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 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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Walk On Guest Blog Post written by: Madison Nixey

When discussing any difficult issues or topics what motivates me and keeps me hopeful are the people who live a life of inspiration. I was honored and touched when such an amazing woman Madison Nixey reached out to me and asked if she could write a post for my blog. My immediate answer is yes. Madison is someone who I met about three years ago. I have had the honor of seeing her along her journey in recovery and she inspires me in so many ways. Her spunk, her say it how it is attitude, her humor and her strength never stop surprising me. Madison was recently in New York City participating in the NEDA walk and that is where her blog post starts. Thank you Madison for writing and sharing a part of your experience to the world.

(Madison & I at the Norooz Clinic Art Fair where Madison spoke about her journey  & recovery from her eating disorder)

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Walk On written by: Madison Nixey     

Last Friday, October 4th I flew out to New York to attend my second ever NEDA walk. Sunday morning, October 6, I laced up my Nike’s and hopped on the subway. The Los Angeles NEDA walk was in February this past year and my experience there left a lot to be desired. I got off the subway at Foley Square, right by the big courthouse in New York. We wandered for a little but confused because there weren’t many visible signs up. We made a left and found ourselves on the outskirts of a huge group of NEDA walkers. Around 1300 people came out to support the cause. 1300 PEOPLE GUYS! That’s like, a whole 1100 more than attended the walk in Santa Monica!!! The atmosphere was incredible. All around me I could hear stories of sadness and hope. There were many people walking for their kids and their mothers and also lots of groups walking for people who had passed away from complications of their eating disorders. The emotion was overwhelming walking around talking to people. It was a great mixture of pride and sadness and fallen dreams. There were parents mourning the loss of the great future their child could have had and children mourning the years lost spent with their mothers.

The walk was across the beautiful Brooklyn Bridge. You could hear chanting and screaming and laughter. It was truly an amazing event to attend. People were stopping me to ask about the cause and the amount of people who even just turned and gave us a second glance was unreal. Along our route/gathering place, there were signs with statistics and ‘fun facts’ about eating disorders. One of the ones that stood out to me the most was; “35-57% of adolescent girls engage in crash dieting, fasting, self induced vomiting, diet pills or laxatives”. Take a minute and let that sink in………

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Anorexia is the most deadly mental illness and the least talked about cause. It is so so important for awareness to be brought to this issue and we all need to get together and talk about it. Everyone knows someone and everybody’s life whether we know it or not has been affected by disordered eating, whether it be within ourselves or people around us. We need to get together to fight. Fight for better government funding, fight for better insurance coverage, and fight for the right to not be ashamed of what we’ve been through and to be proud of the fight we will have to constantly go through for the rest of our lives.

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My eating disorder started when I was 12 years old. I fought to get treatment at age 17. I’ve been in recovery for three years in February. It’s been the hardest, most challenging road I have ever had to walk but it is also the most rewarding and I wouldn’t ever go back and change anything. I view my anorexia more as a blessing than anything because it has taught me to be a strong, independent woman who knows how to fight for what I want. I spend all my free time I have (which is getting to be less and less being in nursing school) dedicated to talking—sharing my story, sharing my recovery and being an open book. The power of sharing your story holds so much, you never know who is still secretly struggling and who could benefit.

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Untangling the Eating Disorder Web

I reflect back to when I was younger and I remember talking with my friends, laughing over music, movies, actors we had crushes on and I remember how much of my childhood was organic innocent and fun. I now think about times today and it baffles me how much the focus and conversations of todays youth has changed. Young girls and boys have become increasingly more aware and fixated over not only body image but overall appearance and image of self. The focus has become so heigntened and it only continues to grow. With today’s  celebrities, media fixations etc  the younger generation is being fed false images and personas that are impossible and dangerous to want to obtain. I do not blame any specific avenue for the increase in our younger generations precoccupation with self and image but I think there are many contributing components for what leads children at a younger age to develop a complex with their body, themselves and their self esteem.

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I like to compare an eating disorder to a spider spinning its web. It starts small but slowly and over time can continue to be spun and develop and grow bigger and bigger. As it develops it has unmeasurable strength and has developed into the foundation of what the spider lives on. Eating disorders are like the web. It is my mission to help clients untangle that web and remove the tangles that bind them. What makes an eating disorder one of the hardest things to overcome is, like the spider in its web, it becomes the source of survival and a sense of comfort and a home. Understanding this concept alone as a therapist has helped me to help those who are struggling. To understand and be able to empathize with the fact that for someone who has a an eating disorder it is serving a purpose in their lives, it is tangled within them, it is not who they are or a life they are choosing to live but it is what they are are tangled in. Understanding the many layers of their eating disorder web will help the therapist bring to light new revelations but most importantly empower a client to untangle themselves from the web and break free.

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I attended a very interesting talk from a wonderful woman in the eating disorder field, Anita Johnson and she imparted so much wisdom into me and how I will further expand on the way I treat eating disorders. One thing she spoke about really stuck out to me and it was her saying to look past the eating disorder behaviors. As a clinician in private practice or working in treatment centers one thing I have noticed clients say is not everything is related to their eating disorder. If a client is sad, resistant, angry, frustrated I have noticed the clinician will automatically assume it is caused by their eating disorder. This is where the danger lies because we are reducing their whole being to being fixated on the fact that they have an eating disorder. The message is being sent that ” you of course are only upset because you are suffering from your eating disorder, your eating disorder thoughts are causing your emotions for the day” My questions is can someone who has an eating disorder not be upset about anything else? As clinicians we have to be careful and examine all the layers that make up our clients, not ourselves be fixated on their behaviors and relating everything to it

Anita opened my eyes to this powerful revelation. The eating disorder behavior is a symptom of the pattern someone has within other aspects of their life. A powerful question to ask someone who is battling an eating disorder is to see in what other areas of their life are they restricting, binge purging, binging etc. You may be asking how does someone binge purge anything else but food, well here are some examples.

Restricting: Restricting relationships, restricting emotions, restricting pleasure, restricting work and jobs etc

Binge/Purge: Taking on too much and feeling overwhelmed and then needing to get rid of things. Taking on too many jobs, relationships, commitments etc

Binge: Never getting enough of or feeling fulfilled by: love, sex, work, school, friendships etc

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To look at how certain behaviors are translated into other areas of someones life can be rather freeing, to say look you are not just defined by your eating disorder, everything you do is not because you have an eating disorder it is your pattern in many other things. This pattern is serving a purpose in your life! As clinicians we need to help our clients discover their web and all its components and free themselves from it. We cannot continue to fixate on one part of the web and think it will be untangled we must be the facilitators to untangle the many dimension of an eating disorder and the many dimensions of our clients.  We must become the facilitators of change! 

To see more from Priscilla Jadallah watch her online series with Bryan Bixler titled 

Behind The Mask: Eating Disorders Unveiled

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. 

Emotional Reactivity? Our Emotions are linked to our body.. What?

One thing I have noticed working with eating disorders is how much the emotional reactivity of someone affects their thoughts, actions and their body sensations.  The eating disorder behavior whether it be through restricting, purging, over exercising, or binging is usually an emotional reaction to a triggering event. I often hear stories such as a mother or father making a comment that is triggering, friends isolating or alienating someone, bullying, a romantic relationship gone awry, the eating disorder behavior is a way for someone to act out their chaotic emotions. I often ask a client of this reaction ” You did this to get back or punish the person who did you wrong or caused you pain but in the end who is it hurting” It often is reflected back to them, it hurts them and feeds into the cycle of self loathing and affirms the belief that they deserve to be punished. In attempting to punish someone else, the cycle ends up punishing them. One of the emotions that I hear come up is anger, anger is one of the most triggering emotions for someone who suffers from an eating disorder. Anger however is a secondary emotion, there is always a bigger emotion almost like the elephant in the room lingering behind anger. Often times we don’t know to to contain or process anger, that is why many people have coping outlets to deal with anger, shame, frustration etc. It can be alcohol, drugs, or eating disorder behaviors. Many times we respond in anger to the words or actions of someone in our life but not only are we responding to what they did or said but how we interpret the meaning of what was done or said. Your body takes on that energy and then inside you feel anger. Our body takes on our feelings and our emotions are what follows. 

One thing I really love to educate my clients on is how to separate from their emotions which is done by teaching emotional regulation. Those who suffer from an eating disorder often have a hard time even identifying the emotions that are stirred up in them so helping them to not only identify their emotions but how it affects their thoughts and body and then being able to regulate them is a powerful thing. That is why I love to work with clients to help them identify these emotions and learn how to think about them, cope with them so they can feel their feelings but not stay stuck in them. There are many great techniques for dealing with emotions, calm music, journaling one thing I find really helpful is opposite action. Opposite Action is a skill from DBT ( Dialectical Behavioral Therapy) .

This skill educates you on one basic fact, every emotions has a leading action. If we feel fear we have an instinct to hide or run away, if we feel sadness we cry etc.

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The second point of Opposite Action is that our actions affect our emotions. It is described as a cycle so if we change our actions we can in turn change our emotions, just as if we change how we deal with our emotions we can change our actions. The big question to ask yourself is ‘Does the situation actually justify the emotion?’ This question will help you know when to apply opposite action & to reverse the cycle. To achieve opposite action it requires you to be very present and in tune with yourself and emotions and you do the work to change the initial thoughts and reaction patterns. 
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It is important to accept your feelings and not judge them or allow yourself to feel guilt or shame for experiencing emotions. My hope is that you realize that your feelings thoughts and emotions are valid and meaningful. We cannot help how we feel sometimes, sometimes our mind and emotions sneak up on us when we least expect it, but through work and time and self awareness you can control how you handle your emotions.