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.

The difference between you and me.

“How presumptuous”, you must be thinking, “to group all of your readers into one lump sum, overgeneralizing between us and you.”

Well, unless you are a member of my exclusive club, the one-in-750-in-the-US-living-with-Multiple Sclerosis, then I think you'll agree. As I'm sitting here awaiting the chemotherapy treatment to infuse into my veins, I'm painfully aware that I live with a chronic disease, a potentially debilitating one at that. But for now, I'm fortunately unaffected by this progressive neurological condition. 

Perhaps, like you, I'm on borrowed time. Borrowed time? Yes, because neither of us can predict just when the impact our conditions will hit us the worst. Or when the damage from our situation will lead to a fatal consequence.

A depressing shift in perspective from me? Not really. In fact, my intent is to show you just how fortunate you are. And to demonstrate that change is, in fact, in your hands.

I live with a healthy dose of denial. (Ok, so we really may not be all too different from each other.) That said, my denial allows me not to dwell on the ‘what ifs’. What if my condition progresses? What if a symptom hits me suddenly, like temporary blindness or double vision, my presenting symptom? And what if I become unable to work? Or walk? Or cycle and hike? Or leaves me unable to be present and functional? 

In spite of my denial, which I find quite beneficial, I am not denying my need for treatment. The stats are quite unimpressive—treatments don't cure MS, just like meds don't cure an eating disorder. But they might prevent my situation from progressing. Or they might not. MS is an unpredictable disease. And boy do I dislike uncertainty. But doing nothing ensures that nothing good can happen. 

Hmm, maybe I ought to change the title of this post to read "What you and I have in common"?

But here's where we differ. Besides the fact that you might be living with an eating disorder—bulimia, anorexia, binge eating disorder—or you might feel ruled by your rules (compelling you to deny yourself enough food or the pleasure of food)—the differences between us are vast.

Here's the biggest: You can do something to reverse your eating disorder or your disordered eating. You can use the tools of CBT or DBT or FBT to move you along. You can potentially utilize your resources—your friends, your family, a higher level of care, if needed. No, it won't be easy and it's not a quick fix. But these are strategies that can turn your condition around.

You can decide it's time to move on, to prevent your rules from ruling you, and eat enough to nourish your brain to soften those unhealthy voices. You can remove the triggers which result in purging and learn to move on after a slip from less than perfect eating and disordered behavior.

There's evidence that people recover, fully recover, from bulimia, binge eating disorder and anorexia, and that normal eating is a real possibility. Yes, you can take an active role in reversing your condition and prevent your eating disorder or disordered eating from robbing you of the life you so deserve.

I have no such option. Sure, I can choose to focus on the positives from living with such a condition as MS, but let's be real. Living constantly aware that any part of my brain or nerve pathway can be damaged and stop working is hardly something to see the positives in. 

In fairness, living with MS has had its benefits. It has made me much more sensitive to the fact that many individuals who look just fine—and act fine, even—may be harboring a condition that zaps them of their energy and steals their ability to life a full life. Living with MS reminds me that I can never look at someone and assume that they are just fine, when they may be living with a disability like MS or an eating disorder or disordered thoughts. Or depression. Or OCD…

Like those of you living with an eating disorder, we share a genetic predisposition to have the diseases we have—and we are not to blame! And our conditions might have been triggered by something in the environment. Stressing about it may only worsen our fate—high stress and anxiety—while not the cause of either of our conditions—may be obstacles to recovery and wellbeing. 

Based on statistics, I'd have mentally checked out of treatment, believing that chronic disability was my fate. But it's not. Not for me and not for you. 

You can live with some denial to get you through the days, but you still need to take your medicine—your food, your nourishment. And we need to put one food in front of the other and follow the recommendations of those in the know—our treatment team members—for without that commitment we fulfill a self-fulfilling prophecy that recovery can't happen. A positive outlook, and the belief that we can beat the statistics is essential to moving forward and making the most of what we’ve been dealt.

Personally, I cannot simply eat or take a medication to cure my MS. But you can certainly do just that. You can help your brain function fully, by eating enough, all the while improving your quality of life.

You can shift your thinking and ultimately your actions, and make change happen. I am at the mercy of MS research to be successful and find a cure for Multiple Sclerosis.

Neither of us is at fault for our conditions. But you are at fault if you take a back-seat approach to management of your eating disorder. Passively showing up for appointments fails to support recovery and well-being. Yet acting to change your course makes all the difference.

So as you move through the day, ask yourself if you are changing what's in your hands to change to move toward recovery. And if you answer no, then it's time to make a plan for moving forward. Not on Monday, nor on January first, but today.

I'm feeling disconnected and groggy right now. The Benadryl pretreatment has hit with a bang. I know no hunger, for now, and my thinking is compromised. My heart rate is slower than usual, and I have little control over much of anything—thank goodness for spellcheck. I'd be at risk if I dared to check out of here and attempt to drive my car or to exercise. I am compromised. Right now, you and I are truly quite similar. But my state is transitive. Yours can go either way, depending upon your actions.

Do not have pity for me, for I am fortunate enough to function 100% and I am living my life to the fullest. Have compassion for yourself, and may this post inspire you to get your butt in gear and turn your situation around.

Do you believe recovery just isn’t possible, at least, not for you?

Lessons from ICED 2013

I see 30-40 individuals suffering from anorexia, bulimia, binge eating disorder and disordered eating each week. Men and women, preteens through age 70+.  So short breaks and vacations are, of course, quite refreshing.

But last week’s Academy for Eating Disorders Conference, the International Conference on Eating Disorders (ICED) offered anything but relaxation.

Stimulating, inspiring, fascinating and hopeful—even these words do little justice to the conference presentations. I became pumped, and felt validated that the progress I see with my patients is not random. I was sparked by the incredible research demonstrating the progress in the understanding of eating disorders and their treatment. It only confirmed my belief that there’s reason for you, too, to know that recovery is possible.

Let me tell you about a session I was most excited about—Lisa Dawson, a PhD candidate’s research presentation entitled Recovery From Chronic Anorexia Nervosa: The Tipping Point for Change. You don’t have long-standing anorexia? Don’t stop reading. The lessons from this psychologist’s research are inspiring for all.

Dawson decided to select those individuals who recovered from anorexia—and I mean trulyrecovered—because by looking at this population we can figure out what elements are critical for recovery in anyone living with an eating disorder. They had to be free of anorexia for 7+ years, in an objectively normal weight range, and free of eating disorder behaviors. “You mean such people really exist?” you’re thinking? You bet. And she identified the common elements that contributed to their movement toward and their ultimate full recovery, based on extensive interviews with the participants. Here are some key points she identifies:

There are 4 stages to recovery, which individuals move through in one direction, and for differing amounts of time:

1. unready/unable to change
2. the tipping point of change
3. active pursuit of recovery
4. reflection and rehabilitation

In the first stage, people feel like they didn’t know why they were doing what they were doing (wrt ED behaviors) but felt they just couldn’t stop. They internalized the eating disorder and they perceived treatment as unhelpful. They felt misunderstood and lacked insight. In summary, recovery seemed impossible; they didn’t feel like anything they did made a difference for recovery, they had low motivation and had a sense of helplessness and hopelessness.

Over time, they realized that their eating disorder wasn’t helping them. Those who recovered also started to experience feeling understood. They were able to externalize the eating disorder and over time gained insight into their condition. They became more worn out by their eating disorder as well. Motivation increased. They started to feel that they had the power to change their situation, that they could impact their curse.

More value was placed on life outside their eating disorder. They learned skills to help them cope as they let go of their eating disorder behaviors.

Self-discovery, self-acceptance, and learning to love oneself were components of the maintenance stage.

It was a long, and slow process. But it happened.

So here’s an email I received this week from a patient of mine who, in spite of living with anorexia for more than 25 years, is now in recovery. The timing couldn't have been more fitting for this post:

"I've been continuing to do well with food.  I know I was upset at my last apt with life in general, but that did not affect my eating.  To date, I still have not purged or restricted or exercised.   Can you believe it? And... I don't want to forget to tell you so I'll share now, re: exercise...  I have been taking walks after dinner with either one of the girls or my husband or all (not every night, but several) and it didn't dawn on me til yesterday that I can go on these walks and I haven't:

• thought about how many calories I'm burning
• gone at fast pace to burn more calories
• obsessed over having to walk each and every night/same time/same pace/same path 

Instead, I:

• go on a walk if I feel like it
• enjoy whatever pace I seem to be going at, without thoughts of burning calories
• actually enjoy being present with the people I'm walking with!!! 

I do not fret if I can't make a walk.  I do not keep track of how many nights I've walked. I do not feel it's necessary if I've eaten a larger dinner. The obsession is not there!  Where did it go? I don't feel it, all I feel is the happiness that I'm going on a walk with a very loved family member where we can chat and talk and laugh. 

Huh? When did this happen?! Although it may not seem big, it really didn't hit me until yesterday that these walks are not the same walks as in the past. Not one bit. I am totally present and I completely enjoy them. And I continue to eat. Normally. I think I now know what normal is. At least, my normal. And I never, ever thought I would find "normal". And "normal" to me means:

I can eat when I'm hungry, know when I'm full, eat what I want in moderation... and because of this, I have not gained 30 lbs in 5 days as previously thought. I have gained weight.  I am working on accepting the feelings that accompany this. I think I'm in a better place to work on this. Nobody likes to gain weight, that's pretty much reality. But... I'm healthy.   

I put myself, my body, through hell. Can you imagine deliberately depriving your own body of nutrients it needs to stay alive? Can you imagine the destruction throwing up food causes? Or ingesting a plethora of pills to help further the weight loss process? How good is THAT for your body?! Oh my God, I sit and think how the hell am I still alive!!!  This has been going on for decades!  

I am at a really low point - sad, lost, confused, lost, angry, lost...  I feel like everything is out of control in my life.  Where did I turn for all those years to gain control over something when everything else felt so out of control? Ed. But what is happening now? Everything feels so out of control, yet the ONLY thing that feels IN control is my decision to eat well. Isn't this the complete opposite? What is going on here?  

So, the point of this email is to tell you that I have the strength to continue fighting this and I will succeed.  You are not going to see me relapse. Everything about this eating disorder is finally beginning to make sense. I have so much more to share but I'll save that for our next meeting. 

Lori, boy I can't begin to tell you how everything you've taught me is now landing in place and making sense and how in the world do I thank you for that?I was so, so sick.You saved my life.I still have work to do, I'm a work in progress, but slowly I'm regaining inner strength - which is just what I need to move forward. 

Thank you, thank you, thank you..."

I share this, with her permission, because while recovery is challenging, to say the least, it happens. And what I hear from her and from others confirms what Lisa Dawson shared in her study—that belief that you can recover, that change is in your hands, is essential for recovery. And that working with providers who get it and help you feel understood, and provide hope that full recovery is possible, can make all the difference.

Your thoughts?

Desperate for Overeaters Anonymous?

6 Reasons to Skip This 12-Step

It's January and if you watch TV, read Women's (or Men's) magazines, or overhear locker-room talk you know what that means.  Just last week my husband emerged from the gym, biting his tongue having heard a couple of guys talking about white flour and 'bad' foods to eat and their New Year's resolutions to strike them from their diet.

Yes, one of us bites his tongue. I, on the other hand, feel compelled to discuss the issue further.

Why a post on OA anyway, you ask?

Because I have been hearing tales of OA meetings, about Grey Sheet, about control and powerlessness for years now, from clients who’d been involved with OA and wrestled to break out of it’s grip, and from those struggling to move on. And, because I want to point out--as I did in the Weight Watcher's post—what you need to be cautious of if you are considering taking advantage of this program.

But first, here’s a disclaimer; I have never personally experienced Overeaters Anonymous meetings, nor the sponsor relationship, although I have read through their booklet several times to ensure I am taking their information first hand as well as through the filter of its ex-members. I am writing based on what I frequently hear in my office, from those who have left the group, often with mixed emotions. They left, ultimately because they realized it wasn't working for them, sometimes feeling a longing for the camaraderie of the group, sometimes seeing their departure as their own failure. But often recognizing that the OA approach was ultimately far from healthy.

Overeaters Anonymous is a peer led support group based on the 12-step model of recovery. What's 12-step, you ask? Here's a link for an explanation:

http://en.wikipedia.org/wiki/Twelve-step_program

Twelve-step programs are fabulous for helping individuals take control when struggling with a range of addictions—such as alcohol and drugs. But eating should not be so black and white, with columns of drug-like foods and good food. We can compulsively overeat on anything—given the right setting and triggers.

So what's my beef about this 12-step program for compulsive overeating?

1. It's free. But you get the expertise you pay for.

Guidance and support abound, by well-intentioned individuals (called sponsors) struggling with their own compulsive overeating. And their approach to managing food is simply avoidance. Are sweets an issue? Ban them. Bread? Ban it. Anything white, as in white potatoes and white rice—purge them from your diet. Admittedly not all OA members follow this rigid approach (aka Grey Sheet), which has supposedly lost favor with the organization. Yet even in their descriptive program booklet, there’s specific reference to avoidance of these foods.

It appears to me, from my patients’ descriptions, that issues of control around food get transferred to control in the sponsor-member relationship. Instructions and repeated check-ins and accountability come from sponsors, lay people struggling with compulsive overeating themselves. They are not trained professionals, and draw only from their specific issues and experiences. Patients have described feeling shame and the need to be dishonest with their sponsor, and they ultimately complain of difficulty being released from the hold of the sponsor even after deciding to leave OA.

2. You decide what you eat?

With Overeaters Anonymous, you can follow whatever diet you please—it's up to you, not them! “We choose what’s appropriate and nutritionally sound for ourselves”, they say. Sounds perfect, no? Yet this can be dangerous, if you are misinformed as were the gym goers my husband overheard or if your thinking is distorted from years of diet rules. If you believe that limiting your intake to fruits and vegetables is adequate for yourself, I just wouldn’t agree. There is a place for some reality checking with a professional!

3. We must admit we are powerless over food?

That's their ‘step one’ so it’s no surprise that OA and I differ philosophically here! No, I do notbelieve you are powerless—although you may certainly feel powerless around food. Yes, when you have under eaten throughout the day, you will feel out of control when food finally appears. When you are stressed and have not yet learned alternative means to manage your feelings other than relying on food, you will overeat. And if you feel you are not entitled to eat—because you shouldn'tfeel hungry, or if you desire something palatable but feel that you are not entitled to eat what you enjoy simply because of your weight—surely you will eat it compulsively and feel powerless. “Our mind/body as compulsive eaters is different than a normal eater…” they say, and I couldn’t disagree more.

4. “Spiritual growth is the basis for stopping and maintaining compulsive free eating.”

That’s what they say in their manual. Sure, a sense of peace and inner calmness will help you move away from compulsive eating. But frankly, if someone leaves a plate of home-baked brownies on your kitchen counter, even if you’ve had a spiritual awakening, you’ll likely still eat more of those delectable baked goods than you intended—and there’s nothing disordered about it! Rather, it’s a pretty normal response, triggered by our senses. And if we’re distracted at the same time, we’ll likely eat more. And if we’re hungry at that time, we may consume them faster and in greater portions. I’m all for spiritual growth, but you don’t need to believe in a higher being to take control of your eating.

5. “Then we need a plan of eating…that includes refraining from particular foods and or specific compulsive behaviors.”

Unfortunately, restricting food intake and creating lists of good vs. bad foods does nothing to change your long-term relationship with food. Short term, this black and white view may seem to serve you well. But after some time, thoughts about the forbidden foods, longing for what you miss eating, and ultimately overeating on that which you’ve eliminated, will result. But you may just blame yourself instead of this outrageous approach that itself contributes to your lack of control around food. I do not endorse their approach of identifying and then eliminating all foods that you struggle to eat in control.

“Think of it not as deprivation but of as a positive act and spiritual discipline…” they urge. Really? Is this the kind of guidance that will help free you from disordered thoughts around food and eating? I don’t think so!

6. Where do we agree?

I support OA’s interest in helping you move away from unhealthy behaviors, including [my additions in parenthesis]:

• Eating until (uncomfortably) stuffed
• Rigidly restricting (your food intake and the foods that give you pleasure)
• Having to clean your plate
• Hiding, and hoarding food
• Distracted eating
• Purging and restrictive dieting

“These behaviors should be stopped.” They say. And with this, I agree. But their recommendation to follow a 3-0-1 plan to include only 3 meals with nothing in between is simply absurd. It will neither stop your behaviors nor your preoccupation with food and eating.

So now where can I turn?

Support groups can be quite valuable, but I’d advise joining one moderated by a professional in the eating disorder community. In Massachusetts, check out medainc.org, or explore your local eating disorder organization. Yes, compulsive overeating is an eating disorder and needs to be address by professionals whose treatment is based not on their personal experience, but on years of clinical expertise and guidance from evidence-based research. Well-intentioned free guidance can cause more harm than good, as you‘ll struggle to let go of the additional set of rules they’ve imposed.

For more on this topic, check out What I've Learned About Food Addiction, Black and White-Great for an Outfit, Not for an Outlook