Recover From Your Eating Disorder
William C. Shearer, Ph.D., M.P.H., M.B.A.
Robin L. Shearer, M.A., M.P.H., R.N., M.F.T.
You are not alone. Millions unconsciously battle stress, depression, and low self-esteem through food and weight obsessions. All too frequently, the result is binge eating, bulimia, anorexia nervosa, and self-torture through impossible diets. Quality of life erodes, leading to deepening distress, despair, and in some cases, death.
People do recover! If you want recovery, real and seemingly overwhelming issues must be confronted without the smoke-screen diversions of food and weight.
If you suffer from an eating disorder, your urgent need is the building of self-esteem, a strong sense of identity, and a solid sense of personal power. In over twenty-five years of treating eating disorders we’ve never seen anyone develop these qualities without finding recovery.
So, ready for your recovery journey? The following 26 points will help.
1 RECOGNIZE THE REAL PROBLEM
First, admit to yourself you have an eating disorder. The real issues do not involve food and weight, and binges, purges, starving, or finding the right diet will not fix what is really wrong.
Ask yourself, “If I did not have to spend all of my time and energy on food and weight worries, what issues would then be facing me?” Obsessing about your weight is often a case of needing the problem more than needing the solution.
Eating disorders are about anxiety and avoidance. They are not about your relationship to food. They are about your relationship to you, and the extreme anxiety generated by that relationship. They are about your need to avoid anxiety that threatens to overwhelm you. They are about your need to feel safe and in control of your life.
Did you ever notice what happens when you begin a diet? Other issues quickly fade into the background. Your body becomes the focal point for nearly all thoughts, feelings, and efforts, leaving little or no time to ponder larger life issues. You have simply traded what seems confusing and overwhelming for a single obsession that carries with it the illusion of control. “If only I lose ten pounds, my life will be okay.” It is a case of trying to change the shape of your life by changing the shape of your body.
2 DECIDE TO RECOVER
Doesn’t everyone want to recover? Aren’t the benefits of recovery obvious enough? If the answers to both questions were unequivocally, “yes,” eating disorder treatment would be a snap. It isn’t, and most of our clients approach recovery work with much ambivalence, even staunch resistance.
That’s because the path of recovery is often long, lonely, and rocky. It can be the hardest work you’ll ever do and it can filled with deep emotional PAIN!
It is human nature to avoid pain. This is especially true if you have learned to have little faith in your power to grow and change. You may doubt recovery is possible, or you may have been led to believe that no one recovers. Eating disordered people feel trapped by their past and powerless to influence their future.
Why try to escape? Why struggle? Maybe I'll recover tomorrow. The reality is-- there will never be a better time. Life with an eating disorder is dismal, and it gets progressively worse. Recovery is possible for those who want it bad enough, learn self-acceptance and patience, and refuse to give up making recovery their first priority and pushing hard to have a full, balanced, and satisfying life.
Karen (real names are not used) recounts the terror and confusion of her first appointment. She could no longer live with her bulimia. Facing a life of ever increasing isolation and shame filled her with despair. She could not imagine recovering. Not ever again being able to binge and purge by vomiting frightened Karen as much as an alcoholic is frightened by the idea of life cold sober. How would she handle things? What would she do with those bad feelings? How would she keep from getting fat? Surely, if she stopped purging, she would weigh 400 pounds in no time at all.
Initially, giving up bulimia can be like parting with an old friend. Bulimia fills a void, distracts from unpleasantness, and provides a method of escape. Bulimia numbs. Most bulimics believe that purging is essential for weight control. Ambivalence about giving it up is common. In fact, if someone told us she was 100% ready and committed to give up her eating disorder, we would be skeptical. Eating disorders serve a purpose, and the thought of going without one’s principal coping mechanism is often terrifying.
As bulimia progresses, its tyranny becomes apparent, but life without it seems intolerable. Parallels with alcoholism are helpful. An alcoholic grows to hate booze, but hates the thought of life without it even more. A bulimic faces the same dilemma.
Karen stayed in treatment despite her terror. She learned that bulimia is not a method of weight control. Most bulimics gain weight over time and most bulimics lose weight when purging stops. Karen learned that confronting real issues led, in time, to real solutions. Optimism and confidence replaced fear. She learned to live with her feelings and to grow beyond her pain. Binges and purges stopped. Nothing terrible happened.
3 ACCEPT NO GOAL LESS THAN RECOVERY
Recovery does not mean perfect eating. It does not mean lifelong strict abstinence from “bad” foods or snacking. It is not about sugar. These ideas helped get you in trouble in the first place. Recovery means gaining freedom from constant, overwhelming guilt and anxiety about food and weight. Recovery means being able to tackle actual problems realistically and confidently. Recovery means fading into the general population of imperfect eaters and imperfect people. It means occasional overeating and occasional discontent with your figure, but not to the point of a crippling preoccupation.
Not everyone will recover, and those who do may carry lifelong scars. It is clear, however, if you do not believe you can recover, you will not recover. It is a self-fulfilling prophecy. Believing you will be forever sick sets you up for being forever sick. Aim higher. Whether your struggle takes months or a lifetime, your happiness is tied to your goals.
4 FIND HELP
Having an eating disorder tends to be lonely. You may be isolating, fearing rejection or disapproval. You may be afraid to seek help out of shame or the mistaken belief that you should be able to handle all problems on your own. You may fear being seen as weak and sick. You may fear others will find out and judge you negatively. You may be telling yourself that it is just a phase that will pass.
Those with an eating disorder rarely recover on their own. Also, you are most vulnerable to getting worse when alone. Withdrawing from friends and avoiding professional help only intensifies the cycle. It is NOT a passing phase, but rather a progressive illness. There seems to be no getting around it--- seeking help and support is imperative!
Help is available. Self-help groups can provide needed nurturance and support, a good foundation for recovery. Therapy from a qualified professional is usually a must. Make sure the therapist has specific and extensive experience with eating disorders. Ask questions. Do they believe recovery is possible? What is their treatment philosophy? What are the components of treatment? What is the composition of their treatment team? Remember, you are a paying consumer, and you have a right to ask and know.
Care must be taken that treatment does not focus on food and weight to the exclusion of emotional and developmental needs. When this happens, an eating disordered individual may switch from food to alcohol or drugs, replacing one addiction with another.
At the same time, another danger arises when treatment focuses solely on one’s inner world. We occasionally have clients who come to us who have been involved in therapy for years without food and weight issues having been addressed. This is akin to treating a still actively drinking alcoholic without dealing with the alcohol abuse. When someone is engaging in destructive eating behaviors and these behaviors are not being discussed in therapy, treatment is “off the mark.”
Working with a therapist provides an opportunity to explore feelings and thoughts. As an eating disordered person is able to be more accepting of her needs and feelings, the desire to use food as an emotional tranquilizer is lessened. In therapy, she learns to be aware of the difference between emotional hunger and physiological hunger. A variety of ways to nourish self are discovered. People with eating disorders tend to interpret emotional experiences as hunger and respond by eating, or they may try to “stuff down”? unacceptable feelings by stuffing down food -- or they may restrict feeling unentitled to food in the same way they are an unentitled to have feelings.
Hospitalization may be necessary for stabilization prior to longer-term outpatient therapy. We occasionally hospitalize to boost overall treatment and accelerate progress.
Accept your need for help. Others will be far more understanding than you think. Many types of help are available to sufferers and their families. Obtain information about treatment options. Being informed can make the process of coping and regaining health smoother and easier. The right help can get you moving. Do not let anyone or any group discourage you from finding competent professional help.
5 GIVE UP MEASUREMENT AND COMPARISON. BE PATIENT
You are a work in progress. In your quest for recovery, proceed with patience. Avoid measurement that leads to feelings of failure, and comparison with others that leads to a deep sense of inadequacy. Long term problems usually require long term solutions, and progress can be slow and frustrating.. Old habits die hard and may reoccur under extreme stress. Resist the urge to declare yourself a failure for predictable setbacks. Congratulate yourself on your successes, and celebrate even the smallest ones. Forgive everything else.
After years of binge eating and purging daily, Mary began therapy with twenty-five consecutive days of normal eating. On the twenty-sixth day, she purged and immediately began mentally beating herself up. In group therapy, Joan is distressed because Karen appears to have made progress. Recovery is a mode of traveling rather than a destination to be reached by a certain date. Relax! Accept! Be patient! Easy does it! It will get better and better.
6 HAVE THE STRENGTH TO BE WEAK AND IMPERFECT
This step means giving up control. When you can accept that you are a fallible human being like the rest of us, you are on the right track. Striving for excellence is fine. Wanting to grow and develop is commendable. Self-condemnation and guilt are the real character flaws and obstacles to recovery. Maintaining a mythical perfect you generates enormous stress. The façade requires extraordinary self-oppression.
Here is the paradox. Over-control is out of control. The more you relax, accept, and let go, the more you discover genuine power and strength for living. Learned to believe that your ordinary self is enough. We're not saying this is easy. The fact that this seems almost impossible at first clearly illuminates the basic problem -- an extreme lack of self acceptance.
Control itself is addicting. You may have developed a compulsive need for control as a child. Feeling in control kept you from feeling overwhelmed and insecure. You may have become obsessed with becoming totally self-reliant in an effort to control everything around you and feel safe. The price is high. Such control leads to guilt, fear, and lack of intimacy. It leaves you unable to free yourself from your past and grow beyond your present.
Giving up white knuckle control means freedom. It means self-acceptance and the ability to be close to others. It means reducing stress, thus lessening the need for the numbing effect of a food fix -- whether that "fix" is binging or restricting.
7 MAKE FRIENDS WITH FOOD
Food is not your problem. Food nourishes your body and should be enjoyed. It is guilt and fear over food that is crippling. It is a smokescreen for real problems. Food has become symbolic for needs and feelings not seen as legitimate. Food in turn has become something to which you are not entitled. You feel wrong for eating in much the same way you feel wrong for being.
To break out of this trap, you must reach a point where you honestly believe two things:
1). You may eat what ever you choose to eat and enjoy it without ever having to feel fearful or guilty.
2). You can learn to act directly on your needs and feelings without ever having to feel wrong or unentitled.
The first point is paradoxical. If you no longer have to restrain yourself from eating, it becomes much less important to have “forbidden foods.” Getting rid of guilt over food means the stress of eating “wrong” foods ceases to be a trigger for compulsive eating.
This is terribly difficult. If you believe your only problem is your addiction to certain foods, it becomes a self-fulfilling prophecy. If you believe that sugar makes you crazy, then you must act as if it is so. The more you restrain yourself, the more you will obsess and feel out of control and guilty. The more you can free yourself from guilt and self-condemnation, the less important food becomes. This is especially the case if you are able to meet your needs in a wide variety of non-food ways, without guilt and fear.
8 COMMITMENT TO ORDERED EATING
Eating disorders require disordered eating. A blind faith in dieting or missing meals , coupled with guilt and fear over food, underlie the beginning and continuation of the disorder. Commitment to regular meals, guided by one’s own hunger, is a must for recovery.
If you think you have overindulged, you still need to eat the next time you are hungry. Do not fast to compensate for perceived overeating. Eat the next meal anyway, no matter how much you feel you have consumed that you shouldn't have. This is not a punishment but simply a recognition of the importance of ordered eating in breaking the eating disorder cycle. You are setting yourself up if you feel compelled to make up for the guilt of eating by denying your hunger. You are creating the very craziness you are struggling to overcome.
Jan maintains her anorexia by counting every calorie and rigidly eating small amounts of the same food each day. No variety, absolute control over quantity and phobic avoidance of “bad” foods help her feel secure and in control of her life. Ignorant of caloric arithmetic, she believes that even a few extra calories will make her instantly fat. She believes totally eliminating fat and carbohydrates from her diet is practicing good nutrition. She is unaware that her constant obsession with food is a natural consequence of starvation. For Jan, the food thoughts are terrifying and further strengthen her resolve to remain in control. Surely if she wavers, she will be insatiable. Her obsession has destroyed her quality of life. What began as a diet has become an all consuming full-time job and a self-perpetuating disorder than may eventually lead to death.
Val heroically starves all day. Guilty over anything she eats, she struggles to get through the day to a well-deserved low calorie evening meal. By quitting time at work, she is already feeling control slipping away. Another night of gorging will follow.Tomorrow she will renew her commitment. This time she will be stronger.
9 NO PURGING
Vomiting is only one form of purging. Other purging behaviors include: laxative or diuretic abuse, excessive exercise, extreme dieting, missing meals, and fasting. Any of these behaviors can set you up for a binge. Once you have made the decision to purge later, you have the green light to binge now. The decision to undue in the future, such as a pledge to not eat tomorrow or start a new diet on Monday, opens the door to eating without restraint in the present. Conversely, when you have made a commitment not to purge, binges slow down and food becomes manageable.
10 TALK ABOUT IT AND WRITE ABOUT IT
With this point, recovery begins to accelerate. What is “IT?” Quite simply, “IT” is everything other than food and weight, particularly feelings. When you begin to free yourself from food and weight obsessions, you quickly become aware of an ocean of long avoided issues and conflicts. A daily journal can be helpful in clarifying needs and feelings. Friends and therapists can provide understanding and feedback. The writing exercises prompted in a twelve-step program, such as Alcoholic Anonymous or Narcotics Anonymous, can be extremely productive. Painful experiences and thoughts retain their full intensity if perpetually avoided through food or other emotional pain killers, and all personal growth is put on hold.
If dealt with on an ongoing basis, the intensity of emotional distress will diminish. Begin. No matter how scary, allow yourself to believe that the only way beyond emotional pain and distress is through it.
11 ACCEPT THE DISORDER
Underlying the eating disorder is a drive to protect and nurture self and to avoid pain. These are understandable and vital motives and should not be denied. Do not condemn yourself for your disorder. Instead, take ownership of the hidden meaning and allow the energy of these needs and feelings to propel you toward discovering constructive alternatives. Guilt perpetuates the problem. Self-acceptance frees.
Beth, like many we work with, has been learning to view her bulimia as a signal of something wrong in her life. Rather than seeing her disorder as further confirmation of her worthlessness, Beth has come to see it as a constructive learning experience. When aware of her needs, and able to act decisively, binge eating and purging are not a problem. When she overrules her own needs, denies or minimizes her feelings, she is immediately fully caught up in her disorder.
Beth needs to break free of a destructive relationship with an alcoholic who refuses treatment and drags her down. When she ceases to allow herself to be manipulated into continued involvement, and instead guiltlessly focuses on her own well-being, her symptoms disappear. Each time she hasgiven in to her boyfriends guilt trips, binge eating and purging began again with a vengeance. Finally aware of this recurring pattern, Beth now has clear vision. Denial of her inner voice and concern for the demands of others have generated the stress that led to her eating disorder. Instead of condemning herself for signs of her disorder, she now accepts them as signals of the mounting stress of unmet needs. Rather than using her disorder to avoid feelings, she now uses it to alert her to her need to fully experience those feelings. Rather than running from this awareness, she is learning to use needs and feelings to guide her recovery.
12 CHANGE YOUR THINKING
Eating disorders seems to coexist with learned dysfunctional thinking. Do you believe that you must please everyone all the time? Do you think anger is unacceptable? Do you believe it is terrible to make a mistake? Do you think you are selfish if you act upon what YOU need? If you answer yes to any of these questions, you have impossible and irrational ideas that you are trying to live by. Learn to be aware of these beliefs, Learn to challenge them and replace them with rational, less stressful thoughts. Practice actively attacking and replacing thoughts that lead to panic, guilt, and self-hatred.
You have learned to be a harsh judge of yourself. That's actually good news! If you learned erroneous thinking based upon faulty evidence, you can now learn to think more realistically about yourself based upon real evidence. You can now learn to recognize and dispute your own ego puncturing thoughts. Practice congratulating yourself on even the smallest successes. Practice self-acceptance. Practice having gentle and loving thoughts toward your inner child. Imagine having a daughter just like you. Could you love that daughter? Can you have the same regard for your inner child?
13. FIND A GENTLE INNER VOICE
We all talk to ourselves, all the time. This is normal, yet we're usually not aware of this inner conversation. Becoming aware of your "voice" is crucial to recovery and this means not only aware of "what" you are telling yourself, but "how" it is being said. Are you harsh and critical? Are you demanding and perfectionistic? Are you demeaning and contemptuous? Can you talk to yourself in a loving, accepting, and forgiving way? Do you immediately respond to that last question with "No way! I haven't earned it and I don't deserve it? "
The goal is to find a gentle inner voice. How might you talk to your best friend? If you have a dog or cat, what voice do you use when talking to them? Yes, terms of endearment and baby talk are okay. Start with developing an awareness. How do you talk to yourself now?
Tune in to this inner voice, and if it's a harsh one, make up your mind to change it. Practice talking to yourself in a kind, soft, loving, encouraging, friendly, compassionate voice. If you find this difficult, as we think you will, try something that's often advocated in 12-step programs -- "Fake it till you make it!"
14 COMMITMENT TO FUN
This is difficult. Those with an eating disorder tend to see fun as a waste of time or selfish. One “should” be productive and serious. Fun can wait, and besides, others’ needs come first. If this sounds familiar, you may be in need of an unusual prescription. Have fun. Schedule fun. Frivolous or even silly fun is fine. Taking time to guiltlessly indulge yourself while rediscovering the inner child who can still laugh and play powerfully undercuts the need for food obsessions. Such obsessions thrive in a bleak climate of self-deprivation, where food comes to symbolize the fulfillment of unmet needs.
An eating disordered world is one without balance. It is a world of either/or thinking in which the worst view of self is the one held with greatest conviction. It is a world where relaxation is wasting time. It is a deadly serious and threatening place where fun does not exist. Balance means that when you work, you also need to play. If there are serious moments, there ought to be lighthearted moments as well. The more the better. Busy and active is fine, as long as there is time to be still and quiet. Creative goof-off time is essential, and most importantly, skip the guilt.
Balance means looking at all aspects of your life, not just your shape and weight. Our clients often act as though their essence as a human being is identical to their narrow and negative perception of their body. If you are unhappy with your body, must you be unhappy with all the rest of you? Do you have an identity beyond your dress size?
Here is an exercise that will help put things in focus. Imagine that each spoke on the “Wheel of Life” below represents the range of satisfaction you feel in a particular area of your life. You might have little or no satisfaction at the hub, 100% satisfaction at the rim, or a degree of satisfaction at any point in between. Place a dot on each spoke according to how satisfied you feel with that area of your life.
Next, connect the dots. You now have wheel representing the smoothness or roughness of your journey. Are you having a bumpy ride? Is there balance?
If you are not satisfied with part of your life, work on it! Get help! Build satisfaction in realistic and direct ways. Do not buy into the illusion of control that comes with a new diet. Losing weight will not guarantee happiness, fix problems, or change the shape of your life (or “wheel”). It should be apparent after you have worked on your wheel that you need to ditch the eating disorder and work on the real stuff.
The Wheel of Life
16. ACCEPT ENLIGHTENED SELFISHNESS
Many eating disordered people feel selfish and guilty when acting on their needs. You may have been taught that others’ needs come first and the expectations of others must be fulfilled. You may fear hurting others’ feelings or making them angry. The thought that you may cause them to reject you if you are not extremely cautious is uppermost in your mind. Forever nurturing, seldom nurtured, your resentment grows. Such resentment is seen as dangerous and cannot be openly expressed, so you stuff your feelings and turn once again to food or a food/weight focus.
Enlightened selfishness, a cornerstone of good mental health, means fully accepting the legitimacy of your needs and feelings. It means being able to express your feelings and act on needs you fully own. It means putting aside guilt and fear and allowing yourself to be nurtured. It means taking responsibility for reducing the stress of your unmet needs. You can be a world class nurturer, if you are also on the list of those to be nurtured.
Anne, a bulimic client, has learned that her bulimia becomes more intense when she trades her anger for helplessness and depression. When she becomes “wimpy,” binge eating and purging follow. When she accepts and acts on her own power, without guilt, her bulimia leaves. How about that for a powerful insight?
17 ACCEPT INTERDEPENDENCE
Judy has always been everyone’s friend and the life of the party. It was Judy who made others laugh or who was always there to listen. All requests for help were met. Always cheerful, always smiling, no one guessed her deep unhappiness. All who knew her would have been shocked to learn that Judy had never felt close to anyone and never believed that she had friends at all. She had constructed a mythical Judy, a perfect being, totally pleasing and blemish-free. She seemed to be exactly what everyone else wanted her to be.
Secretly, she was terrified. It took all of her energy to keep up her act. She dared not let others get too close, lest her terrible flaws be revealed. Being the mythical Judy was like taking a thousand tests a day, the only acceptable performance being perfection. The stress was unbearable, the fear overwhelming, and always complete loneliness. Bulimia and alcohol provided her only release, guilty secrets requiring greater control and increasing isolation.
Face it. Ours is an interdependent world. I need you and you need me. Having an eating disorder often means eating or starving alone, choosing the pain of loneliness over the terrible risk of letting others get close. Closeness means risking rejection with the expected discovery of just how awful you really are. You are most vulnerable when alone. This is when your disorder intensifies and accelerates. Secrets keep you sick. Recovery takes place with people.
Go public. Tell selected family and friends of your disorder and ask for their help. Get involved in therapy and support groups Let others help you, and in turn enhance your recovery by sharing it with others.
Trust is noticeably absent with our clients. Recovery cannot take place without it. Dare to be vulnerable. Let others know you. Build trust by taking increasingly greater risks. Move closer.
However, a word of caution follows.
18. CHOOSE FRIENDS WISELY
We are very aware of who our clients have as friends and the tremendous influence those friends have on recovery.
Jane’s only friend, also eating disordered, has no motivation for recovery. Jane listens to seemingly endless talk about food and fat. Her friend appears to be competing with her by boasting of her latest diet or weight loss. Her friend’s ruminations about “fat thighs” leave Jane feeling self-conscious and insecure about her own body. Yet, it is because of her feelings of inadequacy that Jane finds it easier to hang out with someone who has a problem. Deep down she realizes such safe choices keep her from growth. A recovering alcoholic’s sobriety would almost certainly be jeopardized by having drinking friends. Recovery from an eating disorder is no different.
Linda belongs to a well meaning and close self-help group that does not believe recovery is possible. They believe anyone with an eating disorder will always be sick and can only manage to stay out of trouble by strict self-discipline in regard to food. Linda desperately needs their support and caring, but their lack of belief in recovery reinforces her despair and sense of hopelessness. Strict food rules add to her guilt and stress, making her want to eat. If Linda is going to remain a part of the group and recover, she may have to accept the nurturance she needs while ignoring messages that are destructive. Borrowing still another insight from Alcoholics Anonymous, "Take what you need and leave the rest."
Recovery takes place best in the company of those who are clearly committed to recovery. Sometimes new friends are needed. It is a painful choice, but often a turning point.
19. SET BOUNDARIES
A favorite term we use in family therapy is ENMESHMENT. That is a twenty-five cent word that refers to the sticky togetherness found in some families. It is the kind of closeness where each family member’s business is every family member’s business. Privacy does not exist. Growth toward independence is not permitted. One person’s problems are problems for all. It is the kind of family where a child often plays parent to her parents. Children come to feel responsible for all family problems, compelled to fix them, guilt ridden when they cannot.
Boundaries do not exist, either between individuals or family subsystems. Kids get in the middle of issues between parents. Members intervene and interfere in communication between other family members. Communication is often indirect, utilizing a third party.
Kids are afraid to grow and change, fearing the loss of family support. Parents are afraid to let go. The most important developmental tasks of kids and parents alike are blocked; kids cannot grow up and parents will not let them.
Grown children may continue to struggle against enmeshment, unsure of the boundaries between self and parent. Adult daughters tell of the frustration of their love-hate relationship with parents who are excessively involved and controlling. Their dilemma? Act independently and feel guilty, or suppress needs and feelings with stifled growth and a damaged sense of self.
Not setting boundaries means being so caught up in pleasing others that your needs are indistinguishable from theirs. You are left not knowing who you are or where the boundaries lie between self and others.
Alice, age 36, constantly worries over hurting her mother’s feelings. She believes she must always be there when her mother calls in distress. She must make her mother feel better. She knows she is being manipulated and harbors intense but hidden resentment over this burden. As a result, she punishes herself with guilt for feeling that way and resolves to try harder to care for a mother who seems insatiably dependent. Alice cannot seem to live for herself without hurting a mother who has to have her close at all times.
Joan’s friend has had several suicide attempts. When not in the hospital, she talksto Joan for hours about her hard life and bad luck. She seems to expect Joan to fix it. After all, Joan is forever fixing problems for others. Joan feels desperate and suffocated. She wants relief, but cannot refuse a request for help. Never focused on her needs, always there for everyone else, she feels she is dying inside.
Debbie goes for months without binges and purges. When entering a new relationship, her bulimia begins again. With each new man in her life she acts as though she no longer owns her body, her sexuality, or even her choice of clothes. She feels powerless, a non-person. His needs must be met.
Extreme examples? Perhaps, but they represent a common theme for eating disordered clients. Clear boundaries do not exist. There is not a distinct sense of individuality.
You have a perfect right to set boundaries and preserve your sanity. Give yourself full permission to limit interaction with others. You have a right to refuse requests for help. You have a right to put yourself first sometimes. You have a right to be a whole person, separate and distinct from others. You have a right to your own space.
If all the above seems terribly difficult, know that this is a problem shared by most people with an eating disorder. It may be awfully hard to learn, given that you have practiced a different way of thinking for your entire life up to this point, but this crucial shift in thinking is doable given patience, support, and good coaching. The good news is that you can take "baby steps" in this direction, developing competence in your assertiveness skills Little by little. This work will transform your life in a very positive way.
20. BUILD AN IDENTITY
As far back as Sarah can remember, she has needed to please. She seems to operate on the belief she must please everyone, all of the time. She worries incessantly about offending or disappointing others. If she perceives the slightest upset, she feels compelled to fix it. Many have learned that Sarah can easily be manipulated with guilt and the threat of disapproval. Sarah secretly resents this treatment, but dares not show it. The world sees a smiling face, in reality a mask. Many would be surprised at the rage, fear, frustration, and feelings of worthlessness within.
Debbie recently unloaded her resentment in group therapy. She talked of how she frequently changes clothes after seeing some sign of disapproval in her boyfriend’s eyes. She announced she was tired of trying to be perfect for others. Next time she would shock them all by dressing outrageously. That would fix them! Another group member quickly pointed out that whether she was dressing to please them or shock them, the focus was still on them. How would Debbie dress if she were dressing to please herself? The question stopped her cold. She honestly did not know. She had never thought about it, had never taken enough of a break from preoccupation with others’ expectations to know the answer. She had never been involved with her own identity.
Most of our clients have a poor sense of who they are. They are experts at figuring out what others want. They usually appear composed and confident, a well rehearsed smile hiding an ocean of insecurity.
How do you build an identity? To become clear on who you are, you must look within to your own uniqueness. What you find needs to be appreciated as yours and yours alone. The expectations of others and their evaluations of your inner qualities are not particularly important. We are talking about your identity, not theirs.
Who you are has a lot to do with becoming fully aware of what you think, what you believe, what you feel, what you like and dislike, and what you want and need. Become convinced those qualities matter. Your thoughts, feelings, and needs are valid. Become empowered. Fully believe it is right and appropriate to act on your thoughts, feelings, and needs. When you can confidently do so, without guilt and fear, you will have grown in self-esteem and established a strong identity of your own. An eating disorder cannot exist in the presence of healthy self-esteem and a strong sense of identity.
21 HONESTY, HONESTY, HONESTY
You can not build an identity on anything less than rigorous honesty. This means honesty with self as well as others. Honesty is facing the fact that food and weight are smokescreen issues. Honesty is looking beyond to the real issues. Honesty is examining your feelings and needs, then acting on them. Honesty is expressing to others those feelings and needs. This kind of honesty can be uncomfortable, but it is only by self-examination you discover what you really need and want, what pleases you, satisfies you, and nourishes you. This takes courage. The reward is worth the risk.
Eating disordered people often find themselves saying “yes” when they really mean “no.” They often pretend problems do not exist. They often deny their family was troubled or dysfunctional. They do not say what they mean or mean what they say. They have often lost track of what they really do mean. They say what they think will please people. They do not express their opinions until they are sure of others’ opinions. They laugh when they feel like crying. Denying themselves in this manner, they have set themselves up to become emotional pressure cookers.
Susan grew up thinking anger was unacceptable. She never allowed herself to feel angry. She never raised her voice. Denial of years of inner turmoil eventually catapulted her into ferocious binges. During her attack on her hamburger, she would find herself mentally yelling at all those people she had been angered by in her lifetimes. No one ever heard her. The words were always stuffed down by food. Guilt, fear, and self-hatred followed, renewing the cycle.
22. LEARN STRESS MANAGEMENT SKILLS
Actually, we are saying, learn new stress management skills--and unlearn your favorite (your eating disorder). Believe it or not, your eating disorder is your learned habitual way of managing stress. Surprised? You might be thinking, “Wait a minute. My eating disorder is STRESSFUL, not stress reducing!” Your eating disorder is a self-perpetuating stress reducing AND stress generating machine. It creates stress simultaneously with lowering stress. The cycle picks up momentum and intensity over time. Useful, healthy stress management skills must be developed. Without these, even if real issues are addressed, examination of underlying issues could aggravate food and weight compulsions.
What is stress anyway? Below are a collection of definitions to give you a good idea of the variety of forms stress can take.
* The body’s physical, mental, and chemical reactions to circumstances that frighten, excite, confuse, endanger, and irritate.
* What prepares you to handle things you are unfamiliar with or things that appear to threaten you.
* The effect the mind exerts on the body. It occurs when combined tensions of life become greater than a person’s ability to handle them.
* The rate of all the wear and tear caused by life.
* The effects of broken or damaged relationships (between self and God, self and others, and/or within self) resulting in actual physical changes within a person.
* Stress = Stressor x Subject, Frequency, Duration, Intensity
* Too many changes within too short a period of time.
* The response of the mind (emotions, intellect), body, and behavior to stressors.
From this list, we can generalize a stressor to be any demand on mind or body. Stressors may vary in several ways. They may come from within or from an outside source. They may be pleasant or unpleasant. They may be few in number or many. They may vary in intensity and/or duration. They may be new stressors or they may be familiar ones. They may or may not be changeable.
Distress occurs when there is intense stress causing damaging wear and tear in the mind or body, serious interference with daily life, or destructive behavior toward others. Distress shows up as physical, emotional, intellectual, or behavioral damage.
Each of us has a “stress filter.” This “filter” is the combination of factors that ease or exaggerate the impact of stressors. Components of an effective “stress filter” include: health and fitness, minimum “unfinished business,” a sense of control over events in our lives, inner strengths, awareness of our own needs and feelings and those of others, a strong sense of identity, patience and tolerance, a solid support system (made up of friends and/or family), personal stability, and being clear on our personal beliefs and values.
Evaluate your “stress filter.” Is it effective? What are things you can do to enhance it? Learn stress management skills so stressful events will have little harmful effect on your mind, body, or behavior. These techniques will help you cope with stress constructively so it will be reduced rather than increased.
23. RECOVERY FOR THE FAMILY
An eating disorder does not occur in isolation. Many factors underlie its development: the afflicted individual’s style of coping with life’s problems, society’s thinness mania, the idea that appearance equals self worth, family rules and messages setting up the entire family to become dysfunctional. (It is not uncommon for eating disordered women to have chemically dependent brothers.)
Family therapy is imperative if you are a young person living at home. It is often essential for others as well. Usually, family therapy occurs in addition to individual sessions. Couple therapy is appropriate for the client who is in a conjoint relationship. The form of family therapy varies with the clients needs. The goal is for members to learn new patterns of interacting that foster individual growth and enhance family functioning.
Frank came to the office deeply distressed. He was faced with the possible loss of his job as a police officer despite eighteen years of exemplary service. The reason--Frank’s inability to adhere to departmental weight standards. Repeatedly he had failed to lose weight or maintain weight loss over time.
The lack of lasting weight loss was not the result of poor treatment. In fact, the program he had participated in was an excellent one with a knowledgeable, dedicated staff. Rather, the lack of positive results stemmed from the perception of the problem as an individual one rather than a family-based eating disorder treatable through intensive family therapy.
Apparently, no professional had bothered to inquire about Frank’s family. If they had, they would have discovered that his wife weighed in excess of three hundred pounds, while his daughters were being subjected to daily ridicule by other school children for their obesity. All were deeply depressed and anxious with markedly low self-esteem.
Frank had been a compulsive eater for a number of years. Food was his way of coping and feeling connected with his family. The family was dealing with a number of extremely stressful issues. They supported and nurtured one another through food. Food had become a way of giving and receiving love, managing anger, filling a void, a method of insulating the family against the slings and arrows of the outside world. It had become an all purpose pain killer, relied upon in the same way many come to depend on drugs and alcohol. Food constituted a family addiction.
Viewed in this context, Frank’s dilemma can finally be understood. To succeed at meeting police standards, his connection to his family system would have to be drastically altered. The psychological price was too high, and Frank repeatedly and unconsciously sabotaged his own weight program. In his mind, consciously or unconsciously, weight loss was equal to the abandonment of his family, severing the only avenue open to him for nurturance and emotional support. With a deepening crisis developing over his career, Frank turned to family and food for solace and support.
These family dynamics are now being addressed. The family is responding well. They are highly motivated and excited about their team effort toward family recovery. All have become more active. Family nutrition has become drastically improved. More importantly, depression and anxiety have been reduced while the self-esteem of each family member has been increased. In short, the real problem has been identified and corrective measures are working. The police department now has an opportunity to salvage a valuable resource.
There are no magic pills or diets. Change will not be effortless. Change will not come from outside. No doctor, therapist, or support group can change you. They can only provide a helpful environment. Decide you want to change, grow, and become well. Actively participate in that process. Take responsibility. Confront the problem head on. Stick with it! Actively pursuing the points in this article is an effective start. Take charge.
25. CULTIVATE MINDFULNESS
What is Mindfulness?
The idea of mindfulness comes from an ancient Buddhist practice of meditating to be fully conscious of the present moment and the choices that we face. We tend not to be fully present in the here and now, calm, and focused, able to purposefully make effective decisions. We're living in the past, worrying about the future, bombarded by often confusing and conflicted thoughts and feelings, often out of touch with our bodies and our emotions. What we are left with is a feeling of tension, an uncomfortable state that we want to avoid or distance ourselves from.
What are the uses of mindfulness and mindfulness meditation?
We specialize in three areas, eating disorders, anxiety disorders, and relationship difficulties. For many years we've been using mindfulness in treating anxiety problems such as panic disorder and relationship difficulties such as not dealing well with conflict. It is our contention that all eating disorders have an underlying anxiety disorder.
Anxiety disorders treatment, and eating disordered treatment as well, require that anxious people gain control over their minds and bodies. We do breathing retraining along with training in corrective self-talk. Mindfulness meditation combines the two in a powerful way resulting in much greater awareness of one's level of anxiety and substantial ability to calm yourself and act purposefully.
What's the connection with emotional intelligence?
Emotional intelligence is a vital quality that involves being intelligent, and acting intelligently about one's emotions. It means managing your emotions, not stuffing and stacking them -- or avoiding them altogether. It means being in touch with your feelings and in touch with the feelings of others. It means not being threatened by emotions but seeing emotions as very useful in dealing with self or others. It means being able to not only be aware of feelings but able to verbalize feelings to others without fear or guilt. Emotional intelligence is far more important than IQ in being effective in career and relationships. The lack of emotional intelligence is often part of extreme inner distress, conflict with others, and addictions used to avoid painful feelings. Mindfulness meditation is extremely helpful in building emotional intelligence, which unlike IQ can continue to develop.
How is mindfulness training used with binge eating?
Mindfulness--based eating awareness training utilizes meditative exercises with food and exercises aimed at becoming more aware of needs, feelings, and choices in the present moment, suspending automatic reactions and negative self-judgments. Learning mindfulness skill provides a powerful tool to curb binge eating, feel your hunger, trust your taste buds, and become deeply satisfied with the quality, rather than quantity of food. Take charge of your food and your life in a relaxed, satisfying non-compulsive way.
26. MOVE BEYOND YOURSELF
Along with the food and weight obsessions of an eating disorder comes a focus on real or imaginary flaws. We often hear clients bemoan “fat thighs,” “large hips,” “rounded stomachs,” etc. as if the entire world was scrutinizing their bodies for the slightest imperfection.
The fact is, few people, if any, take time out from worries about the mortgage, kids, fights with their spouse, nuclear war, drought, famine, pollution, etc., to dwell on someone else’s size or shape. The only people who are likely to notice at all are other eating disordered people with similar obsessions. Our clients tells us they are absolutely sure other people do this because they do.
Group therapy and support groups can be a place to begin moving beyond yourself. Here you realize you are not alone. You did not invent eating disorders. Many others share your problem and experience similar feelings. You will find you can learn from others. As your recovery accelerates, you can maintain momentum by sharing your growth.
All the forgoing has focused primarily on the needs and feelings of the individual and upon the recovery of that individual. Something is missing! Let's call it “perspective.” Truly moving beyond yourself requires a shift in focus from a preoccupation with you and your problems as if nothing else in the universe matters, to you as part of all that is; shifting from a myopic preoccupation with self and appearance to a more realistic perspective that helps you feel integrated with everything around you. Confused? Let us look at it another way.
You have three dimensions to your being: physical, mental, and spiritual. These three are seriously out of balance in someone with an eating disorder, causing lack of harmony and self acceptance. Physical and mental (emotional) recovery are only part of the equation. Complete healing takes place when we are centered spiritually.
Consider for a moment there is order and interconnectedness in the universe. We experience the rhythmic cycles of spring, summer, autumn, and winter. We observe life unfolding, birth, metamorphosis, loss, death, and rebirth over and over again. The life force pulsating through nature is undeniable. All of nature lives by the law of life, “receive to give.” Like it or not, all are inextricably linked to this universal order. The real you doesn't really represent a separate entity in the vastness of creation, but is related inextricably and interdependently to everything that is, was, or ever will be.
Most of the clients we see in therapy are looking for the “perfect relationship,” i.e., one that makes them feel safe, un-lonely, cared for, and one that reaffirms in spite of imperfections. Many cling to the therapeutic alliance in order to feel they have this type of relationship somewhere in their lives. They are searching for unconditional love, total acceptance . . . the perfect parent. Human love will never do it! There needs to be an inner belief that says "I belong here. I have a right to be here. I matter!"
Faith can be a definite plus in recovery work. For many, the ultimate perfect parent is God. , and their belief creates the only perfect relationship. When this happens, many are finally able to fully self-nurture. Healthy relationships form naturally because we do not ask others to fill our empty spaces. We connect to others out of love and joy. We then fulfill the law of nature, “Receive to give.” We discover growth and joy in service to others. This is very different from meeting others’ needs with hidden resentment and at the expense of self. Service to others now becomes satisfying, exciting, and self-enhancing.
What ever you believe, it's vital to believe in something beyond your own shortcomings. Get outside of yourself and pay attention to the bigger picture. It's a beautiful world with a lot of wonderful things and wonderful people to experience if you're only open to it and not mired in myopic self-hatred.
Norman Vincent Peal tells of his first visit to the Grand Canyon. He consulted a man who had spent much time at the canyon, asking of him which trip he should take in order to observe the most possible.
Imagine his surprise when the elderly gentleman advised him not to take any trips at all. Instead, he should come out at sunrise and take a seat on the rim, sit there and watch the morning pass into noontime, and noontime into afternoon, with the ever changing colors gleaming across the great abyss. Then get a quick supper and return to observe the purple twilight settle over the canyon as nightfall shrouded the canyon in darkness. The wise man said if one runs around, he merely wears himself out and misses the beauty and greatness of it all. Open yourself to connecting with all that is good and positive. Continue obsessing about food and weight issues and you miss the good stuff.
The points we have outlined above are guidelines and a starting point. Do not expect to be cured of your eating disorder by simply reading the points. Rather, they should be read time and time again to provide sound direction for your journey. At the same time, become actively involved in your growth. Change will be difficult and painful. Resist the urge to retreat to the security of your disorder. Remember, the only way beyond the pain is through it. Take responsibility. Seek guidance and support. Begin!
© 2005 William Carey Shearer Ph.D., M.B.A., M.P.H
Robin L. Shearer M.F.T., R.N., M.A., M.P.H.