provides herself
   
                      with support, encouragement and tools to withstand her stresses without acting out,

                      begins to develop health and strength so she no longer needs the eating disorder to

                      cope with her life including her family relationships.

          The good news is that pain aroused during the holidays waken the person to the fact that her

issues are not about her personality or will power.  Her pain can show her that she suffers from an

illness and can motivate her to begin or recommit to her recovery work.

                                                      

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA

bulimia, anorexia, compulsive overeating recovery:  www.poppink.com

Bulimia Help Without Treatment?

Again I am asked:  How can I help my bulimic friend without her going into treatment?

Example: (not real names) Miranda and Trudy are both in their late twenties, married and in their late twenties.  They've been close friends for 16 years.  Trudy recently revealed her 12 year struggle with bulimia to Miranda. Trudy only speaks to Miranda about the bulimia.  Miranda feels she is helping by being the confidante and pitching in to help Trudy with family, household and business responsibilities. She also keeps a careful watch on Trudy's behavior and emotional states.   After two months Miranda is happy that Trudy has six weeks of not throwing up and pleads for help in knowing how she can help Trudy continue to get better without her going into treatment.

Please note that in this example, Miranda asks for help not Trudy. 

When I hear this plea for help my heart aches for the suffering Miranda, Trudy and their family members experience. What is it that makes Miranda and Trudy desperate to avoid treatment for an illness? 

My open letter to all friends asking this question:

            Dear Miranda, 

You and Trudy are not alone in thinking that bulimia is a behavior that can be stopped through will power and love. Bulimia is a serious illness that only grows worse without treatment.  The acting out behavior involving food is only part of a long list of symptoms. Plus, as you understand from your knowledge of other illnesses, reducing or removing symptoms is not the same as healing.

When you say Trudy has made it for six weeks now! with an exclamation point, I feel an emotional aching because of the all too familiar false hope in your inferred sense of victory.

Trudy is doing her best to remove a defense, to stop a coping mechanism that helps her deal with unbearable feelings.  Without the healing work that occurs in treatment, she has no defense against inner issues that plague her. She probably doesn't even know what those issues are.  Bulimia blocks not only her pain but also will block awareness of the source of her pain.

Your valiant efforts in helping her cope with her daily life tasks ease some of her stress. Your attentive and well meaning actions allow her to live without some of her bulimic defenses because you are providing the support she previously received from the binge/purge cycle.   But you can't carry the responsibilities of her life and yours indefinitely.

You�ll get tired.  You�ll be under pressure to put your energy into your own needs or the needs of your family or your business.  You�ll remember how much of your energy is required to tend to your own life.

As Trudy grows dependent on your energy as a replacement for the numbing caretaking of bulimia her needs and expectations will increase.  Your energy and motivation will decline. You�ll want and finally, I hope, start putting more of your energy into your life and less into hers.

Gracefully or ungracefully, you will both will struggle with the effects your withdrawal.

And by withdrawal, I mean easing up. For example, you might do her laundry once a week rather than every day, or watch her children for two hours once a week rather than several hours four or five days a week. You might talk to her once a day rather than five times or even talk to her only once or twice a week.

When Trudy�s stresses - even normal everyday stresses - are present for her to deal with without your constant presence and without her eating disorder coping mechanism, she will go back to the binge/purge pattern to protect her psyche. 

When the binge/purge cycle returns she will feel guilt, shame, humiliation, sorrow - and even despair.  She might also feel angry with you for letting her down or feel bewildered and grief that you abandoned her. Those feelings can be unbearable and will only increase her need to binge and purge.

She will feel like a failure.  But she hasn't failed.  She just tried to let go of a lifeline without developing muscle and ability to learn how to swim.  Anybody who is drowning will reach for a lifeline.

And your being the lifeline doesn�t teach her how to swim or help her understand why and how she came to be so over her head in the first place.

So please, if you can, please, please help me understand why the way to get solid recovery, i.e. treatment, is something you both so actively avoid?

I would so appreciate hearing what you have to share about this vital question.  So many people suffering from bulimia get well because of treatment.

Thank you.

Joanna

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA

bulimia, anorexia, compulsive overeating recovery:  www.poppink.com

Anorexia is an Illness, not a Life Choice

Despite publicity around eating disorders today, a major block to treatment
for some young people continues to be ignorance.  Teen-agers may not get
treatment because influential adults in their lives believe anorexia is created by
willful stubbornness.  Too often, the illness propels a teen to a precarious state of health before treatment, usually residential, is sought.   

Because issues of power, control, independence and rebellion are normal in families
with teen-agers, symptoms of an eating disorder can be misinterpreted and not seen
for what they are: indications of serious illness.

Parents and adults in responsible positions who would be quick to call an ambulance
if a teen was bloodied, or quick to call a doctor if a teen was running a high
fever may not see anorexic symptoms as a signal that requires fast professional
attention..

The calls from young people can be heartbreaking.

Voices:  (paraphrased and summarized)

...  i sometimes can admit to myself that i have this problem,
that getting thinner and thinner day by day is only going to kill me, but
most of the time i just deny it all together.  the one time i tried to see
a therapist, i heard him say on his way into the room that he couldn't
understand why these g.d. kids insisted on starving themselves.  i
clammed up and never went back.

...  My coach said,  i always thought you were too smart for this sort of thing:
you are the girl  who has it all:  grades and friends and looks and a great athlete. 
with so many other kids looking up to you, you owe it to them to be a little smarter.

the "you're too smart for this" thing wiped me out. do people
really think i don't know that what i do to my body every day is killing
me?

...my parents are so proud of the way I look and how great my
grades are. I heard my mom say, 'She's amazing.  She even gets
up early so she can run on the treadmill for two hours before she
starts her day.  That must be where she gets her energy because
she doesn't have time to eat.'

....We (people of any age with suffering from anorexia) can't choose to
erase the fear of food and calories.  We can't eliminate the panic that
arises every time we eat more than the allotted number of calories or
foods that aren't safe to us.

...We're afraid all the time. We're being as courageous as we can, even
if that courage isn't strong enough to let go of our obsession.

The challenge we as the human community face is to raise the level of
eating disorder awareness in families, schools and all the health professions
so that we can help our young people quickly and effectively in the
early stages of anorexia.  Even better, we could get on the path that
would eliminate the development of anorexia entirely. That's my wish.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA

bulimia, anorexia, compulsive overeating recovery:  www.poppink.com

How women with eating disorders surrender their power to exploiters

      

       Often women with eating disorders feel generous, powerful in

their relationship with a man and at the same time they feel weak,

exploited, bewildered and afraid they will be abandoned.

In general, and we can talk in more detail if I see that you are

interested, in this all too common situation. 
                                    

       Again, in general, women with eating disorders are harsh

in their self-criticism.  They also do not use their gifts such as

creativity, intelligence, endurance, determination, resourcefulness,

education, or talents in the service of their own hearts desire. 

They feel like failures because they are not living up to abilities they

sense are within them.


       Other people (who may not even know they have a tendency to

use others), perhaps a romantic interest or friend or family member,

will see the abilities an eating disordered woman is not using on her own behalf. They

will applaud the woman for having such talents and resources.

 

      They will also invite her to be involved in their projects.

She will be delighted.


       They then feed her compliments that are deserved about her talents.

She will feel relief and pleasure at being recognized as the valuable person she is.

What she cannot give to herself, she gives to them.


       Examples include these scenarios: She helps them start or run a business.

She designs and perhaps also creates promotional material for them. She

extends herself financially to shore up their poorly handled money situations.

She entertains their friends and associates magnificently.  She fields their

phone calls making excuses or apologizing or lying for them. She smooths

their difficulties in work and personal relationships.  She tends to their

personal well-being.


       She can do this for any person she wants to please and hopes to make love her.

A certain type of person is happy to take what she is not using.  A few compliments

and a sincere looking smile, an expression of yearning and need will evoke in her a

hopeful joy that she can meet the person s needs and find appreciation and love.


       Once she is giving and feeling vital to another person's life she will feel good

about being competent and productive.  She'll continually postpone the effort required

to nourish and make real her own dreams because she feels strong in what she

accomplishes for the other person.
 

       Eventually she will like a weak failure in terms of her own life. But she sill convince

herself that the other person's life is her life and that she should get satisfaction

from this.  The other person by design or through the routine of this unbalanced relationship, will expect

the system to continue, has become an exploiter and will  build up that belief in her.


       This belief can become so strong that she becomes arrogant.  She may feel a sense of

superiority created by her self defined noble self sacrifice or contributions to the other's successes.

This superior attitude can be off putting to others who are shocked by her obliviousness to her

acceptance of being willingly used.


       At some point she will feel tired and drained.  She may protest or request

relief. Too often she will her fatigue as a badge of honor, as proof that she is

giving her all and proving her love.


       If and when she tries to put some of her energy into her dreams the

exploiter will speak in a supportive way but will actually attempt to sabotage

her efforts or become actively abusive. The exploiter may also accuse her of

being selfish and too sensitive for wanting to withdraw or limit her services

in any way.


     She will be terribly hurt and bewildered by this reaction and won't

understand how someone who has been so reassuring and full of praise could

attack her when she wants something for herself.


       Unfortunately she often thinks the other person is right, that she is selfish

and too sensitive. Then she does even more for the exploiter in an attempt to get

what she thought was a loving person in her life to be loving again.


       It can take years before she understands that the person will say and do

anything to keep her supplying his or her needs and ignoring her own.  Too often

she never understands and becomes a tragic figure when she is discarded.



     Her grief or eventually, rage will plunge her more deeply into her eating disorder.

  For some people, this kind of intense flood of emotional pain will bring them

to psychotherapy, perhaps for the first time.  They come for relief. If they

stay they have a chance to do their real recovery work.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA

bulimia, anorexia, compulsive overeating recovery:  www.poppink.com

Mothers with eating disorders

       Women with eating disorders can be mothers.  Some come to my practice

because they want to heal for the sake of their children.  They do not want

their children to have eating disorders or suffer because their mother

is ill. 


       These often are women who could not rally themselves to put their own

well being first and get help earlier.  Maternal love pushes them to be stronger

and more courageous and determined than they dreamed possible. They

seek recovery for the sake of their children.


       At a garden party last week end where most of the guests were new parents

I heard one mother voice concerns I hadn't considered. I felt startled and humbled

by my own thinking deficit. She spoke to me about a situation I am not likely to

see in my practice.


       Her child is three years old. One of her child's best friends from school is being

raised by a mother with an obvious eating disorder. That three year old child is

concerned about carbohydrates and about getting fat.


       The mother I was speaking with didn't t want that influence on her three year old

daughter and was struggling with the idea of breaking up the friendship between these

children. She is probably going to put an end to play-dates with the child from the

eating disorder situation.


       I can appreciate the mother's concerns for her child.  Eating disorder thinking

and behaviors are beginning in children at increasingly younger ages. 


      My hunch is that the mother with the eating disorder would be horrified to learn

that her illness is apparent and already having a powerful effect on her young daughter's

emotions, thinking, behavior and social relationships.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA

bulimia, anorexia, compulsive overeating recovery:  www.poppink.com

Symptoms are not people

          People with eating disorders often don't know the difference between their

symptoms and who they authentically are.  Our culture doesn''t help.  Women and

men are often applauded  for some symptoms and criticized for others because our

culture doesn't recognize the difference between a symptom and a healthy human

being.



           Long before I became a psychotherapist I read the book, Captain Newman,

M.D.  The  book made a powerful impact on my developing sense of being human

with other human beings.  One scene in particular, stayed with me then and

remains a  vivid image today.



          Captain Newman, M.D. was made into a movie starring Gregory Peck, Angie

Dickinson and Bobbie Darrin. I wondered hopefully if my favorite scene would

make the editor's cut.  It did.



         Peck, in the title role, was a psychiatrist in the army in charge of a ward full

of PTSD soldiers.



          At one point Peck is with a seriously disturbed patient, played by Darrin. 

Darrin is wildly upset and Peck is shouting.



          Later the nurse, Dickinson, expresses her disappointment and horror with

Peck saying, "How could you shout at your patient like that?"    

       
        Peck responds, "I wasn't shouting at my patient.  I was shouting at his symptoms."      

             
            I can still remember the flood of new awareness and compassion that filled

me at that moment in the story.



            Author, Leo Calvin Rosten, gave me an early lesson in how to perceive as a

psychotherapist.  Symptoms are not people.



            This theme will come up often in my blogs.  A powerful and profound

aspect of eating disorder recovery occurs when a person with an eating disorder

discovers that she is a valuable human being with untapped riches that are blocked,

not by her character or basic nature, but by symptoms.



              When a person even gets a hint of this fact, she feels a surge of hope and

renewed dedication to  getting well.

            

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA

bulimia, anorexia, compulsive overeating recovery:  www.poppink.com

Early Inspiration in Eating Disorder Recovery

     Eating Disorders define a person's life. An eating disorder requires

intelligence, strategy, commitment, endurance, strength, organization

and secrecy, money, acting skills, ability to influence, persuade and

manipulate others repeatedly. I'll go Into more requirements to sustain

an eating disorder in another post.


       An inspiring question that often helps an individual get on

her healing path is this:

     "If I used all the time, energy, skills, strategizing, intellectual and

emotional involvement I devote to my eating disorder to something else,

what could I do in life?"


      This is often a staggering question, and people are shocked by

the answer that occurs to them. Answers come in many forms, usually in a

low murmuring voice with a hand over the mouth where I can barely hear

and actually need to ask for repetition.


               "I could run five fortune 500 companies."

               "I could make a wonderful impact on the whole world."

               "I could go back to school and finish my PhD."
                or law degree, or medical degree etc.).

               "I could get out of this horrible relationship and
                support myself and my children."

               "I could write my book....make my film.....design
                my clothes.....start and run my business.....
                create a school....."

               "I could be free to find out what I really could do."


               You get the idea. Vast options suddenly open to a person

who has been living a limited life controlled by all that an eating

disorder involves.


       And maybe those possibilities are real. The point is that when a

person genuinely looks at everything she does, thinks, feels, says in

a day that involves her eating  disorder and then thinks about what she

could do what that energy and those skills if she were free she gets a

glimpse of a new world.


               She knows she could have useful and meaningful power in the

world if she were free. 


       She doesn't know what she would do or how, but she gets an

emotional and physical sensation of freedom, just for a moment. 

She gets a sense of what might be possible if all her resources could

be channeled toward something that would make her life worth living.


       Sometimes people ask that question of themselves, and the revelation

leads them to psychotherapy. Sometimes people need to be asked.


       When I bring that question to people with an eating disorder I see

faces change.  Eyes fill with tears. Voices quaver, so afraid to speak what

seems too good to be true  A feeling of bewilderment and hope permeates

the room.  This momentous shift in awareness and sense of possibility

always touches my heart.


       It's a long road between that moment and full recovery, but  that

moment of awakening can be the start of a deep and rich healing journey.



    

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA

bulimia, anorexia, compulsive overeating recovery:  www.poppink.com

Professional Confidentiality and Blogging

               Blogging is public and psychotherapy is private.

Sharing my knowledge with you is a challenge. 


               My deep learning and knowing come not from books and lectures

but from intimate meetings with courageous and determined people who

have given me their trust.  The work takes place in what I consider sacred space.


               In fact, I think the work can only be successful if the time and space my

patients and I share is impenetrable to others and solid for us.


          So please understand, when I give examples I am describing people who are not

and never have been patients or I am creating a fictitious person who represents

what I have seen and heard over many years of being in the field of eating disorder

recovery.


               What I say in these blogs will be as true as I know truth to be. At the same time I

will be honoring the confidentiality of my patients - past and present. I hope you

understand and can appreciate this aspect of my blog.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA

bulimia, anorexia, compulsive overeating recovery:  www.poppink.com