How Long Does It Take to Recover from Buliimia or Anorexia? Part II
Why does recovery from anorexia or bulimia take years? Because vital developmental tasks must be addressed, and development takes time.
Let’s look at what needs to be accomplished in recovery.
Psychological Function of Eating Disorders
Eating disorders develop to serve a protective psychological function.
1. They protect a person from being aware of what they cannot bear to know or feel.
2. They give a person a sense of control when the person has little real control over what’s important to them.
3. They give a person a private island of limited sensation and limited awareness. This is a defense that helps when a person is incapable of preventing physical, psychological or emotional boundary invasion.
4. They create an obsessive sense of entitlement to make up for the lack of boundary awareness or the lack of knowledge or skill in honoring personal boundaries or limits.
5. They protect a person through numbness and obsessive thinking from knowing what they feel such as anger, fear, disappointment, regret, guilt and shame. A person may even need to block feelings of love, passion and joy if knowledge of those feelings would disrupt the status quo of her environment.
6. Eating disorders allow limited but intense feelings to surge within the person and explode out as a form of relief from tension. These episodes are often highly dramatic and can be both manipulative and destructive in relationships.
7. In many situations eating disorders protect a person from knowing she is competent, intelligent, capable and creative when such knowledge might be disruptive to her present life and the imagined (and sometimes real) consequences are intolerable.
Necessary Psychological Development
Healing from anorexia and bulimia requires deep, rich and healthy development along many layers of the personality. When this is achieved the person can cope with the difficult ordinary and sometimes extraordinary challenges life presents without the protection of the eating disorder. Healing also frees a woman to be capable of giving and receiving honest emotions in worthwhile relationships.
As a matter of fact, healing frees a woman to actually be a woman.
I’d be glad to elaborate on any of these points. Please feel free to ask questions and share your opinions and experiences in the comments.
In the service of easy blog reading I’m trying to keep posts as short as I can while still giving you as much recovery information as possible.
In my next post I’ll talk a little about some of the work required to heal from bulimia and anorexia.
Binge Eater Discovery
A post just came in to my eating disorder recovery discussion board on www.poppink.com. The poster was shocked in her discovery that she is a binge eater. She is now looking for help.
I hope you can appreciate my gladness at her discovery. I’m not happy that someone has any form of an eating disorder. But when a person discovers that she does have an eating disorder that discovery is good news.
Now she has an opportunity to stop criticizing herself about her weakness, bad character, and all the other horrible and relentless judgments she makes about herself. Once she knows she has an illness, a disorder with a name, she can begin to look for guidance in her recovery work.
She can stop the endless pain of trying to do what doesn’t work and begin her path to health and freedom from those debilitating binges.
Joanna Poppink, MFT, psychotherapist, Los Angeles, CA eating disorder recovery specialist, bulimia, anorexia, binge eating recovery; www.poppink.com
Coping with Family Visits over the Holidays
Most people with eating disorders have experienced strained relationships within their family with one or more family members. Creating distance from family is an attempt to create a safe barrier in order to avoid familiar emotional difficulties.
However, separation from family during a holiday season opens up an inner black hole of loneliness, abandonment, isolation and terrific grief. The ideal holiday celebration images streaming in through media, billboards, music, street corners, malls, shop windows is in extreme contrast to the real experience.
Yet, to be with family triggers floods of anxiety because the family will be the real family, not the media images of the holiday. If the person is in the early to mid stages of eating disorder recovery she does not yet have the ability to protect herself and stand firm in the presence of the people who remind her of the original stressful situations.
Early recovery from anorexia, bulimia or compulsive overeating is a sensitive and emotionally painful and frightening time. The person is quite vulnerable.
Here are some tips on coping with family visits.
1. Decide in advance what boundaries you need to keep yourself safe and secure. e.g. separate room for sleeping (i.e. no sleeping on the living room couch) or other public places.
2. Let people know in advance that you have a food plan you need to honor. Make arrangements for the food you need to be easily available.
3. Set up a phone support team in advance. You make calls at specific times to specific people who will listen to your stress and your achievements with understanding. These people can be from eating disorder support groups, your psychotherapist, Overeaters Anonymous members.
4. If your feelings get out of hand, if you are on the verge of being overwhelmed, make your outreach calls and find an OA meeting. Put yourself in an environment where the top priority for others is eating disorder recovery.
5. And always, always: Don t get too tired, too hungry or too thirsty. Keeping yourself well rested, well nourished and well hydrated not only helps keep you healthy. It also helps keep your blood sugar levels reasonable and your emotions more even and mellow.
Please remember, the greatest challenge in eating disorder recovery is to recognize that you suffer from an illness and that your recovery depends on your bearing your own feelings. We all must live in the world as it is.
When your feelings are unbearable, as they often are when you suffer from an eating disorder, your challenge is to find healthy ways to reduce the stress in your environment. At the same time, since isolation is tempting but not a good idea, you need to find ways to build your inner strength so that you can bear more of the stress of life.
All this may seem like an arduous task. But you will be surprised at the joy and satisfaction you experience as you discover your own creativity and new skills in caring for yourself well. You’ll discover ways of being more at peace with your family. What’s more, you will like yourself better.
Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA
bulimia, anorexia, compulsive overeating recovery: www.poppink.com
Eating Disorders, Family Visits and the Holiday Season
People with eating disorders or in early or mid recovery
from eating disorders call for help more often during the holidays
than any other time.
If they are separated from family for any reason they feel
bereft. At the same time, if they are going to be with family, they
are flooded with anxiety.
The eating disorder behaviors, too much or too little, purge
via throwing up or exercise, are defenses against both real and
perceived dangers. Unfortunately the person with an eating disorder
often cannot tell the difference. She feels vulnerable and actually is
unable to take care of herself in many mild as well as severe stressful
situations that arise in family gatherings.
Options are:
1. avoid the family gatherings. consequence: feels lonely and abandoned.
2. attend the family gatherings. consequence: feels rage, fear and attempts
to control others
3. act out her eating disorder, i.e. binge, purge, starve and do what she is told:
consequence: is numb to people and stress around her, feels isolated among
people, feels guilt, shame and lots of tension.
4. call for help and commit to recovery work. consequence: provides herself
with support, encouragement and tools to withstand her stresses without acting out,
begins to develop health and strength so she no longer needs the eating disorder to
cope with her life including her family relationships.
The good news is that pain aroused during the holidays waken the person to the fact that her
issues are not about her personality or will power. Her pain can show her that she suffers from an
illness and can motivate her to begin or recommit to her recovery work.
Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA
bulimia, anorexia, compulsive overeating recovery: www.poppink.com
Bulimia Help Without Treatment?
Again I am asked: How can I help my bulimic friend without her going into treatment?
Example: (not real names) Miranda and Trudy are both in their late twenties, married and in their late twenties. They’ve been close friends for 16 years. Trudy recently revealed her 12 year struggle with bulimia to Miranda. Trudy only speaks to Miranda about the bulimia. Miranda feels she is helping by being the confidante and pitching in to help Trudy with family, household and business responsibilities. She also keeps a careful watch on Trudy’s behavior and emotional states. After two months Miranda is happy that Trudy has six weeks of not throwing up and pleads for help in knowing how she can help Trudy continue to get better without her going into treatment.
Please note that in this example, Miranda asks for help not Trudy.
When I hear this plea for help my heart aches for the suffering Miranda, Trudy and their family members experience. What is it that makes Miranda and Trudy desperate to avoid treatment for an illness?
My open letter to all friends asking this question:
Dear Miranda,
You and Trudy are not alone in thinking that bulimia is a behavior that can be stopped through will power and love. Bulimia is a serious illness that only grows worse without treatment. The acting out behavior involving food is only part of a long list of symptoms. Plus, as you understand from your knowledge of other illnesses, reducing or removing symptoms is not the same as healing.
When you say Trudy has made it for six weeks now! with an exclamation point, I feel an emotional aching because of the all too familiar false hope in your inferred sense of victory.
Trudy is doing her best to remove a defense, to stop a coping mechanism that helps her deal with unbearable feelings. Without the healing work that occurs in treatment, she has no defense against inner issues that plague her. She probably doesn’t even know what those issues are. Bulimia blocks not only her pain but also will block awareness of the source of her pain.
Your valiant efforts in helping her cope with her daily life tasks ease some of her stress. Your attentive and well meaning actions allow her to live without some of her bulimic defenses because you are providing the support she previously received from the binge/purge cycle. But you can’t carry the responsibilities of her life and yours indefinitely.
You?ll get tired. You?ll be under pressure to put your energy into your own needs or the needs of your family or your business. You?ll remember how much of your energy is required to tend to your own life.
As Trudy grows dependent on your energy as a replacement for the numbing caretaking of bulimia her needs and expectations will increase. Your energy and motivation will decline. You?ll want and finally, I hope, start putting more of your energy into your life and less into hers.
Gracefully or ungracefully, you will both will struggle with the effects your withdrawal.
And by withdrawal, I mean easing up. For example, you might do her laundry once a week rather than every day, or watch her children for two hours once a week rather than several hours four or five days a week. You might talk to her once a day rather than five times or even talk to her only once or twice a week.
When Trudy?s stresses - even normal everyday stresses - are present for her to deal with without your constant presence and without her eating disorder coping mechanism, she will go back to the binge/purge pattern to protect her psyche.
When the binge/purge cycle returns she will feel guilt, shame, humiliation, sorrow - and even despair. She might also feel angry with you for letting her down or feel bewildered and grief that you abandoned her. Those feelings can be unbearable and will only increase her need to binge and purge.
She will feel like a failure. But she hasn’t failed. She just tried to let go of a lifeline without developing muscle and ability to learn how to swim. Anybody who is drowning will reach for a lifeline.
And your being the lifeline doesn?t teach her how to swim or help her understand why and how she came to be so over her head in the first place.
So please, if you can, please, please help me understand why the way to get solid recovery, i.e. treatment, is something you both so actively avoid?
I would so appreciate hearing what you have to share about this vital question. So many people suffering from bulimia get well because of treatment.
Thank you.
Joanna
Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA
bulimia, anorexia, compulsive overeating recovery: www.poppink.com
Anorexia is an Illness, not a Life Choice
Despite publicity around eating disorders today, a major block to treatment
for some young people continues to be ignorance. Teen-agers may not get
treatment because influential adults in their lives believe anorexia is created by
willful stubbornness. Too often, the illness propels a teen to a precarious state of health before treatment, usually residential, is sought.
Because issues of power, control, independence and rebellion are normal in families
with teen-agers, symptoms of an eating disorder can be misinterpreted and not seen
for what they are: indications of serious illness.
Parents and adults in responsible positions who would be quick to call an ambulance
if a teen was bloodied, or quick to call a doctor if a teen was running a high
fever may not see anorexic symptoms as a signal that requires fast professional
attention..
The calls from young people can be heartbreaking.
Voices: (paraphrased and summarized)
… i sometimes can admit to myself that i have this problem,
that getting thinner and thinner day by day is only going to kill me, but
most of the time i just deny it all together. the one time i tried to see
a therapist, i heard him say on his way into the room that he couldn’t
understand why these g.d. kids insisted on starving themselves. i
clammed up and never went back.
… My coach said, i always thought you were too smart for this sort of thing:
you are the girl who has it all: grades and friends and looks and a great athlete.
with so many other kids looking up to you, you owe it to them to be a little smarter.
the "you’re too smart for this" thing wiped me out. do people
really think i don’t know that what i do to my body every day is killing
me?
…my parents are so proud of the way I look and how great my
grades are. I heard my mom say, ‘She’s amazing. She even gets
up early so she can run on the treadmill for two hours before she
starts her day. That must be where she gets her energy because
she doesn’t have time to eat.’
….We (people of any age with suffering from anorexia) can’t choose to
erase the fear of food and calories. We can’t eliminate the panic that
arises every time we eat more than the allotted number of calories or
foods that aren’t safe to us.
…We’re afraid all the time. We’re being as courageous as we can, even
if that courage isn’t strong enough to let go of our obsession.
The challenge we as the human community face is to raise the level of
eating disorder awareness in families, schools and all the health professions
so that we can help our young people quickly and effectively in the
early stages of anorexia. Even better, we could get on the path that
would eliminate the development of anorexia entirely. That’s my wish.
Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA
bulimia, anorexia, compulsive overeating recovery: www.poppink.com
How women with eating disorders surrender their power to exploiters
Often women with eating disorders feel generous, powerful in
their relationship with a man and at the same time they feel weak,
exploited, bewildered and afraid they will be abandoned.
In general, and we can talk in more detail if I see that you are
interested, in this all too common situation.
Again, in general, women with eating disorders are harsh
in their self-criticism. They also do not use their gifts such as
creativity, intelligence, endurance, determination, resourcefulness,
education, or talents in the service of their own hearts desire.
They feel like failures because they are not living up to abilities they
sense are within them.
Other people (who may not even know they have a tendency to
use others), perhaps a romantic interest or friend or family member,
will see the abilities an eating disordered woman is not using on her own behalf. They
will applaud the woman for having such talents and resources.
They will also invite her to be involved in their projects.
She will be delighted.
They then feed her compliments that are deserved about her talents.
She will feel relief and pleasure at being recognized as the valuable person she is.
What she cannot give to herself, she gives to them.
Examples include these scenarios: She helps them start or run a business.
She designs and perhaps also creates promotional material for them. She
extends herself financially to shore up their poorly handled money situations.
She entertains their friends and associates magnificently. She fields their
phone calls making excuses or apologizing or lying for them. She smooths
their difficulties in work and personal relationships. She tends to their
personal well-being.
She can do this for any person she wants to please and hopes to make love her.
A certain type of person is happy to take what she is not using. A few compliments
and a sincere looking smile, an expression of yearning and need will evoke in her a
hopeful joy that she can meet the person s needs and find appreciation and love.
Once she is giving and feeling vital to another person’s life she will feel good
about being competent and productive. She’ll continually postpone the effort required
to nourish and make real her own dreams because she feels strong in what she
accomplishes for the other person.
Eventually she will like a weak failure in terms of her own life. But she sill convince
herself that the other person’s life is her life and that she should get satisfaction
from this. The other person by design or through the routine of this unbalanced relationship, will expect
the system to continue, has become an exploiter and will build up that belief in her.
This belief can become so strong that she becomes arrogant. She may feel a sense of
superiority created by her self defined noble self sacrifice or contributions to the other’s successes.
This superior attitude can be off putting to others who are shocked by her obliviousness to her
acceptance of being willingly used.
At some point she will feel tired and drained. She may protest or request
relief. Too often she will her fatigue as a badge of honor, as proof that she is
giving her all and proving her love.
If and when she tries to put some of her energy into her dreams the
exploiter will speak in a supportive way but will actually attempt to sabotage
her efforts or become actively abusive. The exploiter may also accuse her of
being selfish and too sensitive for wanting to withdraw or limit her services
in any way.
She will be terribly hurt and bewildered by this reaction and won’t
understand how someone who has been so reassuring and full of praise could
attack her when she wants something for herself.
Unfortunately she often thinks the other person is right, that she is selfish
and too sensitive. Then she does even more for the exploiter in an attempt to get
what she thought was a loving person in her life to be loving again.
It can take years before she understands that the person will say and do
anything to keep her supplying his or her needs and ignoring her own. Too often
she never understands and becomes a tragic figure when she is discarded.
Her grief or eventually, rage will plunge her more deeply into her eating disorder.
For some people, this kind of intense flood of emotional pain will bring them
to psychotherapy, perhaps for the first time. They come for relief. If they
stay they have a chance to do their real recovery work.
Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA
bulimia, anorexia, compulsive overeating recovery: www.poppink.com
Mothers with eating disorders
Women with eating disorders can be mothers. Some come to my practice
because they want to heal for the sake of their children. They do not want
their children to have eating disorders or suffer because their mother
is ill.
These often are women who could not rally themselves to put their own
well being first and get help earlier. Maternal love pushes them to be stronger
and more courageous and determined than they dreamed possible. They
seek recovery for the sake of their children.
At a garden party last week end where most of the guests were new parents
I heard one mother voice concerns I hadn’t considered. I felt startled and humbled
by my own thinking deficit. She spoke to me about a situation I am not likely to
see in my practice.
Her child is three years old. One of her child’s best friends from school is being
raised by a mother with an obvious eating disorder. That three year old child is
concerned about carbohydrates and about getting fat.
The mother I was speaking with didn’t t want that influence on her three year old
daughter and was struggling with the idea of breaking up the friendship between these
children. She is probably going to put an end to play-dates with the child from the
eating disorder situation.
I can appreciate the mother’s concerns for her child. Eating disorder thinking
and behaviors are beginning in children at increasingly younger ages.
My hunch is that the mother with the eating disorder would be horrified to learn
that her illness is apparent and already having a powerful effect on her young daughter’s
emotions, thinking, behavior and social relationships.
Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA
bulimia, anorexia, compulsive overeating recovery: www.poppink.com
Symptoms are not people
People with eating disorders often don’t know the difference between their
symptoms and who they authentically are. Our culture doesn”t help. Women and
men are often applauded for some symptoms and criticized for others because our
culture doesn’t recognize the difference between a symptom and a healthy human
being.
Long before I became a psychotherapist I read the book, Captain Newman,
M.D. The book made a powerful impact on my developing sense of being human
with other human beings. One scene in particular, stayed with me then and
remains a vivid image today.
Captain Newman, M.D. was made into a movie starring Gregory Peck, Angie
Dickinson and Bobbie Darrin. I wondered hopefully if my favorite scene would
make the editor’s cut. It did.
Peck, in the title role, was a psychiatrist in the army in charge of a ward full
of PTSD soldiers.
At one point Peck is with a seriously disturbed patient, played by Darrin.
Darrin is wildly upset and Peck is shouting.
Later the nurse, Dickinson, expresses her disappointment and horror with
Peck saying, "How could you shout at your patient like that?"
I can still remember the flood of new awareness and compassion that filled
me at that moment in the story.
Author, Leo Calvin Rosten, gave me an early lesson in how to perceive as a
psychotherapist. Symptoms are not people.
This theme will come up often in my blogs. A powerful and profound
aspect of eating disorder recovery occurs when a person with an eating disorder
discovers that she is a valuable human being with untapped riches that are blocked,
not by her character or basic nature, but by symptoms.
When a person even gets a hint of this fact, she feels a surge of hope and
renewed dedication to getting well.
Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA
bulimia, anorexia, compulsive overeating recovery: www.poppink.com
Early Inspiration in Eating Disorder Recovery
Eating Disorders define a person’s life. An eating disorder requires
intelligence, strategy, commitment, endurance, strength, organization
and secrecy, money, acting skills, ability to influence, persuade and
manipulate others repeatedly. I’ll go Into more requirements to sustain
an eating disorder in another post.
An inspiring question that often helps an individual get on
her healing path is this:
"If I used all the time, energy, skills, strategizing, intellectual and
emotional involvement I devote to my eating disorder to something else,
what could I do in life?"
This is often a staggering question, and people are shocked by
the answer that occurs to them. Answers come in many forms, usually in a
low murmuring voice with a hand over the mouth where I can barely hear
and actually need to ask for repetition.
support myself and my children."
"I could write my book….make my film…..design
my clothes…..start and run my business…..
create a school….."
who has been living a limited life controlled by all that an eating
disorder involves.
And maybe those possibilities are real. The point is that when a
person genuinely looks at everything she does, thinks, feels, says in
a day that involves her eating disorder and then thinks about what she
could do what that energy and those skills if she were free she gets a
glimpse of a new world.
world if she were free.
She doesn’t know what she would do or how, but she gets an
emotional and physical sensation of freedom, just for a moment.
She gets a sense of what might be possible if all her resources could
be channeled toward something that would make her life worth living.
Sometimes people ask that question of themselves, and the revelation
leads them to psychotherapy. Sometimes people need to be asked.
When I bring that question to people with an eating disorder I see
faces change. Eyes fill with tears. Voices quaver, so afraid to speak what
seems too good to be true A feeling of bewilderment and hope permeates
the room. This momentous shift in awareness and sense of possibility
always touches my heart.
It’s a long road between that moment and full recovery, but that
moment of awakening can be the start of a deep and rich healing journey.
Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA
bulimia, anorexia, compulsive overeating recovery: www.poppink.com
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