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Contemplating Change: Moving Beyond an Eating Disorder

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Recovery from an eating disorder requires an incredibly courageous step into the unknown. It requires relinquishing control and moving through the stages of change to reach acceptance and health. This is easier said than done and takes time. One of the first steps is identifying what purpose the eating disorder serves and therefore what emotional needs it is meeting. Only then can the person begin to find healthy ways to meet those needs and heal.

What is the Function?

Very often, people with eating disorders find themselves in life circumstances that leave them feeling like they’ve lost control. Maybe there’s been trauma or a loss, or maybe bullying at school or a lack of identity. The eating disorder swoops in at these vulnerable times, offering a lifeline in the form of a sense of power and control, a numbing of painful emotions, something to feel accomplished about….a savior that ends up creating devastation and life-threatening complications.

Stages of Change

Moving beyond resistance and denial to contemplation and action feels impossible when the eating disorder is in full swing. Many people arrive at treatment at the urging of family and friends without the slightest idea themselves of why they are there. The stages of change put a timeline to this process, and it is possible to envision when one might arrive at identifying and challenging the purpose the eating disorder serves.

Precontemplation: People in this stage tend to be resistant to change. They are in treatment for others. They feel hopeless.

Contemplation: Recognizes there’s a problem (and perhaps now is aware of the purpose the eating disorder serves) and begins to anticipate an imminent change.

Preparation: People sometimes experience ambivalence in this stage as they prepare for change but still aren’t 100% convinced it’s a good idea.

Action: Time and energy are committed. Behaviors begin to change.

Maintenance: Continued action is required to maintain recovery. It is a fluid process with frequent adjustments.

Letting Go

A person in the throes of an eating disorder truly believes that the illness brings value to their life. It likely has shown merit at some point, in the form of the purpose it serves in the person’s life. For example, someone who has experienced life in an alcoholic home may now feel in control for once….amid all that chaos, the eating disorder created a way for the person to feel competent, in control, and superior. In this case, the eating disorder creates control where there was chaos and a false sense of self-esteem where there was self-hate and uncertainty. It becomes difficult to build a case against the eating disorder when it has brought some semblance of order to the person’s life. Recovery begins when the person recognizes the purpose served and can accept that what once felt like control has now become out of control and not sustainable. An article by Emily Troscianko (2010) poignantly states: “Somewhere along this road….You may come to see that exerting control is simply no longer what’s required of you.” Letting go catalyzes action, and action leads to recovery.

Troscianko, E. (2010). Why Control Won’t Bring You Happiness. Psychology Today, www.psychologytoday.com

I think I can. I think I can. I think I can. Keys of Eating Disorder Recovery

I think I can. I think I can. I think I can. Keys of Eating Disorder Recovery

 

I have seen so many of my own patients with Eating Disorders (ED) struggle with how to move beyond the Stage of Change in recovery : “I know I have a problem but not willing to do anything about it ” and get to the Stage of Change: ” I know I have a problem and I am willing to do everything I can to get better”.

With my patients who tell me that they can’t get better, they won’t get better or they don’t even really have a problem, I have noticed a few things:

  1. GREY MATTERS: The majority of people that have the disease of an eating disorder think in absolutes. Black and White. I am either fat or thin. I have no control or I am in total control. I have to do everything perfectly or not at all. 
  2. They feel they can not survive life without their Eating Disorder. They believe that if they choose to start recovery they will lose all control, their voice, their protection, their identity and their purpose in life.
  3. They believe that if they do not have their ED they will no longer be successful, fulfilled, special and worthwhile.

So to be able to get to the next stage in recovery, one must believe:

  1. That they are capable of anything they put their mind to. Someone with an eating disorder is a very determined and capable person. Perseverance is key.
  2. Their ED has begun out of some form of unmet need. They need to learn to be able to fulfill their wants and needs out of assertiveness, determination, perseverance and creativity.
  3. They are capable of change. They are not made of stone, but of soft clay that they can continue to mold, sculpt and make into their best selves.

As a therapist, my role is to never give up on finding a way to communicate these truths, to motivate them to take risks and to take one baby step at a time.

I think of the “little engine” who despite it’s limitations, never gave up, believed in it itself and always had someone cheering him on.

Heather Baker, LCSW, CEDS

 

When Perfection is Imperfect

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What is perfection? Current society would have us believe that it is the Stepford Standard, that anything less than keeping up with the Joneses makes us substandard, less relevant, not good enough, or just plain not enough. Webster’s defines perfection as “having all the required or desirable elements, qualities, or characteristics” and “completely free from faults or defects”. Maybe it’s just me but I feel like these definitions are in conflict.  Why can’t I have all the required or desirable elements, qualities and characteristics, AND still have faults? Why can’t I be perfectly imperfect? Perfection can be found in the faults, in the quirks that make us who we are and the experiences that we grow from that have been less than perfect.

Is it even possible for anyone or anything to be truly perfect (i.e., without flaws)? Rationally, I think most would agree that it’s not. Rationally, we know that it is part of the human experience to be flawed, to make mistakes, to rise from the proverbial ashes. But how can we rise if we’ve never been burned? Rather, in perfectionism we are consumed by the flames, the need for this unattainable perfect. Why is accepting imperfection so hard? Brene Brown has done an amazing job of addressing this question, in fact much of her work focuses this very topic.

The point of this post is not to delve into imperfection, but rather how we know when our need to be perfect, to be “completely free from faults or defects” is getting in the way of this thing called life. Society tells us that if we aren’t the highest performers, if our parties aren’t the biggest, the best, the ultimate event that has Gatsby in envy, then we aren’t doing it right.

How does this happen? How do we miss the point of the very thing we are trying to achieve? It’s simple, we forget to think about the intent of the goal itself. And, when we forget about the intent (the desired end state or outcome) we go into the perfectionistic planning mode. If you are prone to this mentality then you know how time consuming and crazed the planning gets around a desired goal. The flaw here is that the obsessive planning, the extensive preparation and painstaking compulsion to think about everything that should happen, everything that might happen, the need to think (aka obsess) about all of the knowns and unknowns, gets in the way of the goal. Not to mention it makes the process of reaching the goal exhausting. Essentially we run ourselves into the fire of worry about the “what if’s”, all the while missing the point of the event.

Take this for example, say you want to get friends together for a game night. The idea being that you would get folks together, maybe have some food, maybe some drinks, and everyone has a night full of commercial worthy fun. The perfectionist dives immediately into the planning and organizing of the “perfect” game night. Sending out the fancy semi-formal electronic invitations with the “perfect” play on words that “perfectly” captures the theme of the night. Then to the food, drinks, and venue prep. The perfectionist struggles with letting everyone bring a dish (what if two people bring the same thing, or some other catastrophe happens?!), people can bring a side but no matter what the “perfect” host needs to have the “perfect” culinary item that could make Martha Stewart green with envy. Everything must be organized, “perfectly”… heaven forbid the drink cooler not match the centerpiece. The games, must be selected with care, to facilitate the most fun of course. And then amidst all the planning and preparation for the “perfect” party, the home must be spotless. Above all cost’s this house must not look lived in!!! In the perfectionist frenzy, you stop thinking about the intent of game night, and start obsessing on the need for “perfect”, the rave reviews; you’re looking for the 5 star yelp review for what started as a means to connect with your friends/families.

Rather than connecting, you’re disconnecting. There’s no room for fun and friends when there’s a “perfect” party on the horizon. If you think your friends can’t feel the anxiety of your perfection obsession aura puts off, let me tell you, in no uncertain terms, they can. Your “perfect” planning is imperfect. It’s driven by an unattainable need to be “perfect”. Did you ever stop to wonder what perfect was?… in this case it’s not the best party favors, or the game selection, or the food, or the drinks. What makes game night perfect is the intent. You are creating a space for people that you know and love to come together and have fun (that’s the intent, that’s the desired outcome). It doesn’t matter if people love the food, or find a speck of dust under the coffee table, or if no body plays games at all on game night. What matters is that you brought people together for an evening of levity.

Some of the common cognitive distortions associated with perfectionism are:

  • Black-and-white thinking – “If this is not perfect, I am a failure.” Or “Only lazy people ask for help.”
  • Catastrophic thinking – “Everyone is watching me, if I make a mistake they will think I am stupid.” Or “If my presentation isn’t flawless, I will lose my job”
  • Probability overestimation – “Even if I study a lot, I still won’t do well on my exam.”

What happens in the above statements is that there is no room for life; because perfect isn’t defined and the intent hasn’t been identified, there is no way to determine success. There are always things we can do differently or do better in the future, that’s part of the learning curve of all life’s situations. Perfectionists have a hard time thinking about what success looks like ahead of time, instead they look retrospectively and judge themselves harshly for the things they “should” have known, never accounting for the fact that these things could not have been known at that time.

Here are some questions to ask yourself to make sure you aren’t going into a perfection obsession.

  • What is the intent? (really think about it)
  • Are the thoughts and actions you are engaging contributing to or detracting from the intent?
  • Are you enjoying it? (If the answer is no, ask yourself 1. Why am I doing this (i.e. is it aligned with my intent or my need to be perfect)? 2. What about this am I not enjoying? 3. Could I approach this differently to feel better about this?
  • Am I being competitive? (With myself? With someone else?)
  • Am I willing to ask for help? (perfectionists tend not to ask for help and/or have trouble truly delegating, also known as micromanaging)

 

Be kind to yourself, be kind to others, and keep it moving.

 

Ashley Steelman, MSW

The Continuum of Trauma

Trauma is becoming a household concept in the past decade, as we see the many atrocities that are going on around our world and in our own communities. Now many organizations are placing a significant focus on raising awareness of how trauma affects individuals, families, and communities. We hear a lot about trauma and PTSD, they have become buzz words we use to describe war scenarios, domestic violence, and other tragic life events. We hear the word and maybe we have a clear concept of what it is or what we think it isn’t, but the surprising reality is that trauma can be present anywhere at any time. How so? Well, it happens on a continuum.
In the mental health community trauma takes two forms, Big “T” and Little “t”. It’s fairly intuitive, the Big “T” traumas are the classic examples of trauma, it’s the BIG events, like car crashes, sudden death of loved ones, natural disasters that sweep away communities, sexual or domestic violence. Makes sense right? These are the jarring events that leave us questioning, searching, lost, confused, and angry (all at once or in progression). They are the events that are readily recognizable as overwhelming, the events that have awareness groups rallying in line to support survivors of the tragedy. There’s an outcry to help these survivors and an increasing inventory of programs and services available to inform, normalize, and process the aftermath of the Big T.
Little ‘t” traumas are often overlooked. Its death by a thousand cuts… it’s the little inconveniences that send you into a sneaky hate spiral (click here for a hyperbolic explanation of the sneaky hate spiral). It’s all the little jarring things that happen throughout the course of the day, week, or month that progressively add up. Without the necessary skills or supports in place to counter or process these “mini” stressors our systems (mind, body, spirit) get overwhelmed. Little “t” can be things that are recognizably stressful like a new assignment at work or be the minutia that builds and ultimately overcomes us, leading to the same mental chaos as the Big “T”; the problem is that we don’t realize our systems are overwhelmed by all these “small” things until our health or sense of peace suffer.

The beauty of it is that solutions are available. Since this is a therapist writing for a therapy blog, I’ll bet you are thinking I’m going to recommend it as a first line of defense. Surprise, that’s not the case! What I would recommend is slowing down, easier said than done, but give it a try. We spend so much time and place so much emphasis on being perfect and having it all together all the time that we forget to step back and appreciate the little positive moments or don’t take time to process and rebound from the little negative ones.

Try the tips and tricks below to help manage the Little “t’s”; if that isn’t enough, therapy is always an option. There is no shame in asking for help or in seeking new tools and resources to get you over a hump.
• Breathe – use the power of breath to literally breathe life back into yourself
• Body Check – keep an eye on where you hold your tension, the more aware you are the easier it is to see when your body is feeling overwhelmed, even if your mind is telling you to push through it. When you feel it, take a step back and let yourself recover.
• Find an Outlet – everyone’s is different. If you don’t find joy or peace in running don’t run, if yoga isn’t your thing don’t do it. The goal is to find a thing that works for you.
• Put it in Perspective – it takes a little practice but try the rule of 10’s. When you are feeling anxious or overwhelmed ask yourself what impact the outcome of whatever you are focused on will have, really… will this matter in 10 minutes (the guy that cuts in front of you on the freeway), will it matter in 10 days (the balloons you forgot to pick up for the birthday party), will it matter in 10 months (the exam you did poorly on or the job interview that didn’t go so well), will it matter in 10 years (the relationship with your friend or significant other that is in a rocky spot).
o In short, put the level of energy you give something some perspective. Life isn’t perfect and it doesn’t have to be. Some of the best moments are in the mishaps and I am pretty sure no one is on their death bed commiserating over the person that cut them off in traffic 40 years ago. Essentially, let the small things, be the small things.
• Find a Friend – countless studies have been conducted showing how social support mitigates the negative impacts of stress. Meaning the Little “t’s” don’t build as quickly or as uncontrollably when we have healthy social supports to help us process (or vent) our stressful days. Side note: don’t let the venting become the premise of the relationship, that doesn’t do anyone any favors. Allow yourself one cup of coffee and one conversation, then move on.
When you feel like these basic tactics aren’t enough, it might be time to seek professional help. When Little “t’s” overwhelm us we often become anxious or depressed, which can skew our decision making and behaviors, which in turn keeps us in a rut. This is where a professional can help you peel back the proverbial layers and help you reverse or counter the things in your life that aren’t working for you. It’s always OK to ask for help and there is always light at the end of the tunnel.

Be kind to yourself, be kind to others, and keep it moving.

More Information on Trauma:
http://www.prolificliving.com/100-positive-affirmations/
http://www.trauma-pages.com/
http://www.nctsn.org/resources
https://www.psychologytoday.com/basics/trauma
http://www.helpguide.org/articles/ptsd-trauma/emotional-and-psychological-trauma.htm 

 

Written by Ashley Steelman, MSW

Ashley

 

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