Danger and Safety for Women with Eating Disorders

Eating disorder behaviors, like bingeing or purging, or starving or compulsively eating are methods a woman uses to ease or ward off entirely, feelings of anxiety.

 If successful, the behaviors block the woman’s access to her feelings of fear. This may be a preferable state of being, but it can be dangerous.

 A woman can feel safe but not be safe.  A woman can be afraid and that fear can help her make herself more safe.

Reaching for immediate comfort to block fear comes in many forms. The result is that the woman can unconsciously accept a large degree of vulnerability and potential danger in her daily life.

 I’ll describe a few high-risk situations in this post and more in posts to come.

High Risk Home Environment

A woman lives alone in an apartment or a condo.  She is numb to a sense of anxiety that might come if she let her awareness awaken to the physicality of her home.

1. Her parking is not secure.  She may have to walk a block or more to each her front door.  She may park in an underground parking structure that is not well lit, not secure and leaves her exposed to predators.
2. The entrance to her building is not well lit, is shrouded with bushes, perhaps involves dark steps or a turn in a pathway that makes her invisible to others.
3. Her rooms are on the ground floor with unsecured windows facing a public walkway.

A woman who lives in any one of these circumstances may feel a low-grade sense of anxiety most of the time but not attribute her feelings to her vulnerable position at home.

She may criticize herself for feeling a bit anxious coming home and may feel shame when she runs to her front door.

Worse, and this is often the case, she is oblivious to the safety flaws in her environment and accepts as normal activities and events that may raise the level of potential danger.

If she were followed home (because of other unappreciated risk factors in her life) the person following her would have little difficulty in approaching her under these minimal secure conditions.

Certainly driving home alone after dark and then walking some distance to her front
door and/or walking through an area where a predator can lurk creates a dangerous vulnerability.

Safety Relates to Eating Disorder Recovery

Recovery from an eating disorder involves first creating a safe and secure container from which to do the psychological work necessary for healing.  Usually this is discussed in terms of the therapeutic alliance and the therapy itself.  And this is true.

But the early stages of psychotherapy and recovery from an eating disorder also involve creating a secure space or correcting a fragile space in the person’s external world.  She needs to be able to live reasonably safe from danger and more free to feel and progress on her healing path.

Also, in creating safety for herself, she can begin to learn that some of her fears are justified.  When she acknowledges realistic fears they can inform her about what positive and self-protective action she can take on her own behalf. 

This can be the beginning of developing confidence and trust in herself as she draws on her own power to genuinely care for herself.  This can be the beginning of solid recovery.

Well-lighted pathways, secure parking and other safe conditions are far more effective in keeping a person safe than any binge or purge or compulsive eating activity can ever be.

 

 

 

Eating Disorders: Response to Cry for Help

Today I received a long post from a young woman caught in a desperate tangle of bingeing, starving, guilt, shame and anxiety.  She is bewildered by her own experience and frantic to find relief without getting professional help.

Here is my response to her.  I believe she represents many young women in a similar position of suffering.

Dear S.J,

Reaching Out

Good for you for reaching out.  You are suffering and looking for a way to find relief.  That’s great.

You are in the throes of a serious eating disorder.  Looking for a way to end an illness suddenly and completely is understandable but not realistic.

You need treatment.

Shame Issues

I’m concerned when you use the word “confession.”  You are describing symptoms.  You wouldn’t feel shame about “confessing” a fever or lung infection or rash out of guilt and shame, would you?  I hope not.

Feeling severe pain would lead you to a health practitioner where you would describe your symptoms to help that practitioner help you.
 
Further, I don’t think you would expect a word or a one-time meeting to bring an end to your symptoms or your illness. Nor would you expect yourself to heal out of will power and determination.
 
Bingeing, losing all appetite or needing to binge during holiday visits with family, guilt, shame, quick weight loss diets to stop misunderstood eating disorder eating patterns, throwing food away as an attempt to control a binge and later digging into the trash to find that food and eat it are all symptoms of an eating disorder.

Feeling rushes of anxiety with these symptoms is part of the profile.  Being torn about keeping this emotional and behavioral turmoil secret and sharing it with someone who will offer support and ways to help is part of the pain and frustration of life with an eating disorder.

Past Attempts to Get Help that Didn’t Work

I’m sorry to learn that your attempts to see psychotherapists in the past were frightening to you.  I wonder how old you were, how the clinicians were selected and what the emotional environment was for your preparation to see them. 

Getting Help Now

You are older now, and perhaps in a position to select a psychotherapist based on criteria more of a match with your personal experience.

I encourage you to seek professional help from a clinician who knows about eating disorders and who seems warm and trustworthy to you. Looking for short cuts to address your illness willl only postpone recovery, and in the meantine your eating disorder can become more painful and disabling.

Resources for Finding an Eating Disorder Psychotherapist

For finding a local psychotherapist who knows about eating disorders please explore these urls.

Eating Disorder Referral and Information Center

National Eating Disorder Association

Academy for Eating Disorders

For finding support groups see:

ANAD National Association of Anorexia Nervosa and Associated Disorders ~ The oldest national non profit organization dedicated to alleviating the problems of eating disorders and promoting healthy lifestyles.

You can also work the action plan in my (free) Triumphant Journey Workbook . 

The exercises in the workbook may be helpful to you in preparing to do the deep work necessary
for your healing.

I’m going to post a version of my letter to you on my blog.  You raise issues that I believe will help others who are not as articulate as you in describing their anguish.

Of course I will not reveal your name nor will I post your words to me.

If I can be of more help to you, please let me know.

Warm regards,

Joanna

Parental Acceptance of Eating Disorders

One of the powerful and moving moments that occur in my work as a psychotherapist is when a woman, who never sought treatment for her own eating disorder, comes in for psychotherapy for the sake of her child. 

She couldn’t rally her strength for her own well being. But when she is pregnant or has a young child she finds the courage and determination to do her own work in order to protect her child from developing an eating disorder.

Often, a child has already begun to develop symptoms, but often too, not always, but often when the mother works on her own healing she is in a better position to support healing in her child.

Love and courage bring the mother in.  Love and courage create a powerful healing force.

 

Parental Denial of Eating Disorders

When adults are in denial about their own eating disorder, they can be in a position to deny the eating disorder symptoms in their child or children.

Parents can even be angry and punishing to a child with an eating disorder because the child’s behavior threatens the adults.  The child’s symptoms have the potential to force adults to look more closely at themselves.  These parents, who believe themselves to be loving and caring people, defend their denial and defend their distorted view of themselves and their child. 

The tragic paradox of this situation is that their denial causes them to neglect and punish the child. This unempathic, non-supportive and punishing environment only increases the need for the child to maintain and develop more thoroughly, her own eating disorder.

Seeing the child with empathy and realism would force the adult to recognize her own symptoms. This is one of the terrible tragedies in a family with unrecognized and untreated eating disorders moving through the system.

What’s the answer?  Pursuing health is always the answer, and courage is always required.

 

Eating Disorder Recovery: Amazing Day

Today has been quite moving and confirming.  It seems that when I begin to wonder if I’m making any headway in my work I get gifts.

Los Angeles Hong Kong Healing Bridge

Someone asked for help in getting eating disorder treatment in Hong Kong.  Then a post arrived from a clinical psychologist in Hog Kong who specializes in treating eating disorders.  She was thanking me for my work and asked for my list of in-patient programs.  I could match them up.  wow.

Reader Benefits from My Writing

Then a reader wrote several posts telling me how much my writing has helped her and that a story in my online workbook (Triumphant Journey) described her childhood exactly.  She said it was as if I had been an observer in the room seeing what was happening on the outside and also seeing her complex inner experience.  She says that my writing has been essential in her recovery.

Former Patient Brings Health and Hope to Third World Country

And then, one more.  A post came in from a former patient - so I can’t give you details - how I wish I could.  She has become internationally famous for her heroic work in third world countries saving countless lives while often putting her own life on the line.  She tells me that she loves her life now that it’s so full of meaning and that she is forever grateful to me for making this possible.

Gratitutde

I’m glad for my studies in Buddhism.  That helps give me images to hold these feelings. I’m grateful that people write to me, sharing their rich experiences.

 I’m in awe and reassured about my work and grateful to the healing life energy in the world and in me that can make what seems like miracles happen.  Just when my skepticism about human nature was rising, I’m met with what makes human nature worthwhile and amazing.

I think I’ll sleep well tonight.

 

Eating Disorder Recovery: Why “To Do Lists” Work and Don’t Work

 When you suffer from an eating disorder your psyche has developed in such a way that the eating disorder is needed.  Anyone with an eating disorder knows that deciding to “stop” doesn’t work.

If you have an eating disorder you also know that you do things unrelated to food that cause problems in your life.

Problem Habits      

Postponing anything or everything is standard behavior for a person with an eating disorder.  Withdrawing from social contact, immersing in reading or watching TV or other escapist fare is part of the life of a person with an eating disorder.  So is staying up late and/or falling asleep on the couch in front of the TV, always feeling tired, skipping breakfast, breaking promises and more.  If you have an eating disorder you can add to this list.

Decision to Improve

Every once in a while the person with an eating disorder will make a decision to improve her life. She rallies her energy and makes a list of what she needs to do to live better. She knows she can’t stop the eating disorder, but she will try to improve in other areas.

The “To Do List”

Your list might go something like this:

1.     Don’t watch TV (or limit TV to 2 hours a week or one or two favorite shows).
2.     Get eight hours of sleep every night.
3.     Eat a balanced breakfast every day.
4.     Call friends (or people who used to be friends) and invite them to something.
5.     Take a shower or bath every day.
6.     Get dressed nicely every day.
7.     Clean the house and get rid of clutter.
8.     Throw out junk food and binge food.
9.     Get to an employment agency and go on interviews for a new job.
10.   Take a class at a college extension program.

Okay.  Sound familiar?  These are all worthwhile tasks.  Usually a version of this list will its way into self-help programs, self-help books, blogs and suggestions from support groups, friends, therapists, and here it is on my blog.  It may be pinned up on your bulletin board.  A worn and faded version may be floating around in your desk or bureau drawer.

Does the List Work?

Does this list work if you follow the instructions?  Yes, following these guidelines will give a person an opportunity to improve her life. So if you follow your list you will improve your life, right?

So why doesn’t it work? Why does the person revert to the old behaviors despite the good intentions?

Why that List Doen’t Work

Here’s the key, the crucial piece that needs to be understood. All avoidant behaviors serve a function.

By avoidant behavior I mean anything that keeps people and opportunity away: being tired, dirty, smelly, raggedy, angry, bored, listless are effective blocks between a person and a more full life.)

All the things you do or do not do are based on the your psychological and emotional condition as you are  —-not as you wish to be, as you your are. 

Making a mechanical change in your life will bring the immediate consequences of the change, e.g. sleep more and be more alert during the day, don’t watch TV and have more time available for other activities.

But, making a mechanical change does nothing for the interior structure you needed.  That structure supports the old status quo that allowed you to bear your life. You need the isolation because you can’t bear the feelings that come up when you are more in the hustle bustle of life.

When the mechanical structure is tampered with, your psychological and emotional vulnerabilities are not protected.  Powerful feelings, usually frightening and painful, emerge in a torrent.

The old structure isn’t there to hold you.  So you will rush back to the TV or the junk food or the sleep deprived state to make yourself “okay.”  And, of course, you will be highly critical of yourself for “failing” again.

When Can the To Do List Work?

When does such a “To Do” list work?  In effective psychotherapy, you make a small change following such a list.  Your emotions will come up.  The psychology of your inner self will react.  You will feel pain, fear, anger, act out and both feel and actually be “out of control.” (Because the old structure isn’t there to hold you, i.e. keep you “in control”.) 

The Process

But, on the journey to health with a knowledgeable and caring psychotherapist who understands the healing system of a person with an eating disorder, that acting out can be held.  It can be understood, shared, processed and eventually brought to awareness and integrated into the whole of the person.

That’s the complex psychotherapeutic work in a nutshell.  When this piece is completed, you are a bit stronger and healthier than you were.  Then you will make another change. Again, your vulnerabilities are exposed with no structural protection except the new holding environment that is her therapy.  Again your feelings and acting out behavior find understanding and holding as you heal a bit more and grow a bit stronger.

And so again, you works down the list and add more complexity to that list as you enter a more full and complex life.

So, the list does and doesn’t work, depending on how a person prepares to deal with the inevitable consequences of tampering with the balance an existing system.

Value in Experimentation

Above all, experimenting with a “To Do” list, can lead you to a genuine recovery path.  Often it’s when we do everything we can think of, use everything we have available and still fail to accomplish our goals, that we then reach for something beyond what we know about.  That’s when we reach for teachers, schools, therapists, educational programs, creativity and spirituality practices, and healthy body movement experiences to grow beyond our limits.

If you have an eating disorder you need to reach beyond the limits of your abilities and risk trusting the heart and mind of another to find your way through that list to healing and a better life.

When your “To Do List” fails it may be just the signal you need to reach for your deep recovery work.

Bridge Building: from Spiritual Aliveness to Binge and Back

 

Feeling Alive and Hopeful

My last post brought healthy eating into connection with love, appreciation for life and gentleness with body and soul.  If you have an eating disorder, you’ve probably had glimpses of this experience and continue draw hope from these glimpses.

However, anyone with an eating disorder of any kind knows that such feelings are seemingly “off the planet” and out of awareness during the urge to binge or the urge to actively control anything or anyone. 

Feeling Like a Thing and Hopeless

When the binge or the bone cracking hours of treadmill running are over, when the empty candy and cookie wrappers litter the room, when friends and family are distant because of demanding manipulative remarks and actions, the person with an eating disorder feels ashamed, guilty and like a failure. 

What Happened?

What happened?  Where was the awareness of love and kindness for self, food and others?  How did the you become a driving thing, afraid and warding off more fear and pain by using anything you could to get through your experience?

During the glimpse of beauty and health, the desperate need to use is just as far away and non-existent and the good feelings are during binge times.  It’s as if the person’s mind or emotions or personality or even identity itself are divided and not in communication at all. 

Bridging the Two

This consistent aspect of eating disorders has me thinking about bridges and bridge building.  Healing from the bottom up is required for eating disorder recovery.  Picking up from where the person left off developmentally and proceeding on a healthy psychological developmental path is also required.

However,  It seems to me that a fundamental piece of this complex business of thorough healing from an eating disorder involves bridge building.  With a bridge the person, instead of being totally in harmony with spiritual aliveness or totally gripped by the eating disorder desperation, could hold on to reality.  She could have, at least a chance, to gain a foothold on emotionally stable ground.  Even if one side of awareness could just just throw a line to the other, it would be a powerful start.

Importance of the Link

As I think more I can imagine your asking, why would someone want a line from the binge side when the person is in the lovely love side?

Good question, and maybe pivotal.  Part of the answer may be that we need to respect and embrace ourselves as whole complex individuals.  We each contain the good, the bad, the ugly and the beautiful.  How to hold our own complexity and so experience ourselves as neither extreme saints nor sinners, but as humans full of ambiguities and paradoxes is a great challenge for all of us and especially for people working toward eating disorder recovery.

This holding of both or all sides of experience and identity is so very important during the process of psychotherapy.  In fact in psychotherapy many people discover for the first time that such a way of carrying themselves in the world is even possible.

A little bit of heaven in hell and a little bit of hell in heaven allows recognition and communication between the two worlds.  It’s the basis of internal bridge building.  It’s what helps us connect and understand each other as well as ourselves. 

Creating and using her internal bridge allows knowledge from both realms to join in a more powerful and healthy way of being in the world.  When you can simultaneously hold awareness of  your feeling of aliveness as well as your need to binge you begin to develop the ability to ward off extreme highs and lows, stay aware and be present for your own experience. 

I’ll be thinking and writing more about internal bridge building.  I hope you’ll share your thoughts and experiences about this area of eating disorder recovery work.

A mind not to be chang’d by place or time.
The mind is its own place, and in itself
Can make a heaven of hell, a hell of heaven.

John Milton (1608–1674)  
Paradise Lost. Book i. Line 253. 

Healthy Eating - A Memorable Lunch

My neighbor, Jody,  transformed part of her front yard into an organic vegetable garden. Two rectangles about 15’ x 6” bounded by wood framing are devoted to her “farmette”.  The median between her sidewalk and the street has wooden supports for the tiny tomato plants that are starting to reach for the sky.

 I walk past her house at least twice a day and sometimes four when I walk my dog, Winston. (He actually should take up more space in this blog because he is a co therapist in my practice as well as a friend in my life.)

 Jody, who loves Winston (everybody does), and I chat when her gardening time and my Winston walks coincide.  I love gardening too, but my garden is flowers, bushes, trees and citrus.

 Yesterday, a golden spring day, brisk, clear and filled with gorgeous scents, Jody and I talked, she from her garden and me from the sidewalk with Winston in tow.  (He’s what I am starting to call a “Corgier”.  Trans. Mixture of Corgi and Terrier.  27 pounds of gold and white shaggy energy, proud curled up tail, big brown eyes and a grin that lets everyone know he’s looking at the bright side.)

 Jody and I spoke of gardens, of the scent of her sweet peas, and the scent of my jasmine, honeysuckle and orange blossoms exploding in my garden.  She asked if I’d like a bouquet of sweet peas. 

 I responded, “Yes, There’s no other possible response to that question.”

 She cut about a dozen flowers and before she gave them to me asked, “Would you like me to cut you some greens for a salad?”

 “Yes, please.  That would wonderful.”

 She said, “You can go on with your walk while I cut them. I’ll have them for you when you get back.”

 I said, “I want to watch you cut them.  That’s part of the wonderfulness.”

 She smiled.  I smiled.  Winston continued smiling, but by now was lying down realizing our walk was at a pause.

 In a small brown paper bag Jody tenderly placed red romaine, sorrel, radicchios, cilantro, green lettuce, spinach and fresh sweet peas.  She laid the red, purple, white and pink flowers on top. She presented me with this gift that was full of beauty, caring and natural wonder.

 I felt the life energy of the soil that nourished and supported the growth of these living things that were full of the nutrients for life.  I felt the life energy of this woman who made the potential manifest.

 I felt and thought about how all life supports all life.  I thought about how all life must feed on life and how we humans need to embrace this fact with our hearts as well as our minds.  I thought of the giving generous nature of soil and I thought,  It’s about love.  It’s about life loving life and offering our lives to one another for the benefit of all with no demarcation about species or form.  

 Feelings given words and validated by the blooming spring day continued.  We humans need to expand our awareness of what actually is alive.  The love and ongoing generosity  of life giving to life includes the life force of air, sea, sun, moon, rock and stone. We need to cherish, honor and respect it all for healthy life and healthy eating to be possible.

 My lunch from that salad was exquisite – an all encompassing experience in healthy eating.

Transition to WordPress

In eating disorder recovery work, daily life and blogging, if all goes well, we develop and grow.

Growth inevitably involves change and the process of transitioning from one way of being or living or working to another.

So here I am, in the midst of public transition and change. I believe that I can offer more to people seeking information and support about eating disorders through WordPress.

So I’m learning the new blogging methods required, changing categories so they are more clear for you, and figuring out with my web designer and my WordPress for Dummies how to make this new system work.

Technorati is a big help once it’s connected properly. My biggest challenge is to achieve a free and relaxed enough feeling with the technology so I can speak to you about issues around eating disorders that I consider compelling.

This blog and I are developing during this transition. I wish for you something similar: a growing positive developmental change as you transition into more of the life you find fufilliing.

Catch 22 in Getting Effective Eating Disorder Treatment

Calling for Help

Many people with eating disorders call or write to me asking for help. They often face a dilemma.  I wonder about the people who don’t call or write because they may be in a state where they the dilemma prevents them from reaching out.

Positive Opportunity

Here’s how it goes.  A woman of any age or social or economic or educational level says, “I’m suffering.  I can’t live this way anymore.  I need help.”

Okay.  That sounds good to me.  The woman realizes her eating disorder makes a fulfilling life impossible.  She has reached the limit of her tolerance for pain.  Her denial system is breaking down.  She is ready to commit to the deep and sustained psychological work that can result is deep and sustained recovery. The next step is to discuss her experience in detail to determine what kind of treatment would best serve her given her life situation. Then I refer her to professionals in the field who I think may be a good match or she makes an appointment to see me if that seems right to both of us.

Opportunity Glitch

But.  She goes one.  “I feel so guilty and ashamed.  I try to stop this and I start again.  I was better for a week (or a month, or two days, or five months) but then I started again.  I have to stop being so weak and just do it.”

Uh oh.  Now she is succumbing to symptoms.  Guilt, shame, sense of personal failure are symptoms that accompany an active eating disorder.  If those symptoms are given power she will continue to attack and criticize herself.  She will refuse treatment because she feels certain that she should be able to stop her behavior from strength and will power.

She doesn’t appreciate the fact that she is trying to stop a symptom through will power in much the same futile way as a person who attempts to use will power stop lung congestion or a fever.  Will power cannot cure illness or disease. The belief that she can use will power to stop her eating disorder is one of the symptoms of an eating disorder.  This is a powerful dilemma.

When her will power fails to stop or cure her eating disorder she will feel more guilt,  shame and fear.  She certainly will experience more suffering.  And that can cause her eating disorder behaviors to increase. This is the road to despair.

She continues.  “I don’t want anyone to know.  I can’t tell _______(my husband, parents, friends, doctor).  Can you help me?”

 Wanting to keep her agony a secret is part of increasing shame.  It’s also related to keeping up a good front to others.  She does this because she is afraid other people will be disgusted with her if they knew the truth of her life. She fears that they would pull away.  She would then be more isolated, alone and afraid. 

This fear of instilling disgust in others and therefore making it necessary for them to abandon her is also part of the symptoms that accompany eating disorders.

The Catch 22

She asks for treatment which would hopefully  include symptom reduction. But those symptoms prevent her from getting the help she needs.  A woman needs to get past some of her symptoms on her own in order to reach out for effective treatment.

Getting Through the Obstacles

 The good news is that she doesn’t have to cure herself before she can enter treatment. That doesn’t make sense and is not required.  Her pain will push her to seek help.

If she hears often enough that some of her feelings are symptoms she might entertain  the possibility that this might be true.  She might rally her courage despite her fear and shame and risk putting herself in a healing environment.  With a competent and caring mental health professional who understands people with eating disorders she can begin real recovery work.

She doesn’t have to believe that some of her feelings are symptoms.  Wanting to believe may be enough to get treatment started. That desire to believe breaks the lock on the dilemma. 

When that lock breaks and real treatment begins she can start making her desire for recovery a developing reality.

 

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