Caught red handed.

I recently received the following feedback from another eating disorder treatment professional regarding my approach as she perceived it from reading this blog:

“It appears [we have] a differing philosophy in treating eating disorders. We don’t help clients to lose weight or make that part of our treatment plan. We help them regulate eating and discovering the underlying issues driving the ED behavior. Sometimes that results in weight loss. In addition, we have found that keeping the focus on weight and a restrictive diet maintains the ED. We do not recommend elimination diets such as the Whole30 as this is another way the ED stays active.”

I had rather a lot of feelings upon reading her response.

The first of these was the hot flush of shame, and thoughts that I’d been caught doing something wrong by an authority. Incidentally, shame and a fundamental belief in my own “badness” is one of the “underlying issues driving the ED behavior” that I unearthed in my own early treatment experiences. This was followed by a roller coaster of anger and defensiveness. So, first I dealt with the feelings: 73 deep breaths, a draught of lavender essential oil, a big glass of cold water and a long walk with my partner to talk it out. Thus soothed, I returned to my critic’s words for some reflection.

Going back over the feedback line by line, from a less emotionally reactive place, I made an interesting discovery: what she wrote has absolutely nothing to do with me or my treatment philosophy. In the words of Byron Katie, her response is not my business.  The feedback I received was the author’s reaction to my blog, which reflects her thoughts, her beliefs and her agenda, none of which are my business.

What is my business are my reactions in thought and feeling to the feedback I received and what I choose do with those. I could rant and rant here about how my post about the Whole30 virtually insisted eating disordered clients not do a Whole30. I could be all righteous and s@#t, but the only person ingesting that vitriol and raising her cortisol levels would be me.

Historically, I would have reacted to these kinds of difficult thoughts and feelings with a cascade of eating disordered behavior, but I’ve learned that the core of recovery is to employ mindfulness in order to be on guard for my triggers and access alternative coping strategies accordingly. In terms of treatment philosophy, this is also what I teach my clients, and what I have intended for this blog to reflect.

Here’s an another potential twist on things: my initial response to the feedback was an angry and defensive “That’s not true! I know what I’m ‘supposed’ to do in this field and I do it!” But what if, for the sake of argument, everything she wrote is accurate? Would that be bad? While the author of the comment reflects the conventional wisdom of our field, I am not entirely conventional in my approach.

While I certainly don’t make weight loss a part of every treatment plan, depending on the context and goals of my client, it’s sometimes included. For example, if I’m working with an obese binge eater who is trying to avoid knee surgery by losing weight, and that goal is the only thing that’s motivating her to work for recovery, then I’m going to honor that goal. We’re still going to need to explore the underlying issues supporting the eating disorder, and regulate eating, but in my experience not every person who wants to lose weight wants that from a disordered or distorted place. To my way of thinking, this is not dissimilar from noting that weight restoration is a goal for an anorexic client.

So.

This is me. This is my blog. These are my words. These are my beliefs. Some people won’t like them, and that’s ok. Some people will like them, and that’s ok, too. Ultimately, neither of those things are my business; my business is to make sure that I am ok with what I put out onto the interwebs, and for today, I am.

 

 

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Why the why is so key.

The Whole30 I did recently with my partner can definitely be filed under the heading context matters. The program was a no-brainier for him: struggling with IBS, overweight and taking a hit in the self esteem department, he was a prime candidate for a lifestyle change. My context, on the other hand, was a bit different: having spent a good part of my adolescence and 20s struggling with an eating disorder, and breastfeeding our infant exclusively, I was (appropriately) apprehensive about any plan that involved restricting my food intake. But, I am the primary food shopper and menu planner in our family (by inclination and by choice) so I really wanted to find a way to make a Whole30 work because it wasn’t realistic for him to do one without me, and supporting his health is an “I love you” I want to choose every time.

I did my due diligence, including reading and rereading this important article, and talking with friends and a counselor before deciding to take the plunge. The vestigial ghostly eating disordered part of my mind knew that, done mindlessly, this was a perfect chance to accidentally get too skinny, and I had to have daily conversations with that voice to keep myself honest.

I did a number of things in order to intentionally “fail” at losing weight on the Whole30 as a breastfeeding Mama in eating disorder recovery. This was not easy, friends. I had the “perfect” opportunity to relapse, and it required real intentionality to choose self love and health throughout. (I’m bragging right now. I am very proud of myself. Just saying.) I cut out any exercise beyond the babywearing up and down the stairs with laundry variety. I put gobs of coconut milk in my coffee. Breakfast was three eggs, a sweet potato spread with ghee and a palm full of olives. I ate dinner portions 150% larger than my partner, who is five inches taller than me and a former ice hockey player. To steal Melissa Hartwig’s phrase, I ate all the things.

When we weighed ourselves again after the month long program, I had stayed exactly the same weight, which while a disappointment to the ghost, was a victory and a milestone on the path of my ongoing recovery. (My partner, on the other hand, reports that his IBS has literally never been better managed and that he lost a significant and healthy amount of weight.) I did have a number of non-scale victories over the course of the month, by the way. My sleep, digestion and overall energy levels all improved. I broke a nasty MyFitnessPal habit I had developed postpartum. I reset my sweetness meter. I actually made more milk for my baby. Wins.

So why am I sharing this? Because choices. Because mindset. Because motives. These all matter enormously. So often in recovery, it’s not what you’re doing or what’s on your plate, but why. Many people do a Whole30 to lose weight, but it doesn’t have to be about that at all. Same goes for anything else you or I choose to undertake, be it exercise, a relationship, a career change… all of these can be recovery wins or purposeful self-sabotage.

You choose.

Answering this Question is Key to Recovery

Today’s Food for Thought, from Anne Cuthbert, M.A. of http://www.foodisnottheenemy.com

“What does disordered eating and body image protect you from? Do the constant thoughts distract you from thinking about or feeling about other parts of your life? Does it keep you in a safe world that you can control? Does it give you a good excuse to not go somewhere or be with someone in which you feel uncomfortable? There is always a reason for it. What is it for you?”

Coping isn’t a five letter word (it has six).

In my last post, I referenced having a long list of things to do to distract and calm myself “that I actually use.” While the list is personal, the concept and potentially some of my options are universal, and so I offer them here.

Marsha Linehan’s DBT manual features a list of “Adult Pleasant Events” in the Emotion Regulation curriculum, and I have often poked fun at the suggestion therein to chop wood, but the reality is that for the right person, that’s a great idea. When you’re overcome by either an overwhelming, extreme emotion or an intense urge to make what my preschool aged son calls “not a safe choice”, finding the right distraction, alternative outlet or self-soothing strategy is key to making it to the other side of the experience without making your life worse.

Before I get to my own list, there’s another DBT concept worth mentioning called Willingness, which is part of Linehan’s Radical Acceptance module in the Distress Tolerance portion of the DBT curriculum. Willingness is set in opposition to Willfulness, and it basically means you have to actually give recovery strategies an open-minded, whole-hearted chance. Example: refusing to try an alternative coping strategy because your special, special pain could never be helped by something as simple as taking a walk. That’s willfulness. Example: sticking to your commitment to actively engage in  15 minutes of a self-soothing strategy that sounds stupid and pointless at the outset before reassessing your desire to give into an urge to binge. That’s willingness. I’m not a huge believer in the magic of the cosmos, but I will say that the number of times I’ve gotten a phone call from a supportive friend at minute 14 of the aforementioned scenario is uncanny. In other words, it’s often not just the calming or uplifting properties of the strategy that gets you through, but rather, the shift in mindset to being willing to make space for recovery that makes the difference.

So, without further ado, here is my (partial) go-to list of Adult Pleasant Events. I’ve chosen my top few tried and true because this post is brought to you by a napping infant who is likely to wake up soon.

  • Leave my current space. Like it’s on fire. I have often found that making the choice to leave the place where I’m upset or triggered opens a fresh perspective. Sometimes this means going outside for a walk, other times it means going into my mother-in-law’s bathroom to cry with the sink running.
  • Serenity (it’s an essential oil blend, not an ephemeral concept). Because the olfactory nerves terminate near the amygdala in the brain, scents are highly evocative of emotion and memory. I have found that Serenity consistently evokes feelings of peace and contentment for me, as well as now being associated with memories of previously having coped well.
  • Making and drinking a cup of tea (usually decaf jasmine green because it reminds me of my sister). This one is multi-faceted. A watched pot never boils, and I use that to my own advantage and stand with the kettle while it heats, which forces me to slow down and opens an opportunity for mindfully observing my thinking. The warm steam and aroma as the tea steeps offer a soothing sensory experience, and also evoke memories that calm and uplift me. 
  • Drinking 20 oz of cold water out of a Mason jar. The Mason jar evokes memories of the supportive friend who first introduced me to the joys of vintage jars, as well as humorous ones of the various clients who have seen my jar and accused me of drinking moonshine in my office. The coldness of the water forces me to slow down and pay attention because I’ll be rewarded with brain freeze if I don’t. Also, I associate water with cleansing, which can work as a metaphor in moments where I’m working through a difficult emotion like shame or toxic anger.

Just drink a glass of water and your eating disorder or depression will be cured forever! sounds like an obnoxious article in a self-help magazine, but it’s not the strategies themselves that do the heavy lifting. Yes, it’s useful to find strategies that speak to you and tap into your particular set of memories and preferences, but the real magic comes with cultivating willingness to employ them.

You Have to Do It.

During my time out of the office, I’ve been reflecting quite a bit on success. As in, who have I worked with who has really nailed it and made a major improvement in their quality of life and functioning? What has been necessary to drive my own ongoing success in recovery? And how can I boil those answers down to help others better?

What I come back to, time and again, is action. For myself, and others, insight is great because it can provide valuable data regarding why a pattern or behavior started and is entrenched, but it’s basically useless if you don’t act. It’s entirely possible to spend years in therapy making insight after insight and seeing absolutely no change in how it feels to live your particular life. 

For example: Thanks to insight gained in my own treatment, I know exactly why being home alone makes me vulnerable to the siren song of eating disordered urges. However, learning that did nothing for my recovery until I learned to turn the knowledge into action. Now, not only can I predict when those ugly urges will surface, but I work to a. Minimize the likelihood that I’ll be faced with them b. Decrease my sensitivity by actively cultivating positive associations with being home alone and c. Having a long list of things to do to distract and calm myself that I actually use.

This is not groundbreaking information, but it makes a huge difference in outcome, and a surprisingly small number of folks actually approach the work this way. Why? Well, for one, it’s hard, especially at first. Acting on your insights often requires a kind of brute force, blind faith approach at the beginning because the action is often uncomfortable, new and scary, and probably runs counter to a lot of (distorted) beliefs. However, the discomfort wears off fairly quickly once you start to do your insights because evidence builds up that the new actions are working in your favor. 

In other words, you have to take a leap. The classic metaphors here are about letting go of one trapeze to grab the next, or letting go of your leaky life boat to grab a solid buoy – in both cases, there’s a deeply scary moment where you’re holding onto nothing. 

The question I ask, in my office and of myself is, how is that leaky raft working for you? We have the illusion that there’s a choice, to act on our insights and behave in new ways, or to stay in the current patterns. The reality is, you’re drowning. If the new raft is leaky, too, you were going down anyway, which while not exactly cheery, makes my point that, scary or not, you’ve got nothing to lose and everything to gain by taking action based on insight.

But, you have to do it.

What would it be like to start now?

This isn’t exactly the most dramatic “I’m back!” post, but…

here I am.

Elizabeth Alice was born 7 weeks ago this past weekend, and early motherhood (now of two, which is challenging squared, not challenging multiplied by two) has been beautiful, messy, occasionally heart-breaking and totally worth it.

Also, I’m tired.

Which is what got me thinking about this post – the experiences of birth and early motherhood are a profound reminder of the immense impact that physical health and self-care (or lack thereof) can have on emotional well-being.

I’ve been through this before with my son in his infancy, but the interruption of sleep several times a night for the first few months, combined with the body’s recovery from any birth trauma, the re-organizing of hormones, and never having two hands free at the same time (well, almost never) can seriously undermine two things: your emotional well-being, and your ability to do anything about it.

How is this all related to eating disorder recovery? (Because it so is.)

The collection of behaviors associated with any eating disorder, be it severe restriction, binge eating or purging are similarly destabilizing to the body, and therefore to the mind. And as I think I’ve mentioned before, your brain is connected to your body at the neck. Malnutrition, wacky electrolyte balances, dehydration, type two diabetes, impaired digestive health… All of these are common results of disordered eating, and all of them can pretty severely impair your functioning.  In a way, that makes having an eating disorder a lot like postpartum depression. A brain in a sleep-deprived, malnourished, or otherwise compromised body is not a happy brain.

In many cases I’ve seen in my practice, the depression and anxiety a person is experiencing along with their eating disorder are either caused by, or at least deeply exacerbated by, what they’re doing with food. Additionally, the physical sequelae of the disorder directly impair the ability to recover. Dr. James Greenblatt, whose article I’ve just linked to, is the Chief Medical Officer at Walden Behavioral Care and a solid resource for information about these connections.

Example: gut health. Anorexia, bulimia and binge eating can all do a number on the intestinal flora that allow for happy digestion, or may be in part caused or exacerbated by gut microbe issues (for a good overview, check out this article). So what? Screwy gut health can make you gassy, bloated, malnourished or overweight, as well as depressed, all of which make recovery way harder.

If my anorexic client is faced with the task of learning to eat again, and she’s depressed, and every time she eats she feels bloated and therefore “fat” because her belly bugs are out of wack, how’s that going to go?

If a binge eater has done solid work to decrease binge episodes and is enjoying food in moderation again, but  his gut flora are keeping him both depressed and overweight, how will that impact his motivation?

Luckily, we can make lifestyle and supplementation choices that may right the ship, in terms of gut health, and could thereby have a profound impact on (linking to Dr. Greenblatt again) recovery. In my own experience, the use of a probiotic supplement and digestive enzymes made the early phases of recovery, as well as maintenance, far more bearable. When my body was better able to handle the food I needed to eat, and eating gave me energy rather than a distended stomach, trusting the process was more of a possibility.

So, in summary because apparently I’ve missed writing and gave you all a novel here: the postpartum period has been an important reminder to me about the intricate links between physical and emotional wellness. You can’t feel good if you don’t feel good, if that makes any sense. I’ll be returning to my practice with renewed empathy for why this link makes eating disorder recovery so extra challenging, but also a renewed belief in the importance of supporting my clients in tending to the bodies their minds are trying to live in.

(I’m not a doctor, so this isn’t medical advice, but rather for information purposes only. Please consult your doctor before making the decision to try any supplement.)

Perfect.

This may very well be my last blog post before I head off on maternity leave, so I thought I’d address something I need to be reminded of myself – the absolute fallacy of perfectionism, which is a trap many people who struggle with disordered eating fall into (as well as many mothers).

When we approach our lives from the perfectionist perspective, anything that is not “perfect” is a failure. This eliminates the vast majority of how most people function from day to day from the success category. For example, it’s an important goal of mine not to snap at my son. If he’s having a very mischievous morning, and I make it through almost the whole thing using the kind of measured tone I’m aiming for, but eventually get so exasperated that I bark at him about putting his boots on, what kind of mother am I? Perfectionism suggests I have failed. A more balanced perspective notes that if I said 100 things to him, and 99 of them were on target, I’ve just gotten a very good Mama grade.

This isn’t just semantics – our emotional health and efficacy as people in the world are at stake when we choose the perspective from which to view and experience our actions. In the above example, if I take the perfectionist route and castigate myself for failing as a mother that morning, a number of nasty things will happen. First, my self esteem will tank, and so then I’ll be in a lousy mood, which means my temper will be rubbish and I’ll actually be far more vulnerable to engaging in exactly the sort of behavior I’m trying to avoid – snapping at my son.

When perfectionism is a part of disordered eating, it often plays strongly into a vicious cycle of restricting and binge eating. “I don’t know what happened, I was doing so well” is a phrase I hear often, and it usually comes from an individual who has set themselves up with an unrealistic and/or inflexible eating plan. If I’m “supposed” to eat only whole grains, and at a work breakfast, the only options are more processed, and I function best when I don’t skip breakfast, and have a bagel with cream cheese, how am I doing? Perfectionism says I’ve failed (and if you’re a failure today, you might as well go ahead and have a muffin and a Danish and…), but a more balanced perspective means I can pat myself on the back for making the best of the choices in front of me and move the heck on with my self esteem and motivation intact, far more likely to continue to be successful-ish for the rest of my day.

This is the important part, which is why it is in capital letters: YOU WILL ACTUALLY BE MORE COMPLIANT AND CONSISTENT IF YOU’RE NOT TRYING TO BE PERFECT.

Perfectionism is the enemy of success because it is demoralizing and leaves no room for learning from mistakes, or even making them. I’m not suggesting you adopt a sloppy, anything goes attitude. Goals and setting expectations for oneself are very useful tools, but only if wielded with some sanity. If my goal is to exercise 4 times a week, and I exercise 3 times, have I failed? (Hint: NO.) No. How can that be a failure if 3/4 of the time I did what I set out to do? If I reject this as a failure, I also lose the opportunity to celebrate and reflect on what made my success happen the 3/4 of the time that I did meet my goal, or to explore what the obstacles were on the day when I wasn’t as successful.

This stands out in the article I linked to above: “Wouldn’t it be good if your surgeon, or your lawyer or financial advisor, is a perfectionist?” said Thomas S. Greenspon, a psychologist and author of a recent paper on an “antidote to perfectionism,” published in Psychology in the Schools. “Actually, no. Research confirms that the most successful people in any given field are less likely to be perfectionistic, because the anxiety about making mistakes gets in your way,” he continued. “Waiting for the surgeon to be absolutely sure the correct decision is being made could allow me to bleed to death.”

And now, if you’ll excuse me, I’m going to go have a baby. She’ll probably be perfect.