Why recovery blogs (such as this one) should be read with discretion

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I write a recovery blog, so I understand the irony of this post. I need to write it anyway.

When I had “active” anorexia, I never read a thing about it. I remember a couple of times people trying to send me a newspaper or magazine clipping on anorexia (yes, I am that old, and blogs were not really a thing 15 years ago). I threw them away and pretended I had never received them. I was taking a psychology degree at the time, and so couldn’t escape a couple of lectures on eating disorders, but other than that I totally head-in-sanded the subject. I did not want to know.

When I was in recovery, I never read any blogs, memoirs, anything. I read some of the FEAST forum, but that is about it. If anything, I researched scientific literature to help me understand things I was experiencing physically. I’ve only ever read a handful of other people’s recovery blogs. To this day, I have never read a book on anorexia. I don’t think I ever will, to be quite honest. That is an embarrassing truth to admit, because I now have plenty of friends in the field who have written books on anorexia, and it feels rude for me to say I’ve not read them. But that is the truth. It’s not that I don’t want to read them because I am worried I would find them triggering or anything like that, it is because if I have time to read a book — which is rare — it is going to be one from my bucket list of books I want to read. When I read I read for fun.

In recovery, I very much did my own thing. And then I started writing about it. Sometimes, and this is the ironic part, I think that one of the reasons I was so able to use my common sense in recovery was that I was so ignorant as to how recovery was done. I didn’t have thoughts of “well, so-and-so says this,” or “but whosit did this to recover … .” I just did what felt right (in terms of my healthy brain, of course, not my anorexia brain).

Writing about my anorexia experiences has been a blessing. But, there is something that concerns me about people reading recovery blogs, and that is they forget that they are a unique, special, individual, and that no two humans are the exact same.

Sharing stories is important. We can and do learn from one another. We inspire, and are inspired by one another. But my story, and my recovery, cannot be used as a blueprint. You have your own personal experience, and you will have your own unique path to recovery.

Anything you read in my blog I have written because it is my truth. If my truth doesn’t sit right with you, or conflicts with what you know about your body and your life, then you have to defer to what you know is right for you. Your own experience and knowledge about yourself trumps the advice of a stranger on the internet.

The older (and wiser?) I get, the more I am learning to use fewer blanket statements, not more. The more I understand the importance of making it clear that I write about my experiences, and that no one person’s experience can be taken as a rule.

Nobody in the world has more information about your eating disorder than you do. Nobody knows your life better than you do. Nobody else is living in your body. You are the person most qualified to make decisions about what is right for you.

As you read this blog, remember you are you. Take what you need from this blog, and leave the rest.

Recovery commitments: Allow it to be simple

Over the next couple of weeks I will be posting blogs focusing on “recovery commitments.”

These recovery commitments posts will be outlining some of the most common reasons that people in recovery get anxious and stressed and suggesting some simplifications for those moments.

I believe that one of the fundamental reasons that we feel stressed in recovery is because we forget that we are meant to be going against the things our eating-disorder brain believes to be important and true.  I will be looking at ways to help you keep your focus when your eating disorder is screaming at you.


One of the sayings I created for myself in recovery was this:

If it feels complicated, you are doing it wrong!

Nobody ever said recovery was easy. It isn’t, but much of the time it doesn’t have to be as stressful, difficult, or as complicated as we make it. Or rather, as our eating disorder brain makes it. The anxiety that we feel can be a signal that we are allowing our eating disorder brain to overcomplicate things.

Sometimes even reminding yourself that there is nothing complicated or diploma-worthy about eating unrestricted amounts of food and resting helps. Genuinely. I would often find my brain was harking off down tangents that it had no business being in.

For example, if you find that you are fretting about whether or not the pop tarts, chocolate croissants and bowls of Lucky Charms that you are really craving and eating in vast quantities at 6am in the morning constitute a balanced diet or not. You’re already walking up a street that you don’t need to be in. You are not supposed to be trying to artificially “balance” your diet in recovery and trying to do so is overcomplicating a simple process. If you have been restricting for a long time and if you are in malnutrition your body is waaay out of balance already. Your cravings are your body trying to get back into balance by eating lots of sugar, fat, and yummy things that it needs. If you are following your hunger, then your judgement is not required. If your body wants pop tarts, then your body knows what it needs. You can reduce a lot of the anxiety you feel if you make a simple rule not to allow yourself to question, second guess, or judge what you want to eat.

Allow it to be simple.

 

Trying to recover while also trying to appease your eating disorder is stressful. So don’t!

I believe that much of the anxiety that is felt when you are trying to recover comes from feeling backed into a corner — feeling as if you don’t know what to do or what the right decision to make is. This is why it can be really helpful to have some words and phrases to say to yourself that help you stay focused. If you are worrying about whether or not you are eating a balanced diet, you lost focus. Your eating disorder brain has got it’s foot in the door. In fact a good rule of thumb is that if you are anxious or worried about eating you are playing the game of trying to “recover” without upsetting your eating disorder. That game is impossible to win, so no wonder you feel stressed.

Recovery is not about trying to keep your eating disorder happy. I know that you already know that. I also know how that knowledge can be lost in the moment when you are faced with a food decision to make and all you want is to choose the most peaceful path. Tough luck. You have to consistently make choices that your eating disorder will not like. Funnily enough, when you relax into doing just that, this is when you will find your anxiety lowers. It is the trying not to “get it wrong” that causes the stress. So do the opposite, actively break all the rules.

 

If you feel like you can’t win, or that decisions are difficult, your eating disorder is in control

This was another red flag to me. If I felt like I couldn’t make a simple decision over what I should eat, it meant that my eating disorder brain was over-complicating things. I was allowing my fear to step in front of what should have been a simple and easy decision based on nothing other than what my healthy-brain and body was desiring. This commonly happens when your healthy brain desires something that your eating disorder brain doesn’t want or is fearful of. Then you feel like you are torn between two conflicting internal desires.

If you feel like you can’t decide what to eat and the decision is getting stressful, step back mentally for a second and block all the thoughts of what you should eat. Get yourself back to detecting what you want, not what you think that you should have.

The more uncompromising you can be about eating what you want, rather than what your eating disorder brain wants, the easier you will find you handle many decisions and situations in recovery.

The next couple of weeks I am going to look at the key commitments that you have to make in order to make recovery happen. These are:

  • Committing to not suppressing your natural bodyweight (this often means committing to gaining weight)
  • Committing to eating without restriction
  • Committing to stopping all complusive behaviours and rules/rituals

Commitment actually makes recovery less stressful

I should know! I didn’t commit for years, and those years were the stressful ones. I was forever “trying” to gain weight. Believe me, there is no excuse for not gaining weight. All those years I was “trying” to gain weight I was not committed to gaining weight — because it didn’t happen. When I committed to gaining weight, and started to eat in a manner that honored that commitment I was successful in reaching my unsuppressed bodyweight.

When I was not committed to gaining weight, but I knew that I should be trying to, my food choices were very stressful. I wanted to eat more … but not “too much” more. This is anxiety provoking as one is constantly in the middle of trying to please recovery and trying to please the eating disorder. This is  literally an impossible position to be in. One cannot win!

Committing to recovery makes it actually happen because it gives one a North Star. This is what I ask of all my clients in consultation meetings. “Are you ready to commit to do what it takes to recover?”

Okay, stay tuned for the commitment blogs!

 

Rebecca Scritchfield 2018: Body Kindness and postpartum body image

 

Rebecca Scritchfield is a registered dietitian nutritionist, certified exercise physiologist, author of the book Body Kindness, and host of the Body Kindness podcast. Through her weight-inclusive counseling practice, she helps people make peace with food, find the joy in exercise, and create a better life with workable goals that fit individual interests. Central to all her work, Rebecca aims to develop self-compassion in place of shame by rejecting the rules of diet culture and the pervasive myth that to achieve better health one must lose weight.

Using her Body Kindness philosophy, Rebecca mentors registered dietitians and supports women from around the world in collaborative, online learning spaces free from unhelpful diet chatter and negative body talk.

Rebecca has influenced millions through her writing, podcast, and appearances in over 100 media outlets including NBC Nightly News, CNN, the TODAY show, the Washington Post, O Magazine, Self, Real Simple, Health, Yoga Journal, and many others. She lives in Washington, D.C., where she was recently recognized as one of ten “Supermom” entrepreneurs in the Nation’s Capital.

LINKS:

Postpartum Body Image Research Study: Body Kindness Reader Survey with option for free Body Kindness e-book

https://www.bodykindnessbook.com/research/

Free Body Kindness E-Course, Book Chapter

https://www.bodykindnessbook.com/get-started/

Articles:

Whole 30

https://health.usnews.com/health-news/blogs/eat-run/articles/2018-05-18/this-nutritionists-manifesto-against-the-whole30-will-shake-your-view-of-healthy-eating

Take Fat Shaming Out of Fitness Culture https://www.washingtonpost.com/lifestyle/wellness/why-we-need-to-take-fat-shaming-out-of-fitness-culture/2018/03/08/728365ac-1e31-11e8-9de1-147dd2df3829_story.html

Why Fear of Sugar May Be More Toxic Than Sugar Itself

https://www.self.com/story/why-fear-of-sugar-addiction-may-be-more-toxic-than-sugar-is

 

Transcript – thank you Marie!

Hello there welcome to this week’s podcast. This week I talked to a lady called Rebecca Scritchfield. Rebecca is a registered dietician, nutritionist and she’s also a certified exercise physiologist and author of the book Body Kindness. She actually has her own podcast called The Body Kindness Podcast so you can catch up with her there as well. Really she is all about weight inclusive counselling practise and how to help people make these food… and for people who are at the point where their body’s are healthy and able to exercise, how to find the joy in exercise and for the correct reasons, the healthy reasons rather than those compulsive reasons that many of us know so well.

 

So Rebecca’s and I today are actually talking about Health At Every Size things, we’re talking about weight inclusivity and how to have that kind relationship with your body but we are mostly focusing on post-partum body image things. Which I think is pretty interesting for me because I’ve never had a child, so it’s something I’ve never had experience with so I’m always wanting to learn about things that I haven’t had experience with. I have had had experience through my clients but I haven’t had that first hand experience so I’m very interested in those things and I do hope that those of you who have maybe been through a pregnancy, going through a pregnancy this podcast will be helpful for you to understand that that bit at the other side, when you’ve actually had the baby, is really important and can be a crucial part of you maintaining your recovery, how you handle that bit of the other side. Anyway, here’s Rebecca.

 

Rebecca: I’m Rebecca Scritchfield, I’m a registered dietitian and nutritionist and a certified exercise physiologist and a mum to two young girls. I am the author of a book Body Kindness, Transform Your Health for the Inside Out and Never Say Diet Again. So it’s a book really about helping people answer the question what do I do if I care about my health and well-being but I can’t do another diet again. So whether that’s because you’ve tried it a million times and you know that they don’t lead to better health or happiness that’s usually the typical reason.

 

We don’t just try a diet once and say oh not for me and never again. We usually try dieting multiple times. It’s really related to my past experiences as a chronic dieter as well as experiences of working with clients. I have a private practise based in Washington DC and I’ve been counselling clients since 2007 and I started out, I guess I would say now kind of on the wrong side of the tracks because I was promoting diets and weight loss and all that stuff. I was slowly evolving and realising it wasn’t helping me and that I was struggling with intrusive negative thoughts from my inner critic, judgemental thoughts and then difficulties with eating what I realise now, I was restricting and then my body was asking for food and I was giving it food. But at any rate there was a confluence of me realising this isn’t the kind of life I want and I’m not even being helpful for clients in the long run. So what do we do if, how do I live as a dietitian if I’m not promoting what I was taught in school which was dieting?

 

T: Yes, how hard was that change, within the industry? Because it’s kind of going against the tide a little bit isn’t it, or a lot?

 

R: Yes, how hard is the change? So I think I want to say that the change for me is absolutely worth it. Like at this point, it’s about living my values and so I could never go back. It’s interesting because I am mentoring a group of dietitian and therapists in a supervision group right now for body kindness and a couple of them are at the beginning stages and they are uncertain about the difficulties and how everything is going to evolve but that’s exactly what they said too, now that I see the literature on chronic dieting and have experience I working with clients with body image concerns, and that dieting does not improve health habits or well-being, I know I’m never going to go back but I just feel scared about the process and the reason I know I’m not going to go back is that I couldn’t do it, it’s against my values.

 

So I certainly would not say, oh it’s really no big deal right? Because we live in a diet culture and a body image obsessed culture. So I would say, from a dietitian perspective and also an exercise and fitness professional perspective, cause those are the two main areas where I have expertise, I think that the big challenge is when you have to emotionally come to terms with pretty much every thing you worked at was wrong or lacking, was almost like missing stuff.

 

So when you study medical nutrition therapy for diabetes, there is evidence about what would help a person with diabetes through self care choices. But what you also study about is weight loss and then your basically told that you help a person eat in a certain way and that weight loss is going to help improve outcomes. That’s where the problem comes out right? It’s not like information about how you would help someone with diabetes is all wrong, it’s just this idea that we are taught that weight loss is going to improve outcomes and that if people wanted it bad enough could lose weight. A person is non compliant if they don’t weight.

 

I guess to re-characterise it, it’s more like there’s this missing piece of the puzzle and so what you have to contend with is a lot of emotion so I remember feeling guilty for clients I have hurt, shamed unknowingly. Angry that I was never taught this information in the first place, angry at diet culture, I started dieting when I was 9 so when I finally realised how badly entrenched I was, there was a lot of anger. Then the 3rd one was certainly this idea of, wow well what do I do now? And it takes time to figure that out and to have a new way thinking and of being and living in the world. When you’re trained that exercise is something that you do to earn food, or to make up for something you ate there is a lot of reprogramming that has to go into that.

 

I really do feel like exercise is something I do, for joy and for taking care of my body. I would say that if I’m going on a walking/running loop in my neighbourhood, there are all these trees around and it’s very natural and soothing and that could be truly a joyful movement type of experience. And then I might go to a workout class that is focused on strength training and it’s meant to be intense, but in both of those scenarios, I’m not there because I hate my body or to try to make my body lose weight or change it’s shape. I’m there because I know that strength, having strong muscles and bones is important and I know that movement and cardiovascular health is important. So there might be different types of movement I do for different reasons but underlying all of it, it’s not about I need to fix my body or my body is a problem.

 

For me, I’m someone with thin privilege so that’s just a choice, I can just choose that and it might be hard to deal with my inner critic but that’s a decision that I can make and with time, I start talking to myself in more kind, positive ways. But for someone who is at a higher weight, they can still make those choices like, I’m not exercising for weight loss, I’m exercising to take care of my body but the culture is going to make an assumption that they are there because they don’t like the way that they look. They are there because they are desperate to lose weight and that is a problem I’ve written about that for The Washington Post about removing fat shaming from fitness culture.

 

Because even if you’re trying to support someone and motivate them, it’s actually a micro aggression when you say something like, oh good for you, good effort and it’s so great to see you here. That person could have lots of fitness experience, they could be a trainer themselves. But your kind of congratulating them for doing something about their body. So that came out of some interviews that I did for that article and so there are a lot of layers to how you evolve out of diet culture you have to start with yourself and then as you become more aware you can also understand just the ways in which we make assumptions on people based on their weight and shape and appearance and the judgements we make about what their health must be like and what they must do for habits or care about their body.

 

You’ve got to evolve through it as well so I would not want anyone listening who is at the very beginning to be like OK this sounds like a lot of work, or this sounds like I might make too many mistakes. Do not lose motivation, it’s just more of the understanding that once you realise that there is a discrepancy, that the way you talk to yourself, the way you are living your life is no longer working for you, that is the only sign you need to start making changes in a direction that is more framed around your well-being and self care.

 

But you’re going to be doing that while existing in a culture that is constantly going to be questioning why would you make those changes. So in my private practise I specialise in a Health At Every Size approach I see people of all different weights who have concerns about their weight and their body image issues. I also work with clients who have eating disorders at any stage of their recovery. There’s a lot of universities near me so sometimes I’ll get college students who were working on recovery while in school and they may go to a higher level of care if they need it more on a summer break so that’s something that I work with.

 

I also specialise in working with high risk pregnancies so that’s usually people that are pregnant with multiples or have a diagnosis of gestational diabetes and certainly I see women throughout all the stages of pregnancy but also it’s a very important vulnerable time in a woman’s life but also if there’s any challenges with whether it’s food aversions or being able to do what you need to do to take care of your body and your baby. I’m thinking of a client who actually had bulimia who wanted support throughout her pregnancy in managing her recovery and actively choosing not to purge throughout her pregnancy. There could be a lot of intersecting issues there. A lot of blame and shame.

 

Someone gets gestational diabetes and it can be very scary. So when you are someone who has a Health At Every Size approach you are knowledgeable about harm reduction and shame reduction and building self compassion regardless of somebody’s weight or shape or appearance. That can be really helpful in their healing too.

 

T: Yes and so we were going to talk about body image and pregnancy right?

 

R: Yes pregnancy and post-partum

 

T: So where should we start with that?

 

R: (laughs) Well, I guess generally speaking the idea of understanding what do we even mean when we talk about body image, it’s really just a picture we create in our minds that goes with us throughout our life. It’s how we see ourself and yes in an appearance way but also in what our mind tells us that may influence how we see our appearance. There is comparisons that we will do, out of social comparison theory the idea that we will compare ourselves to others and make up stories that somebody else’s life must be so much better, based on a comparison of our appearances and that can actually increase our own levels of shame.

 

So I think understanding that pregnancy or not, we all have a body image and for women, most women struggle with their body image. I want to say it’s 80% or above, I’ve got this great clinical book on body image that I’ve been reading recently but I don’t have it at my desk right now. But I’m just mentally recalling general trends from that. Its basically a persistent problem and pregnancy is a time where our bodies are changing so there is a lot of increased anxiety and uncertainty because of course understanding that our cultural message is the worse thing that could happen to a woman is that she could gain weight yet in pregnancy you’re supposed to be gaining weight.

 

Then there are even twisted messages around if you’re a higher weight maybe you should gain less weight or maybe even not gain any weight at all and it just becomes very overwhelming as far as, OK you’re pregnant, you want to have a healthy baby and you get these messages that’s like, everything you do could make or break your babies healthy. So what I find is people do a little bit too much research and with the internet you can find anything online that days, do this, don’t do that and it can actually be a time of increased anxiety.

 

So you know what’s interesting about it is that there are I think everybody’s pregnancy is different. I have two girls and both of my pregnancies were very different but they are also different among different individuals and I think that we have a lot of pressure to enjoy every moment of our pregnancy and we actually might be uncomfortable, so being able to say that we are uncomfortable whether it’s because we’re feeling nausea or tired. People make the assumptions, aren’t you so excited? Don’t you feel amazing? And it’s like, better not say that I have low energy today. So I think that there’s this added pressure of especially in a first time pregnancy because it’s all new for you, you don’t know what your experience is going to be like so that you are afraid of being honest about what’s really happening and what you really may need because oh this is supposed to be only a positive experience.

 

So that’s something that I would say, allowing yourself to feel your true feelings is really important because even negative emotions are beneficial. They tell you that your body needs something so feeling nausea might mean that your body needs something to eat, and some fresh air and maybe a gentle stroll rather than whatever other type of workout you may have planned to do because those things can help you feel a little bit better or at least help you make it through some difficulties.  

 

I think that in my experience some who are pregnant have concerns about gaining weight and in a certain correct kind of way even comparing to those charts, when I was pregnant I didn’t necessarily gain in the third trimester how the chart said I should. So I really chose to take a real flexible approach and in my first pregnancy got on the scale backwards, had a doctor that I really trusted and it made it easier, going through the process of pregnancy and there’s of course the expectation that you’re going to get your body back I guess is what they say. Especially you hear among celebrities its celebrated how quickly post-partum women can quote get their pre-baby body back. But in my opinion you always post-partum right? You are always, there isn’t just a short time of post-partum period, once you’ve had a baby you are always post-partum. Even the idea that your number one goal as a new mum is to see how quickly you can get your body back is ridiculous.

 

T: It’s horrific. It’s so sad isn’t it really? If you think about it?

 

R: Well it’s a cultural thing, I don’t think that we really respect pregnancy and the post-partum period whether it’s from how much maternity leave we get to the support a women really needs and the caring and nurturing a woman really needs. It can feel very isolating and I’ve certainly seen that in my counselling practise where there is your tired after having a baby and you’re also up, your sleep is disrupted and for whatever reason because the most important thing we should be doing is working on getting our pre baby body back that then we feel like every exercise we could have done is a failure because it wasn’t hard enough, good enough, we haven’t lost weigh fast enough.

 

That’s what we really want to step away from and really resist. Just this idea, that’s not to say oh Rebecca, never exercise again? No, not at all but its how do you reframe that putting your baby in a stroller and going on a short walk where you can get some fresh air and just relax and breathe. That is physical activity and not as good. The same thing for nourishment that if you’re somebody who used to spend a lot more time cooking, you don’t have to spend a lot of time cooking to be well nourished and you don’t have to eat perfectly or follow a prescriptive diet to be well nourished so just really re-framing expectations for what that would look like too.

 

There maybe days where you really are craving some sort of salad with a yummy dressing and protein and guess what there are going to be days where you are like, I’m tired and I don’t want to cook and I feel like pizza. There should be no moral difference between those two types of food choices at all. But we do.

 

T: Yes. What you were talking about there, about feeling that expectations of somebody to lose baby weight as the priority as soon as they have a child. It made me think of something I heard on another podcast, women’s hour which is a BBC thing recently, I think it’s one of the royal family, Kate Middleton I think has just had a baby and there was all this discussion on how she came out of hospital after having a baby looking just perfect and is that actually OK or she should have looked a little more real? Does it add to the pressure of women to think I need to be able to come out with my hair flowing…

 

R: Yes so I was watching that and I read a couple of articles and some of the comments on it and what I loved is about how social media can help bring about this almost like rebuttal response so as human nature, we are going to do that social comparison we are going to look at a picture of Kate Middleton and be like, wow, her hair is perfect, she’s in a dress, she’s smiling, she’s in heels…right??

 

T: That alone is not for me!

 

R: I know, I rarely wear heels. And she had a baby 7 hours ago or something and there could be this nature of I could never do that, so my life sucks etcetera and then it’s like you read more in the story and peoples comments and they talk about how many handlers she has and all the resources that she has and I think that’s one way that helps people mitigate that comparison pressure to reduce the shame that might result but the other great thing is when people started posting their own pictures and it’s just like the complete opposite, no make up, dishevelled greasy hair. I remember women posting pictures of them wearing their mesh underwear and diapers which I was fully subscribing too as well.

 

What’s great about that is you also see what’s common and real and those also get lots of likes and clicks, those can also help us feel good and like we are not alone. It just sort of helps to mitigate that social comparison. I was also inspired by Serena Williams who recently had a baby and she is arguably the best tennis player in the world and she is quoted as saying that there is a fourth trimester and I’m in my fourth trimester and I think that that’s something that’s really powerful about the need to support women in the post-partum period. She talked about being very honest, saying I remember not being able to find my baby’s bottle and it made me cry. And things like that do happen, your sleep deprived so you see Serena Williams as a strong, powerful, can do anything superhuman athlete and at the same time, because she’s willing to be honest about what it’s really like, losing my baby’s bottle made me cry, so I love following her, what she’s saying in her post-partum window and she’s also talking about her size and appearance and saying my body isn’t meant to be a size 4 so I’m not going to try to be a size 4 and that’s the words that she used, but I think that it was really powerful to say, I am strong and I’m not going to try and contort my body into a smaller size despite what society might say about me. That’s just not, no thanks.

 

And we need to hear so much more of that, especially from celebrities because they have more power, the financial power, the popularity. Those are all forms of social power, so when they make statements it has much more impact than if somebody who has less social power, like if someone like me makes a statement. I hope it helps people but not being Serena Williams, I don’t have the reach that she does, or that strong impact so I think that part of we can do is make sure that we follow and support the celebrities or the influencers on social media who are living the kind of life that we want to live and then we unfollow and we just take pauses away from the magazines that don’t help us live a better life or the articles, skim the headline and ask yourself, is this helpful or not? Not everything is going to be helpful and stop consuming some of this media that just sends you down that spiral of criticism of shame and judgement.

 

Amy Poehler has this phrase that I love, she says good for her but not for me and so you could use that for any little thing that might be out there. Even if it’s someone you normally like and follow, it’s just like this is not for me, let me just turn that off and tune that out because it’s in that rumination and that over thinking where shame really grows and thrives and it can lead to significant problems in our well being and mental health and our sense of self worth and self esteem and those things all are going to impact our ability to take care of ourselves. Which is if we care about our health and well-being, it’s the daily compassionate self care choices that really help us create the kind of habits and life we want. But if we are always comparing ourselves to perfection and judgements  and shame we are not even going to do little things, like drink a glass of water in the morning.

 

T: Right, I think, good for them, not for me is for anyone with a history of an eating disorder is a pretty good phrase to remember all the time when we are surrounded by this diet culture and I think though that do you think that people say somebody might have a history of a restrictive eating disorder and they might have been recovered and gotten pregnant, do you think that that time, that fourth trimester do you think that that is a higher risk for that person to maybe go into energy deficit again because they might get sucked into that I’ve got to work out, as soon as I’ve had this baby and actually not look after their body. I imagine that having a child is quite an energetic drag on the body. And I haven’t had one so I wouldn’t know, but I’m just imagining that it’s going to be quite a big deal for the body.

 

R: Sure  absolutely I mean we need time to heal and recover and so your next doctors appointment is about 6 weeks after  you’ve had a baby.

 

T: Seems like a long time.

 

R: Yes well your kind of sore, I was wearing diapers for a couple of weeks. I left the hospital still bleeding (laughs) yes so it is a miracle and it is a lot on the body. So you’re right, the fact that just culturally, all genders don’t holistically understand all that goes in the process that shows the level of isolation that occurs.

 

But to specifically go back and answer your question. So it’s a recovery period for anyone but in respect to an eating disorder history, I mean anything can be triggering and so I have a client list right now of folks who are post-partum who have had eating disorders before their baby who have dealt with triggers and who have dealt with some relapse issues is yes its absolutely possible and anything can be triggering.

 

I think it really just, the number one thing is going to be will you let yourself say, I have needs and my needs matter. Because no matter what negative thoughts you’re having, no matter what, maybe you even started on some restrictive type behaviour, even that, Whole30’s not a diet, but deep down you know that is not what your healthy self would say. Trust your ability to say, I have needs and my needs are valid and worth it. I think that’s t he only thing you need to be able to do. Because if you can say that out loud and know that to be true, no matter what your negative thought bullies are saying about it, because they might be saying, but but but and giving some sort of reasons to why you should go back to behaviours, you can say I have needs and my needs are valuable.

 

That is the first step to then doing the right thing which is getting the support that you need. We all need a support system and so acknowledging that you have needs then getting some kind of support, whether it’s talking to a friend, any professional you trust and to just get the feelings out in the open. That now they can exist and when your feelings can exist and your thoughts can exist.

 

Even if you feel guilty for those thoughts, you might feel shame, like I can’t believe I here again, this is not the kind of person I want to be, that’s actually good information. That is information that whatever is happening with you right now is not in-line with your values and that’s going to lead to your next decision, from that conversation with the friend, then you decide to contact someone from your care team, find somebody that specialises in post-partum well-being.

 

You can then take meaningful actions that is even if you feel attached, like gosh I really feel attached to doing past behaviours, I’ll just use an example of the client I mentioned earlier who struggled with bulimia and she did not purge during her pregnancy but it’s sometimes it was later in post-partum she started purging again,  and she did get back in touch with me and we worked again on no longer purging and she was doing some chewing and spitting behaviours and it was that she was dealing with when she felt her anxiety escalate, she would reach for food and it didn’t matter what it was, because she was also working on intuitive eating when she realised she wasn’t hungry she would feel guilty about eating when she wasn’t hungry and then she’d spit it out. So what’s still a behaviour and she knows she doesn’t want to do it, but what the work ends up being is understanding that intuitive eating, sometimes you eat when you’re not hungry and it’s OK to eat as a response to anxiety. What would it feel like, even if she became aware that she was eating something that she didn’t want to eat, what would it feel like to say, it’s OK, this is nourishment too. So let me finish chewing, let me rest and digest, and let me do some mindful breathing and relaxation this is going to be OK. It’s about having that action plan and that permission to not be perfect right?

 

We’re humans and if she’s using intuitive eating to say only eat when she’s hungry that’s actually a mistake with intuitive eating, do you see what I’m saying? So now she can say, OK you’re right so lets work on not chewing and spitting, because it’s actually a form of intuitive eating to be able to sooth emotions with food while at the same time I work on other ways noticing my anxiety and practising positive self care so that some times I  might not reach for food. So I think that that’s a really good example, she still struggles deeply with body image and weight concerns and not all clients with eating disorders have direct appearance related issues but this particular client does. So it has been interesting to work with her over the past several years, she has done tremendous about of work in her recovery and things do get better.

 

But then there are these versions of relapse where what she does as a behaviour might change and shift but the key situation for her of why it’s not relapse worse is that she’s doing that initial step of I have needs, my needs are important and you know what? I need some help, I need some support and as long as you can do that, it doesn’t matter what you are struggling with, you will get the help that you need and you are worth the help that you need.

 

T: So you mentioned the what was it? The 360 diet?

 

R: The Whole30, I don’t even know what 360 is but that sounds awful too.

 

T: I lose track! I know that you have some thoughts on that, so maybe just quickly because there are probably people listening to this who are looking at that or who have thought about that.

 

R: Sure so I can share a link to an article for US News which is just about for people who don’t understand Whole30, it sounds healthy enough what’s the problem with it? The way that I addressed it in the article is that there are people that have, so Whole30 will say it’s not a diet and it’s about all these inflammatory things and it’s going to help you feel better. Yet there are people who have concerns with their relationship to food and their weight and Whole30 will say right on their website, if you follow Whole30 your body composition will improve, it just has to. It’s basically ridiculous, it’s not science based, the people who created it are not experts. They’re rich because they’ve sold best selling books because they’ve play right into diet culture, but it’s not what you would do medically if somebody had a food allergy or intolerance.

 

There are people who came out and said I liked Whole30 and blah blah blah you are always going to find people who don’t agree with your point but by and large a lot of people were like, thank you for bring these issues up because at the end of the day you can’t say you’re not on a diet and then say well this is going to change your body composition. That is a diet and then I went into a lot of the emotional damages that can come with Whole 30 and things like that so I’d be happy to share those links as well as links to some of my other writings and I’d love to share a little bit about the research that we are doing.

 

T: Sure, yes.

 

R: So I’m really excited to be working with Doctor Jennifer Webb. She is the lead investigator on a research project, she’s based out of the UNC Charlotte and she runs a lab that is grounded in mindfulness and positive psychology and those are central to the body kindness philosophy. She reached out to me about wanting to study how body clinics can help enhance body image in post-partum women. So right now we are doing focus groups in Charlotte and there’s also a secondary component that I’m helping to collaborate which is a research survey so people who qualify are women who are pregnant or up to 5 years post-partum and who are living in the US and who have read Body Kindness.

 

So to learn more about it you can go to www.bodykindnessbook.com/research and from that page you can get a link to do the survey but you can also get, if you don’t have a copy of Body Kindness, we have limited of free electronic copies so what you can do is go there click the link, read the book and then take this survey once you’ve read it. So we are going to be conducting that research this summer and that’s just what we are trying to do with the survey is take a look at the material we have in the book and how what they are finding helpful in the post-partum as far as self care and well-being and then the goal between the survey and the focus group is to then create tailored self help programming for women that are going through this transition.

 

Anyone who does the survey in addition to getting a free copy of the book, there is a body kindness after baby electronic tool kit that I’ve created, so it’s a video and a series of resources that you can get and you get a link to that once you’ve completed the survey.

 

T: Do you think a lot of your motivation to create these resources for people after they’ve had a baby, does that come out of your own experience? And realising there wasn’t much there.

 

R: That’s a good question, so it’s interesting because when I came up with Body Kindness. I wanted to help as many people as possible. So my focus was more about anyone who wanted to step away from dieting but if you read it you will see there’s only 1 male story. But there’s a lot of female perspective and my perspective as a female so I apologise to men but it does work for men.

 

Hopefully we will have more tailored resources because men also deeply struggle with their body image concerns. So with respect to the post-partum period it’s interesting because there is some research that shows that women who breast feed they verbalise a body appreciation in some research like yes, my body is different but look at all the amazing things my body can do and I also believe that whether or not you breast feed I think you can have that mindset of body appreciation and that’s really important because having a healthy body image doesn’t mean that you’re never going to think a negative thing about your body but it’s your ability to express appreciation for your body that helps you build resilience in body image.

 

In the post-partum window myself was actually when I was writing Body Kindness so my inner critic was very strong so my youngest was 6 months old, so I had a 6 month old and a 1.5 year old. Just everything I did sucked, whether it was my writing that sucked or that walk that I did with the stroller wasn’t enough or you’re making pasta again, you suck. What was so interesting about it was that it wasn’t how I normally talk to myself, it was how I used to, but the problem was I was going through a very difficult time in my life where I was tired and where I was uncertain of how to be a mum I don’t think I wanted to do it perfectly but I really felt like I was making a lot of mistakes and so there was this constant self flagellation and that really hurt my self esteem and my well being.

 

And so when people read Body Kindness, I’m like I wrote that to help me as well. It’s grounded on research and positive psychology and I think that because of this time transition with becoming a mum and also that your body does change after a baby and it doesn’t necessarily go back to the way it look before and over time even without babies bodies change so I think that it can be particularly helpful for that window because there is a lot of change and transition that you may be adjusting to but certainly anyone who just feels like I need to talk to myself more kindly, I need more self compassion, I need less shame, they are also going find help and support for that.

 

T: Big thank you to Rebecca for coming on and talking to me on this weeks podcast. You know I imagine that quite a few of you listening to this will have had children and I’ve never wanted to have children so I never did but even though just the process or the idea or the concept of being pregnant fascinates me because it’s such an incredible feat from the human body your growing another person inside of you and then giving birth. I mean that has to be traumatic in the proper sense of the word, for the body. It’s actually going through a process that’s creating a lot of muscular internal, there’s just a lot happening, come on!

 

It’s incredible and so I think that there are a lot of physical things going on when a person is pregnant and when a person gives birth and a lot of those physical things are to do with hormones as well and thoughts and feelings and it’s probably an incredibly messed up time actually. In fact, if I didn’t have to have the child afterwards, because I don’t want to have children, I would probably go through it just to see what it’s like. Actually that’s not true because if I was invested in that, I’d be a surrogate, I do not want to do that. So that’s not entirely true, but I am really fascinated in the concept of what happens to the human body when it does something that epic.

 

Then you’ve got to think from the context of some body who has had or does have an eating disorder, there’s this added layer of complexity on it and maybe if somebody is fabulously fully recovered and very robust, then none of that complexity is there, they are going to feed themselves, they are going to ignore diet culture, they don’t care about it anyway, so they are not going to worry about the baby body afterwards. But for a lot of people, I imagine that that’s not entirely going to be the case and so it does add this other level of complexity and it probably can be a time where ones brain starts to listen to messages from outside maybe be even more prone to just trying to look the way that the culture wants them to look and follow things that everybody else whose had a baby should be doing apparently.

 

I think that I really like the idea that people like Rebecca are actually focusing on this, people who have been through the process and have also had experience in helping people with eating disorders and body image stuff. Because it’s a big deal and I think that if you are anywhere close to struggling with this stuff then it’s a really good idea to seek support because your body is very precious and we wouldn’t want anything bad to happen to it in this time when things are so important. That’s all for this week, thank you for listening to this weeks podcast, cheers and until next time cheerio!

 

When you partner has an eating disorder: Avoiding intimacy

This blog is for partners of adults with eating disorders. However, I’m writing it from the perspective of a person with an eating disorder.

I was a person with an eating disorder who loved her partner, but there were times when my actions might have given the opposite impression. So, a lot of what I am going to try and explain here is based around trying to help you understand why your partner, like I did, may at times seem unable to tolerate you touching them.

If you are a partner of a person who has an eating disorder, I am going to make some assumptions about you that I want to disclose. I am going to assume that you care about and love your partner. I am going to assume that you are not abusive and never have been. I am going to assume that you want nothing but full recovery for your partner. I am assuming these things, because why else would you be bothering to take the time to read this blog if that were not the case?


M: “I’m on my way home, see you in 10”

Me: “Can’t wait to see you babe.”

That would be a fairly common text message conversation between my partner and I. I meant it. I was looking forward to seeing him. Very much so.

However, I would hear the key turn in the lock and my hackles would immediately come up. I would go from looking forward to seeing him to already anticipating not wanting to be touched in a nanosecond. He’d come in, and try and hug me, and I would wiggle away immediately. I might even snap at him and say something mean. Usually it would be something completely unrelated, such as “You didn’t make the bed this morning.” It didn’t matter what it was specifically that I said, the desired effect would be to get him to move away from me. I don’t care about the bed being made; it were as if my brain was plucking for anything that could be aggressive and create distance.

That’s not cool. Is it?

I knew it wasn’t cool. I didn’t like my own reaction there either. This, thank goodness is one of the things that certainly got better as I recovered. I no longer shy away from being touched. Nor do I pick arguments for the sake of it. Since recovering I have put a good deal of thought into why, when I was sick, I was such a … meany … a lot of the time.

1. Well duh, when a body is under-resourced it doesn’t fancy any hanky panky

I don’t need to explain why when a brain thinks that food resources are scarce that brain might not be prioritizing reproduction, right? Sex and intimacy are associated with one another so while a kiss on the cheek and a hug doesn’t hold much threat alone, the brain may be wanting to signal general disinterest in those types of things. That doesn’t mean that your partner is no longer interested in you.

Think of the times when you might have lost your sex drive. Usually it is when you are stressed and tired, right? Well a body in malnutrition is in energy deficit, and that means it is stressed and tired all the time.

When my body was malnourished I certainly lost my sex drive. But I also was at times aggressively opposed to intimacy and affection. Not logically. Logically I knew I liked both of these things. The reality was no matter how logically I was on board with intimacy, my reflex reactions told a different story. The brain stem area doesn’t use logical thinking, it reacts. Hence this may explain the incongruence here.

2. Prefrontal cortex regions are not always consulted when we react

No two people with a restrictive eating disorder are the same. I’ve learned from lived experience that within the same person. the reason for not wanting to be touched can vary. At least, the logic that our brains use to excuse the reactions that we have to touch, can vary. What I understand to be true is that when our brain stem area is reacting, our prefrontal cortex is not consulted. This leads to us trying to make logical sense of our reaction after it has already happened. As humans we want to know why we did something. I think that most of the time the “why” = malnutrition. However, the catch is that many people who have anorexia have anosognosia which makes them believe that they are not really in malnutrition, so the logical brain tries to come up with all these other explanations as to why one feels narky.

I’m making this point because often other people may have projected reasons for my reactions onto me. Such as I was reacting that way due to trauma or fear of intimacy. I don’t believe it was either of these things, because as soon as I was out of malnutrition, I stopped having these reactions to intimacy. But when one has anosognisa, and one cannot see malnutrition in oneself, it makes these other “reasons” seem more attractive. Then we start barking up the wrong tree so to speak.

For me, when I was very underweight, the logical reason I thought I hated to be touched because I hated being thin and being touched reminded me that I was thin. Then, as I gained weight, I figured that I hated to be touched because I hated to be reminded that I was gaining weight. However, in the moment, I would feel like I didn’t want to be touched because I was annoyed with ther person trying to touch me. For what? For not making the bed? For leaving dishes in the sick? Nah.

Because I think that the aversion to being touched was a brain-stem response, I don’t now believe that any of the logical reasons my higher brain projected onto it are really true. I think my reptile brain was just saying “no way no how”  and my higher brain was throwing out reasons to try and make sense of something that didn’t make sense —  I loved my partner so it didn’t make sense I did not want him to touch me.

I also know that my hyper-awareness of my own body made all this a lot worse. I didn’t have huge negative body image problems other than those anorexia created. For people who do have a high level of negative body image thoughts, this can make everything in the intimacy and touch department much worse. Even without negative body image, anorexia heightens ones awareness of one’s own body changing and gaining weight.

Luckily, and ironically, that hyper-awareness lessened the closer I came to my recovered weight.

Eating disorders are complicated and confusing. Listen, do you best, and encourage recovery

We area all very different. You have to know your partner in order to figure out how you can be the most help to them.

For example, for me, it helped if my partner drew attention to areas like my stomach and told me he wanted it bigger. This, in a sense, gave me permission to eat more. For many people, this would not help and would make them even more self-conscious of an area they are not yet ready to talk about. The only right answer is treating a person as the individual that they are. Also, within the same person the situation can change as they progress in recovery. So that makes the “right” respond a bit of a moving target.

Initially when I got together with my partner, I was very self-conscious about being touched in fleshy areas. As I progressed in recovery, and in confidence in our relationship, I grew to like being touched in those areas. That’s a hell of a lot of change in one person and I don’t expect any partner to be able to get this right or be a mindreader because half the time I couldn’t even get it right myself. For that reason there is no “here is the answer and how-to guide.” I went from radiating “you can’t touch there” to “touch me there!”  as my body and brain came out of malnutrition. And the trouble is that you can’t tell if a person’s brain is coming out of the famine mindset by looking at them. So you can’t assume if a person is recovered or not from their bodyweight. You just have to listen and be patient.


One thing I do know that my partner did perfectly was he always encouraged me to eat without restriction. He always encouraged me to gain weight. He always told me he wanted more of me. He was incredibly persistant and consistent with this message and it really, really helped me. That was what I know about me and what was helpful to me. So again, not a how-to guide. Just some information that you may or may not find useful.


If you know your partner and love them and are willing to try and work out in any one moment how to be the most helpful to them, you can be instrumental in their recovery. I can’t tell you how to navigate what the right thing to do is in regards to intimacy if your partner has an eating disorder. Good news is I don’t have to. Because you are smart. You will work it out. Listening and being sensitive is a good start. I have one, single, piece of advice that is going to make this easier for you:

Don’t. Take. It. Personally.

Ha. I’m such a hypocrite for writing that because I cannot imagine coming home and trying to hug my husband and him brushing me off and me not taking it personally.

I want you to know that the shrug off is not about you. It is not that you are unattractive. It is not that you are not good enough. It is not that you are not loved. It is important that you understand that. It is important that you remember that.

That’s why I am writing this. You are going to have to be told, sternly, honestly, and bluntly that this is not about you. You didn’t do anything wrong. You couldn’t change this by doing things differently. This is not a reflection on whether or not your partner loves you. It is not about them not being attracted to you anymore. It is not anything about you.

This is an eating disorder. This is malnutrition. This is an incredibly stressed mind and body. This is a reptile-brain reaction from your partner that their logical brain is not in control of.

This is not about you.

What can you do?

Other than not take it personally, you can encourage unrestricted eating. Because your best bet at getting your partner back mentally and physically is to get them fully nutritionally rehabilitated in a way that convinces their reptile-brain that food is abundant. When the brain thinks that food is scarce (and restricted eating leading to energy deficit gives it that impression) then all hell breaks loose for a person with eating disorder genetics. We need to convince their brain that food is abundant and that normal, happy, functioning can resume. Not stressed out, irritable, meany functioning. (Yes, anorexia turned me into a meany.)

Family support: is it appropriate for adults too? [Podcast]

In this podcast I talk about my personal highlights from the ICED conference presentation that I was part this year with Rebecka Peeples, Rachel Millner and Therese Waterhaus.

 

Rebecka Peebles

Rebecka Peebles, MD, is an Adolescent Medicine Specialist and Co-director of the Eating Disorder Assessment and Treatment Program at Children’s Hospital of Philadelphia.

Dr. Peebles is an assistant professor in the Division of Adolescent Medicine at The Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine.

Prior to joining CHOP, she was an instructor at Stanford University School of Medicine’s Division of Adolescent Medicine, Department of Pediatrics, and was primarily involved with the Eating Disorders Program and the Center for Healthy Weight at the Lucile Packard Children’s Hospital.

Dr. Peebles’ research interests focus on the health outcomes of disordered eating in adolescents of diverse weight ranges, and how the Internet can be used as a vector to both help and harm young people as they try to approach a healthy weight. Her most recent work has been funded by the American Heart Association.

 

Rachel Milner

Dr. Millner is a licensed psychologist in the state of Pennsylvania.  She graduated from the California School of Professional Psychology (now Alliant International University) in San Diego and completed an APA (American Psychological Association) approved internship at the University of Buffalo.
Dr. Millner completed her post-doctoral training at the University of Pennsylvania in Philadelphia, PA.

Dr. Millner is a member of the American Psychological Association, the Pennsylvania Psychological Association, the Philadelphia Society of Clinical Psychologists and the Lower Bucks Chamber of Commerce.

In addition to her private practice, Dr. Millner has taught at the University of Pennsylvania and is currently teaching at Gwynedd Mercy College.

Dr. Millner’s website: http://www.rachelmillner.com/aboutus.php

 

Therese Waterhaus

Therese has been a Registered Dietitian for nearly 30 years, she completed her doctoral degree in nutrition biochemistry, studying vitamin D and bone metabolism. She has been in private practice for over 9 years and has been involved in the eating disorder community for over 15 years. Her goal is to bring to the local community the most recent information about eating disorders.

Therese’s website: http://www.willamettenutritionsource.com/

 

 

Hello there and welcome to this weeks podcast. This week I’m going to talk again about adult treatment that involves families and I know I harp on about this a lot but it’s a discussion topic that I think is very important to me and it seems to be quite relevant to a lot of people that I work with. Because I work with adults that are in recovery.

 

I recently did a presentation on this at the ICED conference which is run by AED it was at Chicago this year and I was presenting along side the wonderful Rebecka Peebles, Rachel Milner who you’ve heard on this podcast a number of times and  Therese Waterhaus who has also been on this podcast a number times. So I’ve actually was going to today run you though that and just the key points that we made in this presentation. It was an hours presentation so we’re not going to go through all of that but I just want to take you though what I think are the key points here.

 

So our presentation was titled ‘Why Go it Alone? How Family Based Treatment of Young Adults with Anorexia is Possible and Productive in Reaching Full Recovery’ and we actually started the presentation with a 5 minute audio clip which I’m going to play at the end of this. But that 5 minute audio was, some of the voices you’ve heard before on this podcast, you’ve heard Simon’s Cat before, talking about how she went home in her 30s to be with her parents and there’s also some new voices on there which you may not have heard before. But this 5 minute audio is just clips, one minute clips of different people talking about their experience of being an adult and working with families. To help them get to where they needed to be in their recovery so it’s kind of cool.

 

Now Rebecka Peebles who if you don’t who Rebecka Peebles is, she is a clinician and she is just absolutely, she is one of those fabulous people. She’s a doctor and she works with people with eating disorders and she was talking about how families from a clinicians point of view, how families can be a part of the process, even if they are an adult.

 

One the things that she spoke about that I really liked was she brought up this idea that I think is sort of out there that when somebody is an adult, when they are past the age of 18 it’s not developmentally appropriate for their parents or family to help them in recovery. I’ve heard this plenty of times, I’ve heard this from a therapist of one of my clients a couple of years ago who’s parents were thank goodness very involved in her recovery and my clients own words were my parents have kept me alive despite the fact she was 30. A new therapist whom I was asked to talk to, the first thing she asked me was did I think it was appropriate that this persons parents were still involved and I said yes, absolutely they have kept her alive and she would tell you that herself.

 

It just shows that there is this feeling out there that it’s not developmentally appropriate for somebody’s parents to be involved in their recovery and what Rebecka really brought to light was that it is developmentally normal at any age for a person who is ill to lean on their family members for support and have family members help work them towards health. I think there is just such an important point, families can be dysfunctional, that’s absolutely true. Families can be much less than perfect but I think unfortunately those sort of circumstances or fortunately those sort of circumstances are a minority and for the vast majority of people although we might argue with our families or they might not be perfect, they are people who love us and people who want to help us.

 

Families stick together and families help each other through the tough times and so who else should be there helping you when you are ill, if it’s not your family? So it’s entirely appropriate no matter what age you are that if your family want to help and if they are able to help and if it’s a good thing for you and them that they help, of course it should be. So that was I think my favourite thing that Rebecka brought up.

 

She talked a lot about the sort of more clinician side of thing and skill sets for FBT and she talked about when parents shouldn’t be involved and there definitely are cases like that. Which might be the side of people who’ve had abuse in early childhood and of course you’re not going to involve someone’s family in that sort of circumstances. She also tackled this notion that somehow, this is not just a notion, that somehow parents are automatically told to butt out and it’s thought of that it’s not OK for anybody apart from paid providers or peers, it’s not OK for family to be apart of this which I absolutely disagree with. I think that family can be a very important part of recovery if they are there and if they are able to help.

 

Then we had the wonderful Rachel Milner and Rachel has been on the podcast as I said a couple of times. We usually talk about Health At Every Size type things. I will link to her in the show notes of this episode but one thing that was really interesting that Rachel brought up was the difference between marketing for treatment programs for adolescents and adults. In the adolescents programs they are marketing to parents, they are putting in their marketing things like, as a parent or family member you play an important role in a successful treatment outcomes and then we move on to the marketing for adult programs and it’s more along the lines of, these sessions can allow for honest discussions about family rifts and stuff like that and it’s so different right? When we are talking about adolescents we’re marketing to the parents so we’ve got to sell to them that they can be involved and that they’re important part of and then as soon as somebody’s over the age of 18, oh we’re not marketing to the parents any more so we don’t have to market to them we can just tell them all that they shouldn’t be working with their families and xyz. That maybe really subtle but I think it’s definitely there and Rachel really talked about it doesn’t have to be all or nothing thinking.

 

We can foster as she put it, independent and include family’s. It’s not that if you are using your family’s for support, you don’t have a brain, you don’t have a mouth and you don’t have anything to do with your recovery, you are completely at the mercy of family. No it doesn’t have to be that way. It should be this big team effort. If you are an adult. You are the one that should be building this team of how and who are these people who are going to help me recover.  It doesn’t have to be this sort of black and white. It doesn’t have to look like anything black or white at all.

 

Then Rachel also told some of her personal story as did I and I think that most of you have probably already heard that or read about it one thing that I spoke about ass being really important to me is that yes I did recovery without any treatment, without any family help and if I could go back and do it again, I certainly would not do that. If I could go back and do recovery again I would absolutely 100% without a doubt would walk straight into my parents house and ask them to refeed me and honestly it was my pride that stopped me from doing that. Pride and pigheadedness. And of course fear, I was scared and I know that the way that I recovered was slightly different it has enabled me to learn a lot and has enabled me to share a lot of information but that’s still not what I would do if I could do it again.

 

I think that that’s very important for people to understand that this whole notion of recovering on your own is better is complete crap. Why would that be better? Recovering with support as much support as possible, the correct kind of support, effective support that makes you feel like maybe I’m not going absolutely crazy. That’s has got to be better. The other part of it for me is that anorexia turned me into a complete nightmare and I was just pretty awful actually to my family and I’ve kind of like forgiven myself for all of these things and I know it was because my body and my brain was absolutely starving and that makes one quite irritable but my family have never being anything but loving and wonderful towards me and one of my biggest regrets is not allowing my mum to refeed me because she of all the people in the world deserved to see that happen.

 

And yes, in the refeeding process I sat there and ate entire chocolate cakes and tones and tones of food and I really wish right now that she had been there to see that and I think it would have been really cathartic for her as well to see that sort of things. Just I think it would have been wonderful for her after 12 years of trying to get me to eat more for her to actually have been part of the process of refeeding and eating more and I was too proud and stubborn and all that. I didn’t let it happen and I absolutely regret that. I think it would have been healing for the whole family to be part of the whole process for me. And if I could go back and do that again, I absolutely would.

 

I also spoke about working with adults, the with part is really important, you can’t work AT adults when you are helping them recover. It’s just that actually, you are helping someone recover. It’s not about you sitting there and telling them what to do because they’re and adult, they don’t have to, they can walk out. Its about working with someone and whatever that looks like and I think that again it doesn’t have to be this kind of, oh you’re either, if you’re working with someone you’re totally allowing their eating disorder to run riot and allowing them to restrict, no lets give people respect.

 

When an adult wants to recover, they want to recover. They are trying. They want to do it and so it is this process of working with them as a team and for those people who think that type of person doesn’t exist, I’ve worked with hundreds of them at this point, people who want to recover they just need support and help in doing that. So that’s not about saying you shut up and sit down, I’m going to tell you what to do. That’s actually working with that person to say, of all your life experiences so far, what do you know about your eating disorder? What have you learnt about past treatment attempts? What have you learnt about past when things haven’t gone so well? What can we learn about that because the person who knows most about an adult with an eating disorder IS the adult with the eating disorder. They have lived through years of it, they know where it trips them up. They know what things in the past have actually been successful and helped them move forward in recovery and they know where things fell apart and what they should have had in place in order to not all it to full apart.

 

So that is what working with somebody is all about. And I think that if you are an adult in recovery and you feel that you are not being worked with that’s where you’ve got to kind of work out, OK I’m the adult here, I’m the person in recovery, I’m the person whose life I’m trying to get fully recovered so I have one. It’s all about you actually. It’s all about putting together the support that you want and if you do decide, OK well actually the support that I want are the people who know me and love me, then that’s exactly what you should do.

 

And that is what Therese Waterhause who was the 4th member of our presentation, she really went on to talk about some case studies, she told a story about refeeding her daughter and then how that changed as she was an adult. One point that Therese made that I thought was  really wonderful, was that parents can be helpful in reminding their adult children were like before their illness and that’s super to me because one thing that I used to use to guide me, when I was trying to work out what the right decision was, what would I eat right now if I wasn’t making an anorexia based choice? Because I knew myself as a 16 year old, I was 17 with the onset of anorexia, I was able to ask myself what would the old me have eaten? It sure as hell wasn’t quinoa. And sure as well would have been a cheeseburger.

 

So that really helped me even as an adult, me being able to remember what I was like before I had anorexia really helped guide me when I just didn’t even know any more what I wanted. And I think that for many people, they are much younger than I was when there eating disorder starts. Most peoples starts in their early teens and so you might not remember what you were like, or what your food preferences were like or that you used to just spend all day Sunday in your bedroom on your bed, chatting to friends on the phone. You might not remember that about yourself, rather than going out to the gym or going running or doing the things that you do when you have anorexia. So having people there who knew you before, who can remind you who you used to be, can be very helpful. When you’re trying to make those decisions and you’re trying to figure what does the real me want.

 

Anyway, those were my favourite parts from our presentation. Look I am fully aware that not all of you listening to this are able to use your family for support. I’m fully aware that for not everybody listening it’s going to be appropriate. Or even safe and I’m really aware that for many of you, it’s just not going to be logistically possible, it might be geographical reasons, you might be across the other side of the world, you might have family members who are no longer with you, there are lots of reasons why you may not be able to use family support but here is where you get to kind of like take that word family and you get to turn it to mean whatever it means to you.

 

Family means the people closest to you. I know that most of us define the word as who are closest to you as in relatives, genetics, but it really just means the people who are closest to you. I was too proud to use my actual genetic family for support but in many ways I did use friends for support most of the time, they were quite unsuspecting. I used friend as meal support, who didn’t even know they were being used as meal support, for example things like the first time I went to eat pizza in recovery and I knew that unless I had someone there sort of making me do it, I wouldn’t do it so I called a friend and said lets go and get pizza tonight and he said yes because he would always eat pizza and he came over with pizza and I was locked in.

 

And that’s what I knew I needed to do, to make myself accountable by locking myself in. So there are some ways that I used support even though that support didn’t know they were support but even better, is if you are sitting here and you’re listening and thinking OK well I have to do this really difficult thing. I have to recover from an eating disorder, which is very hard. It’s not rocket science, it’s a process of eating more food and going against all of the rules that you have an rewiring your brain, but it’s just scary isn’t it? And so if you’re sitting here thinking this is what I’ve got to do and there’s no choice this is what I have to do if I want to fully recover. Then also have a think about, well maybe I can’t use my direct family but what can I use? There’s always an answer and you’re a smart person, I know that you are, I know that you can figure this out.

 

It’s a process of just working well what do I need to make myself successful, to ensure that I am successful in this process. What do I know about myself to know what I need? What do I know about my eating disorder and know where it trips me up and know what to put in place to pre-empt that and make sure it doesn’t happen. So then working out what you need and then from there, working out how you can fill that need and that might mean professional help just the best help that you can get in your circumstance.

 

But it also might be that you’re going to use peers and family. And the good thing about family is if you do have family that can help you and if you do have family that are willing to help you and you do have family that you are willing to be helped by, that’s not going cost you a heap of cash. It’s often more accessible than a lot of expensive support is. And that’s also one of the most important things as recovery as an adult that’s different from a child that you might have life circumstances that mean you can’t just drop everything and go off to a treatment centre, you might have people who depend on you. If you’re a parent for example, so sometimes life throws things at us which means that we can’t do what the recommended ideal path is supposed to be. It doesn’t exist and you’ve got to think about how you can make it happen, because you can make it happen.

 

The good thing about family support is that it’s not going to cost you an arm and a leg and often if you have close family that’s going to be even better. But like I said, if you don’t have close family that doesn’t mean that you can’t use the support of friends and other people and even peer, even online support I think a lot of time as peer support as one big family support system for people who get it and people who want to help one another get better.

 

So next week, well the next couple of weeks actually I’m going to be talking to people about Health At Every Size so we are going to have a couple of Health At Every Size podcasts. If you have any particular questions that you have about that, then send me an email, it’s info@tabithafarrar.com or send me a tweet @love_fat_ Cheers and until next time cheerio.

 

Oh silly me, I almost forgot here’s the clip that I’ve been promising to play you for the whole podcast.

 

Here are recovery voices:

 

Ignore the beginning bit because that’s for the conference.

 

This audio is to accompany the talk given by Rebecka Peebles, Rachel Milner,Therese Waterhuas and Tabitha Farrar at the AED conference 2018. The conference is titled ‘Why go it Alone? How Family Based Treatment for Young Adults with Anorexia is Possible and Productive in Reaching Full Recovery’.

 

The following voices that you will hear are of young adults with anorexia in recovery and one voice of a parent of a young adult with anorexia who is in recovery.

 

The first voice that you will hear is an adult male in recovery from anorexia.

 

Tabs: Do you think that your parents could have been of more help to you if they had received support and education themselves on an eating disorder?

 

Male: Oh yes definitely. I think that can go for not just my parents but my friends and my grandparents. And my brother I think if my parents knew exactly what goes on inside my head and had a better understanding of what was happening they probably could have helped me more and that goes for my friends, grandparents, anyone. That goes for anyone who knows me personally.

 

The second voice that you will hear is an adult female in recovery from anorexia. She is telling the story how at the age of 30 something she went back home to live with her parents for refeeding.

 

2nd Voice: I just needed more help because I could wake up and say today’s going to be different, go into the grocery store and leave with the same oatmeal and yoghurt. And I can remember when I gotten to wits end and I literally can not do this. I can not do this by myself, I need more help and I was petrified. I didn’t want to go inpatient because I could see myself being one of those cases that was the rotating door. I was petrified of going and restoring weight and just getting kicked out and relapsing all over. I didn’t want that, I wanted I guess I just needed my parents. My partner had been doing everything that they could but they have their own job, they can’t be with me 24/7, we’ve got to make rent, you know? I could easily lie or hide food. I need extra support and I didn’t want it form people I didn’t know. I wanted it from people knew me from before I got sick. They came into therapy with me, my dad would distract me like no other on the way to the nutritionist on the way back from dinners out. They drove me everywhere because I didn’t have a car there we really got to have quality time and it was amazing. It was really really really hard but it needed to happen but I couldn’t have done it without them.

 

The next voice you will hear is a parent who helped in the refeeding process of her adult child. The question I asked this parent was why did she think that it was both affective and relevant for her and her husband as parents to help their child who was an adult in recovery.

 

Parent: Well one is that we probably know our child more than anybody else and so because in recovery it’s very easy for the child, well not even just a child, the patient I guess to fall back into eating disorder behaviours we are able to identify when those behaviours are not our child’s norm. So that’s really important, we can identify that and I think every person it’s helpful to have a person that keeps them accountable and so when we are able to identify those things, that’s a whole other topic of how you approach that. But being able to keep them accountable is very helpful to them, not only does it help keep them on track but I think there’s a comfort in that, that there is somebody who is really looking out for them and that they are not doing it alone and that they’re not expected to be doing it alone.

 

That’s a huge responsibility even as an adult when we put that responsibility on an adult, it’s just comforting to have that person to walk that road with. I think as a parent, it’s a relationship that’s unique to any other relationship that t hey would have even if it’s a friend. And then things like, meal planning and meal preparation and eating with the patient, all those things are really helpful too so they are not feeling like they are managing this on their own. I think knowing what the meal plan is on a daily basis is really helpful for patients so that when they are tempted to restrict or they are tempting to fudge on their meal plan. If you know what the meal planing is and if you’re able to identify by watching them prepare their meal or eat their meal or anything like that, it’s another place of accountability that they can find comfort in. Just helping them stay on track when they are tempted to fall of the track.

 

The next voice you will hear is the adult daughter of the last speaker that we heard.

 

I think if the parent or the family or whatever truly wants to help the child and they want to learn and know how they can best do it. I think it’s a game changer I think it’s the absolutely the most effective way for the child recover and not just to recover to get to a point where they’re hitting the numbers you know? Because you can do that in a hospital centre, you can do that through a feeding tube, you can get to the weight, an adequate heart rate, go two months without exercise without having the support system but I think having the support system of your family is what pushes you over the edge and puts you in a place where you are actually trusting and comfortably because you are comfortable hearing someone who you know loves you say, this is not OK, we are going to get through this together, we are going to get to the other side and you kind of see that whole process. It’s just different when it it’s someone that you trust and who loves you even if you hate them in that moment because they are telling you what you don’t want to hear or know. It’s so different to having it be just a therapist, or just a dietitian or just a nurse practitioner who’s trying to get you to go through and do the actual stuff. When it’s a family member.

 

Complusive Movement Cold Turkey: Creating space for new things

I mentioned the uncomfortable silence that stopping the compulsions and rituals that many of us with anorexia establish in a previous blog on lower-level movement here. This post is an elaboration on that.


A “spiritually enlightened” person once said this to me: “You have to first create space for new and better things if you want new and better things to fill the space.”

Now, usually I’m too cynical to listen much to anything that someone who describes themselves as “spiritually enlightened” tells me. Unfortunately, this little wisdom nugget held absolutely true for me.

Here is the catch I was in: I spent a lot of my day exercising and complying to movement-related rules and rituals. This left little time for “other things.” Gradually, friends stopped bothering to ask me to do “other things.” This left me with even more space to fill with movement-related rules and rituals and no friends to do other things with even if I had wanted to. When I understood that I had to stop all the movement, one of the many reasons that this felt difficult to justify doing was because I didn’t have anything else to do. I didn’t have anything else to do … because this is all I had been doing for years.

There didn’t seem any point in stopping the movement unless I had something better to do. Especially seeing as stopping the movement opened up all this time and space and made it even more painfully obvious that I had no friends and no interests and NO LIFE outside of anorexia.

After a while, one of the reasons I was filling my days with stupid anorexia rules and rituals was to distract me from the truth that I was lonely and had nothing better to do.


The catch is, that unless you create space for new things and new people to fill, they can’t come.


I wanted it the other way around. I wanted someone to come into my life and give me a reason not to go to the gym. A reason not walk to the shops to not buy anything. A reason not to vacuum my flat again. But while all these things were taking up space, there was no room for reasons not to do them to come in and take over.

Uncomfortable silence

It took me far too long to work out that I had to create space and sit there and wait for it to get filled with non-anorexia stuff.

Doing so was not comfortable. Stopping the gym and the walking and the cleaning left a gaping hole where my life should have been. It pointed out my loneliness, lack of meaningful purpose in life, and lack of interest in anything that wasn’t related to food and movement. I wanted to run away from that gaping hole. I wanted to fill my time with movement and rituals so I didn’t have to face it. But, that wouldn’t have been recovery, would it?

I had to sit there and wait and be uncomfortable in that silence and deal with all the emotions of doubt that the silence brought up before that silence eventually did begin to be interrupted with other interests and people.

It is rather like opening a lemonade stand on your front drive and then sitting there and waiting for customers to come wondering if they will come. Patience has never been one of my strong points, but pig-headedness is something I excel at. My experience taught me that when it came to withstanding that uncomfortable silence that not adhering to movement urges left me with, pig-headedness and determination came in very useful.

I forced myself to sit and rest. My brain pitched a fit about that initially, but then it learned that sitting and resting didn’t actually result in anything awful after all. It got used to it. It started to enjoy it. I began to discover other ways to fill my time.

It worked, by the way

My life did become filled with things. Glorious things. Friends yes. But also activities that my eating disorder would never have allowed. Like sitting and writing. Like sitting and reading. Like playing Donkey Kong on the SNES that my husband got me for no productive reason at all. (It is also the only video game I can play other than Mario World.)

I will never take my friends for granted because I am blessed with knowing what loneliness really feels like. I am busy, but not busy in the same way I used to be when I filled my time with bullshit pointless movement games. My days are filled with people (and plenty of animals) because when you can sit and hold a meaningful conversation and not have half your mind consumed with food and fear of stillness, other people like you more. I do wonderfully normal things like meet people for tea and lunch — more activities that I wouldn’t have been able to do without a good deal of stress before.

I was always worried I would be bored if I wasn’t moving. At least, that was a thought I had. Now I can see that I was so very bored with moving. My life is full in a way I never imagined it could be. It is hard to describe how being so very “normal” can be so very wonderful.

I had to sit though that uncomfortable silence to get here. If you have a complusive movement element you will have to do that too.

It is worth it.