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First of all, thank you all for your comments on the last post! I decided not to respond on that post because it was really about hearing others’ opinions, and I did not want to impose my own.

I will, however, proceed to do that now. 😉 Thank you for humoring me!

Like a few of you said, I absolutely agree that patients/clients should have input as far as whether or not they know their weight. And, I acknowledge that this can be a challenge, especially with patients who are having trouble separating what is best for them and what is best for the eating disorder. When I had my intake with my current nutritionist, we went to the scale, and she just said something like, “We do blind weight here.” It wasn’t presented as a choice, though obviously if I had protested, we could have discussed it (I know that she lets others see their weight because not knowing triggers them). But, I didn’t protest because I was RELIEVED. I know that she if she had presented seeing my weight as a choice, I would have chosen to see it. My motives in seeing would have been driven by the e.d., as I know that I do better with blind weights. But, at that time, I didn’t have control over the e.d.; I would have looked because that’s what Ed wanted. I needed her to take control over Ed by making the decision to do blind weight, because I was not capable of doing so at the time.

I think that, for patients in the later stages of recovery, the decision about whether or not they see their weight should be made in collaboration with their treatment team. I fail to see how wrestling control and agency away from a patient in this area would be helpful to recovery. So, if a patient wants to know her/his weight, and if the treatment team agrees that it is for recovery-positive reasons, I absolutely think that the patient’s weight should not be kept from her/him.

That said, I also think that a patient should not be forced to see her/his weight. This recently happened to a friend of mine, which is what inspired this post, and it was incredibly detrimental to her, and bolstered her e.d. And I actually think that it’s quite possible to go for a very long period of time without knowing one’s weight. I went for a period of years without knowing, and now, unless I let myself look at a GP appointment, I don’t know what it is. If a patient chooses to continue with blind weights, yes, it will take a bit of a commitment to maintain that outside of the treatment center – they will have to ask to skip being weighed or be weighed backwards at Dr. appointments, they will have to commit to not buying a scale, etc. – but it really is very do-able. And there are other ways to gauge one’s weight that allow a bit more for natural fluctuations in weight – how one’s clothing fits, for example. I think we confront the reality of our weight and/or changing weight everyday, whether or not we label it with a number. And I think that, for someone who continues to choose blind weight, if she/he does encounter a number unexpectedly (on a doctor’s chart, for example), if treatment has been truly effective, she/he will be able to cope productively.

Personally, I’m glad that my team enforced blind weight when i needed them to, and I am glad I’m able to choose to continue with it. AND, I’m glad that for other people, they us different methods – one’s that are more effective. I guess this goes back to my firm belief that, generally speaking, e.d. treatment – including whether or not patients know their weight – needs to be about the individual, rather than about blanket policies.

 

I know that the topic of whether or not people in treatment for eating disorders should be told their weight is currently under debate at my own treatment center, as well as a number of others. Blind weight (where the patient does not get to see their weight) is often standard practice in eating disorder treatment, especially for clients who have a strong drive for thinness as a symptom of their e.d. However, some treatment facilities insist that clients in outpatient care or extended care see their weight, as it is something they will have to face at least sometimes in the “real world.” Occasionally treatment providers leave it up to the client to decide, though this of course can be dangerous too if the client is unable to separate what is best for them from what the eating disorders wants. So, I’m wondering . . .

What’s your opinion on the matter? Should whether or not a client knows her/his weight depend on the eating disorder diagnosis? Should it depend on the level of care? Who gets to “weigh in” when it comes to weight? Who decides what is best?

FTFW_Logo_Watermarked

Phew! What a week. Time flies when you’re having fun, right?? Here it is, day four of Fat Talk Free Week – so I suppose this is almost a retrospective. I’d like to take this space to talk about some of the challenges of FTFW, and how we might meet them with positive alternatives.

I teach a college-level Women’s Studies class, and so I gave my students an extra credit assignment to sign the pledge at www.endfattalk.com, then spend the week trying their best to eliminate fat talk, and next week they’ll write a reflection (I can’t wait to read these!). When I saw my students on Monday and Wednesday this week, we took some time to check in about how Fat Talk Free Week was going.

First, they were incredibly surprised by how much fat talk is part of our everyday lives! As a feminist eating disorder/body image advocate and activist, I am often painfully aware of just how much fat talk permeates our society. I mean, it is RIDICULOUS, people! Fat Talk Free Week seemed to give my students the incentive to notice the conversations going on around them too. And they were *not* impressed! When they realized how ubiquitous fat talk is, it made them righteously angry. They couldn’t believe how much time was wasted on fat talk, how much we put ourselves down, and they became determined to change that.

One thing that both my students and I struggle with is internal fat talk. Because I am a role model, and because I know the harm that fat talk can do, I have been *very* careful for a long time now to avoid engaging in fat talk around anyone who might hear. However, the fat talk in my head is out of control (I mean, I have an eating disorder after all. I’m sure this is not surprising). My students echoed my experience and shared – sometimes with frustration, sometimes with disappointment, sometimes with determination – that the fat talk in their heads was the hardest to stop. I found myself desperate to reassure them; I did not want them to think that they were failing because they couldn’t stop their fat talk thoughts. I said, “This isn’t about perfection; that would be counter-productive! I know how hard it is to stop these thoughts – we don’t have the ability to stop our thoughts like we do our words. What matters is that you’re trying! That’s a huge step!”. I told them, “It’s amazing that you’re becoming so mindful of these thoughts in a way that you weren’t before. That right there is progress. And the fact that you’re trying to think something positive to counteract them? That’s huge! That kind of intentional reframing can become automatic over time.”

It’s just that, there was one catch here. I have *a lot* of trouble applying these same statements to myself. I know that having an eating disorder is going to make fat talk thoughts more prevalent, stronger. And yet, because I can’t simply make myself stop with fat talk thoughts, I criticize myself harshly. I disparage myself for disparaging myself! And it was hard to see the same tendency present in some my students. It made me realize (not for the first time, but very forcefully), that I have *got* to recover fully in order to model healthy behavior – physically and mentally – for my future students and future clients. And I hope that my students were able to trust what I said. I hope they were able to know that they are trying their best, and that is the important thing.

My students, like myself, also struggled with how to effectively respond to fat talk going on around us. For me, I often get it in the form of compliments regarding my weight loss. People say I look so good; they want to know how I did it. And though I often want to sarcastically respond with, “Well, wouldn’t you know it? Turns out having a life-threatening illness is a GREAT way to lose weight!,” I generally mumble something about healthy eating and exercise. I’ve never felt good about this response; it’s never been productive like I would like it to be.

Similarly, my students struggled to respond to fat talk, whether it was a comment made to them – “Look at my arms, [insert fat talk here]” – or whether it was a topic of conversation. More than one student said that she felt left out of a conversation because it was all fat talk and she didn’t know what to do to except remove herself.

So, we brainstormed together about ways to deal with the challenges of both the internal fat talk and the external fat talk. What we decided was that the best way to eliminate fat talk is not only to remove ourselves from it or point it out, but to actively intervene with messages of health, strength, and positivity. And, for the record, this is something that I think the end fat talk campaign really encourages!

So, for example, if someone says, “No wonder you’re so skinny; you work out all the time!,” a positive, healthy response might be, “Well, I really work out because I enjoy it and it makes my body strong.” Or if someone says, “These pants  are supposed to be my size, but they give me a muffin top!,” we might reply, “I try to pick clothing that I feel good in and that fit my body, rather than the other way around. It makes shopping way more enjoyable!”

Okay, okay. I know. Those answers might feel a little bit contrived. But, changing our way of talking takes practice. I truly believe that if we practice, practice, practice, these responses will begin to sound more natural because we will believe them.

So, the next time someone comments on my size, I think I’m going to try out, “You know, what’s really important to me is that my body and mind are strong and healthy – and that’s not based in a certain size.” It can’t hurt, right?

And just for funsies, check these out!

*disclaimer* This might be “ranty.”

I’m a vegan. I’m a vegan with an eating disorder. There! I said it.

Well, okay. I’m 100% vegetarian, and a “relaxed” vegan. I eat vegan the vast majority of the time, but I will make occasional exceptions (like, for example, the fun size reese’s pieces that I’m having right now).

I went vegetarian at 16, when my eating disorder was active. I will be honest and say, yes, of course my e.d. influenced that decision. My e.d. influences many, many decisions. It influences, for example, what I put on in the morning. Does that mean I shouldn’t wear pants? Of course not! B/c even though my e.d. might influence what pants I put on, I also recognize the fact that there are many more important, practical, clear, logical reasons to cover up my bottom half today – the weather, public indecency laws, comfort, boundaries, etc. Plus, I just want to wear pants. Probably my cords. Ed might try to influence the decision, but ultimately I am going to wear my cords (whether Ed likes it or not) for reasons far beyond my e.d.

As probably many eating disordered people can tell you, when you have an eating disorder, it influences a HUGE number of decisions – big and small – that you make throughout the day. It’s the all-encompassing nature of the disease. Does that mean my decision to wear my cords today is ALL ABOUT, or even primarily about, my eating disorder? Of course not. That would just be silly!

And I know that food choices are different than pants choices. Food seems more central to an e.d. because that is the symptamotology. Though, I would argue that clothing/size/body image is also very much impacted by an e.d. But, yes, I understand that they are not the same.

What is the same is the fact that, though my choice to go vegetarian may have been influenced by my eating disorder – as so many decisions are – it was not the primary reason I went vegetarian, nor is it now. I went vegetarian initially because I love animals. I love them. I knew that I personally would never be able to slaughter an animal, to take its life, to eat it. When I really thought about this, it seemed unethical to me for me to allow someone else to do that in my name. As I learned more about the meat industry in the US, my ethical decision to be vegetarian was reinforced. Then, as I became Quaker and pledged to live in accordance to non-violence, I saw vegetarianism as in line with that too. So, the reasons are actually logical, rational, and very clearly line up with what I believe. It seems that I have an eating disorder AND *gasp* reasonable, clear, healthy, competent reasons for being a vegetarian.

And, yet, over time, I had it drilled into my head (by books, by doctors, by family members, by some e.d. professionals and activists) that an eating disordered person who is vegetarian *must* be using it to restrict. So, during one of my early periods of recovery, I gave it up. I stopped being vegetarian. I thought I needed to give it up in order to recover. Though I recognize that this may be the case for some people, personally, I regret this choice. My weight skyrocketed above my set point. I felt sluggish. I wasn’t digesting well. And, mostly, I felt like I was living a lifestyle that went against many of my core values. After about eight months, I switched back to being vegetarian. I missed it too much. I missed the lifestyle. And after switching back, I felt so much better emotionally, mentally, and physically. AND I had the medical tests to support it – my weight gradually went back to my set point, my iron levels actually went UP, my vitamin &  minerals were coming from my plant-based diet rather than a tablet, my protein was in a realistic range that my body could use, rather than sky-high like many people’s. My energy came back. I slept better. For my personal body, it seems, vegetarianism is the way to go.

And yet, I still get flack for it a lot of the time. I get things like, “You lost weight because you’re vegan.” No. Dead wrong. I lost weight because *I have an eating disorder.* Let’s not confuse the two. They’re not necessarily synonyms. I also read things with alarming frequency that are skeptical at best and downright disapproving at worst in their assessments of vegetarianism in people with eating disorders. I keep thinking that people will realize that assuming vegetarianism is about restricting is unfair. And yet, it keeps coming up time and time again.

The book “Gaining” is the most recent thing that I read, which is what inspired this post. I had heard so many good things about “Gaining” – that it is progressive, that it is insightful – and, in many ways, it is. Until the lauded example of the e.d. dietitian who, when confronted w/ a vegetarian client, would “test” them by asking what animal rights organizations they were part of.

REALLY?!!!! This is where I almost hurled (involuntarily) all over the book  in Border’s. First of all, people choose vegetarianism for all sorts of non-eating disordered reasons that may or may not have to do with animal rights. Second, REALLY?!! Are we going to tell a a client that she’s not Christian if she’s not actively going to church?? Are we going to tell a client that he’s not against racism if he’s not a member of the ACLU?? Are we going to tell a client we don’t believe she’s a feminist if she’s not a member of NOW?? Are we going to tell a homosexual client he doesn’t support gay rights if he’s not a member of the HRC?? We don’t all join groups to support our core beliefs. And yet, vegetarians somehow have to “prove” their vegetarianism is for the “right” reasons with this litmus test.

I’d like to suggest another approach. What if, instead of immediately creating an environment of skepticism and mistrust by interrogating a client’s vegetarianism, e.d. treatment providers create a space of non-judgmental curiosity and trust that would encourage a client to open up about their reasons for vegetarianism? That way, a client who had chosen vegetarianism as a way to restrict (and, yes, of course I acknowledge that this happens) could ask for help from their RD and treatment team without fear of being told “I told you so” or being judged. Also, that way a client who was an ethical vegetarian could actually have support in having BOTH their ethics AND their recovery.

You know what the skepticism about vegetarianism in the e.d. community does accomplish? It’s incredibly effective at keeping a lot of us out of treatment. I know a number of eating disordered vegetarians who won’t see e.d. dietitians because they fear they will be questioned at best and condemned at worst. Last I checked, there were no IP programs that would support veganism. Some will support vegetarianism, though many won’t. Most residential programs will not support veganism, and often those few that do merely “tolerate” it – be prepared to eat A LOT of peanut butter & jelly (not sure how this helps break repetitive eating). I know a number of people who have gone to residential programs (that shall remain nameless) and were told before admission that they could remain vegetarian, but upon arrival the rules changed (NOT helpful in any psychiatric treatment) and they were told that their vegetarianism was a means of supporting their eating disorder, and the RDs wouldn’t work with them as vegetarians. I have seen them after discharge at my treatment center, wanting to switch back to being vegetarian, but they have had their own sense of self-trust undermined. Those who do switch back for healthy reasons, then have to restructure what they eat yet again under the guidance of the RD at my treatment center. Big dietary changes like this can be difficult for anyone, but especially for people in recovery, vegetarianism or not.

Personally speaking, I put off seeing an RD for quite some time last year because I did not want to have to battle over my ethics. Then, I found my current RD’s description on my treatment center’s website, and her bio said very clearly that she specialized in eating disorders AND was interested in vegetarian diets. I immediately made the phone call. If she hadn’t had that statement on the website, I may never have found my way to my incredible treatment center. I have switched to being vegan while working with her, and it has actually been incredibly beneficial to my recovery. When I decided to switch to being vegan, my RD did ask me about it. Like I said, I do realize that there are people who use vegetarianism/veganism as a way to restrict. So, yes, I think it’s very important for treatment providers to have open and honest discussions with clients about their food choices, perhaps even at multiple points in treatment. And that’s what my RD  (who’s not a vegetarian, for the record) did with me. When I told her I was thinking of switching to veganism, she asked me, with curiosity and compassion rather than judgement, about my reasoning. She asked me if and how I thought it would impact my recovery. I told her my reasons, explained my ethical views, my understanding of veganism and my recovery, etc. And she trusted that I was making reasonable, healthy, competent decisions based on my food politics and ethics. Because of that trust, I have had the benefit of an RD’s guidance as I transitioned to veganism. And it has been so beneficial to my recovery. Often in the support group that I attend at my center, there are other vegetarians and vegans who inevitably at some point mention that they are so grateful to have found a treatment center and an e.d. dietitian who will support vegetarianism/veganism. It has made treatment possible for many of use who had been met with with (and still often are met with) skepticism and mistrust when we have simply been trying to live a life in accordance with our reasonable, rational, mature, competent ethics and beliefs.

Do any of you have experiences with this? What are your thoughts on the matter? How do we balance food politics and eating disorder recovery?

This is something that I’ve been wondering about for a while, and something that has come up in conversation with a few friends in recovery lately. I get the feeling that this is something that people are perhaps hesitant to talk about because we don’t want to be seen as judging others based on body size, etc. I know that’s the case for me anyway.

But, if I’m being totally honest, the body types of my treatment providers DO matter. Obviously they are not the be-all and end-all determinant of whether or not I’ll work with someone. Much more important to me is the level of mutual respect I feel w/ my team members, how easily I am able to trust them, whether or not I connect with them, their views about e.d.’s and treatment, etc. But, at first, their body type IS quite important to me. In therapists, I want someone who is “average,” or even perhaps a little bit above “average.” B/c my set point is a bit on the higher side of normal, I prefer to have a therapist who has experienced what it’s like to move through a thin-obsessed society with a body that is, well, not thin. If I have to go through a weight gain process, I also tend to be less self-conscious doing that with a therapist who is not particularly thin.

Dietitians, however, are another matter. I hate to say it, but, at least when my e.d. is active, it would be a struggle for me to work with a dietitian who was not slender. My first RD was very small (she was clearly just built that way), and that was a bit hard for me because I felt so big in comparison. My current RD is thin, not skinny; she looks like she is a very healthy weight for her frame. Slender, but clearly not disordered. This appeases my e.d. a bit, and it encourages me that one can nourish oneself and not be overweight (something that I absolutely believe in regard to other people, but I have trouble applying to myself). And frustratingly, these kinds of standards, expectations, etc. based on size are in direct opposition to what I believe in my daily life about size, etc. I’m actually a firm believer in HAES (health at every size) and a proponent of body diversity. Yet, when it comes to my treatment team, I have preferences.

What about you? Does the weight/size/body type of your treatment providers matter? If you’re a treatment provider, is this something you’ve considered? Is it something you’ve talked about with clients?

I know this can be a sensitive subject, but in my conversations with others, it seems like it’s something that can be important to people and should be open for discussion. And I’d like to think this blog can be a forum where we can all discuss these matters honestly and without judgment. 🙂

There’s a Lutheran Church that I often drive by on my way to Trader Joe’s. Out front, they have a number of banners. The one that caught my eye was a banner that reads, “Relentless Compassion.”* Maybe it’s because I’m often on my way to Trader Joe’s after an appointment at my treatment center, but when I first saw that phrase – relentless compassion – I instantly associated it with my team.

And let me tell you, they are relentless. My RD has actually said to me, “I know that it’s hard for you to hear good things about yourself right now. AND, I think it’s important to really acknowledge and highlight the amazing work that you’re doing and the progress that you’re making.” My team *always* meets me with compassion and kindness, even when Ed has caused me to lash out at them, even when I’ve had major slips or setbacks, even when I’ve tried my best to convince them they *shouldn’t* be kind to me because I haven’t “earned it;” I’m not the good person that they think I am. Try as I (or Ed) might to convince them that I didn’t deserve that kind of care, they were relentless. I was forced to resign myself to it. I realized that these people were going to be nice to me, and there was nothing I – or, more accurately, Ed – could do about it!

Now don’t get me wrong, I have had numerous other treatment providers who’ve been wonderful, and kind, and consistently supportive. But, I have never experienced it like this. In the past, even the kindest of treatment providers (with a couple of exceptions), have become overwhelmed by my symptoms at times. My old RD, for example, was one of the kindest, most compassionate people that I’ve ever met. Yet, there were days when I left her office feeling overwhelmed or like I had let her down because we spent the entire appointment focusing on what I still needed to work on, or what had gone awry since the last time I saw her. Obviously the goal was not to make me feel overwhelmed. I doubt that she was actually disappointed. And, I understand that eating disorders are dangerous, so in the name of my health, she wanted to focus on progress, on what I still needed to do. And though this came from a very obvious place of care and support, Ed could still wrestle it from me and turn it into, “Look how you’ve screwed up. Again. You still have so far to go.”

With my current team, dare I say something like, “I’m sorry I fucked up again,” or, “I should be recovering faster; I still have so far to go,” it is always met with, “And what progress have you made this week?”, or “What’s one thing you have done to care for yourself this week?” or “And how does now compare to when you first started coming here?” A big part of this is the practice of dialectical thinking. My treatment center uses a lot of DBT. So, when I go all black-and-white in my thinking – when I start belittling myself for not doing well, for not being perfect in recovery – I am encouraged to think of the ways that I am progressing. That way, we can acknowledge and legitimate everything. I can be struggling, AND I can still be working toward recovery. I can want recovery AND I can be scared of it. I can slip AND I can get back on track.

But, the relentless compassion and kindness extends beyond the use of dialectics.. I learned early on that there was nothing I could do that would make these people give up on me. There was nothing I could do that would cause them to write me off as “chronic,” as others have occasionally done. And, though Ed made me try many, many times, there was nothing I could do to convince them that I don’t deserve treatment, that I’m hopeless, that I’m wasting their time, that I’m not the good person that they think I am, that I don’t deserve the credit they give me.

This is a big shift for me. Having lived with my e.d. for so long, the messages that I get from Ed now extend FAR beyond food. In fact, Ed’s favorite tactic is telling me that I don’t deserve, well, anything. Ed tells me that thinking that I deserve something is equivalent to taking things for granted, and I have no right to deserve things or take things for granted when others in the world are denied or do not have access. Obviously Ed tells me this applies to food. But, it also applies to compassion, care, and, yes, treatment. The message goes something like this, “You don’t deserve (insert food here). Other people in the world don’t get it, what makes you think you have a right?” Or, “You don’t deserve this level of care. You don’t deserve this level of kindness. You’ve done nothing to earn it.” From my conversations with other eating disordered people, I know that many of the same people are getting the same messages (lies) from Ed.

My team seems to understand this. So now, I am met with constant (relentless) reassurances that not only do I deserve to take in the nourishment that my body needs, but I am also deserving of treatment, I am deserving of self-care, I deserve to do things because I *want* to, I am deserving of a team that “isn’t going anywhere,” I am deserving of health, I am deserving of treatment even in the face of insurance denial, and I deserve to hear positive things about myself and my recovery, even if it makes me uncomfortable, even if Ed makes me try to convince them I’m wrong.

Like I said, it only took a couple of appointments before I realized that these people were NOT going to stop. They were going to be kind to me whether I liked it or not. They were going to point out positive things about me. They were going to remain absolutely convinced that I deserve treatment. It was out of my hands. This was one area where I had no control. And the kindness was going to start from the very moment I checked in with the receptionist at the front desk, through my appointment, and until the moment I left.

I was skeptical at first. I thought that it was cute, what they were doing. It was a sweet tactic, but it would never take hold. At the very least, I was determined to remain convinced that I am undeserving – a safeguard against taking things for granted. I thought it was nice that they wanted to show me kindness, but it was naive. It would never take hold. At first, when they complimented me, or told me I was deserving, or rerouted negative thoughts to positive thoughts, I (Ed) would try my hardest to combat them, to convince them they were wrong. When that tactic failed, I decided they could say all of the nice things they wanted, but I wouldn’t listen and I would just remain silent and internally combat them.

Then, something happened. I was in my RD’s office one day and she was once again relentlessly referencing my progress and – I smiled. I couldn’t help myself! I knew she saw it, and I tried to repress it, but then she said something else about my progress, and I did it again! And then, later that week, I did it in my therapy appointment! I was actually having moments where it felt good, where it made me happy to hear someone being kind and compassionate rather than placing blame or focusing on the negative, or even just focusing solely on the work to be done.

The next step was that I found myself using their kindness to combat Ed. This is still often a tactic of mine. Ed will be giving me a negative message and I’ll think, “But my team has been so nice to me, and so committed, and I’m not going to listen to you because I don’t want to wast their time.” Or I’ll think, “But, my team says I DO deserve to eat protein and feel well, and they’ve been right about everything else, so . . .”

And, suddenly, this kindness is getting out of control! There are moments now where I – *gasp* – actually think that maybe I deserve to have people treat me this way. There are moments where I will give myself permission to not engage in a behavior because I deserve better. I want to feel better. I deserve to be kind to myself. These moments are still fleeting, and sometimes far between, but they are there. And they are increasing. Ed and the kindness that I’ve received from my team can’t coexist. And my team is proving to be just as relentless as Ed (well, actually, more relentless, it seems), and gradually, the kindness and compassion seem to be pushing Ed out. They’re literally killing Ed through kindness. And I seem to be jumping on the bandwagon, intentionally or not! Kindness is catching, it seems.

And don’t get me wrong, though this relentless compassion and kindness has been incredibly healing for me, I remain committed to my stance that successful treatment must employ multiple tactics. This kindness and compassion works, I think, because it is paired with *very* clear boundaries, skill development, therapy and trauma work, nutrition, etc. For example, regardless of how nice she might be, my RD will not compromise on my weight or my meal plan. My therapist may show me relentless compassion when I’ve been upset about exercise restrictions, but she will not change them. I’ve actually come to see this as a function of care. They care enough about me to *not* compromise in these ways; it is a way of keeping me safe. It is a way of being kind. It is “tough love,” as they’ve stated.

The kindness and compassion that my team shows me has truly fostered an environment of honesty. I know that I can be honest about my struggles, I can be honest about behaviors, and I will never be made to feel guilty or “bad.” The struggles will be honored and worked with, safeguards and boundaries will be put into place, AND my team will be kind and compassionate and positive through the ups and the downs.

There’s nothing I can do about. They’re relentless. And it seems to be rubbing off.

What are your thoughts about this (yes – YOU!)? Is a viable treatment option? Is it “too nice?” Have any of you had similar treatment experiences? Have they been helpful? Unhelpful!

* This phrase is actually borrowed from a UCC church called The Cathedral of Hope. “The Mission of the Cathedral of Hope is to reclaim Christianity as a faith of extravagant grace, radical inclusion and relentless compassion.” This is exciting for me because, though I am personally a Quaker, my father is a UCC Pastor. Yay!

Well. I finally got the time to read this great NY Times Article, Understanding the Anxious Mind. It’s long, but totally worth a read – thanks to edbites and Laura Collins for bringing this article to my attention!

What I really appreciate about this article is the way that it complicates both the biological model and the behavioral/environmental model of anxiety and brings them into dialogue with each other. It’s a desperately needed approach! The article demonstrates that biology/temperament may very well predispose a person to anxiety, but this biology is not destiny and these things are also difficult to quantify in a lab setting that is “artificial.” That’s a *very* rough and reductive summary of the nine page article, so I’d suggest you read it! 🙂

Anyway, some lingering questions that I have:

– The article clearly shows that while we may be able to see clearly neurological, structural, and tempermental paredispositions in people with anxiety, it also shows that many learn to manage this anxiety. For many, though anxiety might be present, it does not negatively impact their daily lives as they mature. So, one may have the biological predisposition, but she/he may not outwardly display anxiety, and she/he may not even necessarily feel heightened anxiety. I wonder, does this work the other way around? Can someone *without* the biological and tempermental predictors for anxiety learn anxiety – from their environment, caretakers, mentors, experiences, etc.? Can anxiety develop via experience/environment, without the biological predisposition?

– What are the implications for this as far as child psychology, parenting, family, etc.? The article shows that the jury is still out in regard to what are the most effective ways to nurture a child with anxiety so that the anxiety becomes manageable (I was a bit miffed at how quickly they feel into the individualist mindset with this). But, I assume that more theories and studies about this will follow. So, if a child shows these predisposition to anxiety, do parents have a responsibility to “deal” with it? Do doctors? Psychologists? How do we stress the important role of parents/caretakers/families in helping anxious children, without playing the blame game? (i.e. “Your child has specific needs that can be best met in this way.” v. “You didn’t raise your child ‘correctly’ so now she/he is an anxious adult!”) Obviously, though, a lot more work needs to be done on the behavioral/environmental side of this before they can draw any conclusions about what is helpful/necessary.

– How does this research impact eating disorders specifically? Research as shown that – at the very least in anorexia nervosa, which tends to be the most researched e.d. (though it’s the least prevalent statistically) – there are certain biological/genetic markers that may predispose someone to develop AN. So, my first question works for e.d.’s as well. Not *everyone* who holds these genetic/biological markers develops full-blown AN. So, there must be other factors involved. If someone can have biological markers, but not develop the full-blown disorder, can this too work the other way around?  Can someone develop the disorder without the biological predispositions? How? Why?

– How does an e.d. exacerbate anxiety? It is clear that when an e.d. is active, many other psychological implications follow – depression and anxiety, for example. This happens for a number of reasons having do to w/ (mal)nutrition & the effects on the brain, added stress in social situations, an increasingly rigid need for routine and order, etc., etc. How do clinicians and treatment providers acknowledge the anxiety and depression without falling into the trap of assuming it underlies the e.d.? For example, for some patients, the e.d. may be a way to cope with anxiety and depression that are already (and perhaps biologically) present, yet for others, the anxiety and depression are a symptom of the e.d. (and perhaps they do not have the biology for it). I have seen, more than once, people medically treated for anxiety and/or depression because it is assumed to be a chemical imbalance, yet in the long run, the medication has proven unnecessary b/c the anxiety and/or depression was a symptom of the e.d. and “cleared up” as the e.d. was treated. Yet, for others, an inherent biological predisposition to anxiety and/or depression may mean that medication is the most effective treatment. How can treatment providers best navigate this delicate balance?

– Are there temperamental signifiers that we should be looking at for people with eating disorders? Certainly many “personality traits” have been outlined for people w/ anorexia  and a bit for people with other e.d.’s (though, again, I wish there were more research for the other eating disorders!). For example, we often hear of people with AN as being ambitious/driven, type A, perfectionist, obsessive, etc., etc. Using myself as an example, I have always been on the “stoic” side of normal. Even as a baby, according to my parents, I was not as expressive as some (I did not laugh or cry as easily as many babies). I remember very clearly that as a young child (we’re talking preschool age) I expected myself to individually manage my emotions and keep them internal, so as to avoid burdening or worrying people. I was often asked if I was “sad” as a child, but I wasn’t sad. I was just stoic! I have no doubt that this internalizing of emotions and perhaps this inherent “stoic” temperament was influential in my development of an e.d. If we do find temperamental markers for the array of eating disorders, again, what implicaitons does this have for parents, caretakers, (mental) health care workers, etc.? If we find temperamental markers, can potential e.d. behaviors be rerouted before they start? Can a certain kind of environment based on tempermanet cut e.d.’s off at the pass, so to speak?

– The article stated that anxious people with high intelligence tended to be better at managing their anxiety. If there’s one thing we often hear about eating disordered people, it is that we are “highly intelligent.” I can’t even count the number of times I’ve heard something to the effect of, “But you’re so smart! How could you do this?!” Given that many people with eating disorders ARE highly intelligent AND highly anxious, what is the disconnect here? Why are these two characteristics so disproportionatly and concurrently present in people with eating disorders when intelligence seems to beneficially mediate anxiety in the more general population?

As always, the more “empirical” research there is, the more questions I have! And wow. This was much longer than I anticipated!

I came across this article a few days ago, and I’ve been dying to respond to it! Should Gyms Intervene If Someone Has an Eating Disorder?

Though the author debates both sides of the question and does not explicitly stated his opinion one way or another, in my reading, it seemed that he was leaning toward the position that the gym should intervene in some way.

I think there are a number of things to be considered here. First, what would intervening do? And the author, to his credit, does consider this. Personally, speaking, if I was working out out a gym and a random employee confronted me (even if sensitively) about my weight loss, I don’t know what it would accomplish. Mostly likely, it would succeed in making me feel embarrassed enough to switch gyms, where my “secret” was not known. We need to remember that eating disorders still carry a stigma. They shouldn’t – there is nothing shameful or “wrong” about having an eating disorder – but they do. To approach someone that you don’t know well and confront them about an eating disorder, while sometimes necessary and beneficial, also has a high risk of backfiring because it is likely that the person will feel embarrassed or shameful. The thing about eating disorders is that yes, in some cases, they are a very visible disease. For me, that is one of the hardest things – people assume that they can tell how well I’m doing (or not doing) by my weight. And it often means that I’m “confronted” with concern or questions if I lose a lot. When that has happened – especially when it has involved someone whom I don’t know all that well – it has felt sort of like that dream where you end up at school or work and find that you’re naked.

I think that if a gym were to decide a member needs to be checked in with, that should ideally come from someone who has an established relationship with the member – a personal trainer, a nutritionist who might work at the gym, etc. I think that it puts an e.d. person in a difficult position to approach them about having an e.d. without having the proper sort of relationship with them to really offer personal support (i.e. a gym manager who doesn’t work closely with members).

The author of the article writes, “when gyms fail to intervene with members who are below a healthy body weight, they risk becoming complicit in the delusions held by these individuals, strengthening the perception that more exercise and weight loss is needed. Not only does this harm the person with the eating disorder, it has the potential to harm other members of the gym who may begin to see the person’s behaviour as normal or even exemplary.”

The thing is, with an eating disorder, the “delusions” are already in place, though they may vary by type/severity of eating disorder, as well as by individuals. Gyms may foster a competitive atmosphere, and atmosphere that can be triggering based on the “perfection” of bodies, etc., etc. But, the “delusions” are going to be there whether or not the gym steps in. And the author needs to remember that “I’m worried about you working out so much because of your weight and eating habits” can sound like a compliment if the eating disorder gets a hold of it!

He makes an interesting point about potential harm to other members of the gym. Certainly, an eating disordered person can be triggering to other people. In my experience, however, the people who get triggered are the people who already having an eating disorder and/or serious body image concerns. In my discussions with people, it seems that most healthy people (by which I mean they are e.d.-free) feel sad and/or scared for an obviously eating disordered person, rather than envious. I also think that the problem is not having an eating disordered person present, but rather, a lack of knowledge and education about how severe and deadly eating disorders are. We live in a climate that glamorizes eating disorders and fosters envy of them. In my view, that is the problem, rather than the presence of an eating disordered person.

Perhaps my biggest critique of the article is that it bolsters the assumption that we can tell if someone has an eating disorder simply by the way she or he looks. And, yes, in some cases, we can make an educated guess based on a person’s appearance. But eating disorders are not always visible. In fact, as most people with eating disorders maintain a weight in the “health” range, they more often than not invisible. In fact, one of the most dangerous things to pair with exercise is purging, and though some anorexics do purge, most bulimics are at a “normal” weight, or are even a bit “overweight.” My guess is that the issue of eating disorders and gym memberships runs much deeper and is much more complex than the author realizes (and he does mention this).

So, should a gym intervene if they suspect someone has an eating disorder? I’m not sure. I think that if there is someone at the gym who has a long-lasting, one-one relationship with an at-risk member and can offer support, then it might be helpful if that person approached the member non-conversationally and appropriately. Should a gym employee who does not know the member well approach them? I don’t know.  I worry that that would only encourage further isolation and alienation.

I am totally supportive, however, of gyms having info available on eating disorders and treatment resources. I also think it would be incredibly progressive if gyms had e.d. and body image educational programs as well as nutrition education/counseling, etc. I think it’s important for people working in health and fitness to help promote an environment of holistic prevention.