There have been many times that a client, fresh from residential treatment or partial hospitalization, has told me that he or she is surprised to return home to find that nothing has really changed. Life around them is still the same. Sure, they learned some skills in treatment but it didn’t solve the life challenges that can be so triggering. Sometimes in the moment emotions are so overwhelming that our first instinct is to return to the coping mechanism that’s become so ingrained in our daily existence. One client actually told me that she didn’t see a point in working so hard on recovery if nothing around her was going to change. She would rather cling to the one thing that’s been consistent in her life: her eating disorder.
Eating disorders are about different things for different people, and at some point in every sufferer’s journey they serve a purpose. For the person who has a difficult home life, the eating disorder may be where she retreats for comfort and control in the chaos. For the person with perfectionistic tendencies who has found that he can’t possibly excel at everything, the eating disorder is something he has complete power over and therefore can excel at. This is part of what makes eating disorders so difficult to give up- underneath the physical and psychological wreckage are definite reasons that hanging on to the illness is reasonable and even necessary.
The problem is that on some level we know that the eating disorder cannot be sustained. We cannot continue to restrict food and expect to live. We cannot binge and purge or over-exercise and expect to lead a healthy, high-functioning life. The physical body clings to every morsel of nourishment and may seem to be able to run on fumes indefinitely. Eventually, the body will crash but the mind will continue to come up with what seem like totally rational reasons to keep pushing. Sometimes, not even hospitalization is enough to spur a leap into recovery.
Life can be a shock for people returning to home, school, or work after inpatient or residential treatment. There is something of a protective bubble in higher levels of care. The intensive treatment provides a safe place for recovery to begin and skills to be learned. It is one thing to apply skills in the treatment milieu or even in family therapy sessions, but it is far another to try to apply them in the overwhelming situations that life can throw at us. According to a study discussed in the Science of Eating Disorders, following intensive residential treatment most women noticed a reduction in behaviors (i.e. they were able to maintain a healthy weight) but cognitive symptoms and thought patterns were still very much present. The cognitive changes that allow us to be able to handle life without the eating disorder take much more time to develop, which is why a solid outpatient program is so important.
The Science of Eating Disorders article lists the major factors that assist people in maintaining recovery:
Social support: maintaining connections with family, friends, and treatment team
Skills application: continued practice of assertiveness, communication, and meal planning skills
Stepping outside oneself: returning to work or school, volunteering, working on higher values all help the focus return to life rather than eating disorder.
Not surprisingly, one major factor that inhibits maintained recovery is loss of support and lack of structure. The importance of these cannot be overstated. People with eating disorders must engage treatment and refuse isolation, even on the worst days. This takes courage and often a profound show of “acting as if” until it becomes easier. Especially as clients return to challenging life situations, the right support can make all the difference.
Science of Eating Disorders (2012). Maintaining Change Following Intensive Eating Disorder Treatment. www.scienceofeds.org
Meaning: Find or create some purpose, meaning, or value in the pain [that’s what I do with this blog, by the way!]. Focus on whatever positive aspects of a painful situation you can find…
Prayer: Open your heart to a supreme being, greater wisdom, God, or your own wise mind. Ask for Strength to bear the pain in the moment…
Relaxation: Try muscle relaxing and tensing each large muscle group…take a hot bath…breathe deeply; half smile; change facial expression…
One thing in the Moment: Focus your entire attention on what you are doing right now. Keep yourself in the very moment you are in; put your mind in the present
Take a Brief Vacation: Rent a motel room at the beach or in the woods for a day or two. Ask your roommate to bring you coffee in bed or make you dinner (offer to reciprocate)…Get a magazine or newspaper at the grocery store, get in bed with chocolates, and read it…
Encouragement: Cheerlead yourself. Repeat over and over: ‘I can stand it,’ ‘It won’t last forever.’ ‘I will make it out of this,’ ‘I am doing the best I can do.'”
We live in a media driven culture with an endless supply of TV shows, internet sites, and phone apps to keep us busy every minute. These platforms are used to deliver messages meant to persuade, inspire, and entertain. Many of these messages contain images of men and women airbrushed to perfection….and it is that very image of perfection that haunts us as we study our own bodies and make comparisons. To say that the internet has influenced body image is an understatement. In recent years, the rise of pro-anorexia and pro-bulimia websites has glorified eating disorders and praised the behaviors that keep sufferers locked in the illness. The Social Issues Research Centre (www.sirc.org) reports that these “pro-ana” websites target individuals who consider their eating disorders to be lifestyles, something to maintain and celebrate. Users share tips on how to engage behaviors and provide support for each other’s illnesses. For individuals who are in recovery, websites like this can be seriously detrimental. Some people in recovery refuse to engage in social media at all, citing the prevalence of hashtags like #thighgap and #thinspogram as just a few of many reasons to shelter themselves from the social media revolution. USA Today (www.usatoday.com) shares the story of Donna, who is in recovery from bulimia. Afraid to expose herself to the kinds of comparisons that fueled her illness, Donna has decided to stay away from popular social media sites like Facebook and Instagram. While it’s clear that social media and pro-eating disorder websites have played a part in our global obsession with obtaining perfection, more and more websites dedicated to positive body image and recovery are beginning to pop up. Someone searching for eating disorder tips may stumble upon a recovery website or blog and be drawn into a story of hope….leading to the inspiration to begin recovery. The National Eating Disorders Association (www.nationaleatingdisorders.org) shares the story of one woman who came across the NEDA website in her search for a pro-eating disorder community….a lucky accident that turned out to be the catalyst for her recovery. Nonprofit organizations dedicated to awareness and advocacy use the power of the internet to spread positive body image messages. Eating disorder treatment centers are also getting involved in the awareness movement, offering blogs, webinars, and professional events designed to educate and inspire. Instagram is also proving to be a powerful recovery tool. An online photo-sharing service, Instagram users can visually communicate their lives to their followers. Some individuals in recovery have turned their Instagram accounts into recovery accounts. The Atlantic (www.theatlantic.com) describes this type of account as a place where users can gain support while maintaining as much anonymity as they would like. Some people don’t use their real names, and others find that it’s easier to open up and share initially in an online environment. Recovery accounts document the progress users are making through pictures of meals, inspirational messages, and even pictures of users’ bodies as they work toward weight restoration. Support from followers during the recovery journey can be motivating and provide comfort during difficult periods. Although social media can be a positive recovery tool, users must be vigilant and pay attention to their triggers. Any concerning thoughts and behaviors should be taken seriously and addressed with a treatment team. Totally In Control: The Rise of Pro-Ana/Pro-Mia Websites. Social Issues Research Centre, www.sirc.org Rojas, M. (2014). Social Media Helps Fuel Some Eating Disorders. USA Today, www.usatoday.com Kay, J. (2014). How Social Media Led Me to Recovery. National Eating Disorders Association, www.nationaleatingdisorders.org Mirhashem, M. (2015). Overcoming an Eating Disorder with Instagram. The Atlantic, www.theatlantic.com
Eating disorders represent a emotional and cognitive struggle of some kind, be it trauma, low self-esteem, poor body image, bullying….clients present with many different root causes of their disorder. A client’s spirit is suffering and a person tends to have a breakdown in their spirituality. The one underlying theme is the difficulty in managing the most uncomfortable feelings. The eating disorder and one’s spirituality are often at competing ends. The eating disorder serves as a coping method that presents as a friend, a confidant, a powerful secret, or a god that needs to be obeyed and the eating disorder appears at the time the client needs it most. In a storm of chaos and fear and inconsistency, the eating disorder swoops in and appears to give the feeling of rescue that the client feels temporarily from the distress.
Michelle Lelwica (2010) shares that while the client is focused on creating a “good” body or engaging in eating disorder behaviors like restricting or purging, the inner life is being ignored. No matter how thin the client gets, no matter how filling the binge, there is an eternal sense of emptiness and hunger that is never satisfied. All of the crises that pile up in life, all of the hurts and trauma, drive a wedge through the true self. Big questions like “What is important in my life” and “How do I understand my life’s purpose” cannot be answered when the soul is entrenched in an eating disorder. There is simply no energy left for living. Recovery becomes a spiritual journey as clients attempt to access their pain and face it with the help of a higher power.
Randy Hardman and Michael Berrett (2015) explain that many people with an eating disorder have had some degree of personal spirituality in their lives. Some have participated in religious observations and others may have felt connected to yoga or nature or a meditation practice. Despite this, during the course of the eating disorder these connections were lost. Feelings of unworthiness creep in as the eating disorder, which at one point served a purpose, becomes harder and harder to sustain. Indeed, eating disorders cause sufferers to chase false pursuits that ultimately replace spiritual connection. Hardman and Berrett list these false pursuits:
False sense of control
False form of communication about pain and suffering
False sense of being the exception or exceptional
False crusade for evidence against self
False pursuit of perfection
False form of comfort and safety
False compensation for the past
False attempt to avoid personal responsibility
False pursuit of approval
Eating disorders may represent some or all of these falsehoods for clients. Richards et al (1997) state that eating disorder clients often have difficulty letting go and having faith, despite their spiritual background, leading to a worship of these falsehoods in pursuit of a sense of control and well-being. Along the way the eating disorder gains control of every aspect of their lives, rendering clients powerless when all they were seeking all along was a powerful sense of being good enough.
Not all clinicians work with spirituality in treatment with their clients, but it is a significant aspect of recovery that should not be avoided. Clients who wish to regain their spiritual connections, or foster connections for the very first time, can do so in the safety of the therapeutic alliance. Eating disorders are very hard to give up because it is difficult to remember what life was like beforehand and next to impossible to consider what life might be like in recovery. There is so much unknown and that is often one of the biggest barriers to recovery. Spiritual exploration during treatment can help clients resolve any negative impacts their spiritual pursuits had in the past and move forward with new resolve to take care of their physical, emotional, and spiritual selves.
Lelwica, M. (2010). The Spiritual Dimensions of Recovering from an Eating Disorder. Psychology Today, www.psychologytoday.com
Hardman, R. and Berrett, M. (2015). Eating Disorder Recovery: A Spiritual Perspective. BYU Idaho Counseling Center, www.byui.edu
Richards, P., Hardman, R., Frost, H., Berrett, M., Clark-Sly, J., and Anderson, D.
Spiritual issues and interventions in the treatment of patients with eating disorders. Eating Disorders: Journal of Treatment and Prevention, 5(4), pp. 261-279
Surviving and Thriving With an Eating Disorder: Skills for Holiday Celebrations
Holidays are for celebrating, and whether it’s creating traditional dishes in the kitchen with family or gathering around with friends for a summertime barbeque, food takes center stage. For people with eating disorders, holidays can be very difficult times. The combination of large amounts of food, family dynamics, and feelings of anxiety and loneliness can be overwhelming and too much to bear. If you are facing down an upcoming holiday with fear or dread, take hope. There are things you and your family can do to prepare for challenges and still enjoy the magic of holiday seasons.
Make a Plan!
If you are struggling with an eating disorder, you know that part of recovery means learning about yourself, setting boundaries, and asking for what you need. Your treatment team can help you to develop a plan for dealing with the holidays that fits your goals. Cognitive behavioral and dialectical behavioral (CBT/DBT) treatment modalities, which are used in all levels of eating disorder care, are great for developing coping skills and self-soothing techniques for distressing situations. Psych Central (www.psychcentral.com) suggests some great, soothing tips based in the mindful approach of DBT:
Find meaning in the season
Take a vacation! Muscle relaxation, baths, snuggling with a favorite pet, reading a great book….give yourself a break and enjoy the moment!
Give back. Get out of your head and into the deeper purpose of the season by volunteering or helping neighbors.
Breathe deeply and stay in the moment
Take Care of YOU!
This is where knowing your limits and honoring them comes in. During the holidays we are usually surrounded by people we haven’t seen since the last family gathering. Inevitably, tensions flare as tricky family dynamics rear their heads. When you’re struggling with an eating disorder, even the most well-intentioned comments from long-lost family members can be triggering and downright hurtful. When all you want to do is make it through the day, these uncomfortable conversations can leave you feeling trapped.
Even if it’s hard to honor your needs, the holidays are a prime time to practice. Enlist a trusted friend or family member to help you slip away for a few moments and regroup when it all becomes too much. If you know that there is a particular gathering planned that will be super triggering, it’s ok to sit it out. Trust yourself, and when in doubt ask to talk it out.
In the Kitchen
Food is a centerpiece of holiday celebrations, and for people with eating disorders just being in the kitchen can create tremendous stress. Many treatment programs work to prepare clients for food-related challenges by offering kitchen skills groups and experiential activities designed to decrease anxiety and increase confidence. At Center for Discovery, for example, clients spend time in the kitchen preparing meals and snacks, participating in food challenges, and learning to plan meals and grocery shop. Anxieties around food are faced and challenged in the moment so clients can put coping skills into action and finally begin to experience comfort around food.
The National Eating Disorders Association (www.nationaleatingdisorders .org) suggests baby-step challenges at holiday gatherings. Review the food offered and make mindful choices. To take the challenge a step further, take a portion of a food you love but wouldn’t normally allow yourself to have. Then, stay in the moment and savor the tastes. Notice your surroundings and focus on the parts of the season you enjoy. Breathe.
A Note For Families
If your loved one suffers from an eating disorder, you may stand by and watch helplessly as another holiday season threatens their joy and well-being. How can you help when you don’t even know how to begin? First and foremost, get educated about eating disorders. Be involved in your loved one’s treatment. Learn about and make every effort to understand what they are struggling with and why. Then, be patient. Ask how to help. Express your love and concern.
The National Association of Anorexia Nervosa and Associated Disorders (www.anad.org) suggests being flexible and willing to start some new traditions that don’t focus on food. Your loved one has interests and hobbies. Tap into those at holiday time. Does your loved one like to sing? Go caroling together. Is crafting a favorite activity? Create beautiful holiday-themed treasures together.
Holidays are challenging for people with eating disorders, but they don’t have to be a time filled with fear and isolation. Shifting perspective and coming together as a family to celebrate with love and support has the potential to help your loved one feel joy and comfort again- even around the foods that create anxiety.