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5 posts from March 2013

03/28/2013

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03/26/2013

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.

03/19/2013

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.

03/12/2013

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.

03/05/2013

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.