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

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

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?

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

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

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

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

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

    

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

 

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