Saturday, May 28, 2011

This post concludes my three part post on RECOVERY! If you missed the first two, check them out here and here. I started this series after a reader asked a question about whether or not full recovery from an eating disorder is possible. I thought it would be interesting to compile a list of quotes from professionals and share their responses! 

"As former eating disorder sufferers, Liana and I feel that a full recovery is absolutely possible. We like our bodies, we eat when we're hungry and stop when we're full, and we think about more pressing issues than the number on the bathroom scale. We also think its important that people continue to push themselves in recovery until they ARE at that place. It is very easy to become complacent, but you can be 100% recovered if you fight 100% of the eating disorder. It often takes many years, but it is very possible and very worth it!"
Kristina Saffron and Liana Rosenman, co-founders of Project H.E.A.L.

"Like Dr. Daniel LeGrange said in his article, an eating disorder is someone's Achilles heel. Relapse remains a possibility for anyone with an eating disorder history, and we would be blind if we didn't prepare people for the possibility that the illness could return. What I think gets lost in the discussion--what I don't think gets emphasized enough--is that preparing for the possibility of relapse doesn't mean spending every waking hour fighting eating disordered thoughts and symptoms. Instead of referring to "recovery," physician Julie O'Toole, founder and director of the Kartini Clinic in Oregon, refers to eating disorder "remission." Just like cancer, a person with an eating disorder can have no detectible signs of illness. Other than periodic tests and check-ups, the person lives a normal, healthy, disease-free life. But experience has taught oncologists that cancer can return. We don't need to be afraid of it, but we do need to prepare for it.

I remain optimistic that full recovery is possible in many people with eating disorders, especially if caught early and treated aggressively. I've seen many people turn their eating disorder from a life-consuming illness into a piece of their past. I've also seen happy, well-adjusted former sufferers relapse through no fault of their own.

An eating disorder doesn't just go away. It's not a cold. One bout with an eating disorder doesn't leave you "immune" to further onslaughts. I have friends from high school who have asked me if I was "over it" yet. A chronic eating disorder isn't something you just get over. It's not something you forget about like the stomach flu or a broken ankle. As much as I intend to one day refer to my eating disorder in the past tense, I also know that I need to keep my recovery very much in the present tense no matter how long it's been since I counted calories or could see my thighs magically expanding after eating cake."
Carrie Arnold, a freelance science writer, author, and Psychology Today blogger.

"I consider myself fully recovered from using eating disordered coping thoughts and behaviors to deal with the stressors of daily life. However, I view the experience of recovery itself as an ongoing continuum and think that the purpose and need for developing a personal understanding of terms such as "recovered" or "recovering" is as unique to each person as the path their individual journey will take. I view the debate re: "in recovery" versus "fully recovered" as part personal preference and part pure semantics and think that care must be taken when placing emphasis on the destination rather than the necessary work the daily recovery journey requires (i.e. reining in impatience and recognizing that there is a reason recovery takes time). Personally, my view of "recovery" aligns closely with that of Dr. John Nash, the famous Nobel Prize winning economist/mathematician who achieved and has maintained an ongoing remission from paranoid schizophrenia. I view my recovery as a remission and that is helpful to me in maintaining my health and wellbeing as the years go by."
Shannon Cutts, creator of MentorConnect, author of Beating Ana, educator and speaker.

Shannon's response struck a chord with me because I have often used the same analogy of Dr. John Nash and his remission from schizophrenia, and haven't heard anyone else use that same analogy before! The movie 'A Beautiful Mind' that was made about 10 years ago chronicled Dr. Nash's life and there is one scene in particular that I have used as an illustration with ED recovery that occurs at the very end of the movie. Spoiler Alert!! Dr. Nash is walking through campus, and he is aware of the delusions that he is seeing (different people that are talking to him that don't really exist), yet he does not stop to talk to them or acknowledge them.. he keeps on walking. They don't have an impact on him anymore, even though they pop up from time to time. I tried to find a clip of it on You Tube because it is a really powerful moment in the film and one that makes a lot of sense when compared to an eating disorder. The bottom line- recovery from an ED is possible. It is possible. Have hope and patience, and seek out the proper treatment and support! If you have any questions or comments about ED recovery, please feel free to leave a comment in the comment section or send me an email at Thanks again to all of you who contributed to these posts :).

Tuesday, May 24, 2011

More on Recovery..

If you didn't get a chance to read my first post regarding recovery, scroll down or click here to take a look! It is a post that is full of encouraging and thought provoking quotes about recovery. I still have a few more recovery oriented posts that I would like to share with you all, and today's post comes courtesy of Johanna Marie McShane, licensed psychologist, author of Why She Feels Fat, and all around awesome lady. When I asked her what she thought about 'full recovery', here is how she responded- below. 

Is there such thing as FULL recovery from an eating disorder?

The answer to the question of whether full recovery from eating disorders is possible depends on two primary things. The first is: how is recovery being defined? The second is: what is the nature of the eating disorder the question is being asked about?

Recovery is often defined in a variety of ways, depending on the viewpoint of the clinicians involved. For example, some people would consider recovery to be achieving and maintaining stable medical health and weight restoration; others would define it as resolution of eating disorder behaviors/symptoms; still others think of recovery as the change in rigid thought and belief patterns inherent in the disorder; while some clinicians see full recovery as meeting all the above criteria.

Characteristics of an eating disorder play a big part in the prognosis for “full” recovery. How long someone has been ill, how severe and frequent the symptoms/behaviors are and have been, the presence of other illnesses, all affect treatment and recovery. In general, the longer the course of the disorder the more difficult it is to treat, as is true for the more serious and frequent eating disorder behaviors and the presence of additional illnesses. However, this is not always the case.

My own view is that the answer to the question, is full recovery from and eating disorder possible, is “it depends” and “it is possible.” I don’t mean this negatively or pessimistically, simply pragmatically.  

It depends on all the variables, and on how we define recovery. Here are two people we can use as examples: the first is a 16 year old girl who developed an eating disorder three months ago- she compulsively exercises and restricts her food intake. The second is a 26 year old young woman who developed bulimia about ten years ago- she binges and purges 40 to 50 times a day (these are both real people who I have worked with).

Recovery might look quite different for these two women, right? For the teenager we might have different goals for recovery- perhaps full elimination of her symptoms and behaviors. For the 26 year old our overall goals might include stabilizing her health and reducing the binging and purging to the extent that she can have a quality of life that’s fulfilling for her.

In fact, this is exactly what happened in both these cases. With some intensive and relatively brief treatment the teenager’s behaviors were reduced to zero and she went on with her life, much like if she’d suffered from a bacterial infection and it was then successfully eliminated. The 26 year old worked tirelessly (and not wholly linearly) in treatment for several years, including a few months in a residential treatment program. She was able to reduce her bingeing and purging to about once a day and she remained medically stable. When she left treatment she had been stable for over a year, with the bingeing and purging frequency at about 3 or 4 times a week. She had a full time job, friends, and a repaired and fulfilling relationship with her family.

Are these people “fully” recovered?  It’s an interesting question. What might be a more valuable thing to consider is the quality of life each achieved and sustained, rather than whether they meet certain or all criteria for “full recovery.”

And perhaps the most valuable thing would be to ask each how she felt about her recovery. Since I know both these women I can tell you what each said at the time they left treatment. The teenager felt “wholly recovered,” almost as if the disorder had been a “dream” and hadn’t really existed. She was relieved to finish treatment and not need to go to appointments anymore. The 26 year old felt a type of gratitude possessed by someone who has worked extremely hard to get herself out of a situation that almost killed her several times. She knew she still had symptoms, and in fact, that she still met the “criteria for bulimia nervosa” (in terms of frequency of bingeing and purging). Compared to where she’d spent the previous 10 years and where she thought she was going to have to stay for the rest of her life with this illness, she felt pretty darn recovered.

Food for thought, indeed.. Would love to hear any of your comments, questions, or feedback! You can also check out Johanna's blog by following this link. Keep checking back for more recovery posts this week!

Wednesday, May 18, 2011

Lately, I have had a lot of conversations that have revolved around recovery and what it looks like to recover from an eating disorder. What exactly is recovery? Is full recovery possible? How do you know when you are 'recovered' or 'in recovery' and is there a difference? Whether these conversations have occurred in therapy sessions with clients, in other public or social forums, or even on my blog, it is a topic that has been popping up a lot recently. When I got an anonymous question from a reader last week about recovery, I thought maybe it was time to explore and discuss this topic here!, especially since it is one that people have varying thoughts about. While I know what I think about recovery, there is diversity in thought that exists related to recovery-- and I think this is an important discourse as it has not been universally agreed upon or defined in the profession. 

For a bit of context, here is the reader's question:

"Do you think complete recovery is possible? It seems that a lot of people place eating disorders in the always in recovery/never healed category of mental health. I would like to think it is possible, but, personally, I tend to agree with those who doubt complete recovery. I notice that it takes a lot of effort to not fall into my old ways- I am healthy weight wise, but mentally I still seek control through food."

One of the reasons that I felt compelled to address this issue is because I believe that the way we think about recovery and view recovery can have a massive impact on how hopeful we feel for our friends, loved ones and ourselves who may be suffering, as well as how effective we can be in moving forward. (Think self-fulfilling prophecy- if you don't think recovery is possible, then you won't likely be motivated to act in ways consistent with recovery, and you will probably feel pretty hopeless.) As a fun way of exploring this topic on my blog, I thought it would be interesting to compile responses from people and professionals in the eating disorder field that I highly respect. It is no surprise that I was welcomed with extremely insightful and thought provoking responses. Below are some of the responses that I received to this question that I posed: "Do you think that it is possible to fully and completely recover from an eating disorder? Or is eating disorder recovery more similar to something like remission?"

"I believe eating disorders are a completely treatable brain disorder and that patients can and should live without symptoms if their community, family, and clinical team work together to intervene firmly and using sound science and compassion. I believe we should settle for nothing less than FULL remission of medical AND mental symptoms. But I also believe that the predisposition remains, even if there are no cognitive or emotional or behavioral symptoms. For that reason someone with a history of an eating disorder needs a lifelong relapse prevention plan. 'Remission' is a word that some people misunderstand as meaning the person lives constantly with a battle to be well, but I define remission as fully well with a risk of relapse. I find this way of looking at an eating disorder-- as a treatable brain disorder and not a choice or failure-- very optimistic. I think of recovered patients as having done heroic and laudable work, and then applaud them and their support."
- Laura Collins, author of Eating With Your Anorexic, Director of F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders) and parent activist.

"I believe in complete recovery though it may take a long time and require lots of resources and effort, but it is worth it. To protect recovery, one must not jeopardize it by dieting, over exercising, criticizing one's body, but instead focus on developing and supporting a clear unapologetic sense of self. I wouldn't be in this work if I didn't believe in complete recovery. My own recovery solid now for nearly 40 years still inspires me."
- Dr. Marcia Herrin, author of Nutrition Counseling in the Treatment of Eating Disorders and The Parent's Guide to Eating Disorders, founder of the Dartmouth College Eating Disorders Prevention, Education and Treatment Program, and a nutritionist in private practice. She also blogs for Gurze (here) and Psychology Today (here)!

"Rather than use the words 'completely' and 'fully' to talk about eating disorder recovery, I prefer the word functionally. A person is functionally recovered though they still may occasionally have eating disordered thinking (upon which they don't act) or even sometimes eat in a mildly disregulated way. They're functionally recovered when they generally and automatically practice 'normal' eating behaviors and hold a healthy attitude about food and weight.
-Karen Koenig, LCSW, M. Ed., therapist, motivational speaker, and author of The Rules of Normal Eating

"After 35 years of recovery and 32 years in the field treating eating disorders I have no doubt that full recovery is possible. Once I recovered I used my self as an example, then over the years I had many former patients become recovered, then more, and then I started meeting recovered people all over the country and then the world. I am talking about 10, 15, 20 and 30 years of being recovered, not just one or two. Full recovery is possible and no one can take this away from those of us who know that our illness is a thing of the past. Once something like this has really been healed there is no going back. This illness is legitimate but it does also have an element of choice involved unlike, say, leukemia. I will never make the choice to restrict my food, weigh my self esteem or starve myself again. I am recovered and I know it like I know the sun will come up tomorrow."
- Carolyn Costin, educator, therapist, founder of Monte Nido and its affiliates (Rain Rock, Monte Nido Vista and the Eating Disorder Center of California), lecturer, author of Your Dieting Daughter, The Eating Disorder Sourcebook and 100 Questions and Answers About Eating Disorders, and Gurze blogger (here!).

I hope these little 'sound bites' on recovery have been encouraging and thought provoking ...! I have more to post, and will be doing so in the next few days! :)

Monday, May 9, 2011

Who Says??

Who says I can't be a grown-up and also post a Selena Gomez teeny bopper song/video on my blog? :) I have nothing against Selena, but I feel like I might be publicly ridiculed by a few people I know for posting this (hey, at least it's not Justin Bieber!!). They probably aren't reading though, so it's okay :) Anyways, Selena! She wrote a song called 'Who Says' that has such a positive message about beauty. Then, along came Jessica Bergren who up and made a cool little video to go along with it. The lyrics to the first verse and chorus are below, followed by Jessica's video, which I found compliments of End Fat Talk! Check it out!

I wouldn't wanna be anybody else.
You made me insecure
Told me I wasn’t good enough
But who are you to judge
When you’re a diamond in the rough
I’m sure you got some things
You’d like to change about yourself
But when it comes to me
I wouldn’t want to be anybody else

I’m no beauty queen
I’m just beautiful me

You’ve got every right
To a beautiful life

Who says
Who says you’re not perfect
Who says you’re not worth it
Who says you’re the only one that’s hurting
Trust me
That’s the price of beauty
Who says you’re not pretty
Who says you’re not beautiful
Who says

my Selena Gomez "Who Says" video from kathryn Jenkins on Vimeo.

Wednesday, May 4, 2011

Happy National Mental Health Counseling Week!! :)

It's probably safe to say that many of us were riveted by the news this past weekend, between a romantical royal fairytale wedding, and the capture of a much wanted terrorist. That might be why you haven't yet heard that May is National Mental Health Month!! It has actually been celebrated since 1949!! Who knew?? :) Anyways, this week happens to be National Mental Health Counseling Week! Why is this important?? Well, according to the National Institute of Mental Health (NIMH), 1 in 4 American adults ages 18 and older (26.2% of the population) suffer from a diagnosable mental illness in any given year. I think it's safe to say that given the statistics, we are all impacted by mental illness. Whether we have been impacted personally, or whether a friend, family member or spouse has been impacted (or even both!), the statistics would indicate that we have all likely encountered and been touched by mental illness!

There was certainly a time when mental illnesses were stigmatized (people were actually burned at the stake due to misunderstandings about the way that mental illnesses were expressed).. and while education and awareness still need to happen to reduce continued stigmatization, I think that overall, we have made some relatively significant strides in this department!! 'Mental illness' covers a range of different conditions, including but not limited to anxiety, depression, bipolar disorder, eating disorders, obsessive compulsive disorder, mood disorders, phobias, etc! For more information on mental illness, you can check out the National Alliance on Mental Illness's site (here) or you can also check out the National Institute of Mental Health's website (here).  

If you or someone that you know is struggling, seeking professional help might be the next step. When people call me to set up counseling appointments, sometimes they wonder or question if they really need counseling. It is okay to be ambivalent about the counseling process. Sometimes the things that prove to be helpful and important for us aren't things that we are initially excited about-- we may have some reservations. Counseling can be a supportive measure that can aid in wellness and health. It provides a safe place to explore symptoms, as well as struggles and life transitions and hopefully provides strength and encouragement for one to move forward in good health. If you or someone that you know is interested in counseling, consider pursuing it! We all deserve to be healthy and well :).

Sunday, May 1, 2011

Here Comes Summer... Here Come Fad Diets...

Today marks the first day of May!! Isn't it crazy how time flies? Believe it or not, summer is quickly approaching, and we are entering an all too familiar window in which people start getting sucked into fad diets in order to prepare for bathing suit season. There aren't many things that I would say truly ruffle my feathers. But one of those things? FAD DIETS!!! :) If you have read my blog before, you have probably seen posts from time to time on diets and dieting (you can check some of those out here, here, here, here...) See... ?? I was being honest- I have a lot to say about this topic :-).  For starters, check out some stats on diets..  
  • Nearly half of all American women are on a diet at any given time. source
  • Two-thirds of dieters regain the weight within one year and virtually all regain the weight within five years. source
  • More than one out of three "normal dieters" develop pathological eating. One fourth of those will suffer from partial or full blown eating disorders. source
Soo, to sum up.. about half of all women right now are currently on diets. What constitutes a (fad) diet? Anything that promises quick weight loss and generally requires that you make some drastic changes to your everyday diet (aka food intake). The stats show us that fad diets are not effective. At all. Not only do nearly all dieters gain the weight back that they lose, but they often gain back more weight as a result of their metabolisms being manipulated. I also don't think people realize that dieting can trigger eating disorders or disordered, pathological eating! 

What compels us to diet in the face of such dismal statistics? I think it comes down to convenience! We live in a society in which we want everything done quickly, ...the least amount of effort and energy required or invested as possible, the better. We live in a short-cut world (which I think unfortunately leads to short-circuiting)! It's not just a weight issue, either- it's a convenience issue. It seems that the cultural majority favors convenience, no matter the cost. Convenience is not wrong, but when it comes with health dangers or potential risk, we are often willing to take the gamble because we simply want to see results. And because of the cultural ideal and unrealistic standard of beauty that is often tied to our body weight, we are willing to do whatever it takes to see quick results when it comes to weight loss.  

While I'd like to say that maybe only some of us are buying into this mentality (hey, it's hard not to sometimes, it's all around us!), I have to believe it's the majority... otherwise, the diet industry would not be a booming business. I think we really need to become more savvy about the way that we are feeding into a billion dollar industry when we diet. We are being taken for a ride as consumers, and the industry is playing on our desires to fit the cultural ideal that they are busy perpetuating so that they can continue to profit. Would you believe that according to a recent healthcare market research report published in December 2010 (Global Weight Loss and Gain Market by MarketsandMarkets), the global weight loss revenue is expected to be worth 586.3 billion dollars by the year 2014?? Who is profiting? When such cash is being made, whose best interests are at hand? If diet products really worked, do you think the industry would gross as much money? Now that my friends is Food For Thought. (Check out an article here by Smart Money magazine entitled '10 Things the Weight Loss Industry Won't Say'--it's a pretty good article minus #7).

One last thing that I want to mention is that while the diet industry continues to grow, the number of people in our country that are obese continues to rise. What does all of this mean? Lots of things I'm sure, but one thing it means is that diets and diet products make false promises that seem appealing and effective.. but that don't deliver and can be harmful. It is such a conflict of values and interests that we are often unable to see how we are being impacted. If you are dieting, all I would ask you to do is think critically about what you are doing, and how your body might respond once you stop the extreme behavior (that is, if you are able to stop and haven't developed a more seriously eating pathology). Are your behaviors sustainable? Are they healthy? How are they impacting your body? (Stay tuned for a post on this). 

My intention here is not to judge, but to encourage critical thinking. It is important that when we engage in certain behaviors that we are educated about these behaviors so that we can make the best possible and most effective decisions. While I'm sure the majority would disagree with me, dieting is the least effective decision you can make when it comes to food and maintaining a healthy weight. Eating when we are hungry, stopping when we are full, and eating a variety of foods in moderation is a much safer bet. This is not something that is always easy for many of us to do-- for a variety of reasons... If this is the case, perhaps this is what needs examination. I'd really love to hear your feedback about dieting, fad diets, etc. If you are on a diet and disagree with some of my thoughts, I would love to dialogue and hear your thoughts on this topic!