White Picket Fence Counseling Center Newsletter Archives

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.

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.

How to Deal With Jealousy and Sorrow

As we see all the time in our sessions at the White Picket Fence Counseling Center, relationship problems are at the heart of most eating disorders. Often the underlying angst that’s causing people to act out with food can be traced back to an interpersonal situation.

I’ve been practicing yoga for much of my life, but I recently discovered just how much yoga can be a gift for those in recovery from food addiction and eating disorders. And this includes giving us a tool for how to handle difficult people.

Last week, I revealed the first two “locks” – two types of people that we deal with, and the corresponding “keys” that we can apply. Today, we’ll talk about the final two.

First are the virtuous people, who want to tell us about all of the good things they’ve done and everything that’s going well in their lives. For some of us, this could trigger feelings of jealousy or contempt, and even thoughts of revenge or sabotage so we can take away some of these good things (and maybe keep them for ourselves, as if that was possible!).

Instead, the key to dealing with virtuous people, according to this yoga philosophy, is with sheer and utter delight – celebrating with them and being glad for their success. As I suggested last week, you might need to use the 12-step slogan of “fake it until you make it,” but I guarantee you’ll feel better about yourself and have a more peaceful day.

The fourth and final lock – the type of person that might be difficult for you to deal with – is the wicked person. Just like with unhappy people, it can be uncomfortable or even painful to be with someone who seems downright evil. You may react and want to fix the person or situation, or get away from the person as soon as possible.

The key is to detach; approach this person with disregard or indifference. It’s the ultimate practice of non-attachment and setting boundaries. Letting someone be where they are without needing to take on the emotions or the problem.

12-steps programs such as Al-Anon and CODA help people who are dealing with co-dependency and boundary issues.

By responding with friendliness, compassion, delight and disregard, we can greatly improve our relationships with others. This simple system of locks and keys can bring the peace we find in yoga and mediation out into the real world of our day-to-day lives.

Maybe it can also help us deal more compassionately with ourselves, when it’s us having the negative thoughts or doing other things we’re not proud of. Maybe today we can detach from our suffering, delight in ourselves, feel proud of ourselves and be happy for ourselves.

Dealing With Difficult People

Much of what we deal with in counseling sessions with our clients is healing relationships. When you are recovering from food addiction or an eating disorder, difficult relationships can sometimes trigger the compulsion to relapse.

We can use food or exercise in unhealthy ways, or obsess about body image, as defense mechanisms that help us avoid dealing with people. Unfortunately, most of us aren’t given proper relationship skills growing up.

Maybe some of us learned some resiliency, but for the most part we have to constantly learn and re-learn how to navigate relationships, whether at work, in play, at home or in the community. Each lesson usually comes out of painful conflicts that are the underlying cause of our angst.

Whether you’re back in close quarters with family members over the holiday season, or dealing with difficult people at any time of year, the right tools can help you detach from the drama and stay committed to your recovery.

Though I’ve been practicing yoga for years, I’ve recently ramped up my study of yoga therapy and the principles of yoga. We’ve started a yoga therapy program at the White Picket Fence Foundation building, with more groups and classes planned for the future.

I’ve also discovered a fascinating, simple and effective concept for how to stay peaceful in all of the relationships and interactions in your daily life.

While it can seem as though we’re up against many different kinds of relationship problems, this yoga philosophy teaches that there are actually only four types of people we deal with – called “locks.” The beauty of this concept is that for every lock, there is a key!

Over the next two weeks, I’ll share about these four locks and their corresponding keys. With these four keys in your pocket, you’ll have what you need to navigate any interactions, even challenging ones, over the holidays and beyond.

The most important goal is to find peace, whether that’s through meditation, yoga, journaling, therapy, calling a friend or another tool. If we have a serene mind, we’re not in disorder or dis-ease and we don’t have to use or abuse food or our bodies because we don’t have to change the way we feel.

Mindfulness and Meditation Resources for Your Journey

This month we’ve been talking about mindfulness and meditation, including a video about the benefits of meditation and how to open your mind to meditation. Here are a few recommended resources if you would like to learn more about these topics:

Books

• The Relaxation Response by Herbert Benson
• Women, Food and God by Geneen Roth
• Natural Prozac by Joel Robertson
• Managing Stress by Brian Luke Seaward

Online resources

• Guided imagery recordings and other mindfulness and meditation resources from Health's Journeys by Belleruth Naparstek -
• Expert-recommended books about mindfulness and meditation at Shambhala Publications – including books by Thich Nhat Hanh
• Books and articles by Dr. Susan Albers
• Mindfulness mediation resources by Jon Kabot-Zinn

Recovery resources

For those in 12-step recovery, ask your sponsor or other recovering compulsive overeaters or food addicts about their experiences with Step 11. learning from others who have walked in your shoes can be a powerful and healing experience..

Related articles

A Few Mindful Moments Can Bring Powerful Healing

Open Your Mind to Meditation

What are the Benefits of Mindfulness and Meditation? (Video)

Open Your Mind to Meditation

I don't have a perfect meditation practice and you'll rarely find me sitting cross-legged or chanting. Yet I do have a regular spiritual practice that incorporates mindfulness and meditation. For example, I center myself each morning, and sometimes again in between clients or in between work and going home. Sometimes I take a moment for myself before making a phone call, to release whatever I might be thinking about and focus my attention on the present moment.

Meditation doesn't have to look like what you think it will. Open your mind to your own style and examine different resources and classes. At the White Picket Fence Counseling Center, we often hold free introductory classes where you can try things out before you commit.

A lot of people come to our Center to reconnect with themselves, and are surprised to realize that we incorporate so many physical modalities. As we discussed in a previous post, these physical activities can actually improve your brain chemistry, helping you to manage the stress of recovering from an eating disorder.  

You can practice mindfulness by sitting still, but you can also practice it when you're moving around, when you're having a conversation with someone. Imagine mindfully listening to another person! When is the last time you listened that way, concentrating on hearing their words and nuances, witnessing their body language, all without any inner dialogue going on about what you think or what you're going to say next?

There are different levels of mindfulness – you may need to work your up to the more traditional forms of meditation. Some stepping stones might include:

• Guided imagery
• Journaling
• Drawing
• Singing or playing music
• Stretching
• Making a collage
• Doing crafts
• Taking a walk
• Sitting quietly on a bench and watching people
• Experiencing something in beautiful in nature
• Taking a quiet moment
• Looking at art

For more suggestions, please see these previous articles:

Stillness Suggestions

How I Incorporate Spirituality into my Life

Some guided meditations instruct you to connect, mentally, with different parts of your body, for example to imagine your muscles clenching and then relaxing. For those with an eating disorder, it may feel too threatening or uncomfortable to connect with certain body parts. My advice? Start with your feet.

Most people find it safest to connect with the feet – though it's not always easy. At a recent training for MY Therapy (a combination of mindfulness and yoga therapy), when the instructor asked us to connect with our feet, we all laughed when we realized we had all looked down instead of just imagining our feet.

So open your mind to the idea of mindfulness, and find a gentle way to introduce this powerful practice into your life. You'll be amazed at the gifts you may find inside your mind.

What are the Benefits of Mindfulness and Meditation? (Video)

Meditation can help you get in touch with your feelings and gain awareness of things that are going on that may be causing you stress and leading you to restrict or overeat. Therapy and meditation can both be catalysts that clear away stuff so people can resolve things themselves and self-activate.

As you'll see in this video, meditation may reveal things you don't like or aren't ready to deal with. That's why it can be helpful to have the support of a therapist, therapy group, 12-step group, sponsor or trusted friend who can help you process your experiences and feelings.

Watch the Benefits of Meditation, by Andy Puddicombe, co-founder of Headspace: 

 

Meditation can help you uncover what's going on, and talking that out in therapy or other safe settings can help you get centered and clear to make healing changes. And maybe even reach enlightenment along the way.

A Few Mindful Moments Can Bring Powerful Healing

Whether you're someone who's not ready or interested to pursue a spiritual life, or someone who's looking for the way to strengthen a connection, mindfulness is an approach that is accessible to everyone.

At White Picket Fence Counseling Center, we hear a lot of people say things like, "I'm so bright in other areas of my life – why can't I get this?" or, "I've been so successful in my career, but I just can't get control of my eating or food issues."

The simple truth is that eating disorders don't make sense. We need to make sense of them. And the only way to do that is to tune in to what's going on inside. Not just in our minds (we're so used to living "from the neck up") but in our whole bodies.

Last month on the blog we talked about the mind-body disconnect of eating disorders, and how yoga is one very effective way to reconnect. A big part of yoga is an invitation to be still and look inwards, listening to your body (on and off the mat) and listening to your mind.

In yoga we call it meditation, but if that doesn't feel right for you, call it mindfulness. Being mindful of who you are, where you are, what you feel, what you know and what you want.

Some people have used the analogy of plugging yourself in, the way you would your cell phone. Whether you're re-charging, or even charging up for the first time, getting quiet and practicing mindfulness can help you achieve the feeling of being centered, or grounded.

When you're lost in the compulsion, obsession, discomfort and unease of an eating disorder, you can feel pretty out of control and out of reach. That's why virtually every recovery and treatment method recommends some form of mindfulness as a way of reconnecting the body and mind.

If you're still not convinced that mindfulness is worth the time or effort, consider this:

Imagine that you're driving along the road and all of a sudden someone pulls out in front of you and you're forced to slam on your brakes to avoid an accident. What's going on in your body at that point? Your muscles are probably clenched, as is your stomach (where digestion has actually stopped, so that the rest of your body's systems will be ready for whatever stressor you're facing). Your heart is probably racing from the urge of adrenalin.

In psychological terms that's called the fight or flight response, and it's a really good illustration of the mind-body connection. The good news is that just as anxious thoughts can cause stressful reactions in the body, so can relaxing thoughts cause healing reactions in the body.

And just as good news, relaxing bodywork can soothe the mind from anxious thinking to more positive and hopeful, actually altering your brain chemistry in the process. So we can see how mindfulness helps to heal both physical and emotional pain. Here is an article from Psychology Today about a research study that demonstrates how meditation positively alters the brain: http://www.psychologytoday.com/blog/choke/201110/meditation-small-dose-big-effect.

Over the next few weeks on the White Picket Fence Counseling Center blog, we'll explore the benefits of mindfulness, as well some methods and tools that you can start using right away – even just a few minutes per day could make a big difference to your mind, body and yes, your soul.

How the Principles of Yoga Can Help Heal Food Issues

Though I've been practicing yoga for years, it was in my recent yoga teacher training program when I started to realize the broad implications of the benefits of yoga. Just as the book Living Your Yoga implies, there are many places in our everyday life where yoga can apply.

Here are some of the yoga principles that have come up most often as I have counseled people with eating disorders and food addiction to "live their yoga."

• Letting go – instead of using food behaviors to bury uncomfortable feelings, let them go
• Getting centered – instead of feeling pressured and anxious, pause and come back to the present moment where you can make more self-compassionate choices
• Connecting to other people and to a higher power – food has been barrier between you and other people
• Tolerating discomfort – learning to sit with uncomfortable feelings will give you the power to move through them without using food or food behaviors
• Taking time to relax and regenerate – instead of feeling intimidated by silence and stillness as they compete with your busy mind, let it all go and give your body and mind the break they need
• Being grounded – feel a sense of support and connection to the earth below
• Soothing yourself – instead of reaching for food or other harmful behaviors, learn to self-soothe in healthy ways
• Surrounding yoursef with beauty – empower your sense of self-worth by choosing to indulge in healthy forms of joy and pleasure
• Witnessing without reacting – let go of judgment and practice accepting things as they come

If you're interested in learning how to apply these principles in your own life in recovery, watch for more details about our yoga classes. For those who want to go deeper, we will offer small yoga therapy groups and private yoga therapy.

Yoga practice is a safe place where you can feel both relaxed and energized. Through yoga you can learn to use these principles and apply them to your whole life, gaining clarity and a sense of rejuvenation, and freedom from the stressors of an eating disorder.

The Mind-Body Disconnect of Eating Disorders

For people with eating disorders, there's a clear disconnect between body and mind – it's like living from the neck up. Because that reconnection is so vital to recovery, many treatment methods are designed to realign the mind, body and spirit.

Getting back that connection helps people find acceptance, awareness and appreciation for their bodies, which naturally leads to wanting to take better care of themselves.

Drawing on my recent experience with yoga teacher training, and in partnership with some of my colleagues who are already registered yoga teachers and yoga therapists, we now have yoga and yoga therapy at the White Picket Fence Foundation.

Yoga is much more than just postures. In fact, some of my therapy clients have been benefiting from my yoga experience for years, as I've incorporated relaxation techniques like breathing exercises, guided imagery and meditation.

The benefits of yoga are well researched, and it is a natural fit to help with food issues. For example, many people have a problem with overeating or restricting during stressful times.Yoga works directly upon the nervous system to evoke relaxation and diminish stress. It activates the parasympathetic nervous system that promotes rest and regeneration and reduces the fight or flight response that brings anxious, stressful feelings.

In the next article, we'll explore some of the principles of yoga and how they can be applied to recovery from eating disorders.

How Relationships May Change in Recovery

As soon as you take your first steps in recovery from an eating disorder, your relationships will start to change. By the time you enter into the maintenance stage of living in recovery, you may focus more of your efforts to dealing with this. By now, you're feeling more comfortable about your day-to-day eating habits and you have many tools and people to reach for when things come up.

With the people who have been in your life for many years, there will likely be communication and relationships patterns that no longer fit with your new version of self. Now that you are more confident and comfortable speaking your mind, people may not know quite how to handle that.

Perhaps you used to be controlled by people pleasing, doing anything to avoid the guilt associated with letting someone down. Perhaps the people around you aren't ready to accept an inter-dependent relationship, rather than a co-dependent relationship with you. As you change and grow, not everyone in your world may jump on board. This is a big adjustment for everyone.

If you're not paying attention to these relationship issues, other people can easily trigger a "lapse" into unhealthy food behaviors, or even a full-blown relapse. Watch for sure-fire signs of relationship struggles, such as talking about other people's faults or wishing they would change. You will have more peaceful relationships if you remember that you can only change yourself. You are lucky enough to have these recovery tools at your fingertips – others are not as well-equipped. Practice compassion for others and healthy communication strategies that protect your recovery.

Your relationships can grow with you, if you give yourself and others the time and attention that are needed for long-lasting change.

Tools for the Recovery Stage of Life

A major part of your recovery will be gaining comfort and acceptance of your body. Whether or not your body size has changed in recovery, you can learn to love and be grateful for who you see in the mirror.

A distorted body image can be deeply embedded in people who are recovering from an eating disorder, whether that's compulsive eating, anorexia or bulimia. The food behaviors they reach for are used to disconnect from the body.

Recovery brings the opportunity – and the challenge – to be present in the body, perhaps for the first time.

To begin, you can use the following tools to discover your personal image and your connection to your body. Then you can start to learn where this story has come from. That way you can release any hurtful or unhealthy perceptions, and move into compassion and full acceptance.

I teach a model called "The Five A's" to guide people through this process:

1. Awareness (includes acknowledgement and anticipation) – Build your awareness of your current body image beliefs by journaling, meditating and talking about what you discover. Acknowledge your positive, healthy perceptions and anticipate the benefits of moving more and more into this new perspective.
2. Appreciation (includes achievement and abundance) – Practice self-caring and self-loving rituals that celebrate your body and all of its gifts.
3. Action (includes attention, amends, aspiration and accountability) – Take the necessary steps to care for and heal your body. You may have spent many years making unhealthy choices, but you can repair that damage one day at a time. Build and use a support team for this process (e.g., therapist, dietician, exercise buddy, therapy group).
4. Acceptance – The sooner you can accept yourself and your body as you are right now, the sooner you will be able to evolve into the next stages of recovery.
5. Affirmations – Talk to yourself kindly and positively, always choosing the perspective that everything you want is already on its way.