You know what you want.  You want to be solid and alive.  You want to capable of being seen and heard without going into anxiety. You want to be real and have a real life.

But experiencing an emotional crisis drives you to save yourself from intense and immediate pain.  You plunge into your eating disorder repertoire.

Eating Disorder Rescues

The eating disorder rescue looks like this:   You crawl under the covers trembling on the inside and afraid to come out.  Or you sink into the television, binge and do not answer the phone.  Or you binge in restaurants wearing what feels like your invisibility cloak or phony persona.  Or you binge in your car, alone and unseen.

You want to be safe and alive yet consider suicide.  Your goal is not to die, although some people die when they attempt suicide.  Your goal in moving toward the suicide act is to get away from the sense of being completely alone, rejected, abandoned, invisible, frightened and in imminent danger.

You may cut. Slicing your body, watching and feeling the blood flow feels like a relief from all the inner pressure and pain.  Your experience of life is too intense to tolerate so you drain out some of your life by
bloodletting.

Magnificent Promise

These emotional and behavioral binges offer the opposite of what you want and need to live a full, rich and satisfying life.

But, the eating disorder behavior offers one magnificent promise.  It will stop you from feeling the horror of the descending energy wave that quickly erodes your mind, body and soul.  In such a moment you are certain you would disappear, unseen and unknown, under the force of that wave unless the eating disorder behaviors save you.

Endless Anxiety Experience

This is the endless, lonely, and frightening experience of a person with an eating disorder. This is what you feel when you have not yet found your healing path or are in the early stages of recovery.

If this is you, then you may be under even more stress now as the people and systems you’ve counted on to care for you are being strained by the current economic turbulence.

Rush for Quick and Easy Solutions

Answers to your emergency questions are unsatisfactory.  Effective ways of caring for yourself require time, healing and focus on developing relevant resources. You don’t want to hear about a seminar or psychotherapist or resume writing class.

You jump at the chance to “talk to someone” in a meeting a friend may arrange.  But you are horrified and thrown into despair when a well meaning person exploring an opportunity with you asks you about your credentials and experience.  You struggle to maintain a calm persona while you are screaming inside.

The would be helpful person describes study programs where you can get a certificate or a degree.  Or he or she gives you a thick packet consisting of an application form that requires samples of your work. Or he or she describes the qualifications you need to gather together to enter a training program or gain membership in a relevant organization.

“No” to solution and “Yes” to deeper troubles (paradox)

You don’t want to hear these long range solutions.  Anything longer than a few hours is too long a wait.  You want to be rescued fast, right now. You want the money or the husband or the recognition or the car or the apartment or the job or the answer to all your troubles and peace of mind right now.

The unhappy paradox you face is that the binge response will give you fast relief, but only for a moment. You will quickly return yet again to your anxiety.

Choices

The eating disorder rescue path leads to despair.  Your only real choice that will lead you to what you truly want is the choice that gets you on your recovery path. Many people make that choice with committment, dedication and courage.  They get well. They get a life. You could be one of them.

More to Come
I’ll be exploring these questions around crises, what they are, how they are perceived, how and why a person with an eating disorder responds and what a person can do to respond with more health and skill in this six part post, “Eating Disorder Response to Crisis.”

Post from: Eating Disorder Treatment and Recovery from Eating Disorders Copyright 2008 - All Rights Reserved

If you have an eating disorder then you experience a crisis when you perceive, real or not, that the presence of a constant, reliable, important and nourishing something or someone leaving you.  Your feeling of being adrift and alone in a vast emptiness with nothing to hold on to and where no one can reach you or even know where you are is unbearable.

Regardless of what eating disorder you have you will feel the urge to do what works for you during periods of real or perceived loss.

Reaction

Depending on the severity of your disorder and the severity of the loss, real or remembered, you may binge on food or exercise or go into starvation mode.  You may cut or edge toward suicide. You can fall into a binge purge episode stretching across a range of once in one day to 15 or more episodes per day for many days.

If you have some degree of recovery you may find yourself saying to a friend or your psychotherapist,

“I don’t want you to worry about me.  I’m not going to do this.  But I feel like I want to tear the flesh off my bones.  I want to poke out my eyes.  I want to scream and pull out my hair.

“I won’t.  I’m not going to.  But I want to.”

What’s happening?

You recognize present or imminent loss that will leave you in endless inconceivable danger. You tremble on the inside.  You feel an endless energy wave descending on your skull which feels like it brings isolation, darkness and an endless fall.

You rush or clamber, stretch or grab, march, run or drive to your binge experience to block out these horrible feelings.

Examples of Loss that Can Trigger Perceived Crisis

When friends leave your home after a dinner party or when you leave friends after a social evening, or when your date goes home you may feel that relentless wave descending. You do your eating disorder activities to find quick a quick rescue.

Perhaps your psychotherapist or best friend or parents or favorite teacher is leaving town for a while.  Perhaps a man is withdrawing from your life or left abruptly.

Perhaps you changed your physical environment:  you changed apartments or moved to a different part of town or different city, state or country.

Change as Crisis

Change means something new starts and something familiar ends. Change means something is not the same.

Yes, this is simple reasoning.  But to the deep psyche of a person with an eating disorder, change relevant to a person, place or thing that serves as a life stabilizer is a crisis and perceived as a catastrophe.

Reaching for Solutions That Don’t Work

Will a binge bring forth warm understanding from a parent or spouse or romantic interest?

Will a binge stop you from losing your job or bring back love from a man or woman who is leaving you?

Will a binge help you pass an entrance exam or make friends in a new environment?

Will a binge help you find a psychotherapist or doctor or lawyer or dentist or electrician or plumber or automobile mechanic or anyone else you need to help you work through your present challenges?

No, of course not.  You know that.

Why Reach for Irrelevant Solutions?

Eating Disorder behaviors will not solve the realistic challenge facing you.

But you know you can’t bear the unbearable feeling of not just losing, but being lost.  You feel untethered, unconnected, invisible, unheard, ungrounded.

You feel and think you are in what could be an isolated, terrifying and endless free fall.  You must binge or act out in other eating disorder ways, to make yourself solid, to find yourself through discomfort or pain, and simultaneously numb yourself to emotional oblivion.

The solution that is irrelevant to your realistic challenge is effective in taking you out of your unbearable emotional experience.  It works.

You are flooded with pain and oblivion. You escaped your perceived crisis via drastic means which could even endanger your life. You won.

Your frustrating problem is that the eating disorder behavior solution only works for a very short time.  In fact, you might have to live your entire life bingeing, purging, starving and cutting to escape crises unless you make the courageous move toward  healing.

More to Come

I’ll be exploring these questions around crises, what they are, how they are perceived, how and why a person with an eating disorder responds and what a person can do to respond with more health and skill in this six part post, “Eating Disorder Response to Crisis.”

Post from: Eating Disorder Treatment and Recovery from Eating Disorders Copyright 2008 - All Rights Reserved

A psychology graduate student felt she could ask me questions about being an eating disorder psychotherapist and get some help in writing her case study because she read that my patients wait in a garden before their psychotherapy sessions. She said she felt welcome to write and ask because of my waiting garden.

Nature of Welcome

I lead with this because gardens do call us to enter. People put fences around gardens because a lovely, open garden invites us in. A garden can be soothing, quieting and can hold you regardless of what you feel or how you look or think you look.

Garden as Co-Therapist

Moreover, if you have willingness and eyes to see, a garden can show you the continuous flow of life force as you behold plants in every phase of development including birds, insects and other creatures that visit or inhabit the garden. Perhaps all gardens are healing gardens.

Over time you develop an appreciation of yourself as yet another living being in the garden. You discover you have a welcoming place and that you too both nourish and are nourishing to the growing life that is present and coming.

Yes, I consider my garden a potent and loving co-therapist. The grad student did not seem to know this with her left brain, but certainly got it with her right. That is why she wrote and opened the conversation.

Research/Case History Study Topics

The list of topics the graduate student needed to cover for her case study were:

1. effective interventions
2. client rapport building
3. assessment techniques
4. clinical theories that guide the assessments and
interventions that apply to the case
5. address clinical practices and describe transference,
countertransference, and termination issues.

Value of topics

These topics make a lot of sense in terms of learning how to be a psychotherapist. They are necessary in terms of background knowledge and an ability to think critically in order to evaluate what may or may not be addressed in the work.

However, if you are familiar with the growing knowledge we have in the field of neuroscience you will appreciate my saying that the list is primarily oriented toward the left brain.

The Other List from the Other Side of the Brain

Rapport, deep learning, personal connection, empathy, compassion, intuition, genuine and profound respect, courage, love, creativity - all essentials for both patient and therapist - are mostly right brain functions. They are addressed, researched and communicated via our personal and authentic ways of being in the world and with each other.

We, as psychotherapists, especially in the field of eating disorders, need these qualities in our work. We need to acknowledge, respect, encourage, nurture and support the development of these qualities in our patients.

Integration is Vital

Yes, a psychotherapist needs to be able to articulate theory and resources. Yes, we need to be able to form treatment templates in our mind and hold various points of view as we listen deeply to what our patients say and demonstrate.

However, for healing to occur both territories of information and brain function need to integrate in the mind of the therapist and be encouraged to integrate in the mind of the patient.

Healing Environment and Process of Healing

Being with one another in psychotherapy is like each of us being in the garden of the other. The patient learns to take in nourishment. She discovers herself growing and developing in a climate of compassion, knowledge and respect. She learns how to recognize and take in both more and different needed types of physical, emotional, intellectual and spiritual nourishment as she develops.

Her development and healing enriches the psychotherapist and teaches the psychotherapist how to provide new support for each of the patient’s new developmental stages. Soon patient and psychotherapist find themselves in a co-creative system in the office, much like the garden outside. And, much like the garden outside, new life and beauty, healing and health emerge.

Post from: Eating Disorder Treatment and Recovery from Eating Disorders Copyright 2008 - All Rights Reserved

Students of psychology, from grade six through graduate school, write me asking for help with their research papers on eating disorders.

Most want fast help in getting through an assignment, but some genuinely want information to help them understand eating disorders and what it takes to recover.

Questions are gifts

Their questions are gifts because they open my mind yet again and allow me to range over the field of eating disorder treatment and recovery. As I explore their questions I continually discover what I know, what I think I know, what I do not know, what I know or knew to be incorrect and what I wish I knew.

Today I received a question about treatment from a graduate student in the field of psychology who wants one day to work with people who have eating disorders, especially women who are high achievers in sports.

Her request inspired my next post.

Post from: Eating Disorder Treatment and Recovery from Eating Disorders Copyright 2008 - All Rights Reserved

The critical incident that triggers binge behavior may be an event in life, the threat of an event in life, or a vivid thought or feeling that may or may not relate to reality. It feels so personal it reaches the emotional depths of you.

When you believe you are in an unstable and precarious situation that threatens your sense of security you can feel that your very self is about to be obliterated. That particular internal experience ignites the binge or binge purge episode.

Changing nature of the eating disorder episode

Once you are in the obsessive compulsive episode, the actual and emotional experiences change form. The binge or binge/purge experience blocks your horrific feelings.  It  grounds your body so you feel more solid or gives you a sense of holding on to something that won’t go away.  It also numbs your ability to think outside the binge.  Your thinking stays rigid and only permits rethinking your catastrophic thoughts and how to continue your binge or binge purge behavior.

As the episode continues you feel a strong sense of shame and despair.  Physical pain enters the experiences,  and once again, you feel a tremendous fear of annihilation.

End of episode

If you are a compulsive binge eater  you will eat till you pass out.  If you are bulimic you will binge and move into a purge episode, perhaps many binge purge episodes.  You try to flee your experience by vomiting the contents of your binge.

No escape exists.  The end of the episode comes with physical exhaustion. You remain with the shame and fear.

Why?

What is the crisis experience that pushes a person with an eating disorder into such drastic behavior?

Where does this overwhelming sense of annihilation come from?

Why are drastic eating disorder episodes required to restore equilibrium?

Why are you willing to pay such a price?

Or are you willing?  Do you have a choice?

More to Come

I’ll be exploring these questions around crises, what they are, how they are perceived, how and why a person with an eating disorder responds and what a person can do to respond with more health and skill in this six part post, “Eating Disorder Response to Crisis.”

Post from: Eating Disorder Treatment and Recovery from Eating Disorders Copyright 2008 - All Rights Reserved

Understanding the Binge Response

To understand an eating disorder binge response to crisis we must understand the person’s lived experience while  she is in her precarious moment of imminent change.  It’s her inner lived experience, not the situation itself, that forces the binge response.

Focus is on understanding you and your internal world

Our focus is not about a particular crisis, trigger foods, eating disorder behavior or a description of a binge/purge episode.

The human being is the focus. You, your experience, what happens in your mind, heart, body and psyche is what’s important. What happens to you when your mind narrows to a binge beam and your body screams for immediate comfort and soothing is where we bring compassion, knowledge, sensitivity and caring attention.

Crisis Definitions:
·  An unstable situation of extreme danger or difficulty; “they went bankrupt during the economic crisis”
·  a crucial stage or turning point in the course of something; “after the crisis the patient either dies or gets better”

·  A crisis (plural: crises) may occur on a personal or societal level. It may be a traumatic or stressful change in a person’s life, or an unstable and dangerous social situation, in political, social, economic, military affairs, or a large-scale environmental event, especially one involving an impending abrupt change. More loosely, it is a term meaning ‘a testing time’ or ‘emergency event’.

More to Come
I’ll be exploring the questions around crises, what they are, how they are perceived, how and why a person with an eating disorder responds and what a person can do to respond with more health and skill in this six part post, “Eating Disorder Response to Crisis.”

Post from: Eating Disorder Treatment and Recovery from Eating Disorders Copyright 2008 - All Rights Reserved

Isn’t it odd how you sometimes need to binge for no apparent reason and yet function well during a major crisis?

Haven’t you wondered why sometimes you need to binge when nothing in particular seems amiss or when something tiny goes awry?

Perhaps you’ve wondered why you can move through part of a day or night without binging or purging at all.

I think about these questions as they relate to my patients and to the people affected by an eating disorder who write or call me looking for help and understanding.

Crisis Response

I heard a bulimic woman say that she stayed abstinent for days when fire forced her and her family to evacuate their home. But she binged and purged herself into major relapse  beginning one morning when, as she was getting dressed, her belt buckle broke.

Is a broken belt buckle a crisis?

What is a crisis?

What is a crisis to a person with an eating disorder?

The broken belt buckle was a crisis to the bulimic woman but maybe not to you or me or another bulimic person. Or does the experience of crisis depend on when the buckle breaks?

More to Come

I’ll be exploring these questions around crises, what they are, how they are perceived, how and why a person with an eating disorder responds and what a person can do to respond with more health and skill in this six part post, “Eating Disorder Response to Crisis.”

Post from: Eating Disorder Treatment and Recovery from Eating Disorders Copyright 2008 - All Rights Reserved

Self-care is essential during these stressful and unpredictable times. For a woman with an eating disorder, self-care is difficult in the best of times.

You may be experiencing more violent anxiety now as you and people and systems you’ve counted on to care for you are being strained by the current economic turbulence.

Now more than ever, you need a trustworthy and caring system to keep yourself functional and safe. The first step is to awaken to your personal strengths.

Give Yourself Breathing Space

Please say the serenity prayer ten times three times a day. Say it regardless of how you feel.  Just keep saying it.  Give yourself time and space for some breathing room.  Let some kindness sink into your psyche.

“God (or some force beyond myself), grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.”

Wake Up to Helpful Possibiities

If you are lost in grief and fear, if you are paralyzed with despair I suggest you, one time,  turn the serenity prayer around to give yourself an opportunity to step outside your own negative thinking.

For example,

God (or some force beyond myself) give me the emotional turbulence to try to change things I cannot change.

Give me the fear to be paralyzed about the things I can change.

Give me the ignorance to not know the difference.

You may discover you’ve been repeating in your heart and mind the reverse of the serenity prayer. If so, then you are reinforcing undermining beliefs.  This can be a wonderful wake up call that will allow you to reevaluate your situation in a fresh and more positive light.

FYI Medicinenet has an excellent article on stress: causes, poor and healthy stress management methods, unhealthy and healthy stress responses.

You are more positive than you may appreciate

If you are reading this post you are not as paralyzed and frightened as you suppose.  You are on the internet looking for something beyond yourself.  You want to go beyond your present limits, whatever they are. You have hope and you are directing your energy toward finding what will help you or even turn your life around.

Whether you are looking to help yourself or someone you love, the serenity prayer, used as a meditation practice, can help you free your creativity and reach through your desperation and paralysis to unexpected and positive possibilities.

Post from: Eating Disorder Treatment and Recovery from Eating Disorders Copyright 2008 - All Rights Reserved

Certainly not everyone with bulimia acts out their disease as I described.  But many do match the scenario in tmy last two posts and many are worse.  At least in the descriptions I gave, the woman got home.

I wrote the full bulimic episode description to make clear that bulimia covers a territory far more vast than eating behaviors.

The Stalker and Early Eating Disorder Recovery

It is not unusual for a new patient to begin her work with me by voicing her concerns about a stalker. Often we begin work by discussing the details of a relationship that has soured.

The relationship began when she was fully in her bulimic life.  When she is speaking with me she has already completed some of her recovery work without realizing how much she has accomplished.

1.      She moved past her denial and despair and allowed a glimmer of hope for healing.
2.      She put effort into finding her psychotherapist.
3.      She arranged her time and finances so she could come to regular session.
4.      She became committed to her recovery work.
5.      She began to tell the truth about her real lived experience.
6.      She began to put action into creating a better life for herself.

These are not the actions of the person she was when she developed the relationship with the stalker. She was then fully in her bulimia. Now she has begun recovery.  She has more self awareness and a changed agenda.

Attracting a Stalker

The symptoms of her illness made her a match for the man who needed a woman who would go blank or numb rather than feel pain, fear or disgust.

A bulimic woman, deep in her symptoms, needs kindness and caring.  She will often misinterpret an exploiter’s need of her as love.

Recognizing a Stalker

When my patient has begun her therapy work she is starting on her road to health and clarity. The man she was involved with doesn’t look so good.  As she becomes more healthy he may fall out of her life.

But often, he wants her back as she was.  He will make demands. He will be angry at her attempts to be well and to expand her life.  He will attempt to undermine her efforts in work or school or developing new friends and certainly, her therapy.

Her recovery work involves not only the psychological work of eating disorder recovery but also the practical and highly emotionally charged work of pulling herself out of the world she inhabited as a bulimic.  Unhealthy exploitive relationships have to end.

Benefits of Feeling Bad

When a man she thought was a friend, boyfriend or lover becomes desperate to keep her in his life she is often amazed, disgusted and then frightened when she realizes he is stalking her. He wants the woman he could use.  She is becoming a feeling woman who wants to climb out of the dark and into a life of health and meaning.

She may try to deny her feelings.  But the very feelings she sought to numb are the feelings that help her recognize her true situation with this man.  Her disgust and fear show her clearly that this man must not be in her life.

Genuine Self Care

In her fledgling state of recovery she must find ways to protect herself from a predator.

Learning how to take care of herself is vital for her survival and is a key element in eating disorder recovery.  She has to develop resources within herself to meet the challenges in her life and not rely on food to give her a false rescue her or take her consciousness out of this world.

From Being Lost to Being Found

The woman in my last two posts was raw and vulnerable.  She had no access to inner strength and no ability to recognize healthy, kind people who might guide her.

At some point we can hope that when she wakes up, she will feel her usual guilt, shame, fatigue, loneliness and, maybe, for the first time,  a determination to not go any lower than this.  If she hits her bottom, she’ll look up, for her way out.

And a way out exists.  Once she is open to recovery, she will ask the questions and see some hints of answers that will lead her to her recovery path.

Many people in my profession devote their lives to eating disorder recovery work.  See Academy for Eating Disorders and International Association of Eating Disorder Professionals.

Overeaters Anonymous provides help and support all over the world for people who are willing and able to move on their recovery path.

We are here for her when she’s ready to call.

Post from: Eating Disorder Treatment and Recovery from Eating Disorders Copyright 2008 - All Rights Reserved

Day 7 continued p.m.

You are out the door.  With firm, fast steps you head for your car. blood surging through your veins, heart pounding, stomach vibrating, electrical energy pouring out of your cells, you can almost hear your
body humming.

You get in the car, turn the ignition and love the engine roar.  It matches your own internal roar. You pause looking straight ahead with hands on the steering wheel. You don’t know where to go.

You drive anyway. You’ve got to feel you are going in some direction, feel some motion.

Options:

1.    You call a man.

You don’t call a woman because you want intense holding.  You want someone to be glad to match your energy.  To your way of thinking this must be a man.

An available man answers the phone – a former lover, a current lover, a barely known man who has flirted with you.  If he is sympathetic and welcoming you drive to his place.

You are as seductive as you can so he will hold you.  You want his touch to become intense.  You surprise him by pushing the experience, without preamble, into a sexual encounter.

He may go for it.  If he does, you feel relieved by the holding, scared by the sense of his emotional intensity.  You feel lonely and isolated as you pretend arousal you don’t feel to evoke more impersonal performance in him. You are numb to any erotic feelings.

No matter who he is he seems like a stranger after the encounter.  Not only does he seem alien to you, but also you barely have a sense of who even you are.

You may leave immediately.  You may try to turn him and the experience into some kind meaningful relationship. You play act.  You may believe you are in the middle of a committed relationship
that will last forever and at the same time feel like a moving mannequin.

Despite a sense of artificiality, you will yearn for him to call and days later feel heartbroken and bereft because he hasn’t.  Or you will feel heartbroken, bereft and disbelieving if he does call and simply wants another unadorned sexual encounter.

You may be horrified, heartbroken and bewildered if he calls and offers you a sexual encounter with his buddy or with a group of his associates.

2.    You’re in the car driving.  You can’t think of anyone to call.

You still are in the state where you want someone to be glad to be with you and match your energy.  Where is this man?

You stop at a bar or a restaurant that has a bar.  You walk into the bar; measure the men who might be candidates for what you want.  You might have a tiny flash of eye contact.

You sit at the bar and don’t look at anyone.   A man or men come forward to talk. One sends you a drink from across the room.  You like that.  It feels caring and glamorous. You feel that someone has seen you and wants to find you.

You feel unlovable, clumsy, ugly, awkward and hope that you can be seen as beautiful, desirable and lovable. You want to be held and cherished out of your pain.

3.    Now what?

Depending on how lost you are in your bulimic episode – yes, this is still bulimia even though food is not in the picture right now – you will talk with him.

Or you will make out with him in the car in the parking lot.

Or you will drive with him to a secluded spot nearby and have sex in the car.

Or you will go to a motel for sex.

Or you could go to one of these places and get raped by him or by more than just him if he’s the kind of man who would call his friends to join in.

You could feel held while a group of others use you sexually. If so you feel hidden and lost by the fervor or grim determination of their actions, numb to any kind of eroticism and hopeful that somewhere in this experience you will find the sensation you desperately believe you want and need.

You struggle to close down your mind when you feel isolated with these strangers whose voices, bodies and hands are unfamiliar.  And at the same time you hope that somewhere in this chaotic, sensual, frightening and exciting mélange is the man who will know you, satisfy you, recognize you, love you and protect you forever.

Day 8 early morning

He or they get dressed and leave.  He or they may or may not say good-bye.

Or you get up, get dressed and leave.  You might feel sad that he or they don’t ask for your phone number.

Or, if he or they ask for your phone number, you feel a crawly feeling and don’t want to give it.

Or, you fight against that crawly feeling hoping that your feelings are wrong and that he or they really do care about you and will give you another opportunity to find the holding love and care you desperately seek.

Maybe you got hurt, and are embarrassed that you are in pain.

Day 8 continued

You get in the car.  On your drive home you stop at a bakery.  You carefully select, one by one, a dozen doughnuts of different flavors. In the car, you eat every doughnut as you drive home.

Day 8 continued

You quietly let yourself in to your apartment.  You run water in the bathroom to hide sound.  You throw up the doughnuts.

Exhausted, you collapse on the bed, fully clothed, on top of the covers and pass out.

Day 8 through 10

You are groggy, feel unreal, quick tempered, guilty, dirty, ugly and fat for days.  You withdraw from other people or you  interact with others while telling the lie with your body and mind that everything in your life is fine.

You tell no one what happened during this episode and do your best to forget it yourself.

You keep yourself consciously removed from you experience by binging and purging every day.

You wait for someone to call you and make your life right. No one does.

Post from: Eating Disorder Treatment and Recovery from Eating Disorders Copyright 2008 - All Rights Reserved