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

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

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

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