Eating Disorders Today

Miss America, Anorexia, Fear: Hiding in Plain Sight?

       Carrie, on ED-Bites wrote an indignant response to what I consider a rather cavalier column about eating disorders in the New York Daily News.

       Carrie said her own anorexia was based not on controlling weight or the external world but on controlling fear.  I agree.  Controlling everything a person possibly can control in an attempt to control what is uncontrollable I feel is at the root of most eating disorders.

       When that point is acknowledged the discussion goes away from food, fashion, weight, appearance, and even beauty and sexuality. 

       The discussion then becomes centered around the questions, Why are growing numbers of women at increasingly younger ages afraid?  What are they afraid of?  Why do they feel that their fears are justified and that they have no way of protecting themselves except through eating disorders?

       Addressing those questions takes courage and honesty.  In my experience as a psychotherapist, the attempt at reaching answers to these questions is the beginning of genuine eating disorder recovery.

       Fitting into what our culture defines as beautiful, even if that definition encompasses an unhealthy and dangerous physical condition, may well be protection women seek from their fears. 

       The authors of the Daily News column, Dr. David Moore and Bill Manville, end their discussion on a victorious note.  They describe proof of Kirsten Haglund’s  victory over anorexia in terms of her becoming Miss America.  Good grief. The woman found a great hiding place.  She is the epitome of what our culture describes as beautiful. 

       I commend Miss Haglund for her industry, her hard work, her outspokenness in terms of eating disorder recovery. I wish her every success possible in living a long and healthy life. 

       I hope she and supportive loving people around her acknowledge that she is 19 years old, only four years away from her past experience of severe anorexia and that achieving a high cultural standard of beauty and acceptance – an anorexic’s dream – does not represent recovery. 

       I hope she is alert to her inner challenges and is prepared to cherish and honor her healthy emotional and psychological developmental needs as her term of Miss America fades and she continues.

       Thank you, Carrie, for bringing up this issue and for letting your honest sense of indignation come through to all of us.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Eating Disorders and Body Communication

       Much material I read and hear about eating disorders concerns how a person feels and thinks about her body.  But not much has come to my attention that relates to how the body thinks and feels.

      How the body thinks and feels may be a concept that requires a stretch for some or even many people until we open ourselves to understanding the language of the body.

       The body has no words.  Still, our bodies tell us when they need sleep or food or a change in external temperature.  Our bodies tell us when they need a more firm or cushioned bed or chair.  They certainly tell us when something is hurtful to them, like too much heat or cold or abrasion or puncture.

       Most of us have had a near miss when our eyelids blinked faster than thought to avoid a spec from flying into our eyes.

       Our bodies communicate potentially life saving information like when the hair on the back of the neck rises.  This is a primitive body warning of danger on a survival level.

       An aspect of eating disorder recovery involves giving respect to the body itself and learning not only its language but also how to heed what the body says.

       What if the anorexic woman listened to her endocrine system that cried out for nourishment as hormonal function shut down?

       What if the bulimic woman listened to her esophagus plead for a rest from the continuous flow of digestive acids?

       What if the compulsive eater or binge eater listened to a stomach that cried out for mercy and relief from the continuous need to stretch to the point of pain?

       What if, instead of war, we learned to make peace with our bodies?

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Imagery and Intuition regarding Eating Disorders

       The Marion Woodman three day Dreams workshop was warm, challenging and wonderful. I’ve been wondering what to share with you.  Dream work is so personal, but then, so is eating disorder recovery.

       The most powerful image I had, toward the end of the second day, my intuition tells me is relevant to all eating disorders.

       Marion is in her eighties.  Her body is disintegrating.  She uses and needs a cane.  She conserves her energy as best she can.  She survived and recovered from a serious bout with cancer.

       But, when she speaks, her spirit is fiery. Her eyes glow.  Her voice is strong.  She beams warmth and assertive direction that makes us forget her physical frailty as we become inspired by her wisdom and passion.

       The image came through to me of a candle, but not a candle with a wick that burns on top. This white luminous candle contains a wick in the center that burns all the way from top to bottom within the wax.

       The fire within sends out heat that melts the wax from within.  So, for Marion, the image was of her inner fire melting her body away.

       I stayed with this image since Marion inspired it but was not it.  The image went much farther.

       The length of interior burning wick, if too hot, melts the wax encasing.  The candle is gone leaving only a line of fire.  Well, that could mean that the spirit burns brightly but is without a body.  This is an anorexic dream.

       Another version is this:  The length of interior burning wick is hot and melts the wax encasing. But, more wax is added on a continual basis.  This makes the wax thick and forever thickening so the heat of the fire doesn’t penetrate through the wax and into living space.  The candle keepsg getting bigger and the light is continually less visible.  This is the experience of the binge eater or compulsive overeater.

      What about bulimia?  In terms of my image, bulimia is tormented in a different way. In this image the wholeness of the fire and the wax is aware.  The fire burns and the wax melts beginning to reveal the blazing wick.  But the feelings that go with that fire are too intense to bear. Then the wax builds up thickly to bury the flame.  The dullness of that burial is too lonely and terrifying, so the wax is allowed to melt away until the terror of exposure forces the build up again. This is the in and out, here and gone grueling and endless repetition that is unaddressed bulimia.

       These are powerful and helpful images for me. They hold intellectual, emotional and physical understandings in a way that only intuitive imagery can pull together and allow to develop simultaneously.

       Where do you go with these images? 

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

Expect Some Dreamy Posts!

       “Dreams” is the title of the seminar I’ll be taking this week end in Santa Barbara with Marion Woodman (a talk) and Steve Aizenstat.

       Integrating a person’s inner life with her outer life in harmony and health has long been crucial, in my experience, for achieving eating disorder recovery.  Regardless of the specific diagnosis:  bulimia, anorexia, binge eating, compulsive overeating – and all the possible associated behaviors, like cutting, shoplifting, over exercising, over scheduling, under achieving, abusive and exploiting relationships greatly benefit from developing a healthy integration between mind, feelings and body.

       Marion Woodman is one of the early writers in the field of eating disorders.  She is a gifted Jungian analyst with a way of understanding and bringing healing opportunities to men and women and, from my perception of her, particularly to women with eating disorders. I listened to her audio tape, "Dreams" many times and often recommend it to patients. Marion Woodman understands women and the language of dreams!

       I plan to walk among the trees on the Pacifica campus, participated in the dream workshops throughout the days, speak and share with wonderful people, write down my own dreams, muse about the dreams of my patients and those collective dreams that speak for our culture.

       The nourishment from the people, place and theme I know will benefit my in mind, heart and soul.  From this will come new and surprising integrative thoughts and feelings that are bound to appear somehow in my blog posts as well as the rest of my personal and professional life.

       If you care to join me in this experience, take note of your dreams this weekend.  Write them down.  We can share them next week on this blog and see where our dreams lead us.

       Here’s a bit about the wonderful Marion Woodman (excerpt from the Marion Woodman Foundation website www.mwoodman.org

Marion Woodman, LLD, DHL, PhD, is a Jungian Analyst, teacher and author of The Owl Was a Baker's Daughter; Addiction to Perfection; The Pregnant Virgin; The Ravaged Bridegroom; Leaving My Father's House; Conscious Femininity; Dancing in the Flames (with Elinor Dickson); Coming Home to Myself (with Jill Mellick); The Forsaken Garden: Four Conversations on the Deep Meaning of Environmental Illness, Marion Woodman, Ross Woodman, Sir Laurens van der Post, and Thomas Berry, edited by Nancy Ryley; The Maiden King (with Robert Bly); and Bone-Dying Into Life. A visionary in her own right, Marion Woodman has worked with the analytical psychology of C.G. Jung in an original and creative way. She is the Chair of the Marion Woodman Foundation.

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

Death, Tragedy and the Wounded Soul

        A young anorexic woman died in Ireland because her psychiatrist mother drowned her daughter in the bath. It's a tragic story of Gothic proportions going back who knows how many generations. The mother couldn't bear the daughter's anorexia.  The daughter refused treatment.  The mother had an eating disorder.  The grandmother committed suicide.  The story in "This is London" stops there, but the human story has got to go back who knows how far.

       I'm haunted, as many people must be, by the horror, the extremity, the tragedy, the ignorance, the blindness, the waste and the ongoing and spreading suffering of this event.

       Eating disorders go deep into our souls.  Personally I think that they go deep into the souls of the individual with the disorder and also deep into the soul of our society.  Something powerful in our current human condition is bringing up a terrible despair that eating disorders are making public.

       If we can a bring thorough recovery to people with eating disorders, and embrace effective ways of preventing anorexia, bulimia, binge eating disorder and all the rest, we will also be finding a deep cure for the problems in our society that spawn eating disorders.

       I hope this sad and profound tragedy will spur people to look more deeply into both the psychological and cultural forces contributing to sustaining eating disorders in our midst.

       Wounds of the soul are showing.

Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com

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

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

Anorexia is an Illness, not a Life Choice

Despite publicity around eating disorders today, a major block to treatment
for some young people continues to be ignorance.  Teen-agers may not get
treatment because influential adults in their lives believe anorexia is created by
willful stubbornness.  Too often, the illness propels a teen to a precarious state of health before treatment, usually residential, is sought.   

Because issues of power, control, independence and rebellion are normal in families
with teen-agers, symptoms of an eating disorder can be misinterpreted and not seen
for what they are: indications of serious illness.

Parents and adults in responsible positions who would be quick to call an ambulance
if a teen was bloodied, or quick to call a doctor if a teen was running a high
fever may not see anorexic symptoms as a signal that requires fast professional
attention..

The calls from young people can be heartbreaking.

Voices:  (paraphrased and summarized)

...  i sometimes can admit to myself that i have this problem,
that getting thinner and thinner day by day is only going to kill me, but
most of the time i just deny it all together.  the one time i tried to see
a therapist, i heard him say on his way into the room that he couldn't
understand why these g.d. kids insisted on starving themselves.  i
clammed up and never went back.

...  My coach said,  i always thought you were too smart for this sort of thing:
you are the girl  who has it all:  grades and friends and looks and a great athlete. 
with so many other kids looking up to you, you owe it to them to be a little smarter.

the "you're too smart for this" thing wiped me out. do people
really think i don't know that what i do to my body every day is killing
me?

...my parents are so proud of the way I look and how great my
grades are. I heard my mom say, 'She's amazing.  She even gets
up early so she can run on the treadmill for two hours before she
starts her day.  That must be where she gets her energy because
she doesn't have time to eat.'

....We (people of any age with suffering from anorexia) can't choose to
erase the fear of food and calories.  We can't eliminate the panic that
arises every time we eat more than the allotted number of calories or
foods that aren't safe to us.

...We're afraid all the time. We're being as courageous as we can, even
if that courage isn't strong enough to let go of our obsession.

The challenge we as the human community face is to raise the level of
eating disorder awareness in families, schools and all the health professions
so that we can help our young people quickly and effectively in the
early stages of anorexia.  Even better, we could get on the path that
would eliminate the development of anorexia entirely. That's my wish.

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

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