If I Woke Up and Didn’t Have an Eating Disorder…

Years ago, I was asked to contemplate the following miracle question (concept from solution focused therapy):

“What if a miracle happened overnight and you woke up no longer having an eating disorder. What would be different? How would you know? What would you do first? Who would be the first person to notice?”

My answer was simple in nature, yet, at the time, felt impossible to achieve. I had dug a hole too deep this time… I had no idea how to ever get back to such a normalcy with my relationship with food. I, however, didn’t feel like what I was asking for was too much though… Perhaps, it was this piece that made me have hope that recovery could be possible.

Years later, as a clinician, I often ask my clients the same question. Their answers are usually very similar to the one I gave all those years ago… to not have to think about food all the time… to be able to go downstairs and make breakfast without having anxiety about it or letting whatever I chose determine the rest of my day… to be able to eat with my family/friends without having to have special conditions or preparations put in place… to be able to eat until I was full and then stop… to give myself permission to have seconds… not needing to punish myself afterwards. Sounds pretty reasonable, doesn’t it? There were no requests to be able to grow wings and fly to the moon or wanting to be able to solve P versus NP (one of the six unsolvable Millennium Prize Problems). The answer usually entails taking back the control food has had in their (our) life.

It is possible you know… Maybe it doesn’t come in the form of simply waking up one morning and living life differently, but the end result can still occur. How? Well, there’s no one correct way or an exact equation in getting there.  That’s not a bad thing, as it allows for treatment to be tailored to your needs.  Connecting with a therapist who has an understanding in eating disorders and disordered eating is a good start! Likely, food has become a coping mechanism in some form and purpose.  Looking at the underlying reasons, and gaining healthy coping skills is definitely important. In the mean time, here are some helpful points to consider…

1.  Is that going to help you in the long run? Sure eating, or not eating, whatever is in front of you might make you feel in control, comforted, distracted, etc in the short term, but how is it going to help you in the long term? Does it teach you how to cope in a healthy manner, or will it continue feeding your unhealthy relationship with food.

2.    Are you really pissed off at those peas or is it about something else? Sometimes we eat, or don’t eat, to avoid feeling our emotions. The peas don’t have anything to do with it… Try to take a moment and recognize what and why you are feeling the way you do and deal with it accordingly. Feeling sad? Comfort yourself with a bath, a hug, a blanket, draw, read, etc. Angry? Assert yourself, set up boundaries, take healthy appropriate action…

3.     Separate exercise from food! Wait at least an hour after eating to go for a walk, run, bike ride, etc. Don’t exercise if your intention is to burn calories. Give yourself time to digest and work through the emotions and thought process that may present themselves after having eaten. Exercise has a time and place, and it’s important to build other skills/coping mechanisms to work through anxiety after meal times. Do a paint by numbers, read, draw, answer e-mails, do the dishes, journal, etc.

 4.     Dieticians Are Great Resources! See a registered dietician (preferably one with experience with eating disorders/distorted eating and practices from a Health at Every Size framework) to learn about portions sizes, national value and meal plans. You might have to relearn what is healthy and normalized, especially if you have been sick or dieting for many years.  Maybe you were never taught in the first place. Creating meal plans can help with preparation and making sure you are getting enough of what you need nutritionally. Following a meal plan leaves less time for scrambling, which often leads to high-risk situations.    

Fitspiration: Are We Fooling Ourselves?

I've seen a plethora of media outlets talking about being 'fit'. This movement has been nicknamed 'fitspiration'. Remember the whole 'thinspiration' movement that encouraged thinness...  Remember how people fought back by creating anti-thinspo quotes that flooded Pintrest, Twitter and Facebook.  People were upset that thinness instead of health and wellness were being encouraged, leaving many people feeling ashamed about their bodies.  Let's not be fooled that fitspiration is no different.

Two of the most upsetting quotes I saw read, "Strong is the new Skinny" and "Skinny people look good in clothes, fit people look good naked". WHAT? Really? All thats changed is the wording.  The obsession with the body is still there. It's like they are saying, not only do you have to be thin, you must now also be fit, have a six-pack, and total muscle definition on your entire body.  The expectation just became greater! Let's not fool ourselves that this message is somehow less damaging than the thinspiration ones. It is still encouraging us to track numbers, whether by how many kilometres we've run or how many pounds we've bench pressed. It's still the wrong message we need to be seeing and believing!

I want to make perfectly clear that I am all for exercise and strength building... I am not denying that exercise has a place in everyone's lives. Many studies show the positive health benefits of raising our heart rate, moving our bodies and doing weight resistant activities... The type of exercise I stand behind is HEALTHY, BALANCED and SUSTAINABLE exercise. It needs to be done in a way that encourages us to listen to our bodies when it tells us to stop. Exercise that allows for mindfulness when we are doing it.  Exercise that has the end result of health in mind instead of a certain physical form, waistline or looking good naked (one of the fitspiration arguments). Let's not narrowly define what is beauty! 

Fitspiration does not teach individuals how to have a healthy relationship with exercise. In fact, it disguising healthy aspects of exercise with unhealthy ones.  For example, in some of the posts, outdoor exercise was encouraged (GREAT! Not all exercise has to be in a gym setting), but then it was paired with an image of a toned, thin woman (NOT SO GREAT). Others are just so blatantly unhealthy (which I choose not to repeat as I do not want to trigger or support by repeating). Where's the health at every size model? Why can't you pair exercising outside with someone of all shapes and sizes.  Guess what... people have cellulite and that doesn't equate to unhealthiness.  Mother's have stretch marks and it's okay if they don't go away. Men do not have to have to look like the Hulk.  We need to encourage and communicate healthy and balanced exercise.  We must not neglect our spiritual, mental, emotional and social needs by spending so much time building our physical physique.  Fitspiration moves way past building strength to a whole other level than meeting physical needs.  And my question is... what's that really about? 

Counter Cultural - That's What I Do

A colleague of mine asked if I could write a guest post for her website, Every Day Health and Wellness Therapy,  on something related to eating disorders.  Jazzed at the opportunity to talk about something I am deeply passionate about, I couldn't pass it up. The post talks about the need to be counter cultural when it comes to your relationship with your body, weight, exercise, feelings, mental health issues, etc. A message that differs from what main stream culture says... 

Below are the 5 main points from the article.  Be sure to check the entire piece out here. 

#1. Weight Isn't the Focus

#2. Health at Every Size (you can read more about that here)

#3. You Don't Have to Have an Eating Disorder to Get Help with Your Relationship with Food

#4. Emotions Are Our Friends

#5. Taking Care of Your Mental Health Issues is OK

Will you think and treat yourself counter culturally on these issues?

Mindfulness - Taking Time To Get Out of Your Head

I've often been told that when I'm deep in thought, I look pissed off. My brow furrows a bit and I don't smile. I'm fully engrossed with whatever topic or debate is occurring in my head, trying to make sense of something I don't quite understand or accept. It looks like I'm cut off from everything and everyone around me, like I'm in my own little world... 

I've also been told I think too much :)

It's taken some time to accept that I am a thinker, perhaps more than others. It's also taken time to accept that there is more to life than just thinking and that I may not figure everything out. Since having learned mindfulness, I try to practice being more aware of my surroundings and how I interact in it (especially this time of year with all the seasonal changes as we move from summer into fall). It brings me back into the present moment, allowing me to experience all that is happening in the here and now. Mindfulness is also great for when I'm distressed, obsessing or catastrophizing. It's easy to go into auto-pilot, thinking about the next thing that needs to be done, a current problem that doesn't seem to have a solution, the topic discussed from today's therapy session, perpetuating dialogue from the eating disorder and so on. Mindfulness does take intention, but once you get the hang of it, it becomes second nature. 

You know what I've noticed practicing mindfulness over the past few days?   People coming and going.  Little children asking countless questions about how what they are experience works. Dogs... tons of dogs. Birds staring down my sandwich in hopes I'm in one of my 'thinking moods' where I'm not practicing mindfulness and won't notice him there. Pianos scattered throughout the downtown core of Guelph, ON for people to play spontaneously throughout the month of September. Huge spider webs you know won't last more than a day. Cloudless days. Sun rays. I see squirrels, which brings me a lot of happiness as they run around (I saw one this morning that looked like it had this amazing beard... it was not a beard unfortunately... it was just something he was carrying... darn!). I noticed how most people respond when you look them in the eye and say hello as you pass them by... a greeting that wouldn't have been exchanged if I were in my head. I see dew on the grass and feel its coolness as I walk through the early morning grass. I taste the sweetness from the honey in my tea. I hear conversations and dialogue amongst friends, family members, co-workers. I see a wasp trying to figure out how in the world it is going to get out of a window pane it is trapped in and back into the wild. 

There is so much life going on outside of ourselves... Lots of precious moments in life we miss when we are disconnected. Health, healing and wellness isn't just about popping pills and doing cognitive behavioural exercises! Although both may* be needed and are helpful, we must not forget the need to be connected outside of ourselves. Try it... what do your five senses experience today? What do you see? What do you hear? What do you taste and see and smell? What things have you realized since having practiced mindfulness? What things make you smile a little? What cool hair cut does the squirrel around where you live have?

Proof! 

*medication is not a 'must' for all clients. This should be discussed and followed by your doctor or psychiatrist. 

Progress? That' Not What the Scale Says!

First of all, if you're stepping on a scale... get off it (click here to read why scales aren't a helpful or healthy).   Just like the number on the scale isn't an accurate measurement of health, so is it with progress. Pretty counter-cultural right? We've been so brain washed to think that the only thing that matters is how much weight you've gained or lost. Forget the healthy lifestyle... forget the long term change or its sustainability.  There is a tendency to solely focus on the number, instead of all the other benefits of working towards a healthier relationship with food, weight, exercise, etc.  Whatever the number on the scale, or if you've stopped weighing yourself already, you can still see the benefits of building a healthier lifestyle as the following examples show*: 

Emotions - When you get back to eating 3 balanced meals and a few snacks per day, you will likely notice a difference with your emotions/mood.  Ever notice when you don't eat enough how you become more agitated than normal? Or, when you've eaten too much, feelings of guilt or shame emerge? A sign of progress is when emotions and food/weight are not so closely linked.  In the beginning stages, as you learn to trust normalized eating, set-point, and a healthy exercise routine, you may experience uncomfortable or distressing emotions. By using skills learned in therapy and following a healthy meal plan and exercise routine, you can learn to tolerate and cope with such difficult emotions, if not experience an elevation in mood.

Energy Level & Stamina - Just as mood improves, as does your energy level.  By giving your body the proper type and amount of fuel during the day, you will have more energy throughout it. You won't be in a food coma, nor be completely exhausted. You may even notice that you can exercise for longer periods of time, and/or know when to finish so you don't overdue it out of compulsively or 'need'. 

Sleep - Sleep can also be interferred with when one does not get the right type and/or amount of food/exercise. You won't wake up to feelings of hunger or indigestion from eating too little or too much of something. You will also get a better quality of sleep when you move your body throughout the day, instead of being immobile. A better quality of sleep is another sign of progress. 

Flexibility - Rigidity around food and exercise is quite common in those who struggle with food/weight/exercise issues. A sign of progress is when you catch yourself adjusting to those moments when 'life gets in the way' without having a melt down. You won't follow rules like, "I'll just double up on exercise tomorrow" when the gym closes unexpectedly or if you've eaten more than you wanted at a birthday party. You will experience flexibility mentally and emotionally as you build a healthier lifestyle. 

Balance - This is a big one.  What I mean by balance is looking at your life holistically, and making sure you are paying attention to each aspect of it.  For example, are you spending time with your friends? Connecting spiritually? Physically getting enough exercise? Emotionally are you getting your needs met? What about mentally? Another sign of progress is making sure you aren't spread too thin and are using a variety of supports to help sustain your holistic health.  

Medical Issues - Building a healthy relationship with food/weight/exercise can also effect things like cholesterol levels, blood pressure and so on. 

The above are excellent ways in concretely seeing both benefits and movements as you work towards building and then maintaining a healthy lifestyle.... much more informative than just a number wouldn't you say?

*Keep in mind that other illnesses/diagnosis can effect the above.  It is important to consult your medical and health team whenever you make changes regarding your health and wellness. This list is not exhaustive.

Goals

So, you are in the process of moving from preparation, into the action phase of change (click here to read an earlier post on the stages of change). For the purpose of clarity, let's say the behaviour you want to change is to no longer purge, although this method can also work for any behaviour or 'thing' you want to change in your life. How many times have you said to yourself, "Come tomorrow (or next week, or next month or next year), I am going to stop purging... cold turkey... that's it, no more purging for me!"? How has that statement worked out for you? Likely, not great. It's too big and broad of a change. It also sets you up for failure, as likely, in the process of change, we makes slips. This doesn't mean your effort to change has failed per se.  It just means, it needs some tweaking.

I encourage my clients to make, S.M.A.R.T. goals (sorry guys, I'm not the clever one who made this acronym up, although I cannot find the source). A S.M.A.R.T. goal is the following:

S - simple

M - measurable 

A - attainable

R - realistic 

T - timely

In the above example, saying you are going to quite purging cold turkey, isn't in line with the S.M.A.R.T. goal acronym. Sure, it might be simple in concept (i.e.: one purges and wants to stop purging), however, as you know, it is not that easy. It may be measurable (i.e.: you no longer purge), but as stated above, you may slip along the process. Is it attainable? Well... sure. Many people break the binge/purge cycle and lead purge free lives. Realistic? Not so much... maybe people do not find success in just going cold turkey. Timely? I would argue you may find short term success with becoming purge free by going cold turkey, however, we are looking to build long term change, which this initial goal is not able to obtain. 

The S.M.A.R.T. goal to be purge free over the weekend might look something like this... "Over the weekend, I want to stop purging by using distraction, socializing, following a mean plan, yoga and distress tolerance skills".  Let's see how we did...

Simple - Yes. You wan tot stop purging over the weekend by using specific skills, which are clearly listed  

Measurable - Yes, you will know after the three days how you did on your goal and what areas you may need to tweak. 

Attainable - Yes, you aren't trying to fit a square into a round hole or anything crazy like that. This said, stopping an eating disorder behaviour (or any behaviour that has become habit, or is long lasting, etc) is quite the feat. Perhaps, at some point along your journey, the idea of being purge free for a weekend was more of a dream than a possible reality.  If challenging yourself to the whole weekend is too long at this point, break it down to a day, or even a short period of time (i.e.: between breakfast and lunch, etc). Even if you can't see it right now, it is possible and attainable for people to go on to live purge free lives. 

Realistic - Yes! Remember, if it is unrealistic to have yourself be purge free over the entire weekend when you haven't got pure free for a day, change your goal a bit to make it more realistic for yourself.  Also, make sure the skills you plan to implement are realistic.  For example, it may not be realistic to socialize with friends when you are out of town and unable to connect with them. 

Timely - Definitely! You will know how you did within 72 hours! It has a concrete beginning and end.

Remember, you want to set up goals that build success, which also builds motivation and confidence! Even with S.M.A.R.T. goals you will have to go back and make adjustments. There is nothing wrong with that. For example, maybe you found out that using yoga as a way to stop purging wasn't as helpful as you had thought.  Change it up a bit, try something different. Totally okay to take this as a learning moment and use this knowledge in the future when you set up another goal.

So, what is your S.M.A.R.T. goal for the week?

Taking Time to Recognize Effort and Attempt

I recently took a trip that held much significance for me.  It occurred around the same time I typically celebrate a particular anniversary in my life.  This year, however, marked a milestone I had been looking forward to celebrating in a special way, which this trip did for me.  It symbolized health, growth, strength, the love for life, the payoff of perseverance, vulnerability, hard work, many tears, and so much more.

Perhaps, celebrating recovery seems weird to some.  I think when you come out on the other side of something that rocks your world in a way you never expected, when life beyond it seemed unimaginable and dim, a celebration of that journey can be a beautiful thing!  Every now and then I am reminded that my experience is not special.  Its a humbling reminder. Many individuals struggle with mental health issues and daily go through the ups and downs it brings. My experience isn't special, but it is unique... and it is meaningful. And that is enough to take note of it! If that's true for me, isn't it also true for you?

Those with eating disorders are often perfectionists and are particularly hard on themselves.  There's a tendency to engage in all or none thinking, mixed with some black and white thoughts, topped off with devaluing or catastrophizing. Am I describing you? This type of thinking makes going through a day without purging no big deal.  These thoughts tell you that you should feel underserving and unworthy when you eat your whole meal plan after months of binge eating or restricting from it.  Is using your distraction and emotional regulation skills just something you 'should' be doing even though its taking months to get to this point?  Why not take some time to recognize your progress... why not recognize the attempt and effort instead of looking at it as a success or failure. 

When I talk about celebrating the efforts and attempt you put into your journey, I'm not saying you should walk around with a chip on your shoulder, inflating yourself into thinking your are the bees knees.  Remember, your experience does not make you special... What I am talking about is changing the voice in your head... You know, the one that says you are underserving and worthless.  Celebrate through saying something like, "nice effort. I did the best I could and I can do better... but I'm going to celebrate I tried something that was difficult." Pat yourself on the back when you tried using your skills when it was probably easier and quicker to go back to the familiar pattern of your eating disorder or other unhealthy coping mechanisms.  Take the time to recognize how far you've come (regardless of how far it is) as I'm sure you never thought you would even get there in the first place!  Throw a party for making it a year of being binge free.  Plant a tree to and watch it grow alongside you.  Do something meaningful to you... big or small...  just take the time to do something in a way that celebrates you, life, health, recovery, growth, effort while giving validation to the tears and effort you put to getting there!  Everyone's recovery is going to look different and thus so will how and what the celebrations are for.  Don't get caught up in definitions or a sense of 'result', but celebrate things the things that are meaningful to you...  Remember, recovery is not a linear process. It is going to have its ups and downs... any step towards health is important! So... what you are going to celebrate? 

Beyond Sadness

Late last night, a neighbour informed me about the death and apparent suicide of Robin Williams.  I was hit with immediate sadness and shock.  Instantaneous thoughts popped up like, "But, he's so funny", "he always seemed so happy" and "he was the last person I thought who would kill himself".  Having had time to process, I was humbly reminded and know all to well that what appears on the outside may not always be the holistic picture of what is going on in the inside, and that depression can affect anyone.  

News articles and social media outlets became flooded with condolences and memories.  One quote in particular, by Jimmy Kimmel, caught my eye.  He tweeted, "Robin was as sweet a man as he was funny. If you're sad, please tell someone."  He is right, when feeling sad, telling someone is often a good piece of advice.   I, however, want to make the argument that those who kill themselves are not just feeling 'sad'.  It is something much more than that... It is often a form of depression.

What's the different you may ask?  Well, we all feel sad from time to time.  Life cannot happen without moments filled with such a feeling. It may last for as little as a minute to perhaps a few days. When someone dies, it is natural to feel sadness.  When a friend moves away, sadness may show its face.  It is still possible, however, to continue with the day to day demands while feeling sad. Sadness is not a mental health issue.  It is a part of humanity, shared by all who walk this earth.  Society has this tendency to throw around the word, 'depressed', when what is really going on is sadness.

Depression is debilitating.  It gets in the way of functioning fully in life. It can interfere with sleep, mood, weight, thoughts, appetite, one's social life, self-worth and so on.  Click here to access the Canadian Mental Health Association for more information on depression.  Depression occurs across genders and ages, and is partly due to genetics and partly due to environmental factors (nature and nurture). It affects comedians and judges, students and teachers, homeless and royalty.  It is too simplistic to rule out any one individual from struggling with depression solely based on their job title, social status or comical abilities.  Sadly, depression is often linked with suicide.  It is important to note that not all people who are depressed will comment suicide, however if feeling depressed, it is imperative to talk to a medical professional and/or call your local crisis line (click here to find a Canadian mental health helpline in your area) . 

So, is Jimmy Kimmel wrong in encouraging those who are sad to talk? No, not at all! Talking to someone when sad is therapeutic.  Friends, family members, trusted individuals, etc are great tools that can be utilized to help cheer you up or validate what you are going through when feeling sad.  If feeling depressed, it is important to talk to a professional who has trained knowledge in navigating this particular area of mental health. Treatment might entail seeing your family doctor, a psychiatrist to monitor medication and/or a therapist. It might entail making changes in your environment (remember the whole nature and nurture thing), such as implementing boundaries and assertiveness, self-care, exercise, change in diet, finding that balance between work and home life, etc. Click here to read more about what you can do if feeling depressed from the Public Health Agency of Canada. 

Suicide Prevention, Signs and Symptoms

Talking about suicide is an important part of actually preventing suicide.  If you are concerned about a loved one, click here to learn about a safe way to broach this conversation (from the Ontario Association for Suicide Prevention). Again, contact a professional who has experience and training in this areas.  Get educated as a way to understand what your loved one is going through. 

If you are contemplating suicide, contact a professional or your local crisis line to talk about what is going on and how you feel.  When we talk about things that are difficult to talk about with someone who is safe and trusting, stigma and shame is often reduced. People often feel less alone when they are heard and understood... and we all need to be heard and understood.  You are not crazy and when you keep things hidden inside, it is easy to convince yourself otherwise.  

A more exhaustive list of signs and symptoms can be viewed here (Ontario Association for Suicide Prevention). I have included some from this site below: 

- getting in order and/or giving away personal affairs

- depressed and/or withdrawn

- marked change in behaviours, attitude, appearance (i.e.: a person goes from being positive,  energetic, and well groomed, to being negative, lethargic and uninterested in maintaining a well groomed demeanour as they would have before) 

- abusing drugs/alcohol, behaving recklessly, impulsiveness

- loss of self-worth, loneliness

- major situational event (i.e.: death of a close friend/family member, job loss, sexual abuse, etc)

- writing about suicide/death

etc 

*Not everyone who displays signs and symptoms of suicide will commit suicide, however professional and medical attention is strongly encouraged

Suicide is tragic. It is hard to see another way out when consumed by such darkness that depression brings, often masking itself as clarity. Keep talking, keep checking in with loved ones, make no assumptions, seek help.  Lean on those who hold hope for you when you can't hold onto it yourself.