To say or not to say…. That is the question?

“Understanding is the first step to acceptance, and only with acceptance can there be recovery.” 

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Working in the field of addiction and eating disorders, as well as being in eating disorder recovery myself, I have experienced and witnessed first hand the lack of knowledge and understanding many people have about eating disorders. 30 million people in the U.S. will suffer from a diagnosable eating disorder during their lifetime, while many more cases go unreported. Eating disorders are often suffered in silence and while there is a sterotypical idea of how someone with an eating disorder should look or act, that is simply not the case. Anyone and I mean anyone can suffer from an eating disorder. No matter the age, race or gender, eating disorders do not discriminate. It is important to not only be aware of signs to look for when you suspect someone in your life may be suffering from an eating disorder but also to be aware of the sensitive nature of this disease. With any form of recovery there will be good, positive days and then there will be dark challenging days. Often times certain words or statements will be enough to send someone who struggles into the dark tangled web of negative thoughts in their head. This is why education and awareness is so important. It is not the fault of those who do not understand, supporting someone with an ED can be difficult and frustrating, it is hard to watch people hurt themselves and know you can only do so much about it. This is why it is so important to educate and increase awareness for those who may not be able to understand the power of this disease. To help people gain understanding is where true change can occur.

“Just because you don’t understand it doesn’t mean it isn’t so.”

Listed below are some things you should not say to someone with an eating disorder-

1.) You look healthy– To many people this seems like a very normal, harmless comment often times meant to be supportive but to someone who is struggling with an eating disorder this comment can be one of the most triggering. The eating disorder mind has a way of turning many comments and twisting them into something negative. The ED mind hears “healthy” and associates that with being fat, being like everyone else, being normal or someone noticing a change in their appearance. Being called healthy can send someone spiraling downhill into anxiety, depression or trigger them to engage in their ED behavior. When in recovery from an eating disorder it is a very sensitive time, people are challenging themselves in many ways and if they feel their body changes are noticeable to others it can re-trigger those negative ED thoughts back in a very strong way. I advice many people I work with to not comment on the weight or appearance of their loved ones and focus on discussing inward positive emotional changes instead.

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2. Comments about food– Another big trigger that can effect someone with an eating disorder is when someone else comments on their food, labels their foods as healthy or unhealthy or comments on the amount of food someone is eating. For someone struggling with an eating disorder they are already hyper vigilant about what they eat and are trying to break away from stringent rules or judgments on food. For someone trying to overcome their eating disorder, eating in front of people is a huge milestone in itself, eating in front of others is a common fear for someone struggling. Commenting on what they eat or how they eat only puts the hyper focus and fear of eating back into action. Try to refrain from commenting and instead enjoy the company of who you are with and be in the present moment.

3. Why don’t you just eat?– This comment can be very hurtful to someone struggling with an eating disorder, if eating disorder were as simple as just starting to eat or stopping when full then this wouldn’t be the deadly disease that it is. Anorexia is the number 1 cause of death among all mental health issues. Eating disorders like any other mental illness or physical illness are not a choice, no one chooses to go down the eating disorder path. It is an all consuming disease that takes over someones life. I educate people that I come across that eating disorders are more than just about the food or appearance. There is often a deep wound or pain often times eating disorders become a way to cope with many different aspects of life. Try and be supportive and ask helpful questions to gain understanding of someone who may be struggling.

4.Commenting and criticizing your own weight- Those who are struggling with their eating disorder are constantly judging and criticizing their own appearance so to be around someone who is picking themselves apart only emphasizes the negative thoughts and enforces them in the ED mind. It is best to be kind to ourselves in thought and in action, one negative thought or comment feeds off another.

5. Don’t use or talk about numbers or calories-–  This is one of the worst things you can do to someone with an ED. Many times someone with an eating disorder is trying to stop behaviors, stop the obsession of the scale, stop the focus on a dress size or weight and calorie counting. To be around someone who brings that focus and attention back to numbers will only trigger someone trying to avoid those behaviors. 

6. You don’t look like you are someone who would have an eating disorder– This comment goes hand in hand with rule #1, do not talk about someone else’s appearance. Like I stated earlier eating disorders can affect anyone. Eating disorders come in many forms and the majority of sufferers are not the stereotypical image we have of a severely underweight emaciated person. Anorexia only represents 10% of eating disorders. Bulimia affects three times as many people who struggle with ED and binge eating has the highest incidence. Many times many people can experience traits of different eating disorder behaviors going back and forth from restricting, binging, purging or over exercising. When someone who struggles hears they don’t look like they have an eating disorder the ED mind twists and distorts this comment to mean that they don’t look sick enough, that they don’t need help. There is no one way to look, to be struggling with an eating disorder and by increasing awareness this is how we challenge the stereotype. 

 

These are a few key points to keep in mind when you are speaking with or supporting someone who struggles with an eating disorder. Remember to try and be supportive, instead of focusing on food or appearance focus on how they are doing, how they are feeling and ask them how you can best support them.

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The Importance Of Emotional Needs

From the day we are born we have physical needs. We are taught how to navigate through the world. From the day are born we also have emotional needs. As babies we cry and long to be held, to be comforted and to be loved.  Our cries as children was the first way we learned how to as for our emotional and physical needs to be met. As we grow older however we forget how to identify or ask for our emotional needs to be met. How can we ask for them if we don’t know what they are?  Some examples of our emotional needs are to feel accepted, appreciated, important, valued, loved or respected. When it feels like most of our emotional needs are being met they become “unmet emotional needs.”

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John Powell, author of Why Am I Afraid to Tell You Who I Am?, believes that unmet emotional needs are one of the two major causes of anxiety. He says the other is supercharged repressed emotions. Emotional needs affect us more than we realize. They stem from childhood to adulthood. We learn from our caregivers how to express or ask for our needs to be met. If in our families needs were never expressed then it will make it difficult in adulthood to be able to identify what our needs are let alone express them. The importance of if our needs have been met throughout our life can often be something we are not aware of, however unmet emotional needs and an inability to identify or ask for them can turn into a negative cycle. If one grows up not understanding how to identify or ask for their needs to be met it will translate into their adult relationships.

I have often times heard people say “isn’t it selfish to ask someone to meet my needs”? My response is, it is never selfish to healthily communicate to someone how they can make you or your relationship better. It is the responsibility of the other person to decide if they choose to meet your needs. All we can do is take responsibility for oursevles and our responses, not the responses of others. If we hold in our needs they will fester and possibly grow into anger or resentment. It can also lead us to look for other external factors to get our needs met.

When What You Say and Do Is Not In Sync With What You Feel

Some Ways We Try to Compensate for Our Unmet Emotional Needs

By managing/controlling/manipulating others

By feeling superior to them.

By seeking status, money, fame.

By competing and trying to be the fastest, the smartest, the best, etc.

By keeping all our emotions inside and never voicing them

By isolating from others

By turning to food, drugs or alcohol to comfort ourselves or deal with uncomfortable emotions

By reacting with passive aggressiveness or hostility

By people pleasing

We do these things to try and make ourselves feel ok, to feel better, to be enough. They are a temporary band aid to a wound that has yet to heal. When we behave in ways that compensate rather than address the issue we are utilziing unhealthy ways of coping. In order to feel emotionally fullfilled we must utilize healthy coping skills and it all starts with identifying what your emotional needs are and then finding ways to ask for them. You hold the key to emotional freedom.

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The Invisible Line: Finding your voice and setting your boundaries

For so many people the ability to stand up for their inner needs and wants can be very difficult. Often times many people I encounter hold many of their emotions and thoughts within themselves. I know especially for the eating disorder population so much of what feeds into their negative view of themselves is driven by an inability to feel they should be seen, heard or have a voice. I work very hard with my clients to not only empower them, but to help them find their inner strength to define their emotions, define their thoughts, define their needs, assert themselves and set boundaries in their worlds. This concept of standing up for ones self is a very hard concept for many people but for the eating diorder community it is especially tough. An eating disorder is a selfish disorder, its a mean disorder, its a bullying disorder. It makes a person feel unworthy, unlovable, and most of all unimportant. This post is for anyone who ever felt unseen, unheard, unloved, for the tears cried at night, for the silent taunting screams that haunt so many. To anyone who ever felt neglected, unappreciated, judged.

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So many peoples lives are spent and driven by the constant worry about what others think, worried about how others see and view them and I ask why? I encounter this pattern with so many of the eating disorder clients I work with, they have such a need and a desire to give all of themselves to loved ones, to worry about how others see them, never feeling good enough, never feeling like they matter. Often times this preoccupation with what others think and how they see us instill a silence within a person. This silence is a dangerous cage, when someone takes their emotions, thoughts and locks them away it’s only a matter of time before all those pent up emotions and thoughts want to break free. I have noticed that for a lot of people who suffer from an eating disorder they have either been surrounded with too rigid of boundaries which leads to suppressed emotions or not enough of a boundary which leads to a sense of not knowing ones own identity. The inability to handle or process emotions from lack of boundaries for someone struggling with an eating disorder can be acted out in many ways.

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Someone struggling with anorexia restricts their food because I often hear it is the one thing that they can control but it is also a way to numb emotions and thoughts. As someone starves themselves and the physical implications start to take affect, the internal implications are unwinding as well. Their is an inability to process or define their emotions and if emotions come up the anorexia serves as a numbing agent. When you are physically depleted, your brain is depleted as well. There is a disconnection between mind and body and often times someone suffereing from anorexia is so malnoursihed or week it serves as a way to disconnect from the world and emotions. This is why in treatment centers when someone is being renourished its an overhwmelming experience. They start to feel again and so many of the negative emotions and thoughts will begin to resurface.

Someone struggling with bulimia its a physical action based behavior. Someone who binges and purges or just purges whatever they ate is coping with emotions and thoughts through a physical act. The pain they feel is often times acted out through purging. It’s a physical release of what has been kept inside of them.  Its a physical representation of trying to purge ones emotions. I hear many comments from so many who suffer from bulimia that its a coping tool for them to release their pain, sometimes its a violent act against themselves, its an aggresive expression of the pain unfolding within them. Within the brain itself the brain associates the cycle of bulimia as a coping pattern so in treatment it is almost like detoxing someone off a drug. The withdrawls from the act of purging leave someone who suffers from bulimia feeling helpless and overwhelmed, when their feelings come up the coping tool they have used for so long is no longer their to serve its purpose and that can be very difficult for someone recovering from bulimia.

Someone struggling with binge eating it’s a way to disconnect from emotions and self. Its an uncontrolable force that takes over its a disociation where a person is not present in the moment until after the binge where guilt and shame then take over. The guilt and shame ruminate and taunt the person which leads to a lower sense of control, worth or value. These negative emotions then fuel the cycle of numbing out and mindlessly eating all over again to further serve a numbing purpose. In treatment for someone who uses food during emotional times this can be a very hard adjustment.

I bring up these three behaviors and components because they all have things in common, they serve a purpose to help someone distract, disconnect and dissociate from emotions that prove to much to bare or handle. I truly believe if someone can develop a way to assert their needs and boundaries and become and advocate for themselves because they believe they are worth standing up for,  it would help them define, process and learn how to handle hardships, needs and emotions. Boundary setting is a crucial skill for people to learn. We must empower our clients to envision and create an invisible line.

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Here is an example list of some unhealthy boundaries:

• Sacrifice their personal values, plans or goals to please others

• Allow others to define who they are and make decisions for them

• Expect others to fulfill all their needs

• Feel guilty when they say no

• Hesitate to share their opinions or assert themselves if they are being treated unfairly

• Frequently feel used, threatened, victimized or mistreated by others

• Afraid of confrontation or conflict

• Take responsibility for other people’s feelings

• Tell others how to think, feel or act

I really work hard to empower my clients to feel comfortable with their voice and their instincts.

Here are some good ways to start defining your needs and emotions:

1. Create a personal bill of rights to slowly feel comfortable identifying  needs and asserting them.

2. Become aware and identify your emotions, thoughts and feelings within your body. This process is about slowly reconnecting with yourself.

3. Set limits for yourself based on your needs and emotions

4. Acceptance- Come to a place of acceptance. Assert your need that you are of value and your thoughts and opinions matter.

For many people when someone starts to assert themselves it can at first be a shock to not only the people in their lives but to themselves. My message to everyone out there who may be struggling with so many emotions that they have pushed down or kept hidden, is to slowly trust in your inner voice, to slowly fight for yourself. There is a purpose to your pain and maybe one purpose is to give you a power you have had all along.

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Breaking Binge

I love to address and discuss topics that inspire me, motivate me or allow me to think of things in a new light. When I decided to start an eating disorder recovery & support group I was baffled that majority of the emails I received were from men and women looking for help with binge eating. I personally have noticed and this is my opinion that binge eating is less frequently talked about or discussed. I believe that clinically and socially anorexia and bulimia are more focused on because of the more obvious physical presentation of the eating disorder however binge eating while physically not as apparent is equally as tragic, harmful and devestating. Statistics state that binge eating is the most common of all eating disorders. According to the National Institute of Mental Health (NIMH), binge eating disorder statistics are as follows: 1.2% of adults experience BED in any 12 month period. This means that 1.6% of women and 2.0% of men will experience BED in any one year. Binge eating is an uncontrollable urge or impulse to intake an overconsumption of food. I am writing this post and dedicating it to those who suffer from binge eating. I have heard many clients desperate to find a way to control their urges to binge. They feel helpless, lost, trapped in the vicious cycle of their binge eating and many feel hopeless. This blog post is not only to educate the clinicians but to give hope to those who feel they will never regain their control. Recovery from any eating disorder is possible.

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I wish I could provide the ultimate answer on how to stop binging or how to overcome an eating disorder, while I may not have an answer my mission has been to educate people on the different resources, techniques and ways clinicians and someone struggling can help think about and fight eating disorders.  I believe every person I work with or see functions and responds differently. What works for one person will not work for another. This is why I am constantly stressing for the clinicians to look at the bigger picture and think outside of what has been or is being conventionally done. Not to take away or say it doesn’t help but I believe we can go further, research more and find new answers or approaches to help those who may be suffering.

Binge eating has always been looked at as an emotional way of coping which it is. So clinicians tend to ask questions and dig deeper into the emotions, triggers and thoughts associated with or what happened before, during and after a binge. These are all great questions and things to examine and explore. Yes binge eating resonates with a great deal of the emotional turmoil going on inside, like I said in my previous post “Untangling The eating disorder web” binge eaters tend to take in to much never feeling fully gratified or satisfied. I am challenged however to look at Binge eating in multiple lights. I discovered this amazing book titled “Brain over Binge” written by Kathyrn Hansen. Reading this book my mind was blown away at her way of describing the binge cycle. While yes for many of our clients and for those who suffer from binge eating it is very emotionally driven however once in therapy and those emotions, issues and triggers are unveiled and identified what about the binge urge itself and the brain chemical component of the cycle? How do we tackle the brains urges and break the habit that has been conditioned and formed for so long. I can honestly say as a clinician like most of us do, we want to find the emotional answers, identify the triggers use distraction techniques coping skills, but what if those do not work for some of our clients? This book gives insight onto another way clinicians and someone who may be suffering can view themselves and their binge urges.  

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The author viewed her urges to binge as a survival instinct coming from a place of restriction or constant thoughts of not overeating. Scientifically if we look at someone who is starving themselves or restricting their food the brain and body kick into overdrive, needing food and nourishment to survive. This can lead to an insatiability and a need to eat more than one normally should to satisfy their body. This is where the guilt and shame come in and for some purging takes place .This cycle is triggered by the brain and body going into survival mode. She calls it the cycle of the divided brain. She splits up the behaviors assigning them as your conscious choices to restrict and diet, they are you and under your control. She describes the binge part the part with no control as “it” meaning the brains survival instinct. This revelation or way of viewing it was very powerful and in many ways made sense.  The cycle diagramed below many clients have expressed to me gave them hope that they could regain control over their urges. They felt their binge eating was not a part of them or their identity which I feel for many can be freeing. They said it explained to them what their binge eating truly was and that they were not helpless to give in to it. 

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As clinician we tell our clients when urges to restrict, binge or purge come up to use coping skills or to distract until the urges go away and for many clients this is very powerful and works and has helped many to recover. I am speaking to those out there where distraction only heightens the urges or delays them until eventually they are given in to. The author has stated to sit with your urges allow them to come over you like a wave and allow the thought to come but DO NOT act on them. She likens it to a storm the waves will come and crash down on you but eventually the storm will settle. She breaks down her steps that helped her which I have listed below from her blog.

1.    View urges to binge as neurological junk. (This means quit believing the urges signaled a real need – physical or emotional – and stopped assigning the urges any value or significance whatsoever.  View them as automatic brain messages generated in the  lower brain that deserved no attention. 
2. Separated the highest human brain from the urges to binge.(This means realizing the urges are not you, but instead are generated in brain regions inferior to your true self. Your true self resides in your prefrontal cortex – Your highest human brain – and it gives you the ability to say “no” to binge eating.  You have to know your urges are powerless to make you binge, and your true self has ultimate control over your voluntary actions.)   
3.  Stop reacting to your urges. (This means stop letting your urges to binge affect you emotionally and spiral you down to guilt and shame.  Allow them to come and go without getting wrapped up in them. This will make the urges tolerable and eventually easier to resist.) 
4. Stop acting on your urges. ( You don’t have to substitute any other behavior or emotionally satisfying activity for binge eating. I only had to refrain from binge eating.)
5. Get excited. (This is a bonus. By rejoicing in the success you do have even if its one urge or one day  you speed along the brain changes that can change habits and behavior.)     

The tools I listed above may only help some people and for others it may not but the beauty in educating people and increasing awareness is getting all different methods and inspiration out there. Every human being is different which is why what may work for one will not work for another. As clinicians we need to to understand and know the different ways to view eating disorders. If we look at them based on characteristics and treat them in one specific way we are doing a disservice to so many people who do not fall into “designated general categories”  We as clinicians by doing more research by exploring new avenues give our clients  to benefit from it. My message today is there is hope, there are alternatives, we just have to be open to explore all outlets and all forms of thinking because for those who suffer educating them and trying to understand who they are will help uncover the ways we can guide them on their path to recovery.

For more information about Binge Eating watch my discussion on the show  Behind The Mask: Eating Disorders Unveiled.

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It’s not about the FOOD

Having worked with eating disorders for over five years I have had many conversations with many different clients. Each story is unique, the way their eating disorder started, the triggers they feel, how they used their eating disorder to cope, the reasons are all very different. One main point I always try to educate people about is no person who suffers or who has suffered from an eating disorder is the same. The behaviors, patterns may be similar but the underlying issues, reasons etc are all very different. One other point I try to educate people on and bring awareness to is that EATING DISORDERS ARE NOT ABOUT THE FOOD!  One common thing clients have come to me and said was, they were triggered or angered by a family member or friend telling them ” To just eat a burger” “Why can’t you just eat ” These types of  question comes from no fault of the person asking it but it does stem from a lack of understanding and education about the depths of an eating disorder. This is why my mission has always been to increase awareness and education because the more people can understand the many layers to the emotional aspects and causes of an eating disorder the better the support system of those who have an eating disorder can understand and cope themselves. My main message to people is that an eating disorder or any addiction for that matter does not discriminate, it does not care about your race, age, financial situation or gender. It can affect anyone anywhere the more we as a nation can understand eating disorders the more we can help those who are fighting them.

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The common assumption is that eating disorders are about an obsession or fear of food. That the main focus for someone with an eating disorder is a fear of getting fat and body image. While these are slightly true and what seems to be the most focused on, the reality is that an eating disorder like any other addiction or drug of choice is another avenue of emotional coping. It is another way to numb out, to feel a sense or release and to escape or avoid unwanted emotions. Anorexia, Bulimia & Binge Eating are also like a drug they give a person a sense of a high or release. The truth is that an eating disorder is often the cause of some sort of trauma, emotional event, life situation, or a number of many other factors.

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I also like to educate people to not blame the parents or family environment. Like anything else a child may have had very loving healthy parents but an outside source could have caused some emotional damage. A person with low self-worth or without a strong sense of identity may be more vulnerable. . This a why eating disorders  can occur at younger ages because at a younger age the identity is just forming and often times the opinion of peers is so important that it can shape how a young adult or child views themselves. I also often hear that people assume eating disorders are a way for someone to gain attention or  “attention seeking”. This infuriates me and further motivates me on my mission to educate. Someone does not choose to develop an eating disorder it is an all consuming disorder that if someone had a choice to just stop they would. It is like any addiction or disease once it reaches a certain point interventions must done to recover. This is why understanding the emotional background of the eating disorder is crucial to developing an appropriate response and treatment approach. Education at an early age is important. Bullying and the medias portrayal of beauty as well as our nations preoccupation with dieting etc are all contributing factors. 

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My message to everyone is do not judge anyone and assume their road is easy. Do not diminish the struggles and challenges someone may be facing. Instead be curious ask questions, educate yourselves there are too many stereotypes about eating disorders that we must break, we must make people aware of the reality. That there is much more to someone who is suffering from an eating disorder than a fear of getting fat and a fear of food. Look beyond what you see.