Eating Disorders Today

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