How Not to Be a Shrinking Woman

I don't know Lily Myers, whose YouTube clip follows, but I know lots of 'Lily Myers'. She is strong and powerful as she describes her mother and herself and the culture which helped to shape her, for better and for worse. She is painfully aware of eating disorders and the grip they can have on us.

Please watch it. But don't blame your mothers, or your grandmothers, just as you can't blame them for the cancer and diabetes genes they pass on to you.

http://www.youtube.com/watch?v=zQucWXWXp3k&app=desktop#!

And make your voice heard--please don't keep silent, waiting for all the others to share their seemingly more important thoughts.

What did you think of her poetry?

Reasons to believe in recovery? Take this simple, anonymous online questionnaire.

Perhaps you CAN rise above the clouds.

I don’t know the Harvard psychologist Dr. Sheila Reindl, but I have recommended her book Sensing the Self, many, many times over the years. It’s filled with wisdom about recovery from bulimia, honed from Reindl’s extensive interviews with 13 recovered women. (Not bulimic? Please read on! There’s something here for you too!)  Maybe I was attracted to it having learned that several of the pseudonym-ed women were actually past patients of mine, shared with a therapist who contributed these cases to the book. 

Or maybe that it meshed research with patient stories, extracting the essence of the recovery process into meaningful chapter themes. Personally, I hate reading books about recovery (but I read this at the insistence of a patient). That likely has mostly to do with the fact that I discuss recovery almost 40 hours a week. Do I really want to engage with strangers’ stories on my down time? I don’t think so.

Yet I likely suggest it because I believe it may help readers with recovery. Just as I recommend Schaefer’s fabulous Life Without Edand Arnold’s blog ED-Bites—long before it became chock full of valuable research interpreted into a language we can all understand.

I don’t know if reading recovery stories truly makes a difference in the recovery process—for better or for worse. But I’d like to find out! Because I’d like to have another tool available to help support recovery.

Can recovery stories show us the way?

Enter Lisa Dawson, an Aussie PhD candidate who has the very same goal and is doing the research to find the answers—and I reallyhope you will help! You may remember her name from previous research I referenced. Here’s the description of her research:

Researchers at the University of Sydney are interested in whether reading stories of recovery are helpful for current sufferers of anorexia nervosa. People aged 18 years or over who have anorexia nervosa or an eating disorder similar to anorexia nervosa are invited to participate. This study is conducted entirely online so anyone in the world can participate. Participation involves completing questionnaires on two or three occasions and reading five short stories about recovery. We are very interested in receiving your feedback about the helpfulness of the stories.

The study has been approved by the University of Sydney Ethics Committee and all aspects of the study, including results, are strictly confidential. We are hoping to have as many people as possible take part in the study. If you are interested in participating then please contact Lisa at lisa.dawson@sydney.edu.au.

So if you have a few moments, please email Lisa to learn more. And say hello for me!

Thanks for helping. Oh, and PLEASE share this any way you can!

Half full? What perspective has to do with recovery

It took me years to grasp this not-so-deep expression.  Rather than focusing on the full vs. empty, I'd get stuck with the half part. So while viewing a cup as half empty suggests looking at what's missing, and seeing it as half full connotes a positive outlook, I simply couldn't see it. The half empty description seemed rather positive to me. I mean, at least it's only 1/2 missing! I'm not sure I ever really contemplated half full—as in "it's just not good enough".

Take a look at the image to the right. What do you see?

And when you look at your body? 

Do you focus on all that's good about it, or get fixated on those parts that disgust you?

When you reflect on your eating yesterday do you highlight where you slipped, or acknowledge what was in place?

When you consider how you've eaten over the past week, do you recognize your mindfulness or your balance? Or can’t you get past where your eating, activity or behaviors were less than stellar?

Oh, and about that image above—did you note the black dot, a blemish of sorts? Or did you notice the full screen of white, of possibility?

Gratitude

Why would you take care of a body you despise—one you view as too fat, or weak, or unattractive? Why adequately nourish it, lovingly stretch it, gently exercise it? And why would you keep pushing for change if you can not appreciate the benefits of your efforts?

What if you woke up every morning with appreciation that you were still breathing, that you had the gift of another day? And what if you noted that, beyond the aches and pains, most systems functioned quite well? I know, I know—this maynot be the case for some of you. Persistent tinnitus (that high-pitched ringing in your ears), chronic hip pain, or knee or backaches, problems digesting or sleeping—these are nothing to be thankful for.

A patient of mine just told me about a buddy of his who's an avid hiker. He climbed all 48 4,000 footers in New Hampshire—an impressive feat, I'll tell you, as someone who knows those trails well; they're steep, rugged, filled with loose rock. It's certainly motivating, though, when rewarded with the stunning panoramas when we hit the peaks.

The only thing is, that successful hiker? He's blind, and hikes with a guide dog. Somehow I suspect he doesn't wake up and dwell on his lack of vision.

I really don't know. I am quite fortunate to have a body which functions at 100%, at least for now.

Do we need to experience the threat of loss of function to appreciate that our body works? Must we starve, or fast, to appreciate food? Can't we appreciate the power we have to change our reality, to shift our perspective?

Shift your thoughts

• Perhaps you purged this week, but only once or twice—per week, that is, versus per day.
• Perhaps you exercised, a goal you set for yourself, for 10-15 minutes per session—less than you intended, but more than you had managed to do in the recent months.
• Perhaps you overate, but stopped yourself much sooner than you usually do, preventing an all out binge.
• Perhaps you ate cookies, or cupcakes, but in reasonable portions, and perhaps you allowed yourself to finally taste them and thoroughly enjoy them. Imagine that!
• Perhaps you are beginning to give yourself credit for some positive actions you are taking—just not all the time. 
• Perhaps you can begin by identifying 2-3 positives each day, while getting ready for bed or when getting dressed in the morning.

Your intake, activity, or behaviors may be far from perfect, but perhaps you’re still moving forward. The work may not be done.

Maybe things aren’t so great. But have you lost the ability to create a positive shift, to see the white space?

Perhaps, it’s only half empty.

My gratitude to Rabbi Leslie Gordon and Rabbi Barry Starr for their recent words which inspired this post.

Consider these other posts on this topic:

http://dropitandeat.blogspot.com/2011/06/30-chance-of-rain-70-chance-of-recovery.html

http://dropitandeat.blogspot.com/2011/10/setting-record-straight-shifting-your.html

http://dropitandeat.blogspot.com/2012/01/saying-goodbye-to-your-jeansa-new.html

http://dropitandeat.blogspot.com/2011/07/losing-part-of-your-body-gaining-vision.html

The Door to Change is Open. Learning about eating disorder recovery from Let’s Make a Deal.

So you long to be at your old weight, the lower size, the place where everything was fabulous? Like the amnesia when recalling an old boy/girlfriend—you know, that selective memory that favors only the good times (not how miserable they made you feel or how unhealthy your relationship was with him/her)—you remember longingly how great it was to be thinner, and you strive unhealthily to get there. Remember how happy you were, how you loved your body then? Don’t you recall how great you felt—physically and mentally? No?

Was it as good as you recall or did you feel trapped?
The door is open for change!

Likely not! What was that disordered relationship with food really like? How great did/do you truly feel and function? Perhaps, as I hear from so many...

• Your mood was off. Depression crept in, as did anxiety. Thoughts might have become obsessive. As a result, you were not truly present. Rather, your thoughts were racing, removing you from engaging in conversation and interacting in a healthy way.
• You were emotionally removed—perhaps that was helpful—but not feeling the negative stuff also meant not enjoying the positive experiences either. Were you missing the connections with friends and family? Did you miss out on those early years of your children’s lives, or the later years as your parents were aging? Present, but in body only?
• You were dragging, deprived of energy from truly getting enough fuel throughout the day. Maybe you made up for it later, but that didn’t help you function throughout the day. Ok, so the coffees or diet Cokes gave you that caffeinated illusion that you were energized, but the headaches and preoccupation about your next meal surely told you otherwise.
• The lightheadedness and fatigue were bad enough. But the disturbed sleep during the night might have been more than you bargained for.
• You hated feeling cold all the time, especially when nobody else was.
• And having to attend all those appointments—with your doctor, your therapist, psychiatrist, and that darn nutritionist. Bad enough to have to take all that time, and copays, but having to be held accountable every visit? Uggh!

Yes, there is another way...

• The missed periods (for you women) were a bit worrisome, never mind the impact that would have on your bone density.
• It was so challenging and overwhelming planning meals and trying to be social, when so much centers around eating!
• Your thoughts became so distorted.
• And you felt so trapped and helpless.
• You were not even happy then, as you were still striving, against your body’s best interest, to lose more weight.
• It was like living two lives. The one everyone else saw. And then the real you, the you you struggled with.

Let's make a deal

Remember that old TV show, Let’s Make a Deal? I guess it still airs, but decades ago when I last watched it here’s what I remember. There were three curtains, and behind each one there were items—some desirable and some, so-called zonks. Contestants would have to make a decision to trade what they were shown behind one curtain with the unknown contents hidden behind

Have you read all the posts this cup mug is on? Just checking!

another curtain. They had a chance to reneg on their decision—offered money to trade back, still site unseen— restoring the hope and promise of possibilities behind the alluring curtain—which of course could turn out to be a worthless dud.

This show somehow seems like eating disorder recovery itself. In spite of knowing that we are living with a zonk, which in the grand scheme of things has so little value, it is challenging to trade for the virtually unknown. Virtually, because we have all but forgotten how much better, how much more value that former non-disordered self had.

If you’re stuck in a pattern that you know isn’t working, why not take the risk, so to speak, and try what’s behind a different curtain? Could it really be much worse that what you are living with now? You knew what the other curtain held—the benefits of listening to your body, of nourishing yourself, body and soul. So why not make a deal and trade up?

Maybe you won’t like all the offerings behind a curtain. So toss or trade back the parts you could do without. Perhaps you'll need to learn to tolerate some parts of the package that aren’t your favorites—you’ll learn how to make due. Yes, with support and experience you can become more accepting of the full package.

"How do I start?"

Ready to trade up? Make a list of what you dislike about your current situation—physically and emotionally. What is it stopping you from doing? What harm is it doing? What would you be able to do if you didn’t have this disorder? What was it like without it?

And what positives do you get from your disorder? A strange question, perhaps. But on some level you must be getting something positive from your current situation. It may be your drug of choice, or allow you to not have to make decisions about your future. There may be all sorts of positives you attribute to your disordered lifestyle.

Now put them together. Bring them in to discuss with your health professionals—your therapist, dietitian, or MD.

Do the math, adding the pros and the cons. Then make your voice heard and make a deal. Yes, it’s time to peak behind the next curtain.

Not thin enough? Not sick enough? YOU—eating disordered?

I’ve done it. In just a few sessions I made my mark on a future generation of nutrition providers—an intern interested in eating disorder treatment, no less. She was, like most, biased by the sensationalized images and the media’s descriptions of emaciated anorexics; of teenage girls who ‘just wanted to be thin’; and of visibly unhealthy looking bulimics. Those were people with eating disorders, she believed.

Yet in the few days she has spent with me, she’s seen anorexic men, normal weight binge eaters, and women in their 40s, 50s and 60s struggling with eating disorders. Some developed their disorder recently, some only recently presented for treatment, having struggled with their relationship with food for decades. All are pained by their condition—no one chose to live with a disorder. Really, there are places they’d much rather be than in a medical office on a nice summer day.

Yet what they all have in common is that their appearance is not a give away. Most look just fine, I must say. (Although I’ll admit that without their layers of clothes some would be viewed as significantly underweight.)

Yet most carry their disorder on the inside.

It’s unfortunate, really, because as a result, they have suffered silently. Their doctors and health care providers never knew to direct them for the necessary expertise and failed to support recovery. And often they put their foot-in-their-mouths with inappropriate comments about weight or “healthy, runners’ blood pressures.” If only they could have seen it. If only it was as clear as the media portrays it. If only they knew that most people living with eating disorders don’t look like they have an eating disorder.

If you didn’t know to ask, you’d have no idea that perhaps 95% of their thoughts are spent perseverating about when they will eat next, and just how much; about whether their stomach is still flat, or whether they will have access to a bathroom after eating to purge; or whether they’ll have an opportunity to binge without anyone to witness it. If only medical providers thought to evaluate food intake and behaviors before the comprehensive, costly GI workups which fail to identify the cause of the chronic distress from hunger or slowed motility, or the reason behind the heartburn—namely, the chronic purging.

How helpful it would be for primary physicians or the referred-to neurologist seeking an answer to the puzzling chronic headaches. No, no one considers inquiring about the time between eating and the food restriction. Yes, migraines and other headaches occur more often with under eating.

Hope comes with new DSM

Fortunately, the new DSM-5 guidelines may help. They’ve changed the criteria for defining anorexia, removing some of the requirements that kept individuals from getting the help they needed. And, from misleading health providers about what eating disorders really look like. Now, rather than defining anorexia by using a specific weight change (such as the previous 85% of normal weight) it appropriately offers a broader definition. A low BMI is not a requirement for diagnosis!

The guideline states “the clinician should consider available numerical guidelines, as well as the individual's body build, weight history, and any physiological disturbances". In other words, an individual who is objectively overweight or high BMI can now, fortunately, be fairly labeled as anorexic if he/she has restricted intake resulting in significant weight loss together with physiological signs of starvation together with meeting all other criteria for the diagnosis. And, missing a period is no longer a requirement for diagnosing anorexia. That certainly may impact the many men out there struggling with feeling like an imposter with a ‘women’s disorder’!

No, you don’t have to fear that your weight isn’t low enough for your disorder to be acknowledged. And you don’t have to look like an adolescent poster child for anorexia.

No longer should you feel you need to lose weight to fit the anorexia definition to enable treatment or, for that matter, to validate your suffering. No longer does EDNOS—that vague ‘not otherwise specified’ diagnosis—need to be used for those restricting, nor for those suffering with Binge Eating Disorder (BED). Yes, you aresick enough.

Anorexics are 60 lbs. And individuals with anorexia are also 200 lbs. Dropping weight with severe food restriction is no less serious if your 30 lb. or 50 lb. weight loss brought you to 130 lbs. or to 90 lbs. Thank you, Deb Burgard, PhD, an AED member and blogger for HAES, for making this point loud and clear.

Having a BMI in the healthyrange is hardly healthy if you are compulsively exercising, purging or restricting to maintain this place.

I’m so glad the intern gets it. It will make her a better provider when the time comes to practice, as she will now know to ask the questions to help identify and ultimately support recovery from an eating disorder.

But have I made my point strongly enough for you to hear? Please pass this along to increase awareness—to your friends and family members who you’d never know might be suffering—and to your medical providers who never thought to ask.