Yes, we eat six times each day.  This is one of the very first conversations that I have with a new client when she enters treatment.  This concept is so difficult for someone with an eating disorder.  In fact, it’s pretty mind-blowing for her.  She always thinks that there has to be some control or compensation involved to maintain a healthy body weight.  This is generally true for all the eating disorders.

Our dieticians create a meal plan that is composed of three meals and three snacks per day.  It is adjusted for the calories needed for weight gain, weight loss or weight maintenance depending on what the client needs.  If one is on a weight loss meal plan it is possible to loose weight by eating six times per day! The client never believes this until it actually happens.  She doesn’t have to restrict/purge/exercise to loose weight and she doesn’t get hungry.

Hunger and low blood sugar can contribute to a binge.  If a client is satiated from eating just a few hours before, she may make better choices.  Also, low blood sugar will create a strong desire to acquire a quick fuel source such as ice cream, energy drinks, candy, etc.  People with eating disorders are usually stuck in a cycle that they are unable to interrupt.

For the client that has a history of restriction it is easier to eat the required number of calories in six portions through out the day.  Usually, she will experience improved mood and improved cognition with regular eating.  In fact, the majority of clients will admit to how impaired they were before eating regularly.

Most staff will become accustomed to eating six times per day.  We pull out our snacks right on schedule as our appetites are used to eating this way.  It helps to maintain our energy too.

In her first week at home, Suzi was overwhelmed by fear even after seeing her therapist.  She tried to remember what she did before treatment when she had such strong feelings.  Ah, of course!  Purging  took away the fear and numbed her so she wouldn’t feel anything.

Two weeks out of treatment, Suzi was at a turning point. Would she decide to use the tools she learned in treatment or would she continue secretly binging and purging? 

In most treatment programs, staff is judicious in teaching the client exactly what to do every day after she leaves treatment.  She can be in touch on a daily basis with her aftercare counselor.  She can begin the day with an inspirational reading and a few moments of deep breathing.  She can plan what she’s going to eat for the day.  She can plan exactly what part of her day might produce anxiety or fear and what she’ll do if that happens or even who she’ll call.  These are merely a few examples of what might work for Suzi.  Hopefully she has a structured plan she made while in treatment.  The plan is something that she can immediately fall back on when and if she begins to struggle.

The road to recovery is long and hard. No one travels it perfectly.  There are many slips, trips, and lapses. Those who eventually do recover learn to pick themselves up, shake it off and keep on going. By doing so, they keep small slips from turning into full-blown relapses.

Suzi has a choice — which will it be?

Eating Disorder Treatment Rarely Fully Covered by Insurance Companies, Lisa S. Kantor of Kantor & Kantor, Offers Helpful Information for Families and Loved Ones

Insurance denials can be life-threatening and now, insurance companies are starting to feel the pressure to recognize eating disorders as a serious mental health issue, says Kantor.

Northridge, CA (PRWEB) January 13, 2015

Dealing with an eating disorder is extremely challenging and being denied insurance coverage makes these times more stressful than they should be. Looking to the insurance provider to fully cover treatment is often a mistake since it will leave patients and their families caught off-guard. Insurance companies are feeling a huge amount of pressure to see eating disorders as a serious mental health issue.

According to the New York Times, an estimated 11 million Americans, mostly young women, suffer from eating disorders, the most serious being anorexia nervosa, in which people starve themselves, and bulimia nervosa, in which they engage in binge eating followed by purging. These disorders, particularly anorexia, have the highest fatality rate of any psychiatric disorder,” (Eating Disorders a New Front in Insurance Fight: New York Times, October 13, 2011).

The Employee Retirement Income Security Act (ERISA) governs if the patient has insurance through their employer. Policyholders need to pay attention to authorization of a treatment, payment time, and where they can get the treatment they need.ERISA is tricky and often interpreted to the benefit of the insurance company. The court will often consider only documents which are part of the insurance company’s file so make sure copies of all documents are sent to the insurance company. Additionally, policyholders should read their policy thoroughly so they know what is covered and their rights under ERISA.

Patients have a choice of staying in-network or choosing a doctor or facility out-of-network. Challenges include covering out of pocket costs, authorization by the insurance company, being allowed enough time to stay in treatment to get well. A key factor is educating facility administrators on how to deal with insurance companies so everyone gets better outcomes. The best way to approach eating disorders is to treat to the outcome, not be limited by insurance. There is a lot of hope for recovery and it is important that insurance denials do not get in the way of helping those with eating disorders.

Families of those suffering from eating disorders are strongly urged to look at what resources they have before deciding the course of treatment.  An insurance company may not see certain treatments the whole way through although many residential facilities succeed in helping patients no matter what. (How to Fight for Coverage of Eating Disorder Treatment, Nasdaq.com, January 07, 2013)

Insurance denials can be life threatening.  Knowing the reason behind an initial denial is the first step towards appealing the decision. The insurance company may not see the eating disorder treatment as medically necessary but lawyers can help with the appeal process or file a lawsuit against the insurance company. Always talk with a doctor about what treatment is needed since the insurance company will almost always make business-based decisions.

Watch Video

“Everything must be in writing,” states Lisa S. Kantor, founding partner of Kantor & Kantor, LLP. “These can include letters of support from doctors, dieticians, family members, and even home videos. Make copies of any documents you have and submit them to your insurance company. The more you can document the better your chances are for a successful claim. I recommend taking notes when talking with the insurance company and confirming the conversation in writing.  Just remember, it didn’t happen unless you write it down and mail it to your insurance company.”

When the insurance company is making a business decision about coverage, it is necessary to fight with them to get the needed medical coverage time in treatment. . The fight is ongoing against insurance companies to cover treatment for eating disorders so don’t give up because one day the struggle should end and loved ones will get the coverage they need.

For resources and more information, visit our website or call 888-569-6013. Lisa Kantor is available for interviews, call Phoebe Nolan or contact Lisa on Twitter @lisaskantor.

As with any mental health diagnosis, eating disorders come with many stereotypes. Most often, eating disorders tend to be oversimplified by the general public as merely a reaction to social pressures about food and body image. Or, it is assumed the patient is probably just victim of exposure to a sport or industry that pressures people to maintain low body weights.

With steady diagnostic surge among males and the rise in increasingly younger AND older patients, the outdated image of the white, middle-to- upper class teenage female no longer works when we’re talking eating disorders.

Incredibly complicated diseases, most recent research suggests eating disorders actually result from a complex web of factors interplaying into the perfect storm. Genetics, social & familial factors, neurobiology, stress, and physical illness are just a few examples.

Eating disorders are further complicated by the fact that they are not just mental health issues. While the mental aspect is incredibly debilitating, the patient may also be suffering with complicated medical issues, which also need to be treated. In some cases, the medical issues may need to be the primary concern and treated first.

With their alarming mortality rate surpassing any other mental illness and half of the deaths resulting from medical complications, acute attention must be paid to each patient’s medical stability. Stereotypic images of stick thin, media-hyped models like “Twiggy” and “Kate Moss” along with assumptions of “teenage angst” leave many doctors overlooking the severity of a patient’s physical condition. Surmising everything as a routine “phase” can lead to failure of thoroughly examining co-occurring or underlying medical complications like gastroperesis, a condition where food is slow to leave the stomach.

Though still underfunded, eating disorder research continues to progress every month. We now know gastrointestinal distress commonly correlates with eating disorders. So far, though, it is assumed that the eating disorder causes the digestive distress.

While some cases may be logically explained by a history of prolonged disordered eating, what if this is the root factor issue for others?

GI issues, such as gastroparesis, GERD, and colonic issues, can actually pose a close presentation to anorexia or bulimia when people begin to fear food and the discomforts of digestion. I’m left wondering how often digestive disorders are assumed to be eating disorders and misdiagnosed. Including the diagnosis of a mental illness in one’s chart changes the course of the medical care one receives and should be decided with thorough consideration.

Patients with core digestive issues are at risk of being treated improperly by the mental health system. The primary diagnosis as eating disorder sends the patient down the path of behavioral and mental health based care, where actual “true GI issues” are often minimized or ignored. Because of the “eating disorder” diagnosis, the patient is assumed to be fabricating the distress to get out of eating. Other times, the facility is just ill-equipped and inexperienced at managing the patient’s particular physical issues.

I know someone suffering with GERD and gastroparesis, who was misdiagnosed in the beginning of her illness. It is possible her initial symptoms could have been controlled with prescription medication. Almost a decade after “x” number of eating disorder program admissions, for an eating disorder she doesn’t think she even had to begin with, she now has to have a feeding tube and possibly additional surgeries.

Thousands of dollars have been spent on “conventional eating disorder treatment centers” that repeatedly missed the target. It also seemed to introduce her to a culture of “ED” that she never knew existed before. While rare, it is almost as though she learned how to have an actual DSM-V eating disorder by being in the wrong level of care.

Where do we go from here?

First, we need to continue to push for research funding toward eating disorders in general. For example, The NIH has allocated only $1.20 in research funding per affected eating disorder patient, compared to $159.00 per affected individual for schizophrenia, less than 1%.

Following suit with recent research data, eating disorders and feeding disorders have been coupled together in DSM-V. For example, anorexia and avoidant/restrictive food intake disorder are in the same category. Evolutions in eating disorder diagnosis have occurred in each of the most recent revisions to the DSM. It seems logical that some digestive and gastrointestinal disorders may also impact food behaviors that result in weight changes, food intolerances, preoccupation with food, and body image distress.

Physicians need to be mindful of this possibility as many of these same complaints come from patients with eating disorders, blurring the diagnostic lines leading to possible confusion and diagnostic error.

In the case where both digestive issues and eating disorder issues are present, individualized care is absolutely vital. Special accommodations not normally thought of as acceptable by eating disorder programs may be necessary, such as supporting a dairy-free or gluten-free diet.

If treatment providers could approach each patient as if they were assessing an eating disorder for the first time, fewer assumptions would cloud their ability to make a complete and thorough assessment.

Editor’s response from Mirasol ED Recovery Blog  Publishing Editor:

My first read through of Faith’s blog sent chills down my spine. I had to include my response because only in the last couple of months have I connected the dots between my own eating disorder and digestive distress.

I have high functioning autism traits and am easily fixated. I always had a heightened interest in food. I loved to play restaurant, make mud pies, and even had a toy grocery cart full of plastic food.

I also had a lot of extreme food dislikes and food preferences.

Eating is a multisensory experience, from the taste, texture, temperature, and even the sound of eating.

My sensory issues probably contributed a bit to my lengthy dislike list as a child, but I now wonder how much of this was also my body’s intuition telling me to stay away from foods that were causing physical distress and discomfort! In fact, it’s taken me several years of experimentation to find food combinations that work best for me. Though completely balanced with ample variety and nutrient content, most non-integrative treatment centers would consider my eating preferences eating disordered. Looking back, many of my “odd” food preferences were things that were naturally soothing to my digestion.

Basically, I’ve always had food stuff, eating disorder or not. Laxative, suppository, and enema abuse presented as my first clinically detectable eating disorder behavior, which all started at age 10. After having to receive an enema for severe constipation due to IBS, I was instantly hooked on the sense of relief from having a cleared out colon after such prolonged
discomfort.

This also happens to be the age when I developed suicidal ideation that eventually became chronic suicidal obsession. Stress and anxiety attacks usually correlated with more IBS flares and spasms. Of course prolonged laxative abuse only exacerbated the GI distress.

A a lot of factors merged together to create grounds for my perfect storm. In addition to depression, autism, and gastrointestinal distress, I also felt the social pressures to be thin. I was bullied for many things, including being chubby.  Perfectionistic in nature, I once checked out all of the eating disorders books available at the school library. I have an innate drive to be good at whatever I do, and the eating disorder was no exception. I became especially pre-occupied with becoming emaciated, which only worsened after my first inpatient stay, further triggered by exposure to severely ill patients. I didn’t openly admit this at the time but I also adopted a lot of ED rituals out of desire for belonging in the ED community. Socially awkward, I desperately needed to fit in somewhere. I definitely didn’t fit in at school or home.

Eventually, and it actually didn’t take long, the eating disorder became my entire world.

It leaves me wondering how the course of my life may have unfolded had my ASD and gastrointestinal issues been diagnosed when I was a tender ten.

When I was in treatment, I always complained to treatment providers of distracting sensitivity to my digestive track while following prescribed meal plans. I routinely experienced bloating, pain, constipation, diarrhea, and even hemorrhoids. Without exception, my voice was always dismissed as eating disordered thinking or ordinary body image related distress.

Digestive Disorder? Eating Disorder? Both? Great topic, Faith!

Order your free 2015 Gurze Resources Catalogue for the newest eating disorder related print publications, recovery tips, and treatment center resources!

Ten Things I Wish Physicians Would Know About Eating Disorders by Edward P. Tyson, M.D., Austin, TX

The most important things physicians need to know have to do not with technical aspects of assessing or treating physical aspects of an illness, although those are important. It is about the physician first addressing his or her own attitudes about eating disorders and those who have those illnesses.

1.  Physicians are lucky to have people with eating disorders as their patients. People who suffer from eating disorders are a special group. Almost without exception, they are empathic, creative, intuitive, hard working, and usually gifted in at least one of the following (and quite often in all 3): academics, creative expression, and athletic endeavors. When these sufferers are free of their illness, they are incredible people to know and be around. And their recovery encompasses all the reasons why, hopefully, most doctors go into that profession.

2.  Don’t be afraid of an eating disorder.  It is an illness, with signs and symptoms and causes, and really good treatment. What other illness would a physician feel so inadequate about and also not seek the advice of colleagues or the literature? Sadly that happens so frequently and it is the topic of sufferers, family members, and professionals in the eating disorder field. Please do not be one of those people we talk about like that. Get educated or get help, but do not ignore, dismiss, or fail your professional responsibility.

3.  Eating disorders will test one’s ability to be humble. These are some of the most complicated illnesses there are, as they involve both complex medical and psychiatric issues. In addition, there are not that many medical experts around, so, yes, most doctors will feel like they are in unchartered territory. And you will make mistakes; we all do. But learn from them and approach the problem in the way that patients expect of physicians—with a cool head and keen mind, unfettered from a sensitive ego.

4.  You will likely need help at some point. A physician cannot know all details about every illness, especially ones as complex as eating disorders. As with any illness one encounters as a physician, the professional approach is to determine what the best assessments and treatments are. Again, be humble enough to ask for or seek advice.  One can seek opinions of experts in the field in any number of ways—a phone call (a so-called “sidewalk consult”), go to the literature, use the AED medical guide, or any number of texts on the subject (consider the books by Mehler & Andersen, and Birmingham & Treasure, or, maybe even my chapter in the book by Maine, McGilley & Bunnell).

5.  You will not be able to successfully separate out the physical from the psychiatric. Both must be treated at the same time. It is no longer appropriate to say, as a physician, that these are psychiatric illnesses. Nor is it permissible for psychiatrists to say that they are not the ones to deal with the medical. Again, if you do not know, do not reject the patient—instead, call in a consultant and work with that other physician.

The same applies to medical and psychiatric hospitals. Eating disorder patients should never be placed in a medical “no-mans land” where they are ping-ponged back and forth from one to the other, each claiming they cannot treat an eating disorder. These hospitals, by the way, do not have a sign outside saying, “WE TREAT EVERYTHING…except eating disorders.”

6. Keep checking every organ system every time. Use screening tools and a consistent pattern to the history and physical to make it easier, faster, and more likely not to miss something important. Use a BMI graph in those who have restricted to predict how serious the decline is, as the more dramatic the drop or angle of decline on the graph, the more likely that cardiovascular complications are present. A dramatic drop of the BMI can be very alarming and convincing to family members and to patients (see example). As I say often in those cases, “Imagine you’re flying Southwest Airlines and this is how the plane is going down. What would you want the pilot to do about now?” The answer is universally:  “Pull up”…How soon?  “Now!”

7.  While they are complex, eating disorder’s medical complications follow specific, predictable physiological patterns resulting from the ED behaviors. However, physicians must consider the specific circumstances of that individual patient and what behaviors and conditions can predict certain medical (or psychiatric) complications. If they are purging, for example, they could have bleeding, electrolyte and dehydration issues, and signs and symptoms consistent with those conditions. Always consider cardiac complications, and in those who are restricting, screen for Refeeding Syndrome. Those who restrict should have signs of hypometabolism, with low body temperature, bradycardia, capillary refill delay, acrocyanosis, and such.

8.  Check lab values frequently, including electrolytes and especially phosphorus and magnesium in those at risk of Refeeding Syndrome. Purgers are at risk of bleeding, so the CBC needs to be followed. The AED medical guide provides a good summary of labs needed.

9.  Remember that many of the psychological issues may be a result of medical issues and vice versa. What one may think is anxiety or panic could easily be hypoglycemia. What may appear to be depression, bipolar disorder, or personality disorder may actually be malnutrition, brain starvation, and such. And the medical issues will tend to worsen what psychiatric issues are present.

10.  Athletes can get eating disorders, too. Don’t assume because the patient is a high performing athlete, that physical findings that would be considered abnormal in others is due just to the patient being an “athlete.” A common mistake is to assume that one’s bardycardia (slow heart rate) is due to being a fit athlete. However, if the resting heart rate is below 50, evaluate if hypometabolism and energy conservation are ongoing, and not due from a fit heart but one that is losing its exercise capacity.

Do not be surprised how many calories it takes to refeed someone who has been malnourished, especially one who was exercising heavily with their eating disorder. It can be enormous calories and the patient may only then slowly gain weight at first. This is because the metabolism has to be reversed and turned from hypometabolic to hypermetabolic and that requires enormous calories, fat, protein, and carbohydrates. It is not uncommon for someone at a very low weight to be eating 5,000 calories per day at a treatment center and very slowly gaining at a rate of 1 or 2 pounds a week after a few weeks of no weight gain or even weight loss.

If a physician were to follow just the above, he or she would know more about eating disorders than 95% of other physicians. We are not looking just for experts; we’re looking for volunteers to care for these deserving patients.

About the author -

Ed Tyson has been treating eating disorders for over 20 years and is in private practice in Austin (www.EatingDisordersDoc.com). He is a member of the AED’s Advisory Board and the Medical Care Standards Committee, and a co-author of the AED’s Medical Guide for Eating Disorders. He considers himself an advocate for those who have EDs, and teaches medical, nursing students and undergraduates and graduate students about EDs at the University of Texas, and presents at professional meetings whenever he can.

I used to work in a level one trauma center, which basically means, you get EVERYTHING and anything. I was one the youngest employees there, earning early exposure to a number of things, and some shifts were just surreal. After a few years, death just became death. The end. To protect myself, my heart hardened. My sense of humor tarnished so that no one else could understand me beyond my co-workers.

I was the phone call no one wanted. “Are you Mr. Miller? Can you please come down? Your son is here in critical condition.”

Although I’m glad to have learned about life all I did, it took a number of years after leaving for the numbness to wear off. I could go into the blood and gore details of experience after experience, but what truly strikes me is the shadow of death. An emotion so often brushed under the rug, it’s easier to pretend it isn’t real.

One of my mother’s friends who had cancer fell out of remission just over a month ago.

In her sixties, a vibrant woman of all smiles, I always pictured her in a fluffy red boa, sparkly hat, silky purple dress, and jewelry with all the bling. When I heard the cancer had returned at a vicious rate, this image changed.

When I heard she had to go back to chemo, I made a fun bracelet for her to wear, complete with a ‘hope’ ribbon and pearls. Sometimes, small tokens like these give us a source of strength. She told me she’d wear it every time she got treatment. These are the little things to treasure that so many people let pass by.

For over seven years, I have been treated at various cancer centers due to an unknown blood disorder, and I have met and seen the most courageous, authentic, beautiful, humorous people living their life to the fullest.

I have dealt with depression, bipolar, eating disorders, etc. Sometimes I feared I would get overcome by life and let it pass by like so many of us do. Yet, here were these amazing people more full of life than anyone else I knew, despite the fact physically they were losing it. They were keeping it together where others of us just unravel, myself included. I have always prayed for these people and asked God, “Let them have their life, they obviously are passionate and have a thirst for life!”

I loved how the infusion centers were set up. The chairs faced one another, you became a group, you got to know everyone, and when a patient’s chemo was done, the nurses would come out with bells, kazoos, whistles, and a big birthday cake! In a cancer community, it’s about more than just medicine. Everyone knows your name. The staff get to know you so well, they even know what type of soda you always want, all the little things. That’s what medical care and treatment should be.

Memories flood me.

Last night I got a message. Beta had passed away before we could even get to the hospital.

Part of me almost longs for those post trauma center days, but I no longer feel that blank detached sense of darkness. I feel and experience the emotions of grieving and loss. The only condolence I am able to draw comfort from right now is that it was quick and it was painless.

If you have ever read Tuesday’s with Morrie, he wanted to celebrate his life and not have some sovereign funeral with crappy appetizers and people dressed in black all stoic. Beta would have celebrated, probably sucked some helium out of balloons, and sang karaoke with her high squeaky voice, and of course, glamorously dressed to the nines. So, I’m going to celebrate her too.

 How does this have anything to do with eating disorders and recovery?

 – Live your life –

Your life is precious. Live your life. Find connection when you feel lost. Do not zone out and let it pass you by!

Make a list or journal about how much the eating disorder has taken from your life: sports, hobbies, school, friends, finances, health, relationships, meaning, purpose, etc. Use this as motivation to no longer stay prisoner.

If you have a rough body image day, go pick out one of your favorite outfits you just love to wear. If you like to put on makeup and do your hair, go for it.

If you have friends and want to go out, do it. Getting out the door is the hardest part.

If it’s in the middle of the night, put on some good music and just dance away dark feelings rather than stay curled up. This can actually be very freeing and fun! Temporarily immerse yourself in the music and know you are beautiful. My level of dancing is right up there with Napoleon Dynamite. I actually got kicked out of a beginner’s tap dancing class my roommate and I took for fun in our twenties. I don’t care, though. I just let it go because it feels great!

If you have a special token from someone or something, keep it with you for frequent, uplifting reminders to take the next best step. One of my favorite nurses at the cancer center I currently live gave me this beautiful 23rd Psalm key chain and I always have it with me. (In fact, it’s what I use to scratch my lotto tickets)

Lastly, let emotions run their course. Things can get really, really hard.  At times, it will seem overwhelming and intense. This was me yesterday reading part of some book at Target with tears streaming down my face.  Despite what society portrays, it’s actually quite healthy to feel your emotions. The woman looking at me funny just doesn’t know that yet! After all, it took me decades to accept!

Holidays

The holidays are coming, and they can be triggering for anyone. The triggers are not just centered on the food; it often goes much deeper into layers of relationships, memories, and years of old patterns that may resurface.

Christmas used to be my favorite time of year as a kid. The decorations, the smells, and the traditions were almost magical. Now, I am grieving and trying to use my wise mind no matter what the situation.

Be proactive and work out a plan for your holiday triggers. You are stronger than you think. Do what’s best and supportive of your recovery. This is a season of love and giving, self included! Be gentle. Be kind. Be wise.

Try not to let this be just another holiday season that passes you by. A woman in her sixties once to told me, “Honey! You might as well go for it!” Smiling, I know Beta did just that. She took life by the horns.

“If I only had a cape and tiara, I could change the world.” Beta had one; she definitely left a mark. We are hanging an angel in honor of her this year, and I know she is flying over us right now.

If you, too, are grieving this holiday season, I recommend trying to create a new tradition to honor and celebrate those you miss. A small token can make big waves.

And a mantra for you:

 Hope

Keep Being Brave

Trust your Strength

Surrender your Fear

Sing Out Loud

Believe in Healing

Unleash you Joy

Celebrate the gift of Today

Never Give Up

Ever!

]]> http://www.mirasol.net/blog/live-life-finding-connection-lost/feed/ 0 http://www.mirasol.net/blog/compulsive-overeating-disorder/ http://www.mirasol.net/blog/compulsive-overeating-disorder/#comments Wed, 19 Nov 2014 01:43:23 +0000 Courtney M http://www.mirasol.net/blog/?p=2017 Compulsive Overeating

As we go through our lives, stress from daily routines and other factors can play a part in the development of eating disorders and other conditions. Compulsive overeating is one such condition and is also known as Binge Eating Disorder (BED). It is categorized by frequent binge eating without the consistent use of purging, laxatives, or excessive exercise to counter the eating. Often it is hard to tell if someone has an eating disorder, and it can be extremely difficult for the person to recognize what is happening to his or her body and seek assistance. Symptoms of compulsive overeating include:

• Frequently eating huge amounts of food
• Eating alone
• Hiding empty food containers and trash from others
• Vulnerability about weight or body image
• Feeling guilty after meals

While the exact cause of BED is unknown, there are biological, psychological, and social influencers that may trigger the development of the condition. If you feel that you may be overeating, there are many things you can do to help regain control. Make sure to eat three meals each day, along with healthy snacks, instead of junk food and sweets. Discontinuing a diet, and getting enough rest and exercise can help manage stress and get your body back to its natural healthy ways. If these do not work, seeking help and treatment from your doctor or a therapist who specializes in eating disorders are the best courses of action.

For a majority of people with eating disorders, weight gain is the greatest fear, challenge, and roadblock to recovery. I get it. It’s been my hardest battle, too. I hope some of these tips help you cope with weight restoration regardless of what stage of change you may find yourself, whether just considering recovery or actually maintaining progress after treatment.

To lift some pressure to help you get started, you could try approaching your recovery as an experiment. A gain doesn’t have to be forever, but at least give yourself some time to work with the differentness of being in a weight-restored body with a nourished brain before you write it off. Hopefully, you will stick recovery through long enough to find relief. But, in a worst case scenario, you can always go back to your eating disorder. First, though, give yourself a chance.

If your body image is still making you miserable, remember that an overwhelming majority of those who recover agree that healing body image is the longest step of recovery. Be gentle with yourself as it may very well take more time for the mind to catch up than for the body to heal.

Here are 8 suggestions to help you along your way.

1. Remind yourself of why you began recovery in the first place. As time passes, it can be easy to begin glamorizing the aspects of the eating disorder that you liked. Do you want to find yourself in the same pain that motivated you to start recovery in the first place? I don’t think so! If you ever reminisce about the good old days of your eating disorder, you have to complete the picture by reconsidering the awful ones too. Dig deep and get to the ugly. What has your eating disorder taken away from you (hobbies, career, relationships, money, energy, hope, etc.)? What complications have you endured? How does having an eating disorder impact your daily life? Also, ask yourself what you are looking forward to by healing. I once made a gratitude list of 101 things I loved about life. From fresh cut fruit to freedom, what are some of your own gratitudes? Together, these are all motivators for your healing.

2. Come up with a food is fuel mantra that works for YOU, such as, “Food is my medicine right now.” Nourishment is a form of medicine, self-respect, and love. Appreciate the foods you DO enjoy. As I learned more about the medicinal values of various whole foods, I began conversing with food on a whole new level. For example, changing my use of food language allowed me to transform my relationship with healthy fats. When I learned walnuts are shaped like the brain and are a healthy brain food thanks to their Omega-3 essential fatty acid content, I changed my internal conversation from, “OMG, these walnuts are fattening and going straight to my bottom half,” to, “This is fueling my brain to help with clear thinking and stable mood. The fats are vital for my nervous system to function at optimum levels.” When I eat avocados, I still think, “Oh yeah. This is going straight to…the shine in my hair, skin, and nails.”

3. Be prepared to deal with body shape, weight, and appearance comments.  Be prepared that many well intended people will want to compliment you on your accomplishment of “filling out a bit” and looking so much “better”, so much “healthier”! Some people will not know better and others may not be able to help themselves because they are so relieved and thankful. For someone still ambivalent about weight restoration, a seemingly innocent word like “healthy” can become a tossed grenade that explodes upon our recovery parade. If this happens, it helps to remind yourself that your eating disorder is confusing enough to you. Imagine how confusing it is to the general population. A little compassion can go a long way as a distress tolerance skill with these unwanted comments. In more valued relationships, you may decide to engage in conversation about how you actually interpret appearance-based comments. In all fairness, what we think at times hardly makes sense. PS. Healthy does not mean fat.

4. Just say no to “Thinspiration!” I know; it’s everywhere. The longer you have had an eating disorder, the more likely it is deeply embedded into your life. You don’t always even have to be looking for it. And it goes way beyond magazines and websites. I’ve been sidetracked on Facebook by someone’s alarming new profile picture, where they have clearly lost weight. Catching the interest of my eating disorder thoughts and with just a few clicks later, I could be perusing through photo albums of others with eating disorders –sucked into the abyss looking for thinspiration. Don’t let your social media support become a weapon of destruction against your hard earned progress. If you find yourself caught in a web of thinspiration, whether online or offline, remind yourself of why you began recovery in the first place. These people likely have very painful struggles they are dealing with, too. Every eating disorder has a shadow. Try not to torture yourself with thinspiration. Instead, fill up your newsfeed with pro-recovery outlets! 

5. Avoid excessive body checking. There are so many ways we do this without realizing it. The most obvious way is probably the use of a scale, but some things are more discreet such as seeking your reflection in reflective surfaces or measuring body parts by wrapping around your fingers. Some of us might have certain clothing items we use to reference our body in space, such as a certain pair of “skinny jeans” that we taunt ourselves with. Consider donating or consigning these items. While body checking is often intended to provide some level of comfort or relief, conflict ensues when we are not happy with the number, size, or measurement. There are schools of thought that we shouldn’t know our weight at all and others that suggest using blind weigh-ins at the beginning of recovery and gradual weight exposure over time. If there is no way you are giving up your scale, at least consider putting this quote up on a post-it note nearby, “This scale can only give you a numerical reflection of your relationship with gravity. It cannot measure beauty, talent, purpose, possibility, strength, or love.”

6. Spend time with encouraging social supports. Reduce your exposure to people who are weight or appearance obsessed. Set the tone and ditch the “fat talk” mania. Encourage your social supports to follow suit. Surround yourself with people who are uplifting and encouraging of others. You probably have enough trouble with criticizing yourself. You do not need further exposure to negative chitter chatter! Positive people will more likely help you appreciate both your inner and outer beauty. It’s also helpful to have a body image role model, whether someone who has recovered for an eating disorder or simply owns body confidence.

7. Adopt doable distraction techniques.  Distraction techniques will not cure underlying issues, but they will help you avoid behavior use, which is incredibly empowering. You also deserve a break from the eating disorder thoughts and behaviors. Urges are temporary and will pass. While they may return, it lifts one’s spirits to be able to conquer urges when they present. I have used whatever works in the moment when I need a shift in focus away from negative body image. I may choose to read, watch TV, or color a mandala. I often use essential oils as a grounding distraction. Listening to music can change my train of thought quite easily as well. You may wish to call, text, or IM a friend. Snuggle up with your furbabies. Don’t be afraid to spend some time day dreaming about a goal you’ve had. Mental rehearsing plants the seed of success. Or maybe you are a list maker. Do anything other than accept mental torment from ED. J

8.       Practice joyous exercise. Exercise can be a touchy subject with regards to eating disorders. If you have a history of excessive exercise, please consider exploring this in a therapeutic relationship, especially before reintroducing exercise into your life. Always seek medical clearance before engaging in exercise. In some cases, you may need a physical therapist to begin physical activity once cleared by your team. Exercise can have incredible benefits when practiced in moderation, including antidepressant benefits. Healthy exercise can also encourage a nourishing appetite, increased energy, and sound sleep – all elements of a balanced lifestyle. When possible, choose joy filled activities such as yoga, gardening, and surfing, where the focus is more likely to be on the activity than the eating disorder. Warning signs of excessive or abusive exercise may include: skipping social opportunities to work out, distress when a workout is missed, unwilling to allow rest days, being driving by obsessive thoughts, using exercise to purge calories, and exercising despite injury.

You’ve made it way too far and worked way too hard to give up now! I cannot emphasize enough that glamorizing the eating disorder only opens the gateway to relapse. Sure, the eating disorder served a purpose for you for a long time, but don’t forget it stopped working, which is why you decided to start your healing. If you find yourself wishing you were thinner or that you had not gained weight, know you are also wishing for all of the pain, struggle, and misery the eating disorder left you. And, you certainly don’t need all of that! You are worth a life worth living.

Recovery from an eating disorder is complex. It’s full of rollercoasters, intense emotions, radical acceptance, willingness over willfulness, courage, and perseverance. It’s easy to go back to negative behaviors where the eating disorder can calm anxiety and make you feel like you have control. But, in actuality, you are only locking yourself back in the box while the ED destroys your life. Bottom line: Recovery can be very scary. As you continue your recovery journey, you will have to face both old and new fears. By gaining a new perspective of how to conquer those fears, you will build more strength and courage every time you step out of the box and face that fear.

If you have read my other posts, you know that I used to be very athletic triathlete and cyclist. As I move further into my recovery and have begun to work towards reclaiming those passions, I have had to look fear straight in the face. It’s not a perfect road…Some days I can do it; other days I might hang back a little and tip toe outside the box. I have a hard time being patient with myself and remembering that my body is still healing, thus when it comes to biking and swimming, I need to learn to be more forgiving without letting fear take over and quitting completely.

I have recently joined a community center that I can both bike to and swim once I’m there. I felt like a small child holding my mom’s hand when I went to try swimming. Luckily, I chose to face this fear by choosing to go with someone from my support system. It was my first time there actually using the facilities, and I didn’t understand how the locker rooms worked. A swim team was starting, and I hate being cold, which all lap pools are kept at a cooler temperature. I had anxiety just thinking about going. Seeing the swim team was intimidating and brought up old emotions of when I swam on a team. I knew my stamina was definitely not up to par, and fear immediately took over telling me, “You can’t swim, look at those girls, they are in the best shape and can swim forever.” I hovered over the lane edge, knowing the cold rush I would feel as soon as I dove. Half of me was saying, “no, no, no!” The wise mind other half was telling me, “at least jump in, you love swimming and you have to start somewhere.”

With a deep breath I took the dive and immediately began sprinting down the lane trying to warm myself up. I could feel my body maxing out, which was a bit frustrating, but I accomplished a small step towards my larger goal. I may have only done two laps but I didn’t quit, I tried it, and I can prepare myself better the next time. I was a bit discouraged, yet at the same time, I was trying to turn my mind and use it for more motivation.

Now, I could get down on myself and compare doing two laps to two miles. However, the initial goal was breaking the box, and I at least jumped in and tried. The next time, I knew what to expect a little more, and although there is still a bit of anxiety, I try to keep pushing myself and not have any expectations other than getting in the pool and swimming. In time, I hope it becomes therapeutic as it used to be.

Another example of overcoming recovery related fears centers around social situations. After isolating for so long, it’s easy to decline the party invitations, going out for meals, returning to work, etc. This may sound silly, but I was invited to see a movie with my neighbor about a book we’ve been discussing. I tend to experience a panic state going to theatres, so I seldom ever go. I don’t think I’ve been to a movie since Harry Potter. Everything inside of me was screaming no! Then, I took into consideration that this was a social event, very few that I ever have, and I needed to push myself instead of hiding in my apartment or avoiding with other tasks. Eleanor Roosevelt said, “We gain strength, and courage, and confidence by each experience in which we really stop to look fear in the face….we must do that which we think we cannot.” I tried using my wise mind, and made the goal that every day I will push myself to face at least one fear, big or small.

Tess Marshall, M.A., who specializes in learning how to live a bold life, has created nine tips to face fear in the face so it no longer rules our lives:

1) GET COMFORTABLE WITH FEAR.

Try and do one thing each day that might cause fear and invite it into your life. Let yourself feel it and breathe through it. Every time you conquer a fear, it builds courage and opens up new doors in your life. Such examples I’ve had this week: actually going to the pool, going to a movie, cycling more and building up a commuter bike, and facing strong anxiety that seems to build in the evening with some yoga.

2) MAKE YOUR DOMINANT THOUGHTS POSITIVE.

Give yourself positive mantras, thoughts, and positive energy that generate success, whereas more fearful thoughts will just attract more fear. I have my apartment posted with random quotes and affirmations. Sometimes they get stuck in my head which helps me turn my negative thoughts around.

 3) DON’T GIVE TIME, ATTENTION, OR ENERGY TO FEAR.

Take action towards fear and don’t let opportunities continue to pass you by. This can be difficult, but if you continue to be consistent, prepared, focusing on solutions, that energy will further motivate you to conquer what’s ahead. This is a perfect example of facing my movie theater fear. I could decline and lose the opportunity to get to know my neighbor better (and possibly seeing a good movie), but I’m tired of letting fear and anxiety keep me imprisoned and losing out on opportunities to grow. If I don’t like theatres still after, then I don’t really have to ever go again. (Isn’t that what Redbox is for?)

4) NEVER DWELL ON SCARCITY

“Focus your attention on being ready, willing, and prepared for the beauty, wonder, connections, good fortune and favorable circumstances that are yours if you are willing to work and be open to it.”

5) REVISIT YOUR VICTORIES.

Every time you conquer a fear, don’t brush it under the rug. Celebrate it and use it to continue building courage, motivation, and strength. For example, I rode the community center once, I can ride again. I got in the pool, and even though I didn’t last long, I got in and tried to swim a few more laps as well as tried out their therapeutic pool – which is a bit warmer!

6) LIVE VICARIOUSLY THROUGH THE VICTORIES OF OTHERS.

Read or learn about inspiring people, events, things that have occurred when people have faced fear in the face and overcome all obstacles to achieve their dream. Some examples are Walt Disney, Oprah, Robin Williams, etc. Maybe it’s not a famous person or event; maybe it’s a special person in your life. My mom may not be famous, but she is one of the most perseverant, compassionate, and courageous people I know. Do you have anyone you look up to? Why?

7) ASK YOUR FRIENDS AND FAMILY FOR SUPPORT.

Use your support team to help you overcome fearful moments. The first time when I just wanted to try the pool (after changing about 10 times because I was letting anxiety take over and not wanting to go), my mom came with me and just said, “Jump in and see how it goes.” It was a small step, but one more step of courage I can build upon to do it again.

8) CREATE A SUPPORT GROUP OF FRIENDS OR COLLEAGUES.

Having a strong support team helps build that foundation of trust and more willingness to overcome the fear. Supporting each other can make tough moments easier, and possibly even more fun.

9) PLAN TO BE GREAT

Create a list of your goals and conquer them. Use the SMART goal setting technique so you can celebrate even the tiniest step. The power is within you to overcome obstacles, and let your dreams and happiness re-enter your life. .

No longer do we have to let doubt, fear, and anxiety dominate our lives. Don’t let the ED or fear steal anymore joy, sleep, dreams, and goals. DO NOT let FEAR define your life. You are all strong and courageous! Sometimes we just need to dust ourselves off and remember that “I CAN” reach my goals and dreams.

A few quotes to fight fear with:

“You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I lived through this horror. I can take the next thing that comes along.”

-Eleanor Roosevelt

“Don’t fear failure so much that you refuse to try new things. The saddest summary of life contains three descriptions: could have, might have, and should have.”

~Unknown

“We gain strength, and courage, and confidence by each experience in which we really stop to look fear in the face… we must do that which we think we cannot.”

-Eleanor Roosevelt

“Your task is not to seek for love, but merely to seek and find all the barriers within yourself that you have built against it.” – Rumi

When you are feeling alone, depressed, scared, frustrated and bingeing away or running on the treadmill as if you were running from a pack of wolves, when you feel you have no place to turn and you reject all options, you still have an option.

Inspirational quotes come through your Twitter and Facebook pages on a regular basis, even if you are not looking for them.  You can use them, not just for a momentary glimpse into a different way of thinking, but as a practical way to get back into recovery mode.

How?  Do a google search on inspirational quotes.  You’ll find many sites with long lists of wise and profound words from people across time.  Pay attention to how you feel as you read them.

When you find one that seems to speak to you or expresses what you wish you had or opens a window of perception for you, linger with it.

Write it down.

Break it down into daily tasks you can do to make that inspirational quote truly your own.

For example, if Rumi’s quote above feels like it is wise guidance to having love in your life, then

• keep it.
• write it down.
• journal about what barriers you have within      you that block love.

This is not a time for self criticism. This is your looking at what those obstacles within might be.

Once you have a list, then you can journal about what you can do to dissemble those obstacles.

•  When you do this you are increasing your awareness of your way of being in the world.
• You are learning how you affect responses around you.
• Best, you are learning how to make many subtle changes that eventually erode your barriers and allow love to enter your life.

Many of your interior obstacles are strengthened by your eating disorder thinking and behaviors.  As you follow your own ways of dissolving your obstacles in order to allow love in your life you discover that you are weakening your eating disorder.

Inspirational quotes can be wonderful guides and support for you.

Here are a few inspirational quote sites to get you started.

Brainy Quotes

Motivational and Inspirational Quotes

100 Top Inspirational Quotes – Forbes

101 Inspirational Quotes from Super Successful People

And more on this subject:

 Inspirational Quotes as Recovery Assignments

Use Inspirational Quotes as Recovery Tools

Joanna Poppink, MFT, Los Angeles eating disorder recovery psychotherapist in private practice, author of Healing Your Hungry Heart: recovering from your eating disorder. Website  joanna@poppink.com

When a person is living with an eating disorder, the effects of the disorder can be felt by everyone in his or her life. It can be extremely difficult to break old habits that lead to developing an eating disorder, which is why it is critical for patients seeking treatment to understand how to recognize the signs of a relapse. By doing so, a person can avoid relapsing and, instead, continue to make strides toward full recovery.

Signs of a Relapse

Patients are at the highest risk of experiencing a relapse between six and 17 months after they are discharged from a treatment center, but many do not know what brings on a relapse. Warning signs to watch for include:

• Feeling hopeless or stressed about your recovery
• Isolating yourself from family and friends
• Obsessing about your appearance or thinking constantly about food
• Hiding information from your treatment professional

Preventing a Relapse

If you notice any of these symptoms, the first thing to do is seek help from your doctor. Even if you feel like you just need someone to speak with about your recovery, talking to a professional is an important first step. This way you will be able to develop the skills you need to confront your disorder head-on and prevent a relapse from occurring.

Be open with your family and friends about your recovery because involving others helps add accountability and shows you how much support you have on your side. Getting treatment, developing a relapse prevention plan, and understanding how your feelings affect your health are all vital steps in your recovery.

From Mirasol ED Recovery Guest Blogwriter ~ Faith

One of the hardest paths in the journey of recovery and living a wholehearted life is retraining our negative thinking, showing ourselves the compassion that we are worthy and that we do deserve recovery. A major part of this process is learning how to embrace shame, guilt, fear, vulnerability, and worthiness. The eating disorder has trained us into negative thinkers with severe cognitive distortions, especially catastrophizing. We set the bar so high we can never reach it, making us feel flawed and never good enough. This leads to drowning in our fears, shame, and guilt at such a toxic level it sends us into a whirlwind making us sicker adding to anxiety, self-doubt, and lack of worthiness.

I never thought such a chaotic rollercoaster of recovery and relapse would go on for so many years, full of experiences beyond my own imagination, including so many experiences I’d like to just hide from and forget. To maintain recovery, I know I have to get at the roots of the disorder. I have kept them hidden and struggled with lack of worthiness every day for years.

It was only recently my therapist asked me to write a list of my shame. I was scared to death she was going to see what an evil person I was. I never thought I had been that “sick,” but when I looked at the dreaded list I was astonished at all the events that had occurred during the depths of my disorder. This was not me, for I highly valued integrity and being authentic. The person on that page was a monster. Despite being at the full cliff of vulnerability giving this to my therapist, it was the first time I had ever verbalized any of it and just how toxically that list affected me every day.

Author and researcher Brene Brown created “Shame Resilience,” as a process to learn how to deal with shame, guilt, and fear, so one can learn to cultivate compassion.  “If we want to live and love with our whole hearts, and if we want to engage the world from a place of worthiness, we have to talk about the things that get in the way-especially shame, fear, and vulnerability.” She found that shame loses power when it is spoken, so I put myself out there with my therapist and took the first step.

One of the most helpful parts of Brown’s work was separating guilt and shame.

Guilt=I did something bad. It is about our behaviors. It is just as powerful as shame, but the effect is often more positive, because it more tangible, leading to apologizing or changing a behavior.

Shame=I am bad. Shame is about who we are and is extremely destructive. It corrodes the part of us that believes we can change and do better.

Learning shame resilience is tedious and may involve some radical acceptance, but it can be an extremely critical and effective skill on your road to recovery. For those who have struggled for many years, these emotions may have built an ugly, interlaced web over many aspects of your life.  I am still at the very beginning, taking baby steps, for guilt and shame runs deep. In addition, I have to face some things on my list, including consequences, every day—such as filling out job applications, trying to repair relationships, not being defined by the eating disorder, and even trying to find a few supportive people with whom I can share my story with.

Creating worthiness is a constant battle for me. This most likely comes from the fact that shame keeps me away from owning my story, leaving me worried that people will think less of me. I am fearful of being judged by my past and I want people to see me as I am now, not as the monster of my past.  The basis for Brown’s research is that: “Shame resilience is the ability to recognize shame, to move through it constructively while maintaining worthiness and authenticity, and to ultimately develop more courage, compassion, and connection as a result of our experience. The less we talk about shame, the more we have it.”

Shame Resilience 101:

Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging.

1.       We all have it. Shame is universal and one of the most primitive human emotions that we experience. The only people who don’t experience shame lack the capacity for empathy and human connection.

2.       We’re all afraid to talk about shame. Shame is the fear of being unlovable, yet shame loses power when it’s spoken.

3.       The less we talk about shame, the more control it has over our lives.

The three seeds of shame that grow quickly like weeds and intertwine you with thorny vines are secrecy, silence, and judgment. The basis for shame resilience is to learn how to recognize shame and move through it constructively, yet maintain worthiness and authenticity. These are critical aspects of recovery as we are rebuilding ourselves and redefining our values. Ultimately, developing more courage, compassion, and connection from these experiences and learning to talk about them, the less power they will have. The experiences we have had are all part of our story. While we don’t need to go broadcasting them to everyone, finding a small, supportive group you can process with will help immensely. The eating disorder will quickly grab onto the weeds of shame and guilt, but practicing awareness and talking about it will help you keep growing with authenticity versus drowning in the swamp of unworthiness and fear.

Everyone has a different reaction to shame, and it is important to become mindful and aware of your own reaction. Dr. Linda Hartling, a relational-cultural theorist, found that in order to deal with shame, some withdraw and keep secrets, some move forward and try to please, and some move against by trying to gain power over others or being aggressive.  The bottom line still comes down to the fact that shame is about fear, blame, and disconnection. It is our story that brings about worthiness, courage, compassion, and connection. We all have imperfections, and letting go of the perfectionistic aspect that the eating disorder loves to hold so high is a key value in recovery.

Most people have actual physical symptoms when they become aware of shame, and it’s important to develop that awareness, too. For me, my negative thoughts start racing; my anxiety runs into a panic attack; my fight or flight rises; I want to run, hide, and isolate; and my level of worthiness drops so low it scares me into worrying I may have very negative, impulsive behaviors. However, by acknowledging and becoming aware of this process, I have learned to step back, take a few moments, practice deep breathing, maybe journal, and maybe go for a walk so I can think things through a little bit more. Basically, I have to create space and time for myself.

In order to begin figuring out your own shame-resilience and story claiming, Brown proposes four questions to help you become more aware:

1.       Who do you become when you’re backed into that shame corner?

2.       How do you protect yourself?

3.       Who do you call to work through the mean-nasties, the cry-n-hides, or the people-pleasing?

4.       What’s the most courageous thing you could do for yourself when you feel small and hurt?

Recovery is a process, and the eating disorder is only part of your story. Learning to acknowledge, own, and grow from all the experiences all help build compassion for yourself. I can live with regrets and shame and wish it all away, but there is no such magic wand. I now have to learn how to embrace and work through it, even if it’s just with one supportive person. I have a lot to work through and it’s not easy. Sometimes I just have to practice kindheartedness, even if some days I can’t really believe the words. Rebuilding myself with compassion, love, belonging, and authenticity all starts at the same place: “I am worthy.” And you are too!

Reference

Brown, B. (2010). The Gift ofImperfection. Center City, MN: Hazeldon.

Author Brene Brown has written an amazing book entitled The Gifts of Imperfection (which I highly recommend getting from your library or online). She goes through 12 guideposts on how to start living a wholehearted life. The first one I wanted to touch base on is how to cultivate compassion for ourselves and begin to let go of perfectionism due to the fact that among those diagnosed with eating disorders, perfectionism is a highly noted characteristic. It runs rampant in our lives, tells us what is good and not good, and makes us believe that the number on the scale determines our worth; it even causes some to believe they have to be a perfectionist at their eating disorder.

In learning to discover ourselves without the eating disorder, we have to start building our whole hearted self, including being able to show ourselves some self-compassion, which can be difficult after abusing ourselves for so many years. Anna Quindlen was quoted, “The thing that is really hard, and really amazing, is giving up on being perfect and beginning the work of becoming yourself.”  Embracing our story and becoming our true authentic self is an exhilarating experience. As the suffocation of the eating disorder lifts more and more, you, too, will understand.

Perfectionism can be toxic and poisonous. It leads to depression, anxiety, addiction, and what Brown terms as “life paralysis.” Life paralysis is missing out on all the opportunities, dreams, and other events/goals because of the fear of being imperfect or failing. This all comes together to determine your self-worth, which of course is a distorted line of thinking and leaves you missing out on this amazing thing called LIFE!

Brown notes there is a definite difference between healthy striving and perfectionism. The following myths will most likely sound very much like the negative tape running over and over in your head, especially at the height of your disorder.

-Perfectionism is not being the best at everything, not looking or acting perfect, nor does it foster growth. Rather, it works as a “twenty-ton” shield that we believe protects us but actually holds us back from making any type of forward process.

-The core of perfectionism is trying to earn approval and acceptance, which does not reinforce self-improvement. This is one of the most common themes found among those with eating disorders. Many are raised or conditioned feeling as though they need to be the best, be people pleasers, and need acceptance all while their self-worth is defined merely by their achievements and what others think of them.

Adversely, Brown came up with her own definitions/guidelines of perfectionism:

-It is a self-destructive and addictive belief system that fields this primary thought. Essentially, if you look beautiful, make great achievements, and do everything perfectly, it minimizes the painful feelings of shame, judgment, and blame.

-Perfectionism is self-destructive because there is no such thing as “perfect.” This unattainable goal is based off illusive perception, and no matter how many awards, no matter what the scale says, you cannot control one’s perception. This is a perfect opportunity to practice some self-compassion.

-Due to the fact that we experience constant shame, judgment, and blame, especially in the midst of our eating disorders, perfection becomes addictive. The false belief that if we were perfect enough we would be able to do everything right leaves us not knowing how to deal with such emotions. This faulty belief encompasses a major root of the eating disorder, because it is wrapped up tightly in shame, judgment, and blame.

-Another common trait among people suffering from an eating disorder is the constant negative voice telling them that “I’ll never be good enough.”  Because they cannot reach such unattainable expectations, feelings of shame and judgment are too much to handle leading to self-blame, resulting in the management of such strong emotions through using the eating disorder.

Beginning to overcome perfectionism, as we disconnect from the eating disorder self and begin to build our authentic identity, we need to be able to identify, understand, and acknowledge our vulnerabilities, including the shame and judgment we carry. In reaction, we need to start allowing for more self-compassion and the process begins with accepting our imperfections. Within this practice, we begin to find courage, compassion, and connection. This is not an easy process as perfectionism and vulnerability often lead to the chronic compulsiveness and addiction the eating disorder imprisoned us with. It’s not a one-step magical process, but by taking one small step at a time and working on the negative tape of thoughts running through your mind, you begin breaking through the trap of perfectionism.

One personal example is that I was extremely compulsive about being prepared for everything and always being on time, usually even thirty minutes early for any appointment or scheduled event.  I had a Mary Poppins bag ready for any situation. A few years ago, I served on a Mercy Ship that served the west coast of Africa, and even the best Mary Poppins bag could not prepare me for what I was in store for there. I learned about “Africa-time” which basically meant when they said they would see you later, it might be eight hours. My first day, I was literally bucketing water from the flooded medical clinic on the ship. I worried, “I am going to sail on this thing?” I did, and it was one of the most amazing experiences of my life. Since my return, I definitely am still on a reduced version of “Africa-time” and am much less compulsive about being prepared, trusting that things will work out somehow. I had to rewrite the negative tape.

Brown breaks down two examples of self-talk: perfectionism self-talk and healthy-striving self-talk.

Perfectionism self-talk: I’m fat and ugly. I cannot reach my expectations. I’m a constant failure. I’ll disappoint everyone; I always mess up. The number on the scale determines my self-worth and it’s never good enough.

Healthy-striving self-talk: I am worthy of love and respect and can be accepted for my authentic self. I will invite courage, compassion, and connection into my life. This journey is for me, and I will take one step at a time. I am strong and I can do this.

As I said, this is not an instantaneous process, but nothing in recovery is. You’ll find it’s all part of the journey.

When Brown further researched healing perfectionism, she discovered that many women spoke of their imperfections honestly without shame and fear. They acknowledged they were doing the best they could and slowed the practice of judgment. A strong root of courage, compassion, and connection was at the core of how they treated themselves. Once again, these can be difficult things to begin to practice: start slowly, one day at a time, and take baby steps if need be. You are doing the best you can!

Self-compassion is at the root of beginning to accept ourselves and being able to live an authentic and wholehearted life. Dr. Kristin Neff, who specializes in research on self-compassion, divides it into three parts:

Self-kindness: Feel our feelings and accept them rather than punish ourselves with inadequacy and beat ourselves up with self-criticism.

Common humanity: Suffering and inadequacy are a shared human experience-it’s not just you! Give yourself a break because nobody is perfect. That’s what makes us all authentic and unique.

Mindfulness: Similar to the DBT practice, we take a balanced approach to all of our emotions, but we don’t get stuck in the sand trap. We let ourselves feel our emotions, but let them run through our “Teflon” mind, so we don’t get stuck in a field of negativity.

At the end of each chapter of Brown’s Gifts of Imperfection, she uses the acronym DIG, get Deliberate, get Inspired, and get Going! (I have used her acronyms before and love them, I am constantly still using TGIF: Thankfulness, Giving, Inspiration, and Faith).

So DIG deep into imperfection and self-compassion:

Deliberate: Brown suggests taking Dr. Neff’s Self-Compassionate scale to help you begin to understand where you are at in terms of compassion, self-kindness, mindfulness, etc. This test can be found at www.self-compassion.org.

Inspired: Take off the mask. The process of recovery is learning to be your authentic self, real and imperfect, letting go of all control. “Imperfections are not inadequacies, they are reminders that we’re all in this together.” You are not alone, and it’s often those vulnerable moments that bring us closer together.

Going: Simply stated, find a mantra for yourself that opens each day up to self-compassion. You are doing the best you can each day, slips or no slips. “Today, I’m going to believe that showing up is just enough.”

Christopher K. Germer once said, “A moment of self-compassion can change your entire day. A string of such moments can change the course of your life.” Moving forward in recovery can be scary, difficult, and hard. We often want to reach back into what we know is controlled and seemingly comfortable.  Learning to treat ourselves with compassion, surrendering vicious routines, and just letting go can change the entire path or the rest of your life. Go DIG!

“The past has no power over the present moment.”-Eckhart Tolle

Brown, B. (2010). The Gift ofImperfection. Center City, MN: Hazeldon.

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Being afraid of wearing a bathing suit on a summer vacation; having a fear of clothes shopping due to poor body image; feeling trapped in your own body; constantly counting calories; obsessing over food, weight, or shape; exercising out of compulsion; restricting or overeating in reaction to difficult emotions; feeling compelled to follow an energy consuming fad diet; spending time binge eating and risking life by purging unwanted calories; and especially losing things of importance (i.e. dream jobs, close friendships, precious time with loved ones, and other amazing opportunities)…These are all merely a handful of the myriad of losses of freedom that occur when you are trapped inside the monster of an eating disorder.

Today, hundreds of millions of Americans are celebrating Independence Day. Celebrating our many freedoms is one of the greatest privileges of living in the United States.

I’m no great historian, but gaining our independence from the United Kingdom was not an overnight accomplishment. In fact, it took more than a year after the outbreak of the American Revolutionary War before the Continental Congress declared the thirteen American colonies independent sovereign states forming the United States of America. In the process, a committee of five men, including Thomas Jefferson, drafted the Declaration of Independence, a document largely dedicated to honoring human rights.

What stand out of greatest importance to me are the rights to life, liberty, and the pursuit of happiness.

It’s astonishing how much recovering from an eating disorder parallels to this short history lesson.

Life with an eating disorder is an entrapment. Just as with the resolution of the American Revolutionary War, recovering from an eating disorder doesn’t occur overnight. Recovery from an eating disorder parallels war itself because it requires a fight for your life with keen and consistent engagement. From start to finish, it can take several years to fully break free. The more chronic the disorder is, the more difficult it may be to overcome entrenched belief systems that maintain the disorder.

Living with an eating disorder denies several human rights, including the basic right to live. Just yesterday, I learned of another precious life lost to an eating disorder. I’ve sadly witnessed a string of such losses in recent months. In war, it is simple fact that lives are often lost in the fight for freedom. It’s a terrible and irreversible reality. These lives are not lost in vain, but it is incredibly unfortunate to know they have each become another statistic. In fact, eating disorders have the highest mortality rate of all mental health disorders.

So what about liberty? From dictionary.com, “Liberty: freedom from control, interference, obligation, restriction, hampering conditions, etc.; power or right of doing, thinking, speaking, etc., according to choice.” Eating disorders have so much to do with control, or lack thereof: controlling emotions, food, weight, etc. They interfere with health, achievements, healthy and meaningful relationships, education/employment, and peace of mind. Individuals may also feel obligated to follow rules or laws that govern and “protect” their disorders. Restriction may include lack of joy, food, and socialization. Hampering conditions may include things such as negative or irrational thinking and limiting beliefs.

Of course these are all examples and are not a comprehensive list of what may go awry in regards to living a life void of liberty.

Considering these above lists, one can surmise that the chance of living with the pursuit of happiness is nearly impossible for anyone struggling with an eating disorder.

If you are currently suffering with an eating disorder and ambivalent about letting go, hear me out. Please trust me, because I am sadly an expert in this department. I have been “existing” with depression, anxiety, and anorexia for 22 years.

I’ve never truly been happy. Though I have managed to have many great achievements despite being desperately ill, especially mentally ill, very few times have I enjoyed or truly treasured my triumphs. In fact, the majority of the time, I have felt like I’ve been hiding behind a mask like a fraud unable to own them.

If you are suffering, please do not retreat and give up your rights to freedom and independence. Reach out for help now. A soldier does not fight a battle in solitude and recovery is no different. You will need a strong and sound support system and compassionate, experienced treatment team to help you win this war. Begin rallying in the troops, those who will be your allies in this tenacious battle so you can conquer the enemy we call “ED”.

So on this Independence Day, I ask you: Do you want to continue existing rather than living, achieving hard earned successes without appreciation and joy, and staying imprisoned to negative thinking and beliefs?

I hope there is at least some voice inside your soul that wants more for yourself, a part of yourself that wants freedom! I wish I could say this was an easy battle but going to war against your eating disorder will be one of the hardest things you have to do in your life. On the bright side, at least you can begin knocking it out now rather waiting 22 years down the road, only to find yourself living in the trenches alone and hiding from the world that wishes to embrace you, the whole you. Together, we can win our freedom and independence back!

In a fairy tale world, what would your Declaration of Independence look like? What would freedom look like to you? What would living in freedom mean to you?

I wish for you life, liberty, and the pursuit of happiness! Happy Fourth of July! Let freedom ring.

A vital part of leaving an eating disorder behind and beginning to regain your sense of self is rebuilding self-confidence. Everyone suffers from some lack in self-confidence.  Confidence doesn’t come in fixed quantities, and sometimes it takes a few introspective lessons and life experiences to begin to build or rebuild a deeper and stronger faith in yourself.

Find your inner light and let it shine!

It is human nature to think negatively, and studies show that negative thoughts and emotions are quicker to form, attract more focus, and more likely to be recalled than positive ones. Try to begin recognizing values and strengths by thinking about one attribute that has served you well in your life, and then get your support system involved as well.

1.       Share your thoughts with your support system and work together to brainstorm a few favorite things about you. Keep an open mind.

2.       You may be surprised at what attributes YOU find strong vs. what others value.

3.       Ask for specific examples of traits in action. This helps the negative voice.

4.       Identify and share your best qualities by repeatedly putting yourself in positive positions so you can build trust in your abilities and assets.

See yourself clearly, flaws and all.

When building self-confidence, everything comes together in balance. Once you’ve identified some of your strengths, be open to identifying some weaknesses–but not in a self-critical or destructive manner.  It has been found that understanding who we are, be it better or for worse, actually improves self-esteem and acceptance. By looking at patterns in your life that may have brought about conflict or “flaws” such as stubbourness, indecision, and hot-temperedness, you will bring light to other character traits that, although we may not find ideal, you can learn to still embrace. Confidence takes commitment. You can’t spend 50% of your time projecting your best assets and 50% trying to hide your “flawed” traits and then expect to strengthen your self-esteem. This is where the practice of balance and acceptance of yourself as a whole comes into play. Your “flaws” do not have to carry a negative connotation; they are just another part of who you are and they allow you to learn to see yourself clearly while you still continue to shine.

Learn to take a compliment.

Somehow, our culture at large has led us to believe in discounting our accomplishments or playing down positive feedback. If you have poor self-esteem and self-confidence, it can be extremely difficult to accept any type of praise because the inner, negative voice can be so strong. Being able to receive constructive, positive feedback can help counteract negative thoughts and build confidence. A first step in practicing learning how to accept a compliment is simply to simply say thank you, whether your mind lets you believe it or not. The more you do this, the more you will begin to find yourself actually beginning to genuinely accept positive feedback. On another note, if you respect someone enough to take their criticism to heart, it’s only fair to also accept their praise. Another exercise is to practice in front of your mirror, and maybe even while driving your car, repeating a positive feedback mantra, “Thanks, I appreciate your saying that. I worked really hard, and the fact that you noticed means a lot.”

Your support system, your cheering squad!

A vital key in recovery, even in general life, is having a passionate group of support that fosters a sense of belonging and security, both of which build more confidence. These may be family members or friends; they may be people who become educated about eating disorders and can support you in recovery. They may also be people who support you in your general life, perhaps new allies and friends you meet through new social experiences. Remember, healthy relationships are two-sided and include healthy boundaries. Just as these people support, inspire, and encourage you, you will have a natural intuition to return the favor, which will feel great.

BUILD A CONFIDENCE TOOLBOX! (ref, Oprah 2013)

1.       Add a photo of those closest to you: When you have a strong support system and feel loved, it provides a source of strength and security that helps you take bold steps forward.

2.       Include a symbol of new endeavor: If you are challenging yourself with a new endeavor, put a reminder in your box. For example, maybe you are learning how to swim. Put one of your first caps or goggles in it. Confidence can be built by reminders that you know you are pushing yourself forward.

3.       Insert a token of improvement or achievement: You have challenged yourself and now met one of your goals or a new accomplishment. Maybe you finally finished your first Sudoku or your first 5k. Save a symbol of this and place it in your box! “Quantifiable achievements provide an instant jolt of self-esteem, because they make it easy to measure progress.”

4.       Enclose a picture or inspirational story of someone you look up to: Research has shown people get inspired by others who have become successful despite setbacks, and having a reminder can help keep you going.

5.       Have a special reminder of an upcoming event: Looking forward to something keeps you focused on good things to come and also reminds you of your supportive relationships. Secondly, it can also be an encouragement that you are no longer being held back and isolated but building relationships and living life!

6.       Include a token reminder of a time you were there for someone: A card, a thank you note, memorable mementos. Contributing to another person’s life boosts your own self-esteem, especially when it helps them make progress toward their own goals.

Be compassionate, be open to new things, be bold! As you build yourself back up, strengthen your self-esteem, & regain your values, you will find you shine with an identity that is unique and all your own.  A few fun quotes to leave you with:

                I’d go after Moby Dick in a row boat and take the tartar sauce with me. (Zig Ziglar)

                I have gone ahead despite the pounding in the heart that says: turn back. (Erica Jong)

Keep climbing forward!

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