Fighting the Urge of ED Behaviours

When is the most difficult time for you not to engage in eating disorder behaviours?  Is it directly after a meal? Is it when you are alone? Bored? Is it after a fight with a friend/partner/family member? Is it pre or post your therapy session? Have your behaviours become habit/pattern that you do without much thought throughout the day?  Here are a few tips to help you push through the times where you may want to engage.  

#1 Eat with Someone - Eating with a friend or family member can help act as a form of accountability.  It can also ease the distress of the meal process as well as post meal anxieties.  Strike up a conversation with the person(s) eating with you to help get you out of your head and into the moment.  Be sure to pick a 'safe' friend or family member who can support instead of trigger you.  If you know Aunt Alma continually comments of how full she is or likes to bring up emotional issues, it might be a good idea to pick someone else. Again, don't forget to have a conversation with this person around what you need from them so you all enter the situation prepared.  One last thing... eat at the table in front of the t.v. to aid in mindful eating!  

#2 Create a Distraction Plan - Make a list of 20 activities you could do during your 'high risk' times (high risk in the sense you are at a 'higher risk' of engaging in eating disorder behaviours).  From that list, try doing 5 to 10 of such activities to distract you from your urge.  Try avoiding putting exercise on your list to avoid creating an unhealthy association between it and food.  To help you get started with your list, here are a few activities.   

- watch a t.v. show, read a chapter in a book, colour, paint, sing, look up places to vacation or of cute sloths (well... that won't be hard as all sloths are cute!!), journal, call a friend, write a letter, send an e-mail, do the dishes, clean, do your homework, create a play list of music, collage, card making, crossword puzzle

#3 Plan Ahead - Take time to figure out when you are most at risk for engaging in eating disorder behaviour and plan for it.  Don't just wing it, hoping your urges won't get the better of you.  It's okay to have a plan! Set a specific day where you go grocery shopping and create a meal plan for the week.  Plan appointments so they don't run over meal times.  If they do, know where you are going to have your meal or snack so it doesn't act as an excuse to engage in ED behaviours. If you struggle with purging after mealtimes, have a guideline where you cannot leave the table for at least 30-45 mins after eating (which would be a good time to do some of the activities listed above). 

#4 Non-negotiatbles - Get back to the basics and set up some non-negotiatbles.  These would be things you do, regardless of how you emotionally or physically feel.  So, when you are sad, mad, anxious, etc, non-negotiables are thing you do regardless of the emotion that is present.  Also, in the early parts of recovery, hunger cues may be out of whack, making them not reliable as to whether or not you feel like eating.   Remember, everyone's recovery is different and non-negotiables may look different depending on what you need to be successful in your recovery.  For example, non-negotiables for one person could mean eating at the exact time for each meal, while another may have more room for flexibility as long as they still eat three meals per day and a snack(s).  Other non-negotiables may entail only exercising on designated days or a specific amount of times per week.  The point isn't to be rigid or 'perfect' in your recovery as it is to help you do what you need to do to be healthy. 

#5 Talk with Your Therapist - Expect struggle and urges! It's part of the recovery journey.  There will be times where you have tried all of the above and still engage in behaviours.  Try talking with your therapist as to what happened, what you tried and what you could try the next time.  Nip behaviours in the bud when they happen and be open about them.  

Do's and Don'ts for Friends and Caregivers

When someone close to you has an eating disorder, it may seem as though nothing you say or do is right. The well intentioned words of encouragement somehow get twisted into cruelty and judgement.  Here is a list of helpful as well as unhelpful things to say.  Every individual with an eating disorder is different and the best way to find out what is more helpful than not is to simply ask! Have a conversation with your loved one to learn the less threatening ways of communicating with them.  Keep in mind, they may not know, which may lead to a season of trial and error. Keep the lines of communication open, or at least, create a safe place for conversation to occur for when your loved one is ready to talk.  Although you might not understand the eating disorder or approve of it, they still need your love and support. 

Helpful Things to Say/Do

• Say to me, "I'm here to talk if you want to"
• Ask me if I want a hug instead of assuming I want or don't want one
• Ask me If I want you to sit with me during meal times 
• Listen, even if I don't make sense
• Validate my feelings, even if they don't seem rational to you
• Ask me what I need from you
• Talk to me about non-eating disorder things
• Spend time with me
• Still ask me to do things with you, even though I usually say 'no'
• Learn more about my illness 
• Acknowledge my boundaries
• Tell me that you're here for me in anyway you can be to support my recovery
• Tell me that you love me, even with the eating disorder

Unhelpful Things to Say/Do

• Don't say, "You look so healthy"
• Don't say, "You've gained weight"
• Don't ask me, "What did you eat today?"
• Don't question what I should or shouldn't be eating 
• Don't assume you know how I feel
• Don't forget I'm still a person instead of an eating disorder
• Don't try to 'fix' me
• Don't tell me not to cry
• Don't comment on my body, weight, shape
• Don't talk negatively about your body in front me of
• Don't comment on other people's bodies/appearance/weight

Self-Care for Caregivers/Friends/Support People

I want to state, right off the bat, that eating disorders do not simple affect the one specifically struggling.  Nor do the needs of family members and support people become null and void. Today's blog post states some helpful tips for family members/friends/support people to keep in mind when walking alongside someone who has an eating disorder. 

• Self-Care - you still have needs, and it is okay for you to get them met.  Give yourself permission to take a step back from the supportive position for awhile so that you can recharge and feel a little more refreshed.  It is also good modelling for your loved one to see that you are taking time to do this.  No one person can be or do everything for another person and this situation is no exception.  
• Maintain Social Connection - Meet up with your friends and talk about anything but eating disorders and recovery.  Try to give yourself a break from this.  You are still allowed to have a life outside of your loved one's illness.  It is okay to keep up with the craft group you have always belonged to or to meet up with friends after work on Fridays.  If you always went walking with Jeff, continue walking with Jeff.  Being a support person is only one of the many roles and aspects of your life.   
• Talk/Share - Gather a few trusted people who can support you as you support your loved one.  Give voice to your frustrations, fears and worries.  Your loved one may get upset with you for needing to talk to others, but you cannot do this alone.  When you talk to these select people, share what the experience is like from you. Identity and own your feelings as opposed to speaking for or about your loved one's.  Just like your loved one needs a support team (and likely one's outside the family), as do you! Also, try having a conversation with your loved one about which topics they would prefer you not to talk about with certain people. 
• Maintain a Health Lifestyle - Take a look at your eating habits, exercise habits, work/home/family balance, etc and make changes if needed. Again, this is good modelling for your loved one.  Keep in mind that you might be able to do certain things your loved one should not be doing... and this is ok! For example, exercising may be problematic for your loved one and their recovery.  This doesn't mean that you shouldn't either.  They are the one's with the eating disorder. Try, however, to be considerate about how you talk about exercising in front of them, etc.  
•  Journal - Writing/drawing about what you are going through can be a very cathartic process.  It can be a safe, non-judgemental place to explore, find meaning, and vent.  It can also be a place filled with inspirational quotes and positive moments/successes from the day.
• Accept and Feel Your Feelings - You will experience a whole range of feelings when caring for a love one with an eating disorder. Try not to judge them, as you feel how you feel and that's okay.  You may feel anger, helplessness, resentment, sadness as well as joy, hope, optimism and love.  Having a supportive network outside of our loved one is important when sharing and exploring these feelings. 
• Therapy - There is no shame in going to a therapist who has experience working with supporting a loved one with an eating disorder. Check on-line to find a therapist in your area and don't stop looking until you find one that you feel comfortable with and trust. 
• Laugh - It's such good medicine!

ICED 2014

I had the pleasure of attending the 2014 International Conference of Eating Disorders (ICED) in NYC for the past 4 days.  Professionally, it has been helpful to meet other professionals, exchange ideas and learn the latest in research.  Personally, the most intriguing and reflective parts of this time away were the conversations that occurred in the evenings at the home of a former ringette coach, with whom I stayed with (and her family) in New Jersey.  I thought I'd share a few things I learned both professionally, and personally.

Professionally: 

• where, why and which parts of the brain that are neurologically affected by starvation, leading to chaotic voices of indecision, high alert, perfectionism, disorganization and discontent in body image 
• how athletes face much pressure to look and perform a certain way... both within the culture of sport and outside the culture of sport.  This can often lead to a disconnect or disagreement with both liking and hating their bodies. For example, being muscular may be an asset in boxing, however, can leave some women feeling unfeminine outside the ring (or whatever sport)
• exposing instead of avoiding mirrors can be a useful tool in recovery
• media is not the enemy, however, we must learn how to harness it and use it to help instead of hinder health and recovery (such as: Rise Up & Recovery, DBT Diary Card and Skills Coach and Recovery Record)
• the strong need to redefine (or/and find) a better definition for the word 'recovery'

Personally: 

• a person's eating disorder will have a wider affect on the people around them than initially understood
• what you perceived as gossip about you in recovery might have genuinely been compassion as well as a legitimate need to talk about worry/concern regarding the one struggling (who may not currently be in your life)
• share with people how they have positively impacted your life while you can instead of waiting 'X' amount of years
• I am not alone in being open about my journey with an eating disorder
• you may not understood how far you've come until years later
• people come and go in life... and sometimes, when you think they're gone forever, it is possible to still reunite
• only in NYC will you be greeted by Elmo, Spiderman, Ironman, minions, the statue of liberty, etc on your way to work

Self-Care: Do You Do It?

What do you think of when you hear "self-care"?  Do you think of going to an elaborate spa fir the weekend or simply getting enough sleep? Is it a concept that is nice in theory but difficulty to practice? Is it a priority or the last thing on your mind? Do you always put the needs of others in front of your own? Do you think you deserve it or do feel selfish for spending time, and perhaps money, on yourself?

Self-care is essential for well-being. We deserve self-care based on the sole fact we are human.  Truly, we can't take care of others if we do not take care of ourselves physically, mentally, emotionally and spiritually. Here are a few suggestions on how to self-care for each of your needs.  Feel free to add to my list!

Physical: 

• shower daily
• get 8 hours of sleep
• get regular check-ups at the doctor and dentist
• eat three nutricious meals a day with a snack or two
• moisturize daily
• regular, healthy amounts, of exercise
• stretch
• brush and floss your teeth
• skin care
• get a hair cut
• have a bath
• go for a walk
• have sex
• massage
• take medication as prescribed

Mental:

• puzzles (ie: sudoku, crossword, mathematical)
• take breaks from work
• read
• take time to have a mental vacation, something that doesn't require you to think a lot
• mindfulness/mediation 
• yoga
• talk about what's on your mind with a trust friend/family member/therapist
• participate in meaningful activities
• create balance and boundaries between work/home/school life
• physical, emotional and spiritual self-care

Emotional:

• talk with a friend
• set time aside for one's self
• go to therapy
• participate in meaningful activities
• feel your feelings
• breath
• radical acceptance - "a series of events has led up to this moment, it is what it is"
• be present
• positive self-talk/affirmations
• get and give a hug
• do something for someone else
• accept where you and others are at

Spiritual:

• talk with God, Higher Power, Someone Greater or outside of one's self
• talk to a spiritual leader
• go to a place of worship
• pray
• meditate
• embrace and participate in cultural significant practices (ie: sweat lodges, smudging, healing practices)
• participate in meaningful activities
• find and live according to your values
• read prayers, poems, religious text
• yoga
• nature walk
• sit/walk in silence
• mindfulness
• forgive others and/or self
• make ammends 
• connect

Make time for self-care. Schedule it into your week if you have to.  Designate specific times throughout the day/week/ month where you specifically attend to each category of need.  You deserve it, you are worth it, you can do it!

Commenting on Appearance

Every now and then, someone will make a comment on my appearance.  Meant to be a compliment (although not exclusively...), it  makes me uncomfortable.  It's not that I don't know how to take a compliment, as it is more that I know how harmful such comments can be, even though 'well-intentioned'.  Here is why, can you relate?

1) You don't know how the comment will be received.  For those struggling with body-image, eating disorders or distorted eating, commenting on one's body/appearance can potentially be dangerous.  It can feed into the unhealthy mentality that looks are the most important thing.  It can perpetuate unhealthy and symptomatic behaviours in others and give the illusion that what they are doing is okay.  Even the comment, "You look healthy" can be interpreted as, "You've gained weight".  A part of recovery is about pulling away from the need and emphasis on looks.  It is learning about who you are as a whole, instead of focusing on one aspect. 

Solution - If you want to encourage someone, try identifying something other than how they look.  What do you like about them? Was it how they were compassionate towards their teammate after a loss? Do they seem more happier or friendlier lately?  Have you noticed their bravery in asserting themselves to a friend/bully/boss/family member, etc? Try asking them how they would like to hear compliments, praise or concern. What may work for one person may not work for another.

2) You don't know how others in the room who hear the comment will respond.  If a thin person is praised, it could lead to body comparison by bystanders.  Those of different weights/shapes/sizes who didn't receive the compliment may feel as though there is something wrong with them and/or that they are not 'good' enough. By praising one thing, it is easy to assume that the opposite of this deserves criticism. 

Solution - Go directly to the person instead of saying it in front of a room full of people.  Obviously, there are times where it is completely appropriate to praise someone publicly (and I'm not talking about beauty pageants or weight loss shows).  Again, try giving a compliment or praise on something non-body or appearance related. Remember, we come in all shapes and sizes, and that's okay!  Perhaps, try praising the whole group or team on their effort instead of singling out one individual.

3)  People get treated differently due to their shape/size. I've heard (and experienced) from too many people how they've been treated differently due to weight loss or gain.  Although many factors could play into this, I do question why and how one's weight/shape has the ability to make one more/less attractive, have more/less 'will power', is more/less intelligent, etc than they were before.  Approval and inclusivity should not be determined by how someone looks.  This is sizeism. This is no different than treating people of different genders, skin colour, culture, religion, age, etc. differently. 

Solution - Ask yourself if you hold any stereotypes about people of different shapes and sizes.  Whatever the answer, don't judge it, just ask, "why is that?" and "do I really believe it?".  Try talking about it to a trusted and non-judgmental friend, family member or therapist. 

4)  Beauty is narrowly defined. There is this cultural idea of what beauty is, which is too narrowly defined.  It is a genetic lottery if you fit into it.  It is not someone's fault if they are short, tall, or have a heavier set point.  Humanity is diverse, let's celebrate it!

Solution - Ask yourself why is being 'beautiful' so important.  Who defines what it is?  Do you have a tendency to buy into the cultural and media driven ideal of beauty? 

5) Self-worth is not dependent on shape, weight or beauty.  Comments from others about your body don't have to make or break your day.  They don't have to define you. You are much much much more than how you look. 

Solution - Practice positive self-talk and self-validation instead of solely relying on the comments of others.

Clothes Shopping and Tips

For many, clothes shopping can be distressing and unpleasant.  With the mirrors, finding a size that fits, salespeople waiting on you, the comments that are said when you step out of the change room, it is no wonder many people feel awkward and self-conscious. While working towards recovery and/or learning to have a healthy relationship with your body, food, weight and exercise, your body may change.  Go through your wardrobe and get rid of anything that does not fit.  Wear clothes that fit today instead of hoping you will one day fit into 'X' size or acts as a reminder that you never want to fit back into 'Y'.  Get rid of your 'sick' clothes.  You are where you are in your body today and nothing in this moment can change that.  Accept this and dress accordingly.  Thrift shopping can also be fun alternative to the mall for those who like to save money or know their body will continue to change due to necessary weight gain, or other changes, etc.

Regardless of having and eating disorder or distorted eating, these tips may help make clothes shopping a little less distressing and tolerable. If you have any other helpful tips, please feel free to e-mail me!

#1 - Shop with a friend or family member that is safe, supportive and encouraging.  Have a conversation with them, let them know what you need from them.  If you try on something that does not fit, let them know how you would like them to respond.  For example, would you prefer to hear, "let me grab another pair and we can see how they fit" or "I think those are too tight/big". If you try on something that really does not look good, would you like to hear, "I liked the pink shirt better" or "My grandma wears shirts like that".  Think honestly about what you want/need and let your support person know.  Maybe you would prefer them to say nothing as simply having them there is all you want. Remember, styles do differ amongst friends.  If you find an outfit you really like, trust yourself!  Maybe you only have a certain amount of times you are allowed to ask your support person what they think of your outfit. Your friend or family member can also act as your 'fetcher' for different sizes, etc. if something does not fit.  

#2 - Tell the salespeople what you want from them, or do not need. If you would prefer not to have them check in on you for sizes, let them know!  Inform them that if something does not fit, you will go out and get it yourself.  If there are no mirrors in your change room and you have to step out to see what you tried on, let them know if you would like them to comment on your appearance or that you would like them to not say anything unless you ask.   

#3 Remember that sizes differ from store to store - bring in multiple sizes.  Ever notice how you may be a certain size in one store, while in another, something different.  It is not your body changing instantaneously from store to store. Stores simply having different sizes from one another.  Remember, you are more than a size, just like you a more than the number on the scale.  Help yourself, be proactive.  Bring into the change room a range of sizes as well as the mentality of, "I'm going to pick whatever fits the best" opposed to thinking, "I'm going to pick the smallest size" or "I'm going to pick whatever can hide my body the most". 

#4 Cut out and throw away the tags.  After purchase, and I emphasize the AFTER part, cut out and throw away any tags that indicate size.  If it is too triggering to constantly see it, get rid of it. Help yourself in this way.  There are two camps on the idea of being aware of your size or weight.  One side says, 'the number is irrelevant so why know it', while the other side says, 'avoiding is not the answer, learn to accept it'.  I think both are true.  Depending, however, where you are in recovery, it may not be helpful to constantly be reminded of the size or number.  Do what is pro health and recovery/well-being for you!

#5 Coping strategies.  Make a list of affirmations and counter statements prior going to the mall that remind you of your worth and value regardless of size, etc. Put them on your phone or in your purse/wallet so you can use them while trying on clothes. Do not forget the basics, such as deep breathing, radical acceptance and mindfulness. Take a moment and try to pick out which song is playing in the store. Do you know it?  Is there a scent in the store? How do the clothes you are trying on feel? Are they scratches like wool or smooth like silk? What colour is the shirt, skirt or pant? Being aware of these things can help bring you back to the present moment instead of obsessing in your head. 

#6 Plan Ahead.  Think what you need and what stores you think you will want to go. Sometimes, endlessly roaming the mall can be a high risk situation. If you do not know what stores you need to go to, or want to browse, give yourself a time limit. This could also help for those who lean too far into retail therapy and overspending. Do not let shopping give you an excuse to not have your snack or meal or to binge.  If you are shopping over these time periods, be prepared.  Either bring your snack/meal or plan to have it at the mall or out on the town.  Again, have an idea of where you wanna go so you aren't left 'conveniently' in a lurch to restrict or binge.

Eating Disorder Play and Panel

Yesterday, I had the unexpected pleasure of being asked to sit on a panel, alongside other eating disorder professionals and colleagues, advocates and individuals in recovery.  Prior to the panel discussion and Q & A, a play was performed, showing what it is like to be in the mind of someone with an eating disorder.  The constant struggle between the ED voice and the rational mind.  The one voice that tells you "you're not good enough, perfect enough, thin enough" versus the voice that says, "I deserve time and attention, I am indeed good enough,  I must continue to fight to get better".  Check out an article done prior to the event about the writer of the play. 

The play did an excellent job with depicting how incredibly ruthless and relentless the voice of the eating disorder or distorted eating can be.  It can be manipulative and cruel. Its pleasantries are often laced with harsh intentions. Yet, I am always amazed by the courage and strength individuals find within themselves as they swagger down the road of recovery.  After years of lies and false promises made by the eating disorder, individuals can find freedom, rediscovery or reinvention of the self, as well as self-acceptance as they fight to reclaim their lives.  I love how such creativity can be found in recovery, which then has been channeled into various forms of plays, books, music, dance, art and so on to increase awareness and encourage health and well-being. 

During the Q & A, many insightful questions were asked.  From spirituality, to family supports, to the reality that eating disorders encompass more than simply 'anorexia and bulimia'.  I enjoyed being on a panel with other experts and front line workers, such as: dieticians, volunteers from organizations such as Hope's Garden, recreational therapists, social workers, psychotherapists and those in recovery.  Each brought their expertise into the discussion, helping to shed light onto such a complicated illness.  As a professional, as well as someone in recovery, it was nice to see and hear that we all shared the same counter-cultural message. It's not about the food, it's not something people choose, there is help, health at every size, etc. 

Another mental health play (not about eating disorders) that is coming up is Elly Litvak's, one woman show, "Now Who's Crazy Now?" It plays in Toronto on Thursday March 27, 2014.  For more information, click here.  I had the pleasure of taking Elly's story telling workshop in 2009.  The workshop was another great way to help make sense of one's recovery journey with mental health issues. For me, it was an emotional, but insightful and therapeutic process.