White Picket Fence Counseling Center Newsletter Archives

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Our Culture of Food, Weight and Exercise

People who have an eating disorder often want to know why. Even though there is much more to recovery than understanding what’s behind your unhealthy eating behaviors, piecing together the different factors may give you some helpful insights.

On the website of the National Eating Disorders Association (NEDA), they present four sets of factors that may contribute to eating disorders. In previous articles I wrote about the psychological, interpersonal and biological factors, and today we will discuss the social/cultural factors.

Whether you’re glancing at the magazines displayed near the checkout line at the grocery store, listening to commentary about people walking the red carpet at the Academy Awards or just having a casual conversation with friends or work colleagues, you’ll hear people being judged based on their physical appearance.

This is such a small way of looking at things, and doesn’t put any value on all the other more important qualities that make us who we are.

Then there is the family culture. There can be a family of triathletes who are all into sports and value physical coordination. There can be a family who are very tuned in to physical appearance and only appreciate the latest fashions. There can be a family who are very sedentary and watch a lot of TV. Whichever culture you’re raised in has an impact on your views about eating, weight and exercise.

When my father was diagnosed with high blood pressure, the whole family got swept up into his efforts to lose weight and get fit. So my family culture became thinness. I had an aunt who was on a well-known diet program for 45 years. When people greeted each other, the first topic wasn’t always how people were, it was who had lost or gained the most weight, and how.

As you recover from disordered eating, keep in mind that the cultures around you are not necessarily changing. It’s a matter of being able to be present with oneself and finding fulfillment in your vision of recovery, things like being healthy, happy and comfortable in your body.

When the Body is Programmed for Disordered Eating

For people with an eating disorder, “diets” don’t work. This is true whether dealing with compulsive overeating, anorexia, bulimia or other unhealthy behaviors and disordered eating such as emotional eating or food obsession. Changing what you’re doing with food is not about applying willpower or self-discipline. Sometimes there are complex biological issues underlying someone’s food behaviors.

At NEDA’s website, the National Eating Disorders Association, they outline four factors that may contribute to eating disorders. The first two are psychological and interpersonal, and today we will discuss biological factors.

There is fascinating research being done in this area. We already know that there are brain chemicals that affect hunger and digestion, and that these may be unbalanced in people who have eating disorders.

While of course we leave these research pursuits to our colleagues in the medical and scientific fields, as therapists we follow it closely, especially when working in a team approach with these other professionals.

At our center we always rule out the physiological issues first. Often our clients will need to go to their primary care physician or psychiatrist to find the right balance of medications/supplements that will restore them to balance or homeostatis.

For example, a client with depression could have a thyroid issue, low blood sugar or a vitamin deficiency. We would want that treated before we addressed the depression in therapy, or at the same time.

And then there is the nature versus nurture debate. When eating disorders run in families, as they often do, is that because everyone in the family is genetically predisposed to have an eating disorder, or because family members have learned unhealthy behaviors from each other?

It’s important to point out that just because an eating disorder is genetic or physiological, it doesn’t mean it can’t be changed, but it sometimes requires a more intensive therapeutic process, or inpatient therapy.

Relationship Issues Can Contribute to Eating Disorders

People often want to understand the cause of their eating disorder. Even though knowledge alone will not create long-lasting recovery, it can help guide the treatment process and help the person understand why we’re suggesting different things.

NEDA, the National Eating Disorders Association, spells out the four factors that may contribute to eating disorders. Last week we discussed some of the psychological factors behind eating disorders and how we treat those factors, and today we will discuss the second group of factors – interpersonal factors.

At our center, we work on relationship issues from our clients’ very first therapy session and all the way through their therapy process – partly because your relationships will change while you are recovering from an eating disorder.

We have relationships with many types of people, and some of these interactions can be very complex. We have parents, siblings, children, extended family, in-laws, friends, work colleagues, bosses, teachers, students, neighbors and committee members, not to mention all the strangers we encounter as we move through our day.

Any and all of these relationships can contribute to eating disorders because people can be difficult to deal with. Eating disorder behaviors can seem easier than facing potential confrontations or disagreements with people. People speak through the food when they can’t speak with words.

Interwoven with the psychological factors we discussed last week, relationships can be linked to emotional issues such as low self-esteem (related to a history of being teased about size or weight) or depression and lack of control (as a result of physical, sexual or emotional abuse).   

We work a lot with our clients on how to express themselves and deal with people. As I often say, “the goal is to be able to speak your truth, with kindness and compassion.” At Castlewood they use psychodrama, which we also use in our intensive programs. Psychodrama provides a way to go back and heal the wounds of the past, grieve, put them behind us and move forward, in order to be able to deal with current relationships.

It’s really important to form healthy relationships with others while you’re forming a healthy relationship with self.

Why You May Have an Eating Disorder

By this point in the year, many people have already tried more than one diet program in order to achieve their New Year’s resolution to lose weight. Others have been trying to keep their daily promise of not using their eating disorder behaviors. They all may be wondering, “Why can’t I do this? Why can’t I eat in a healthier way, no matter how hard I try?”

This is also often one of the first questions our clients ask when they begin therapy. “Why do I have this eating disorder?” They’re convinced that if they know why they do what they do with food, they’ll be able to stop doing those things.

Knowledge is helpful, and we definitely spend a lot of our time in therapy helping you gain knowledge and insights about yourself. Yet knowledge alone doesn’t give you what you need to make the necessary changes, especially without support.

On the website of NEDA, the National Eating Disorders Association, they offer an overview of the four basic causes (contributing factors) of eating disorders. Over the next few weeks, I’ll present each factor and go into more detail about what’s involved.

Their first point is that eating disorders are very complicated, and it’s never just one thing that’s the cause. If it was, there would be just one form of treatment, and as we know, there are many.

The first set of factors that may contribute to eating disorders are psychological factors.

If eating disorders are a method of coping with what’s not working in your life, what are the psychological factors you are coping with? Someone may feel low self-esteem, or a lack of control over what’s happening in their life. They may be experiencing other mood disorders like depression, anxiety, loneliness, grief, abandonment or resentment.

Recovery is not just about eating differently, it’s about looking at your underlying emotions, so that you can begin thinking different and acting differently. 12-step programs, therapy and treatment centers are all places you can go to do this important emotional work.

Workbooks can be a very helpful tool. For example, for low self-esteem we recommend The Self-Esteem Workbook by Glenn R. Schiraldi, 52 Weeks of Esteemable Acts by Francine Ward and Ten Days to Self-Esteem by David D. Burns, M.D. In our experiences, however, workbooks are only helpful if you share your work with someone else.

An eating disorder can be a form of rebellion for someone who feels a lack in control in their life or is feeling angry at someone but is having trouble expressing the anger. It’s as though they’re speaking with the food, saying the things they can’t say with words.

Therapy gives you a place to say those words. Sometimes a more intensive level of therapy is needed, where someone visits our office three times a week. In essence, we become their outpatient program.

For some people, inpatient treatment is the best option. I recently visited the Castlewood Treatment Center for Eating Disorders in St. Louis and learned about some of their treatment methods. For example, they use Internal Family Systems Therapy (IFS) to help their clients integrate different parts of themselves, in order to access their inner compassion, confidence and curiosity.

The IFS process also helps the person see the eating disorder as just one part of their identity, not the sole definition of who they are. This concept was also covered in the book Life Without Ed, by Jenni Schaefer. Your eating disorder may have actually helped you survive and get through traumatic events, but once you go into recovery it’s because the eating disorder is not working for you anymore. It’s definitely not helping your health.

For reducing depression, anxiety and phobias, we may apply a number of different techniques such as thought stopping, cognitive behaviour therapy, mindfulness or thought restructuring. We often recommend that people incorporate movement into their day, in particular things that get them outdoors in natural light.

These psychological factors are only one of four interrelated factors that may contribute to eating disorders. Future blog posts will explore the other sets of factors.

Making Friends With the World

When you’re dealing with an eating disorder, you may feel very isolated and separate from the rest of the human race. Relationships can be difficult, and healing some of your patterns may be a central theme in your recovery.

Here’s a different slant on working on your relationships: How can you be more social and friendly when you’re out and about in the world?

Set this as your intention in the morning, and think about the opportunities you may have ahead of you. For example, if you tend to walk by yourself over the lunch hour, ask someone to come along. If you usually keep to yourself, make eye contact with the people you pass, or even say, “Hi!” Practice saying, “Yes,” when someone invites you to do something social.

If you have a serious social phobia or agoraphobia, you can get help for that. If, like many of us, you’re simply feeling hesitant and unsure of how other people will respond to you, start small. I predict that once you’re being friendlier, you’ll get on a roll.

Be a good friend to the world by being an attentive listener – whether it’s two minutes to ask the cashier at the grocery store how her day is going, or half an hour to hear out a co-worker who’s having a hard time with something.

Strive to be an upbeat influence on the conversations you have. Avoid gossiping or talking about other people. Change the subject if a conversation is focused on something negative.

When you make friends with the world, you create positive feelings that ripple forward and come right back to you. You’ll attract more love, friendliness and support from other people, and you’ll boost your self-esteem with the knowledge that you’ve made someone else’s day a little brighter.

Be Your Own Best Friend

Relationships can be challenging, and are often at the root of emotional issues and addictions. While you’re doing some of the work to repair and rebuild your relationships with others, you can start by being your own best friend.

It’s very empowering to know that we can not only take of ourselves, but that we are complete on our own without needing someone else to fill anything in. Being that comfortable with oneself starts from the self-awareness from having looked within. Journaling, therapy and 12-step programs are all excellent ways to accomplish that.

This process will also help build acceptance – first for yourself, and then also for others. It’s a way of validating whatever thoughts or feelings come up, and then working on healing or changing them. This way, nothing – and no one – has to be “wrong.” It just is what it is, until it is something different.

The title of this blog post was inspired by a book I’ve had for many years, called How to Be Your Own Best Friend by Mildred Newman and Bernard Berkowitz. They have some really neat suggestions, including:

• Having a “bedroom slipper day” – my version of this is allowing yourself a day to just be at home, not pushing yourself beyond what is healthy for you
• Seeing the source of happiness as being within, not outside of ourselves somewhere (a good reminder)
• Just as the title says: Being  your own best friend is the ultimate friendship; liking yourself, feeling fulfilled and true to yourself

Your Body is Your Friend

When you have distorted or unhealthy body image, it can cause you to want to harm yourself instead of love yourself. So before we move on to look at how to be a better friend to yourself and others, let’s talk about how to understand and start to heal your body image issues.

One of my favorite tools for self-awareness is journaling. When you put pen to paper, no one will see what you’ve written unless you choose to show them. This creates an atmosphere of safety and honesty that can lead to some powerful insights and discoveries about yourself.

You can find ready-made workbooks or journaling prompts about many different topics, or you can simply ask yourself a question at the top of the page and write down your answer.

If you really want to get to know yourself, join a 12-step program. It doesn’t need to be one related to food – choosing a group like Al-Anon or Clutterers Anonymous may be less intimidating, while still giving you access to the self-awareness and growth that come from working the 12 steps.

Therapy is another useful tool for understanding the body image issues that are affecting your relationships with yourself and others.

Gentle movement choices like we discussed recently on the blog are important forms of self-care that can create a self-nurturing relationship with your body. Things like yoga, relaxation and massage can all help you feel better in your body.

Choose your clothes carefully. Do the fabrics feels good against your skin, or is anything constricting or irritating you? Do your shoes support you in comfort as you move around, or are they too tight or worn down?

Do you make an effort to feel good about your appearance, choosing clothing and accessories in flattering colors and shapes? Do you practice good hygiene and take an extra few minutes to brush your hair?

In that same article about movement choices, I also mentioned my father’s advice about putting on my “tennis whites” – looking the part really did make me feel more confident and comfortable in my own skin – and as a tennis player!

When you can learn to treat yourself better at the most fundamental level of body care and awareness, you’re well on your to being your own best friend. We’ll talk more about that next week.

The Love of Friendship

People say love a lot, especially at this time of year when Valentine’s Day is approaching. Instead of focusing on red hearts and romance, let’s instead look at the love of friendship. Friendship requires kindness and compassion, qualities that are also very important in how we relate to ourselves.

The more freely we can express kindness, compassion and friendship, the more harmoniously we can live together as humans, and the better we feel about ourselves.

Relationship problems are commonly an underlying issue behind disordered eating and other substance abuse problems, problems at work, and difficult emotions such as depression, frustration and anger.

If our relationships with self and others are more peaceful, we feel better about ourselves and there are fewer reasons to use an addictive substance or act out.

One approach to improving our relationships is to investigate the “love languages” that the other people in our lives are speaking, and how those compare to the love language we use. The concept of love languages was presented in a book by Gary Chapman, as I described in an earlier blog post about building relationships:

The premise of The Five Love Languages, by Gary Chapman, is that we all have different ways of expressing ourselves in relationships. We learn a love language as we grow up, but then we may learn other ones as we grow a bit older and independent of our families. People will automatically give love in the way they're used to receiving it, or in the way they like to receive it, and that can lead to misunderstandings, hurt feelings and conflict.

Chapman's five love languages are: words of affirmation (kind, loving statements about the other person), quality time (spending time together and being attentive to the other person), receiving gifts (small or large, gifts that are meaningful to the person receiving them), acts of service (taking care of things for the other person) and physical touch (small gestures, sexual intimacy, massages or a simple pat on the shoulder).

Do you know which love language you speak? More importantly, do you know how the other people in your life feel loved? Are you being a kind, compassionate friend to yourself and others by using their preferred love language?

Over this month, we’ll look at how being a good friend to yourself and others can enhance your recovery from an eating disorder or unhealthy behaviors around food and exercise.

Healthy Movement Resources and Examples from the White Picket Fence Staff

Here are some of the physical activities that our staff at White Picket Fence Counseling Center love to do:

Diosa Moran, Registered Mental Health Counselor Intern: I enjoy bike riding on nature trails, yoga, dancing and Zumba classes, hiking, and breath work for relaxation.

Jaki Hitzelberger, Registered Mental Health Counselor Intern: As a former athlete, I enjoy a variety of movement now, always switching it up. I enjoy being with others playing sports, biking and paddle boarding, and also working out with light weights. I don't like the word, "cardio," but I like movement activities such as dance. I like to take a month off now and then to focus on other things I enjoy, like reading.

Laura Silvestre, Registered Mental Health Counselor Intern: I enjoy walking my dog around the lake everyday, jogging outdoors, going to the gym, and yoga.

Janet McCurdy, Registered Mental Health Counselor Intern: I am an avid walker, walking about 4 1/2 miles a day. Not only is walking a great exercise for me physically, but it is a time each day that I can listen to music, clear my mind or just enjoy being outdoors. I practice yoga regularly and also enjoy riding my mountain bike.

Rachel Lowe, Registered Clinical Social Work Intern: Various forms of walking- walking dogs or with my baby and window shopping, going on long nature walks, playing on the floor with the baby, and bike riding are my most usual forms of movement.

Kristin Solberg, Licensed Clinical Social Worker: So as most working moms can relate, you can imagine my horror when in the middle of a recent meeting, Sandee began going around the circle asking my co-workers what they did for "movement" in their lives. I felt like I was back in school and I immediately started panicking that she would call on me next! What would I say? I belong to the YMCA but I haven't gone there to exercise in around three years! The only time I enter that building is to bring my kids to basketball or swim lessons. I began thinking about what kind of movement I actually do and I was surprised by my answers.

As a working mom I am always on the go, which means lots of movement! I also take every opportunity that I have with my family to take walks, pull the kids in the wagon, ride bikes, go to the playground (no, I don't sit on the bench with my cell phone!), and to just play in the backyard. So although I may not have as much scheduled exercise time as I would like, I am certainly adequate in the movement department, more than I had realized! Phew! I DO have an answer.

Sandee Nebel, Licensed Mental Health Counselor and Certified Eating Disorder Specialist: I call myself the “ultimate cross trainer.” I take a Yoga class a few times a week: yin yoga, gentle Hatha yoga, or Iyengar yoga (I like to have lots of variety), you may have seen me walking my dog up to Park Avenue, and training at SSP. (I’ve recently hurt my back, , so I am restricted to walking and VERY gentle yoga....it's been a challenge and a gift of creating extreme self-care.)

Here are some of our suggested resources and tools for your physical activity routine:

• Personal trainers – one-on-one or in a group
• DVDs that you can rent or borrow from the library
• Walking clubs
• Group exercise programs

Check your community bulletin boards, local newspaper, gym or YMCA/JCC for listings. 

The Powerful Benefits of Physical Activity

At White Picket Fence Counseling Center, we talk a lot about the mind-body connection. Science has shown us that cultivating a positive attitude and peaceful thoughts can actually bring about physical healing.

Can it go the other way? Can increasing your physical activity help to ease your mind and calm your thoughts? Absolutely!

In moving the body, there’s an internal movement that happens at the same time. We feel more whole and well. We come back into our bodies with more physical energy and the stamina to keep up with our daily tasks or add new ones. It just plain feels good (thanks to the release of endorphins – those happy brain chemicals) and helps us be more optimistic.

If strength training is one of the right physical activities for you, you may notice that as you grow stronger physically you also start feeling stronger about your sense of self. It’s a beautiful thing.

These are just a few of the many mental, emotional and physical benefits of incorporating healthy movement into your life. Which ones have you noticed? Which ones would you add?