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

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

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 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

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

    

Professional Confidentiality and Blogging

               Blogging is public and psychotherapy is private.

Sharing my knowledge with you is a challenge. 


               My deep learning and knowing come not from books and lectures

but from intimate meetings with courageous and determined people who

have given me their trust.  The work takes place in what I consider sacred space.


               In fact, I think the work can only be successful if the time and space my

patients and I share is impenetrable to others and solid for us.


          So please understand, when I give examples I am describing people who are not

and never have been patients or I am creating a fictitious person who represents

what I have seen and heard over many years of being in the field of eating disorder

recovery.


               What I say in these blogs will be as true as I know truth to be. At the same time I

will be honoring the confidentiality of my patients - past and present. I hope you

understand and can appreciate this aspect of my blog.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA

bulimia, anorexia, compulsive overeating recovery:  www.poppink.com