Eating Disorders Today

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