Click here to contact Deborah and/or see her GoodTherapy.org Profile

People who struggle with eating and food issues often also struggle with poor self-esteem. I say “poor” rather than “low” because I believe the concept of high and low self-esteem to be problematic. If low self- esteem means perceiving one’s self to be inferior to others, it follows that high self-esteem means perceiving one’s self to be superior to others. Healthy self-esteem is neither high nor low. It is defined by the lack of concern about one’s worth, coupled with a sense of competence and a belief in one’s innate value. When one is comfortable in one’s own skin and doesn’t worry about whether they are good enough, being neither better than nor worse than anyone else, that’s good, solid, healthy self-esteem.

Years ago, I worked for a foster care agency, where I taught classes to prospective foster parents. Out agency used an excellent curriculum called Model Approaches to Partnerships in Parenting (MAPP). MAPP was designed to help prospective foster parents understand the experience of children coming to live in their homes. One of the MAPP modules was on self-esteem. It explained that, in order for a child to develop a sense of healthy self-esteem, they have to be taught, by virtue of the way they are treated by parents and caregivers, that they are four things: loveable, capable, responsible and worthwhile. It’s not just about what children are told, it’s also about how they are treated, and what kinds of responsibilities they are given and when.

Getting three out of these four isn’t enough. It’s like a dining room table: all four legs are needed for it to work as designed. When parents aren’t able, whether because of their own experiences earlier in life that failed to enable them to develop healthy self-esteem, or by circumstances that interfere with their ability to parent well, to convey to their kids that they are these four things, children look outside themselves for indicators that they are good enough. They compare themselves to others using the criteria available: the grades they make, athletic abilities, physical appearance, popularity.

When eating problems develop, comparing one’s self to others intensifies. The act of comparing functions as an attempt to decrease feelings of insecurity and anxiety. The person who struggles with eating and food usually compares his/her body size and shape to others. A smaller body means relief and reassurance; and bigger body means anxiety and shame. The disordered eater judges him/herself harshly, to keep him or herself in line with food and exercise. This judgment erodes self-esteem even further, and perpetuates an unhealthy relationship with food and body.

The antidote is self-acceptance. This is bedrock. It means zero self-judgment, no self-criticism, no comparing to others, no using external criteria as indicators of worth or value. It means affirming that, “No matter what I do, think, feel, say, or look like, I deeply and completely accept myself.” It’s not about whether one is acceptable in the eyes of others. The active practice of accepting one’s self is healing.

Acceptance doesn’t mean liking or approving of something. It means not fighting reality. Not fighting the body one is living in today, or flagellating one’s self for eating or exercise behaviors, but simply acknowledging, without any judgment, what is. For it is axiomatic that nothing can change unless and until it is first accepted.

The idea of self-acceptance often raises concerns: “If I accept myself as I am, it’s condoning unhealthy behaviors.” “If I accept myself, I’ll never be motivated to change.” “I can’t accept my [body/behavior] because I find it repulsive. I have to improve it before I can accept it.” I’ve often said that I’ve never seen anyone whip or beat themselves into making positive changes. Practicing non-judgment of one’s self creates safe space, an arena in which there is no pressure to better one’s self, but instead an opportunity to heal.

©Copyright 2010 by Deborah Klinger, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Deborah and/or see her GoodTherapy.org Profile

Click here to contact Joy and/or see her GoodTherapy.org Profile

Natalie has been in recovery from Bulimia Nervosa for more than three years. She still, however, unfairly compares her body to other women in the room, tries on several outfits each morning, and sits on my sofa with a pillow across her stomach as we talk.

Long after eating patterns and weight have stabilized, many eating-disordered women continue to struggle with issues of body image. In fact, body dissatisfaction has become so prevalent many authors propose it has sadly become simply part of the female experience. Body dissatisfaction is believed to be one of the highest predictors in adolescent girls of going on to develop an eating disorder.

This topic deserves focused attention in our sessions.

NEDA defines negative body image as:

• A distorted perception of your shape—you perceive parts of your body unlike they really are
• You are convinced that only other people are attractive and that your body size or shape is a sign of personal failure
• You feel ashamed, self-conscious, and anxious about your body
• You feel uncomfortable or awkward in your body

I am a psychotherapist who specializes in the treatment of adolescents and women with eating disorders. For several years I have been leading Body Image Therapy groups in my outpatient practice. What follows are some of the group topics we cover as well as resources and activities I have found useful in body image work with clients.

Generally, the group series runs for 8 – 10 sessions outlined as below:

1. My Body Relationship. How do I feel about my body? To introduce this topic, group members participate in an art activity exploring how they feel about different parts of their bodies–from head to toenails. When asked to voice to the group the body part they like most, frequently the women will speak about a part that allows them to pleasantly experience some aspect of life, for example: “My hands–because I love to play the piano.” This activity allows members to recognize that some parts of their body are just fine in their eyes. It’s not all body “hatred.” Great! We can build on this.

Leslea Newman’s book SomeBody to Love has journaling exercises and activities to help clients creatively work toward repairing a broken relationship with the body. She recommends writing love letters, having dialogues with body parts, speaking compliments into the mirror, and more.

2. Create a vision. How do I want to feel INSIDE this body? If I felt this way, how would I move differently, how would I interact with others differently, what would this free me to do & experience? Using guided visualization to step into and experience this vision allows each client to plant and hold in their awareness a goal to guide them in the work ahead.

3. Contributing factors. How did I come to define beauty? What experiences and messages contributed to my personal body opinions? Using a time-line, each member looks at significant life events and paralleling patterns of weight and feelings about the body. The women in group often speak of having felt “different” from their peers, of family relationships with one another and with food, and ambivalence about their developing bodies. We also take a critical look at the media and the conflicting messages received from advertising. NEDA offers a number of handouts useful in facilitating this discussion.

4. Body Talk. What’s being said inside my head? How we talk to ourselves and what is said has a powerful effect on how we feel. Thomas Cash, PhD in The Body Image Workbook tells us this talk is often self-defeating, derogatory, and distorted rather than realistic. His book (and audiotape program) provides clients with specific steps and tools to help them become aware of their negative body talk and begin to transform these messages.

5. Body as Camouflage. What do I hide with my body? To explore this dynamic, each group member creates a collage with magazine clippings portraying the “inside me/outside me.” Clients have used this activity to explore their beliefs about what others assume and expect of them, the image they try to portray and then what they really feel like on the inside. We explore how they have used their bodies to protect or distract them from certain feelings and what it has been like to live with such a dichotomy.

6. Body as a Vehicle. What can I do and experience, thanks to my body? Sondra Kronberg, RD writes, “True body power is the power of the body to accomplish tasks and be the vehicle through which to experience life.” As a group we meet for a nature walk (adapted from “Sensual Walk” in Working with Groups to Explore Food & Body Connections.) In silence, we mindfully pay attention to the titillation of all of the senses. “Notice the smell of air, the feel of the elements, the textures beneath your feet, the views along your route, the taste on your lips, the ever-changing sounds in the background or foreground” (Christian, p.112). In processing the experience, we talk about beginning a new relationship with our bodies by celebrating all the amazing things our bodies do for us and allow us to experience. Using Thomas Cash’s “Adult Pleasant Activities List,” members are asked to mindfully and joyfully experience something from the list each day for the next week.

7. Body as Container. What is this spirit, this essence-of-me that lives inside my body? Kronberg goes on to write about the importance of helping our clients find their “real beauty,” that is the beauty “stored inside of them.” During this session, group members create a word and picture collage of favorite things, causes they passionately believe in, relationships that matter most, compliments received, qualities of character they admire in themselves. This activity is often a favorite and reminds participants that they are so much more than the size of their clothes.

8. Body as a Rich Source of Wisdom. What can I learn if I slow down and listen to my body? This session opens with a deep breathing exercise to practice being still, quiet, and focused. We then explore “gut” instinct–where and how we experience it in our bodies and how we have used this information to reliably guide us. Members are also invited to explore feeling states in the same way. Using a body outline on paper, members draw where in their bodies they feel anger, sadness, loneliness, etc., noting the size, color, and shape of each, and what distinguishes one from the other.

9. Body Respect. I can honor and take care of my body. This is a brainstorming session of all the things we can do to take care of and nurture our physical selves. Belleruth Naparestek’s affirmations are used from A Meditation for Relaxation and Wellness. Examples from her beautiful work include:

• “I thank my body for all it has done for me in the past and all it will do for me in the future.
• I am learning to trust my body and to make good use of the information it offers me
• More and more I sill save my energy for what truly matters to me
• I am aware that with each breath in I am sending precious oxygen and rich nutrients to the places in my body that need them
• I welcome my ability to listen to the wisdom of my body and sense what it needs—telling me to rest, pace my energy, and take gentle good care of myself
• More and more I can understand that my body is my ally, my oldest friend, and steadiest companion.”

Body image work is a critical step in full recovery from an eating disorder. I am seeking your story for future articles: What helped you most in repairing the relationship with your body?

Recommended Reading:

• The Body Image Workbook by Thomas Cash, PhD
• The Body Myth by Margo Maine, PhD & Joe Kelly
• Eating in the Light of the Moon by Anita Johnston, PhD
• A Meditation for Relaxation & Wellness (CD) by Belleruth Naparstek
• SomeBody to Love by Leslea Newman
• Transforming Body Image: Learning to Love the Body You Have by Marcia G. Hutchinson, EdD.
• Working with Groups to Explore Food & Body Connections by S. Christian, Editor

Additional References:

1. Kronberg, MS, RD, CDN, Sondra. “Nourishing a Healthy Body Image: A Nutritionist’s Perspective,” The Renfrew Perspective. Fall 2002.

2. Levine, PhD, Paula. “The Meaning of the 3D’s,” Eating Disorders & Awareness Prevention. 1993.

3. Ressler, MA, LMSW, Adrienne. “A Body to Die For: Advanced Training in the Treatment of Eating Disorders & Body Image Disturbance in Women,” Renfrew Center Foundation, May 2006.

4. Hawkins, PhD, Nicole. “Battling Our Bodies: Understanding and Overcoming Negative Body Images,” Center for Change.

©Copyright 2010 by Joy A. Davis, LCSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Joy and/or see her GoodTherapy.org Profile

The rising, and often startling, rates of obesity in the United States and many other parts of the world have led to an increased awareness of the health issues facing modern consumers, and of the issues facing their children, as well. Childhood obesity has recently been selected as a major national challenge by First Lady Michelle Obama, and a growing number of professionals in various fields are working towards helping children overcome this potentially debilitating concern. But in some cases, notes a counselor specializing in weight loss in a recent editorial, authority figures may approach childhood obesity in rash and embarrassing ways, potentially adding to the struggles of children attempting to work through their weight issues.

In particular, the counselor notes, weighing children in schools and sending judgmental notes home to parents about children’s weight may have a profoundly negative impact on self-esteem, and can also cause humiliation within the social setting of elementary, middle, and high schools. As some schools have proposed just such measures, the counselor suggests that some professionals have taken on unhelpful roles in the fight against childhood obesity, acting as disciplinarians rather than compassionate and insightful sources of information and support for children in need.

The counselor suggests that school officials and other professionals take a more relaxed approach, doing their best to offer scientific information about diet, nutrition, exercise, and other important topics without making children feel guilty or pathologized because of their weight. As a growing number of adults work towards helping children lead healthier and happier lives, the need to support children emotionally and mentally along with facilitating better physical habits is becoming increasingly clear. In his piece, the counselor suggests that this need must be heeded by schools if meaningful progress against obesity is to take place.

Click here to contact Gail and/or see her GoodTherapy.org Profile

National Eating Disorders Awareness Week occurs this month, and it is a necessary reminder of the role body image plays in women’s self-esteem. While women with clinical eating disorders, such as anorexia nervosa or bulimia, typically have a distorted body image, even those without eating disorders often struggle with body image concerns ranging from mild dissatisfaction to outright self-hatred. Any woman can feel tormented, terrorized, and completely obsessed with the image reflected back in the mirror.

What perpetuates this assault on body-esteem? Well, one of the biggest offenders is the media. Air-brushed, photo-shopped images of models and celebrities create unattainable expectations of perfection. Ninety-eight percent of American women are heavier than most models (Smolak, 1996), yet they frequently aspire to these impossible standards. Billions of dollars are spent each year on anti-aging skincare, plastic surgery, and diet products. According to the Social Issues Research Centre (1997), 80% of adult women are unhappy with their appearance. Many women internalize the media’s standards of an ideal body, and this can be a risk factor for poor body esteem, dieting, negative mood, and binge eating (Vandereycken, 2006). And this dissatisfaction starts early. Collins (1991) found that 42% of girls in first, second and third grade want to be thinner, and by age 17, approximately seven out of ten girls have been on a diet (SIRC, 1997). Wardle and Marsland (1990) found that almost 40% of 11-12 year-old girls viewed themselves as overweight. Family dynamics, peer pressure, and emotional problems, such as depression, low self-esteem or even a history of trauma, can all contribute to a poor body image. However, societal expectations are the most insidious.

Body image distortion and dissatisfaction are characteristic of eating disorders such as anorexia nervosa or bulimia nervosa. Eating disorder symptoms usually consist of restrictive eating, binge eating, and/or attempts to eliminate what was consumed. A poor body image can also compel women to mistreat their bodies in other ways. Some women exercise to the point of injury, unable to accept a body that is not perfectly toned. Others compulsively tan, despite the risk of skin damage. Still others seek out plastic surgery to correct any perceived flaw or forestall the effects of aging. The most extreme form of body self-hatred is body dysmorphic disorder (BDD), defined as a preoccupation with an imagined defect in appearance, or an excessive concern over a slight physical irregularity. Women with BDD may become obsessed with a particular body part, such as a nose or stomach, and will go to extremes to hide or camouflage it. They might avoid social situations, become depressed, and may even seek plastic surgery in hopes of repairing the problem.

While women with eating disorders or BDD often benefit from psychotherapy, others with less severe body image concerns still need to challenge the negative effects of society’s message, that to be attractive you must be young, white, wealthy and impossibly thin. What are some basic things you can do?

1) Challenge unrealistic assumptions and expectations. Appreciate your body for its capabilities and power, for what it can do and how it moves, not just for how it looks. You are a whole person, not the sum of body parts that need to be perfected. Be realistic about your size, build and genetics and learn to enjoy your own unique beauty.

2) Treat your body well. Feed it, exercise it, give it plenty of rest and pleasure. Learn to enjoy all of the good things it has to offer, and the things you take for granted, like walking down the street or drawing a breath. Remember, the body truly is the “temple of the soul.”

3) Refuse to accept the dictates of the media and fashion industry. Question the motives of ad campaigns that stress unattainable standards and vote with your wallet. Wear clothes that make you feel comfortable. Challenge attitudes that equate self-worth with physical attractiveness. Think of the values you would want your daughter, your niece, your friends to internalize. Then apply those values to yourself.

References:

Collins, M. (1991). Body figure perceptions and preferences among preadolescent children. International Journal of Eating Disorders, 10, 199-208.

Smolak, L. (1996) National Eating Disorders Association/Next Door Neighbors Puppet Guide Book.

Social Issues Research Centre (1997). Mirror, mirror: A summary of research findings on body image. Retrieved from http://www.sirc.org/publik/mirror.html.

Vandereycken, W. (2006). Media influences and body dissatisfaction in young women, Eating Disorders Review, 17, 5.

Wardle, J. & Marsland, L. (1990). Adolescent concerns about weight and eating: A social-developmental perspective. Journal of psychosomatic Research, 34, 377-391.

©Copyright 2010 by Gail Post, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Gail and/or see her GoodTherapy.org Profile

Noting the prevalence of weight loss programs and advertisements in modern media, organizers of awareness-raising events at the University of Kentucky suggested that more information about the impact of eating disorders such as anorexia and bulimia should be distributed throughout the population. This information can be particularly critical for women in college, the organizers report, as the specific pressures of the collegiate environment can lead to unhealthy eating and behavioral choices. Other universities and groups touched upon how eating disorders affect men and other age groups, all while taking part in National Eating Disorders Awareness Week.

In many ways, eating behavioral concerns such as anorexia and bulimia are treated as issues that affect females. Many clinics and programs are marketed specifically towards women, and even some diagnostic criteria involves female physiology without providing any equivalency for males. But as awareness about eating issues becomes greater and National Eating Disorder Awareness Week takes place, a greater attention to the difficulties faced specifically by men is emerging among professionals and clients alike.

Men often must confront particular issues when suffering from the mental, emotional, behavioral, and physical symptoms of eating concerns, including a higher prevalence of nutritional supplement abuse and increased stigmas surrounding the acknowledgment of the concern and the seeking of treatment. As men are typically expected to have a muscular, toned form, suggest some experts, taking muscle-building pills and other substances aimed at helping men obtain a certain look can be a tempting and compulsive habit. Some industry professionals note that because men with eating concerns may not present an especially thin look as is the case with many females, diagnosis can be difficult.

The social pressures men experience surrounding body image and mental health can make reaching out to a counselor or therapist extraordinarily difficult. On average, men approach therapy and related services on a much less frequent basis than their female counterparts, and this difference may be especially pronounced in the case of eating concerns. These challenges in their sum, say experts, lead to a need for providing better education and outreach programs for men, along with helping communities understand that not only women are affected by eating issues. Through a greater acceptance of the ways in which eating concerns can manifest, professionals and community leaders can help prevent a great deal of the strife associated with starving oneself, purging, and engaging in other unhealthy behaviors.

Click here to contact Deborah and/or see her GoodTherapy.org Profile

When it comes to eating and food-related problems, various philosophies determine how eating problems are defined and addressed. When the eating disorders treatment field was in its infancy, professionals often based their approaches on those used in the treatment of alcoholism and drug addiction. The addictions model has been used to salvage the lives of alcoholics since the formation of Alcoholics Anonymous (AA), in the 1930’s. AA spawned myriad other 12-Step programs for addressing various addictive problems. One of the earliest of these was Gamblers Anonymous (GA). Overeaters Anonymous (OA), a 12-Step self-help program for people who feel compelled to overeat, was created in 1960, modeled after GA. OA philosophy views compulsive overeating as an addiction to both a substance–various types of food–and to the behavior of overeating compulsively. As OA grew, people suffering from all types of eating problems began attending, and found help there.

However, as research on eating problems proliferated, and eating disorders came to be better understood, health care professionals began to recognize that while 12-Step programs offer members an unparalleled access to peer support, a practical spiritual philosophy, and a systematic approach to healing at nominal (donation-only) cost, the 12-Step philosophy doesn’t always translate well from its originally intended formula as a treatment of alcoholism to an effective means of treating disordered eating.

Applying an addictions model to eating problems means believing that a person has a disease that causes them to be addicted to certain types of foods, certain eating behaviors, or both. The recovering person practices abstinence, the corollary to an alcoholic’s sobriety. This might mean eating only at meal times, or refraining from eating refined sugars, or from other types of food or eating behaviors. Thus, a between-meal snack or a piece of pie at the end of dinner would be as much a break of abstinence as a no-holds-barred eating binge. This perspective dangerously mimics eating-disordered thinking, which says that eating outside of certain pre-determined rules is bad and that the person who does this is a pig.

Eating-disordered thinking comprises certain thought patterns that are common to all types of eating problems. These patterns include the beliefs that the person thinking the thoughts is weak and lacks willpower, and needs to follow certain eating guidelines to feel safe and good about him/herself. Some tenets of the addictions model, e.g., that the sufferer has a disease from which she can never be fully recovered, that sufferers cannot trust themselves, and that self-confidence is a liability rather than a strength, are quite resonant with the voice of the eating disorder itself. Eating disorders sufferers feel intense shame about their appetites and desires. The addictions model, when misapplied to disordered eating, attributes these appetites and desires to “the disease,” rather than exploring their significance.

The disease concept helps relieve alcoholics and addicts of the shame they experience. It helps them understand that their behavior is not a function of personal weakness or flaws, but of an affliction they have. However, it also teaches them that they can never fully trust their thinking because their disease might be influencing it, that they must learn to live with it. A common saying in 12-Step programs is that it’s important not to become complacent because the disease is “always in the next room, doing push-ups.” While this perspective can be very useful for a recovering alcoholic or gambler, it can backfire on a disordered eater.

While eating disorders treatment professionals often find it helpful to separate the disorder from the person, much as addictions philosophy does with the disease concept, the focus is on developing a strong sense of self-confidence and self-worth, and letting go of an eating disordered-identity. The goal is to learn to live without the disorder. Appetites and desires for all kinds of foods are regarded as normal and healthy, and when they surpass desires for “normal” amounts, they are seen as indicative as hungers for other things a person needs.

An integrative model of recovery encourages attention to the body’s wisdom, a reconnection to hunger and satiety signals, and development of self-trust. It says that while recovering people often benefit from nutritional guidance and eating plans, there are no off-limits or bad foods, no rules to be broken. A commitment to stop dangerous behaviors such as purging via laxatives or self-induced vomiting, compulsive exercise, and bingeing, comes at different points in people’s recovery.

An integrative approach to treating disordered eating draws on therapies that address behavior, cognition, emotions, body image, and spirituality. It helps people who struggle with food-related problems to connect to the parts of themselves that are hungering for something bigger and deeper than food, and to feed those hungers appropriately. For people in 12-Step programs for their disordered eating, an integrative approach can incorporate the positive aspects of an addictions approach, while empowering them to return to a state of balance and self-trust, and develop an intuitive and satisfying relationship with food and with themselves.

©Copyright 2010 by Deborah Klinger, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Deborah and/or see her GoodTherapy.org Profile

Click here to contact Lynne and/or see her GoodTherapy.org Profile

Nothing is more basic to human life than eating. The food and drink that fuel our bodies requires our attention every few hours every day, and provides us with experiences of pleasure and rest that most of us share with others. Food choices vary from country to country, and from century to century. While some eat beans and others fish, we all worry about our food. Is it safe? Is there enough? How will it taste? We spend enormous amounts of money, time and energy producing food, transporting food, buying food, making food. Yet fewer and fewer Americans spend equal amounts of time and energy enjoying it.

We want food, but we want it fast. We want it easy to prepare, tasty and attractive, and we don’t want to spend a lot of time cleaning up. We may eat standing up, in front of the television or computer, and even in our cars. And while all of us are well aware of the effect this increasingly rapid and processed food consumption is having on our national levels of heart disease, cancer and obesity, fewer of us are aware of what it’s doing to our family relationships.

For centuries of human life, families have made it a priority of daily living to eat together. At our tables, food is shared, conversations held, relationships cemented. It’s no wonder that in all the major religious traditions, some kind of eating ritual or food offering is a central act. Our holidays are often focused around the foods we prepare and share. Can you imagine celebrating Thanksgiving without a major family meal, or a child’s birthday without cake?

The sharing of food together is such an integral act to family function that when this emotional process gets twisted, eating disorders like anorexia, bulimia and morbid obesity can develop. Each of these difficult mental health disorders is on the rise in our country, and is notoriously difficult to heal. The best current practice of healing eating disorders includes every family member in the treatment process. The whole family has to learn to eat together again.

Many families with growing children have two working parents, whose work lives often extend into the evenings via their business emails, beckoning them from their smart phones or laptops. If those same parents aren’t going to the gym, doing laundry, paying the bills or running errands in the evening, they are often back in their cars taking their children to dance, basketball or Scouts. Dinner may be picked up on the way, or eaten piecemeal by each family member as they come in and out of the house. Even families with one parent home most of the time have difficulty scheduling a time when “dinner is ready.” While dinner might be ready on the stove, is there anyone home to eat it?

As simplistic as it may sound, eating shared, calm, regular meals together as a family is as close to a “magic pill” we may get to hold the scattered American family together. Current research demonstrates that families that eat at least a few meals together at home during the week have children and teens that are more successful at school, are less apt to experiment with early sexual activity, alcohol and other drugs, are less prone to eating disorders and have higher self esteem. Parents have increased sense of connection with each other and their children, and have healthier eating habits.

The only downside is that stressed and busy adults have to make the buying, storing and preparation of food a personal priority. Somebody has to think about and organize the meals. Food is costly, perishable and heavy. Cooking at home can be enormously stressful to an already time pressed and distracted parent, whose own life feels like it is already poured out for the sake of their children, their employer, and their spouse. The regular cook may feel like the only one in the family who isn’t enjoying all the emotional benefits of their hard work.

As important as eating together has been and continues to be, it’s well worth the time and energy it takes to make eating as a family a new priority. Schedules may need to be trimmed down, and rearranged. Expectations will need to be shared about when dinner is eaten and who needs to be there. Work must be shared so that the family chef doesn’t give up from overwork. And new attention may need to be given to the emotional tone of the family dinner, so that laughter is on the menu as much as problem solving. When it comes to helping the family function, the daily question, “what’s for dinner?” may just be one of the most important questions you hear all day.

©Copyright 2010 by Lynne Silva-Breen, MDiv, MA, LMFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Lynne and/or see her GoodTherapy.org Profile

Though the peril of eating disorders have been known for quite some time, many people affected by these mental and psychological concerns do not seek or cannot access treatment, and the need for greater awareness is advocated by many within the therapist community. In recognition of this need and in anticipation of National Eating Disorder Awareness Week, which takes place from February 21st through the 27th, Pace University in New York has announced a series of documentary films and a lecture to help students connect with the issues surrounding these disorders. It is also hoped that the event will help link those in need with available community resources.

Click here to contact Ondina and/or see her GoodTherapy.org Profile

First of all what is body image? Body image is how I look- right? No! Body image is a mental idea about your physical body and how you look. Body image is something that constantly changes as it is based more on feeling than fact. This also makes it very vulnerable to distortion.

Let me illustrate just how vulnerable your body image can be with the following story…

I had a client Marge, who was working hard on improving her body image. She was taking better care of herself. She was eating healthier foods. She was also creating other sources of nurturing for herself by fostering a more caring, supportive friendship circle. She had found an exercise she enjoyed and was doing that regularly. She was really starting to feel better about herself; her self esteem and body image were improving daily and it showed. She had a bounce in her step and an excitement about her that was contagious. She started to get more attention One day she announced to me that she had been asked on a date! She was very excited.

The following week she wasn’t doing so well. I asked her what had happened? She told me that the date didn’t go as she had hoped. Marge had what I refer to as, “A Fat Attack” She felt rejected and blamed her body. “I suddenly felt so fat and ugly!” she told me. “It was the way he looked at me, I knew I’d never see him again.” Marge went into the date and left it with the same body but somewhere in there she felt like she had put on 20 pounds.

How the Media Cashes in on Our Vulnerability:

The media really knows how to cash in on this vulnerability. We are constantly being bombarded with images that tell us that if we look a certain way we too can enjoy success, love, happiness etc. The problem with this excessive focus on externals or how we look is that it takes us away from our internal felt sense of what has true value and meaning for us. When people move away from their truth they become disempowered. It is also really disempowering to be in a constant battle with your own body. Your body then becomes your battleground or ‘shame container’ instead of home for your psyche and spirit. It is a modern tragedy.

Narrow versus Wide Base for Self Esteem:

What exactly do I mean by ‘a narrow basis for self esteem’? It is when your self esteem is based solely on one thing, such as how you look or how much you weigh. With such a narrow base, your self esteem is much more vulnerable to collapse.

What does ‘a wide basis for self esteem’ mean? It is when there are other qualities that form a foundation for your self esteem. These qualities might include your fabulous personality, your talents and gifts, your smile, your contribution to your community, your culture etc. When you have a number of different things that you value about yourself your view of yourself will also be more stable, steady and solid.

Healthy body image means that you are comfortable with the body that you have. It does not mean that you think your body is perfect, rather that you accept and commit to loving and caring for it. Healthy body image means having a relationship with your body that is based on more than what you weigh. It is built on a wide basis for your self esteem. The irony is that when we feel better about ourselves research shows we also take better care of ourselves, this means we are more inclined to feed and exercise our bodies too. Our bodies can be like kids; they respond better to positive reinforcement rather than constant criticism, nagging etc. Try focusing on talking nicely to and about your body for a day and see if you don’t notice a difference.

©Copyright 2010 by Ondina Nandine Hatvany, MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Ondina and/or see her GoodTherapy.org Profile

As obesity among children and adolescents gains understanding as a significant modern health issue, psychologists and others in the health fields are picking up the pace of work geared towards helping young people avoid unhealthy lifestyles and make positive changes to achieve better health –and a better self-image. Recently, a study published in the journal Pediatrics found that when weight counseling programs are paired with reading, the results can take a decidedly positive turn. The study focused on female teenagers with obesity, splitting participants into three groups. The study group was assigned to a counseling program that included the reading of a fictional book related to healthy lifestyle and weight loss choices. A second group was given the same counseling and a fictional book unrelated to weight. The control group was not given a book, but received counseling as usual.

Results were collected two months later, with the girls who participated in the relevant reading group showing the best results for weight loss and positive lifestyle incorporation. While the girls who read the unrelated book performed better than those in the control group, they were still less successful than those who read the fictional piece about healthy weight management. While further work may need to be done to establish whether such tools could be used to aid other forms of counseling and therapy, researchers will likely be excited about the prospects of incorporating other types of media into treatments.

Clients of counseling and therapy for alcohol or substance abuse, or even those in marriage therapy sessions, may be able to benefit from similar methods of providing a positive if fictional example, especially when new concepts or practices are being introduced. The potential for greater incorporation of written media into counseling may also open many new positions and theories for professionals.

Click here to contact Deborah and/or see her GoodTherapy.org Profile

It’s January, the time of year when we’ve rung out the old and are ringing in the new, making resolutions for the coming year. New Year’s resolutions usually involve goals for self-improvement, often including weight loss. Magazine ads and articles extol the benefits of amazing plans that promise permanent weight loss in short amounts of time. Vanity and health concerns drive the desire to get smaller, sleeker, leaner in the new year.

While this might sound like a positive, worthwhile ambition, it can become an exercise in futility, backfiring and increasing one’s sense of failure, not for lack of trying, but because the very premise of “weight loss” is faulty. We can’t lose weight, or for that matter, gain it. We can do things that result in a change in the amount of body fat and muscle mass we have, and that might thus cause the number on the scale to get higher or lower. But weight-loss mentality is about what those numbers represent to us: what we feel and believe about the significance of the numbers, and the lengths we go to in order to get those numbers to change.

When I was in 8th grade, my mother enrolled me in a program for girls given at the local Burdine’s department store, called “Glamorama.” At Glamorama, we learned about make-up and fashion. At one session, the facilitator called out a list of heights and the appropriate weight for that height. I don’t remember much of what went on at Glamorama, but that height/weight list has remained etched in my brain to this day. In puberty, as my body changed and grew, it exceeded the number the Glamorama facilitator had stated was right for my height. In terror and shame, I went on the first of many diets.

Dieting usually involves figuring out a goal weight (determined by anything from a doctor’s recommendation to Body Mass Index or insurance company tables to Glamorama), then deciding upon a diet, and/or an exercise plan. Next, we follow the plan until the magic number appears on the scale. We have succeeded!

In our goal-oriented culture, we tend to focus on outcome, deciding upon a desired end, and then figuring out the means of achieving it. This works well for many things, from figuring out a driving route to another city to saving money to buy a house to making career plans. But when it comes to weight, it’s another matter entirely.

You may have heard that the majority of people who lose a significant amount of weight regain most, if not all, of it. This is because the idea of “weight loss” is putting the cart before the horse. We think of our bodies as things that can be molded, bent, twisted to be the shape and size we find aesthetically pleasing. We forget that they are parts of ourselves that have wisdom of their own and needs to be met.

Our bodies are designed to operate optimally on a given combination of nutrients and amount of energy. Energy comes in to our bodies as calories and leaves our bodies as movement. Our bodies and brains are wired to know when they are in need of energy and nutrients, and we recognize this via hunger. When we have had enough, we feel satisfied. If we care for our bodies and brains by eating the right kinds of foods in the right amounts, and by giving our bodies (and brains—exercise benefits brains, too!) the kinds and amounts of movement they need for good health, our bodies are the shape and size that is just right for us.

The number on the scale is arbitrary: humans invented scales and numbers, and the meaning they have is what we endowed them with. Gearing eating and exercise behaviors to achieve a certain number on the scale is going at it backwards: if one’s body has more adipose tissue (i.e., fat) than is healthy for it, it’s because that person’s relationship with food, with exercise, and with their body is out of whack. Weight—or better, body shape and size—is an indicator of something, not the thing itself. There is no such thing as a “weight problem.” The problem is with whatever one’s internal state is such that it drives behaviors that aren’t in harmony with what they need. Dieting is an externally imposed way of eating—it has nothing to do with listening to one’s body and nourishing one’s self, it’s about eating certain types of foods in certain amounts at certain times to attain a certain weight, and therefore, ironically, exacerbates the very problem behind the problem the dieter is trying to solve: a relationship with food that is disconnected from one’s inner awareness.

It took me many years not only to let go of the Glamorama numbers, but to find my way back after years of bouncing around between dieting, binge eating, and eating according to rules that kept my body smaller than is natural for it, to an intuitive and relaxed relationship with food. To do so, I had to stop thinking about “weight” altogether. Instead, I focused on feeding my physical body the food and exercise it needed to be healthy, and tending to my emotional and psychological “bodies” by giving them what they needed. This was much more complicated than following an eating plan!

Shifting one’s focus from the external and the result—weight—to the internal and the process—hunger/satiety signals and eating and exercise behaviors, and to the underlying issues that drive them, is essential. This involves learning to care for, trust and listen to our bodies. To nourish them because our well-being matters, because we are worthwhile and valuable. (And difficulty believing in our worth and value is part of what drives problematic eating patterns, so healing these problems is often part of healing our relationship with food). This won’t sell magazines, but it will make for living in harmony with ourselves.

©Copyright 2010 by Deborah Klinger, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Deborah and/or see her GoodTherapy.org Profile

Click here to contact Becki and/or see her GoodTherapy.org Profile

Breathing deeply, relaxing your muscles, and staying in the present moment are some of the most common, most effective ways to manage anxiety. But did you know that changing your eating habits can also help you feel more calm and balanced? There are certain foods and substances which tend to trigger stress and anxiety in the body, and in fact, there are several foods that can even trigger a panic attack.

Caffeine, sugar, and alcohol all increase lactic acid levels in the bloodstream. Recent studies show that a high accumulation of lactic acid in the body can increase anxiety and cause panic attacks. Caffeine also blocks adenosine, which is a chemical found in the body. Adenosine is a neurotransmitter which is believed to play a role in suppressing arousal and promoting sleep. Without adenosine, the pituitary gland produces adrenaline and the increase in adrenaline can either cause or increase symptoms of anxiety. In addition to increasing lactic acid levels in the blood, sugar intake causes a release of insulin which decreases blood glucose, resulting in mood swings and agitation. Alcohol use also causes fluctuations in blood sugar levels leading to increased anxiety and agitation.

Seasonings used in cooking can also cause symptoms of stress on the body. Salt depletes potassium in the body. Potassium is important to the proper functioning of the nervous system. Salt also raises blood pressure, which strains the heart and arteries. MSG can irritate the nervous system causing headaches, tingling, numbness, and chest pains.

Artificial food additives, preservatives, and processed foods can also trigger reactions in people who are sensitive to them. Aspartame, an artificial sweetener, is neurotoxic, and should be avoided. Processed foods, those made with refined ingredients such as white flour, white sugar, and white rice, can cause a vitamin B1 (thiamine) deficiency, which can lead to symptoms of anxiety and emotional instability. Refined and processed foods are usually stripped of much of their magnesium as well, and magnesium deficiency may be a factor in symptoms of panic.

People who suffer from panic disorder should avoid skipping meals. Hypoglycemia, or low blood sugar, can cause the body to release adrenaline in order to prevent fainting, which can trigger a panic attack in susceptible individuals. It helps to eat small meals every three to four hours throughout the day rather than only two or three large meals. It is also important to stay well hydrated.

Food allergies can also be a factor in anxiety and panic disorder for some people. It may help to try eliminating different foods (i.e., wheat, dairy) for two weeks at a time to determine whether a food allergy is aggravating anxiety symptoms.

Certain eating habits can induce symptoms of anxiety. Eating too fast, not chewing food enough (15-20 times per mouthful), eating too much, and drinking too much fluid with a meal can all interfere with digestions and the assimilation of food into the body.

A deficiency in several key nutrients can cause symptoms of anxiety. B complex vitamins are important for healthy nervous system functioning and in helping the body to relax and recharge. Symptoms of B complex deficiency include fatigue, irritability, nervousness, and insomnia. Magnesium is needed for muscle relaxation, healthy heart muscle, and healthy blood vessels. A deficiency of magnesium can cause agitation, anxiety, confusion, cold hands and feet, insomnia, and restlessness. Calcium is used by the body for maintenance of electrolyte balance, muscle contractions, and nerve transmission. Calcium deficiency can cause agitation, depression, heart palpitations, insomnia, and irritability. Although vitamin supplements can help keep B complex, magnesium, and calcium at healthy levels, it is especially helpful to get these nutrients through eating fresh fruits and vegetables, adequate protein, and simple carbohydrates.

Managing anxiety involves changing behavior on several levels. In addition to learning to breathe properly, relax, and use cognitive skills to stop anxious thinking, it is important to keep your body physically healthy. Watching what you put into your body can go a long way in keeping it clean, healthy, and calmly functioning.

©Copyright 2010 by Becki A. Hein, MS, LPC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Becki and/or see her GoodTherapy.org Profile

When faced with challenges that involve both mental and physical health difficulties, clients may not know where to turn for help and treatment. Often, a collaboration of different types of services can prove most beneficial, but there are certainly some medical concerns for which therapy can have a remarkably positive impact. Binge eating has recently been identified as one such concern; while psychotherapy and self-help have been shown to be effective for binge eating issues in the past, a new study based at Rutgers University has shown that in the long-term, these types of treatments are significantly more effective than behavioral weight loss programs alone.

Pressure to stay thin while growing up has been significant for many years, as the fashion and beauty industries project images of notably thin women and other media portrayals of beauty suggest that a wraith-like appearance is most desirable. But as waistlines across the country have been steadily increasing, the pressure to keep weight away is doubtless becoming even more great as girls are warned by parents and doctors about the health issues associated with obesity. Taking a mental health-based approach may be a more positive way to teach girls about healthy eating habits, suggests a study recently produced by the National Institutes of Health.

Though the study worked with a small group of under forty participants, girls were split among those who received interpersonal therapy sessions and those who were given basic health educational courses. While all of the participants showed positive results in terms of weight loss, those who had been involved in the interpersonal therapy groups exhibited a higher success rate. During these therapy sessions, which were held over the course of a year while eating habits were recorded, the girls were encouraged to examine their relationships and how various social and other influences had an effect on their desire to eat.

As mental health concerns and fluctuations in weight are sometimes closely linked, this type of therapy may hold substantial promise for young people struggling to understand health and self-image in a media-driven environment. Through establishing a positive exploration and understanding of the self as well as providing support for potential binge eating and other undesirable behaviors, interpersonal therapy for obesity prevention may improve the lives of adolescent girls both inside and out.

Click here to contact Ondina and/or see her GoodTherapy.org Profile

What is Mindful Eating?

Mindful eating is about paying attention to what you eat. Actually focusing on the flavors, textures and subtleties of what you are putting in your body. It is not about eating while you are thinking of your bills, the kids, how many calories, watching TV etc. For most of us this is a tall order. There are so many distractions and people, places, things pulling on us, who has time to really pay attention to what they are eating? What is even the point?

The point is pleasure. When we are really present with what we choose to put in our body we experience the subtleties of what we taste. We experience the food more intensely. We allow it to nurture us more deeply. We are not thinking about our next meal because we are too busy enjoying this meal. We are not reaching for the next piece because we never really tasted the first piece. In this way we end up enjoying more quality and needing less quantity.

For the eating disordered population or those with food, weight and body image issues mindful eating is key. If you allow yourself to enjoy what you eat and practice being present, you will need less to feel satisfied. If on the other hand you are so consumed with guilt while you eat that piece of chocolate and thinking of all the ways you are going to have to make up for this misdemeanour, you are barely going to taste that first piece of chocolate and need another and another.

Next time you want chocolate or that “forbidden food”*, try this exercise. You might find you enjoy more and eat less as a result…

Mindful Eating Practice with Chocolate:

Next time that chocolate craving hits, close your eyes and ask yourself with focus;
What kind of chocolate do I want exactly?
Is it dark, milk or white chocolate?
Is it crunchy or smooth? Gooey or hard?
If it’s crunch you want, ask yourself: What kind of crunch exactly?
Is it a nutty crunch, candy crunch or a rice crispy kind of crunch?
What kind of gooey? Is it a caramel gooey or a fruit gooey?
And so on…. See if you can define exactly what you want. Be specific!

When you have defined exactly what it is you desire, you are ready for the best bit!
Find a space without distractions. Unwrap the chocolate slowly, enjoying the crinkle of the paper and the smell of sweet cacao being released. Look at the chocolate, smell it, lick it. Notice the texture and sensation of biting into it. Let the chocolate melt on your tongue, dissolving in deliciousness. Enjoy the feeling of this chocolate luxury, decadence and pleasure and let it sink deeply into your being.

After a while the feeling of pleasure starts to become less intense. This is your signal that you are nearing the end of this delicious excursion into chocolate. If you are practicing ‘intuitive eating’* you know you can put the chocolate away with the sure knowledge that when you want some more you will let yourself have more and fully enjoy it.

This mindfulness practice can apply to ALL your eating not just chocolate.

- – - – - – - – - – -

In the book ‘Intuitive Eating; A Revolutionary Program that works’ Trobole and Resch encourage making all activities pertaining to food pleasurable ones: “When you eat what you really want in an environment that is inviting, the pleasure you will derive will be a powerful force in keeping you satisfied and content… You will find it takes less food to decide you have had enough.”

“I won’t be able to stop eating!”

All of this might seem really scary for those of us who have been steeped in the diet ruled mentality that advocates controlling our body’s appetites and desires at all costs. We have a $40 billion dieting industry in this country that advocates this way of thinking. It can seem unfamiliar and scary to consider listening to our body and having our body be our friend instead of our battleground. I hear clients voice fears around the concept of intuitive eating all the time: “I won’t be able to stop eating!” Or “ I don’t know how to listen to my body’s appetites.” Be patient with yourself and get some guidance. If you are getting your nutritional needs met you won’t go crazy on the chocolate. If you practice listening to your body it becomes easier and more fluid. It also helps to have some guidance/therapy, especially in the beginning.

Here’s to a Pleasure-Filled Holiday and 2010!

* “forbidden foods” – Intuitive eating principles propose steering clear of rigidity around food. Labeling food as either “good” or “bad” causes food obsessions and contributes to eating disordered thinking.

* “intuitive eating” encourages a ‘bottoms up approach’ of listening to your body versus the ‘top down approach’ of using your mind to rule your body

©Copyright 2009 by Ondina Nandine Hatvany, MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Ondina and/or see his GoodTherapy.org Profile

Click here to contact Deborah and/or see her GoodTherapy.org Profile

Disordered eating is a metaphorical expression of an internal condition. Think about food: you may be a “foodie,” who appreciates well-prepared, high quality food and relishes a lengthy meal with good companionship and conversation. You may be more utilitarian, viewing food simply as something necessary to your health and wellbeing. Or perhaps you relish the sensory pleasures of warm, savory, fragrant, filling foods and aren’t interested in much fanfare around the eating of them. Your eating habits may reflect your values when it comes to the consumption of animals, of refined and processed foods, and/or of foods produced locally v. shipped from afar. Regardless of your personal preferences when it comes to food, a relaxed yet conscious relationship with food is healthy; a conflicted one is not.

My clients who struggle with food-related problems are not relaxed about food. For them, eating is fraught with guilt, shame and self-recrimination. The goal of eating is not to nourish one’s body, support one’s health, or strengthen connection to others by breaking bread with friends, but something else entirely. That “something else” operates according to the rules of disordered eating. These rules include being “good” with food: that is, eating only things that are low in fat, or carbohydrates, or calories (the rules vary from person to person). Disordered eaters fundamentally believe that eating “good” or “bad” foods, or “being good” or “being bad” with food, determines whether they are good or bad people.

Food is a fundamental survival need. When we are infants, one of the first ways we know we are loved and considered valuable enough to care for is that we get hungry, we squirm or whimper, and we’re picked up and put to the breast. We experience relief and contentment and know that we are loved and all is right with the world. Eating is inextricably entwined with being fed, nurtured, protected and loved.

This is true for everyone. But for those who are vulnerable to developing a disordered relationship with food, this fundamental experience of being fed and feeding can morph into something sinister: as life gets more complicated, if our caregivers are unable to meet other developmental needs adequately, we might remember on some primal level what being fed did for us. Food can become a substitute for and a symbol of what we really need. Thus, we may reach for food, or recoil from it, depending on our genetics, our inborn temperament, the dynamics in our families and the circumstances of our lives. We might infer that our needs don’t matter, that it is safer not to need, or selfish to need. In this case, we are likely to deny ourselves food we need. We may figure out that we get attention when we look pretty or get good grades or excel at athletics, and decide that our not-so-excellent qualities are signs of a flaw at the core of our being and that our acceptance by others depends on our hiding that that flaw, but our hidden side cries out for nurturance, driving a tremendous appetite—so we take in huge quantities of food, feel anxious, fearful, ashamed, and vomit it back up to come back to the “right” place: empty, pretty, thin, capable, nice. Or we may feel be driven by those unmet emotional and psychological needs to eat, eat, eat—but the pit is bottomless; there isn’t enough food on the planet, because the need isn’t physical—but not knowing this, we can only interpret our increasingly large bodies as evidence of our fundamental flaw.

Thus, in disordered eating-speak, for example the words, “I feel fat” really mean “I feel inadequate” “I believe I’m gross or unloveable” “I’m afraid people will be repelled by me and reject me” and similar sentiments. “I don’t need this _______[food item]” means “I shouldn’t need things, that’s selfish” “I’m afraid people will perceive me as needy and not want me around” “I want to feel strong and in control” “I’m afraid I want so much that there’s not enough in the world for me.” “I was bad today [because I ate X]” translates to “I am unworthy” “At my core I’m yucky and I’m afraid people will find out” “I want and need too much” “I’m imperfect and therefore a failure.”

Conflict about food is an indicator of conflict around emotional and psychological needs: for acceptance, for love, for safety, for validation, and more. Disordered eaters focus on behavior and appearance as indicators of their worth because their childhood circumstances and environment were such that they did not receive what they needed to develop a solid inner sense of self and self-worth. Healing from a disordered relationship with food involves recognizing belief’s about one’s needs, learning that one deserves what one needs, and learning how to get one’s needs met. This essential aspect of process of recovery leads not only out of the clutches of an eating disorder, but also to awareness of one’s innate worth and value. This can’t be done without understanding what beliefs and fears about food and body really mean. Translating eating-disordered language is key to this work.

©Copyright 2009 by Deborah Klinger, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Deborah and/or see her GoodTherapy.org Profile

Click here to contact Deborah and/or see her GoodTherapy.org Profile

Two primary components of a disordered relationship with food that drive disordered eating are food deprivation: restriction of and compensation for food intake, and emotional and psychological issues: painful feelings with which one lacks adequate means of coping, and wounds experienced in the past that propel one to deal with emotional pain via abusing food. The latter speaks to a disordered relationship with one’s self. Although eating problems affect males as well as females, for simplicity’s sake, I will be using “her” and “she” throughout this article.

An eating disordered individual equates fat with worthlessness and “unloveability.” Someone who suffers from anorexia nervosa typically restricts her food intake because she has developed an intense fear of becoming fat, and by extension, a fear of eating an adequate amount of food. A bulimic individual is caught in a cycle of deprivation/restriction and bingeing/purging, which fuel one another and are driven also by a fear of weight gain and belief that “getting rid” of food taken in during a binge is necessary to ensure that she does not become obese. This is true also of individuals who do not binge, but induce vomiting after eating nonetheless. Binge eaters and compulsive eaters who overeat in ways other than bingeing share the same aversion to fat. They usually struggle constantly with dieting or restricting food intake, thus perpetuating the cycle of under-eating and overeating. Overweight binge eaters, and overweight eaters of other disordered stripes, assign the same negative significance to fat that those with anorexia and bulimia do, believing themselves gluttonous and of little worth. Most all disordered eaters value the restricting/depriving aspects of their relationship with food, seeing this as positive, while cravings for foods and desires to eat are viewed negatively. Ceasing to engage in the restrictive aspects of disordered eating does not automatically solve overeating, but it is a necessary step towards that end.

A disordered relationship with food cannot be fully resolved unless and until each of these components is addressed thoroughly. Therapists can’t get to underlying issues if a client is too malnourished to think clearly, or is insistent that some foods remain forbidden, or focused mainly on weight loss or avoiding weight gain. Neither can clients simply “legalize” foods and eliminate the idea of off-limits-foods, or focus solely on re-feeding and weight restoration. Recovery requires willingness not to abuse food no matter how painful it might feel, nor how tantalizing, appealing, relieving, etc. the thought of abusing food might be, while doing the often painful work of digging deeper. These two aspects of disordered eating necessitate three foundational components of recovery:

• Food and body: “Legalizing” all foods. Letting go of adherence to an externally-prescribed way of eating that is based on the belief that one will eat like a maniac without rules, whether the belief is that the reason for this is that one is a fat pig, or that one is an addict and can’t control oneself. Taking the focus away from weight and body, and learning to eat and exercise for the purpose of self-nourishment, not weight control. Re-connecting with hunger and satiety signals, and learning to trust one’s body as the guide to what, when and how much to eat. Using one’s mind to put information about nutrition and exercise to good use. Understanding that disordered eating thoughts and behaviors an attempt at self-care, yet emotionally as well as physically harmful. Practicing non-judgment of food-related behaviors.

• Psychological and emotional: Becoming emotionally literate, identifying the feelings that one is misusing food to aviod or numb. Doing inner work to identify and heal wounds that caused disordered-eater parts of self to develop, and making peace with those parts. Learning and implementing healthy coping skills to use instead of misusing food. Developing a set of tools to use for emotional self-care. Practicing non-judgment of one’s self. Cultivating radical acceptance. This involves psychotherapy and self-help resources.

• Attitude and action: Committing not to misuse food. The urge to misuse food won’t just disappear because one is doing #s 1 and 2. The willingness to feel uncomfortable and not misuse food when every nerve ending is screaming to do so is essential. This is too much to do by one’s self, so support is crucial. Learning to reach out to others for help when wanting to engage in disordered eating behaviors, as well as when engulfed in disordered thinking (e.g., preoccupation with weight/body, self-judgment) is crucial. Ultimately, #2 can’t be fully practiced while one is still abusing food, but #2 must be begun while one is still misusing food.

The process of recovery from disordered eating is complex and involves a team of treatment professionals (often a primary care physician, a dietician, a psychiatrist and a group therapist in addition to an individual psychotherapist), as well as good self-help resources (books, workbooks, recovery web sites, support from others in recovery via support groups, 12-Step programs, online list serves and chats. In future articles, I’ll be discussing each of these components.

©Copyright 2009 by Deborah Klinger, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Deborah and/or see her GoodTherapy.org Profile

Click here to contact Lynn and/or see her GoodTherapy.org Profile

The hardware store on Third Avenue has a sign in the window that says, “Sharpen your knives for the holidays.”

Many of us are lucky enough to have joyful holiday celebrations, with loving family, friends, people who are positive, and that’s wonderful—but unfortunately not the universal experience; there’s a down side to many celebrations—not everyone is your friend, and some of those unfriendly people sharpening their knives for the holidays want you to be their turkey.

For example, food is love, right? Well, sometimes it is, when your friend cooks you something special and you are free to eat as much or as little as you want, and give a big thank you. But some friends and relatives aren’t satisfied with a compliment– they want to you to eat it ALL UP. Like the Clean Plate Club Kid I wrote about last month. He comes from a family of overeaters and controllers–they’re only happy if he eats so much he gets sick–that’s how he proves he loves them.

Or how about meat eaters who insist you really aren’t a vegetarian, or vegetarians who rank you out because you eat meat, or drinkers who push alcohol on someone who is in recovery. And what happens if you’re on a diet, or you’re allergic, or you simply can’t stand sitting next to Aunt Rose, or anyone, but you have no choice, and you get really mad, so you stuff yourself, or you starve yourself, or you just go in the bathroom and throw up. What about that mean cousin who always gives you the business about your love life, or your job, or your kids, or your bank account?

Walls closing in. Push back and find space.

Object Relations theorist DW Winnicott talked about the play space–an imaginary state where everyone is equally free, holding of self and other, and able to pretend and have fun.
Here are some playful ideas to help you strategize, survive Thanksgiving, and not feel like a turkey. Write me if you think of a few more.

1. Don’t come with expectations. Just show up and be with people as they are, not how they should be or where you would like them to be.

2. Your imagination was your first toy, and it still can be.

3. Make believe you’re an anthropologist observing a strange tribe. Take notes!

4. Had enough to eat? Say no thanks and stand firm. Hide your plate. Or give a very detailed description about what happened the last time you ate too much Thanksgiving dinner. Gross.

5. Pretend you’re a hostage waiting for your release. How much money for your ransom? Who should pay? Maybe you’ll manufacture a wild escape. How should your jailers be punished? Let your imagination run wild.

6. Okay, so Aunt Rose never stops talking and has no manners. You’re not going to change her- you’re stuck. You can sit and steam and ruin things even more for yourself, or you can find ways to dampen your burning fuse. Maybe Aunt Rose wants to be interviewed. Maybe you’re a TV host. Maybe one of you is Oprah in disguise. Take turns, even if Aunt Rose can’t.

7. Try deep breathing. Breathe out and make the room bigger.

8. Tell jokes to yourself, and to anyone else who might have a sense of humor. Keep the mean remarks private though.

9. Remember–all the spiteful things your nasty cousin says tell you lots more about HIM than about you, and you don’t have to answer if you don’t want to. He’s pushy? You’re kung fu master. Let the negative energy flow right past you and back at him. BAM!

10. Try not to leave your body, if you can. Ground yourself by feeling your feet on the floor, your hands in your lap or on the table. Breathe. Focus you attention on something beautiful.

11. If that doesn’t work, how about an out of body experience? How do things look when you’re floating up on the ceiling? Wave to the folks down below. Can anyone see you?

12. Pretend you’re an invisible star or king or Buddha or angel. Knives, sticks, stones, not even nasty words can hurt you.

13. Act like you’re surrounded by Buddhas in disguise, and honor everyone.

Remember- therapy gives you tools you can use for self-defense as well as self-understanding.

Happy Thanksgiving!

©Copyright 2009 by Lynn Somerstein, PhD, RYT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Lynn and/or see her GoodTherapy.org Profile

Reasons for eating a healthy diet abound; from the purported feel-good benefits of chowing down on natural and nutritious foods to the potential to save money on groceries and of course, to lose weight when waist size is an issue, plenty of people are aware of the incentives for picking healthy foods. But it’s not just the case that certain items from the health food aisle can have a positive impact on overall health; picking foods that are over-processed and high in sugars and fats have a decidedly negative influence on health, and may particularly impact mental well-being. Searching for a way to underscore the importance of choosing good foods and straying from those that can be harmful, a research team from University College London in the UK has recently published work divulging the potential for fatty foods to lead to the development of depression.

The research worked with a respectable mass of participants; 3,486 people took part in the study, and had an average age of 55. The participants worked in London in various civil service capacities, and completed surveys in which they self-reported about their levels of depression and related symptoms, as well as their eating habits and food purchasing choices. The study found that those who reported eating high fat foods were more likely to also report thoughts and feelings of depression than those whose diets concentrated on a regular intake of fruits, vegetables, and fish.

Though the results have failed to cause much of a surprise among the mental health community, or among those with an interest in nutrition, they may nevertheless help bolster the available body of material in support of helping people eat their way to better mental health.