Eating Disorders Today

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