Tag Archives: eating disorder recovery

The Butterfly Effect

Life is short. If you doubt me, ask a butterfly. Their average life span is a mere five to fourteen days.   -Ellen DeGeneres
My vision collage this year emerged in the shape of a butterfly and included images of many fellow people in my “tribe.” So I decided to name it “Butterfly tribe.” I then got to thinking about how I could, like Gretchen Rubin in her Happiness Projects, have themes to focus on each month. This is your cordial invitation to join me in the year of

THE BUTTERFLY EFFECT

 thisrsz_1heartbutterflymandala

The butterfly effect is a term from chaos theory that refers to a small change resulting in large differences in a later state or place. Each month I will be making small changes in different areas.

Here are the areas:

  1. Vision (January)
  2. Clarity (February)
  3. Make A Plan (March)
  4. Cultivate Creativity (April)
  5. Connect (May)
  6. Honor Sensitivity (June)
  7. Receive Support (July)
  8. Embrace Change (August)
  9. Play (September)
  10. Romance (October)
  11. Health (November)
  12. Release Shame (December)
Each month I will be writing about the small incremental changes I am practicing in these areas and recommending books or action you could try if you would like. Where do you come in? You are invited to join. If each of us make small changes, they MAY result in large differences. Also, in a tribe, people can learn from each other. For example there may be some spring chickens in this tribe that could teach me about how the heck to “tweet” during May.
Change (recovery, parenthood, living your vision) can be hard. It can be even harder when we attempt to do it alone. I have created a few ground rules for myself and you, should you choose to accept, in this butterfly project:
 butterfly

1. It is ok to choose the level of your participation, to make mistakes, and to change your mind.


2. You do not have to do it alone.

3. Stay engaged with the process (and notice when you would rather not).

Butterflies are fragile. They collapse easily and don’t survive well alone. They need each other, they need heat, and they need light. 4th generation monarchs, the ones that travel to California
and Mexico and live for 180-240 days, travel together for astounding distances. They do this together and then, when they hang in the trees, they do it together. So when you feel alone or collapsing in shame or sick and tired of being sick and tired, Do not give up. In the words of Richard Bach,

What the caterpillar calls the end of the world, the Master calls a butterfly.

A Story Aout Eating Disorder Recovery

Once upon a time, a long, long time ago,  

 there was a King who had been away at war and was finally coming home. As he approached the castle, his dog ran up to him looking crazy: his muzzle was foaming and bloody, he was running round and round the King in circles, and then back toward the castle where the nursery was. The king followed the dog to his new baby’s room and, to his horror, found the baby’s crib and wall spattered in blood and a large wolf laying prone in the crib. The King, terrified and then horrified, turned toward the dog and plunged his sword into him, thinking the dog had allowed his baby to be killed by a wolf. Just then, he heard the baby’s cry from under the wolf. The dog had protected the King’s baby.

Now, you may be thinking, like my clients when I shared this, How horrible! What a terrible story! What the heck does this have to do with eating disorder recovery; why didn’t he just pause before killing the dog; and where is the Queen in all this?

In order to see how this relates to recovery, we have to look at it metaphorically and break out of literal mind. In this story,

  • the dog is our body,
  • the wolf is our critical, eating disordered mind,
  • and the baby is our most precious soul-self.

The King could be many things: he could be our Observer-self (if he had paused), he could be the fierce action-oriented part of our self (that is helpful when channeled in the right direction and destructive when not), he could be the part of our self that integrates other parts…

However, the most significant question I have for you is: how is your relationship with the dog? Because your body is not the enemy here. And, in recovery, your IMG_2222body needs to (and has the capacity to) become your greatest teacher, ally, and communicator. What would happen if you listened, with curiosity, again and again?

Many blessings and so much gratitude for Dr. Anita Johnston, author of Eating In the Light of the Moon: How women can transform their relationship with food through myth, metaphaor and story telling (Carslbad: Gurz books, 1996) for this story.  Dranitajohnston.com

Opposite Land: A Blog about parenting your child playfully (Oh, and you, too)

I stole the Opposite Land game from the most time-honored parenting resource of all: another mom. Here’s how it works: When you are going somewhere or doing something that requires a certain kind of behavior, visit opposite land first. So for example, before we go to the regular grocery store, we go to the opposite land one. In opposite land grocery stores, all the kids ride on IMG_1635the carts flinging their legs and feet into the aisles, toppling cans and boxes off the shelves. They race around banging into people, don’t say excuse me, and throw eggs out of the carton. They fill the cart up with cookies, chocolate, rainbow sprinkle doughnuts and NO GREEN VEGETABLES. Never. Not Ever.

This technique works if you really get into it and are silly, authentic, and loving. Then your kid knows your intention is to connect and stay connected with them. Kids are right brained and have not yet left the land of implicit knowledge, of being deeply connected with their bodies and felt-sense of another person. So if you’re not authentic and silly with opposite land, they will see right through you and know you are just trying to get them to behave in the grocery store (which, of course, you are, but in a child friendly and respecting-ly, playful way).

A Random Confession related to Opposite Land and Never Eating Tomatoes:

My child is a picky eater. Even though I am a HUGE advocate for the intuitive eating, there-are-no-bad-foods, philosophy, I still relapse into encouraging, bordering on nagging, my child to eat vegetables. As you can imagine, sometimes I “win” a particular battle, but I never (Never, Not Ever 🙂 ) win the war. My little one is all over implicit knowing on that. I know you are trying to get me to do what you want, but I am not going to leave what I know to be true in my body and my preferences. So I keep returning to presenting the food, being playful with it, model-ing eating vegetables, but not forcing them.

I recently was given a book in another great chain of motherhood wisdom (also known as passing-along-stuff-please-help-me-clear-a-little-space-in-my-house). It is fabulous. In it, Lola, the younger sister of Charlie, states that she won’t eat carrots (they are for rabbits), peas (too small and green), and:

“I absolutely will never Not Ever eat a tomato.”

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Her older brother, well versed in opposite land and creative, playful parenting, assures Lola that they are not eating carrots, potatoes, peas, or fish sticks. They are eating “orange twiglets from Jupiter, cloud fluff, green drops from Greenland, ocean nibbles from the supermarket under the sea…” You get the idea.

As you can imagine, by the end of the book, Lola is experimenting with trying all kinds of new foods, including the dreaded Never Not Ever (re-named moon-squirters) tomatoes.

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How does this apply to You?

(Parents, Non-parents, and people recovering from Eating Disorders, Depression, Anxiety or General Self-Hatred)

Opposite Land looks different for adults. It includes such blasphemous ideas as:

“You ARE good enough.”

“All foods are possible to eat without guilt, including chocolate cake.”

“Recovery from an Eating Disorder (Depression, Anxiety, General Self-Hatred) is possible.”

“Mistakes are allowed.”

“You can be loved the way you are.”

“There is nothing wrong with you.”

“What happened in your family of origin was not your fault.”

“It is okay to feel angry, sad, ashamed, or insecure.”

“You are not bad.”

I get it- these may seem to live in a fantasy world if you are accustomed to believing the opposite. They may seem even more preposterous than eating cloud fluff or orange twig-lets from Jupiter. But considering the possibility can be the beginning of believing it. Having a trusted loved one (spouse, therapist, supportive peer) help you in this process can be the most healing. You may even, like Lola, decide that you can sometimes, Not Always but Not Never, have the experience of being Good Enough. And that can be even more phenomenal than eating a moon-squirter.

Special thanks to Lauren Child and Candlewick Press for permission to reprint the beautiful images from:

WILL NEVER NOT EVER EAT A TOMATO. Copyright © 2000 by Lauren Child. Reproduced by permission of the publisher, Candlewick Press, Somerville, MA.

Fantasy Island

For those of you who are old(er 🙂 ), you may remember a television show titled “Fantasy island.” In it, there was a fictional character Mr. Roarke who ran an island that visitors flew into to fulfill their personal wishes. A mentor of mine calls this place in your mind “the island.” In this magical place, all of your “If____, then___’s” are accomplished, and you feel relief from whatever your particular form of suffering is. Some common versions of “fantasy island” type wishes include:

“If I lose weight, then_____”

“If I am out of debt, then______”

“If I earn (fill in amount of money), then______

“If I am in the right job/career/livelihood, then________”

The Alcoholic version:

“If I find exactly the right way to stay relaxed and socially confidant without blacking out, getting a hangover, or having any other negative consequences, then______”

The New Mom version:

“If I find the right formula for getting my baby to sleep and eat exactly right, have lost all the baby weight, and am not comparing myself to any other mothers, then_____________”

The Eating Disorder version:

“If I don’t eat any ‘bad’ foods, my stomach looks this way, my arms looks this way, my thighs look this way, then____________”

The Romantic Relationship version

“If I am in a relationship (in a married relationship, could change my partner, am no longer in a relationship) then ___________”

Note the irony of the last one. See how the mind creates suffering? As Oscar Wilde famously said:

There are only two tragedies in life: one is not getting what one wants, and the other is getting it.

You can fill in your personal versions “Ifs” and “thens.” However, the “thens” are often harder to fill in, because they are usually more intangible, like “be happy” or “stop feeling anxious or not enough.” Apparently, even in the fantasy island tv series, Mr. Roarke attempted to teach the guests life lessons through assisting them in seeing errors in their thinking or living in their fantasies.

The Thin Ideal

Carolyn Costin, a leader in eating disorder treatment who recovered herself calls these illusions the thin ideal. The thin ideal goes something like this: of if I were thin, I would be (happy/accepted/worthy/not have uncomfortable feelings…) Many of my clients recovering from disordered eating or body image distress know, intellectually, these beliefs about body image to be not true. They know what they are really looking for is not in there. What they are seeking in the desire to be thin doesn’t provide what they are actually looking for. They know “being thin” is not really going to give them freedom from ever having feelings of anxiety or grief or anger. They know being thin is not really going to give them meaningful relationships. They know that being thin is not really going to give them confidence, contentment, or a sense of purpose in their life. However, this part of the mind gets attached to its beliefs and stories. And when one is challenged, it comes up with new scenarios of “if, then.”

Reality check:

When I was never-thin-enough in my eating disorder 17 years ago, I was unhappy. When I finished my Master’s degree, supposedly “accomplishing” worthiness, I felt disappointed. And when I finished my doctorate, mostly what I felt was tired! After having a baby, I did feel content (amidst the exhaustion). However, none of these experiences provided me with an ongoing and easily accessible “You have now arrived” stamp of approval, feeling of contentment, or belonging in life.

I joke with my mentor about this island not actually being an island, but a mountain. Once I have climbed the mountain, reached the top, I will have “arrived.” Another illusion. One of my favorite authors, Pema Chodron writes: 

In the process of discovering our true nature,

the journey goes down, not up.

It’s as if the mountain pointed toward the

center of the earth instead of reaching into the sky.

Instead of transcending the suffering of all creatures,

we move toward the turbulence and doubt.

We jump into it. We slide into it. We tiptoe into it.

We move toward it however we can.

We explore the reality and unpredictability

of insecurity and pain, and we try not to push it away.

If it takes years, if it takes lifetimes,

we will let it be as it is. At our own pace,

without speed or aggression,

we move down and down and down.

With us move millions of others,

our companions in awakening from fear.

At the bottom we discover water,

the healing water of compassion.

Right down there in the thick of things,

we discover the love that will not die.

It’s not about the island, it’s not about climbing anywhere, and it’s definitely not about going up a mountain. It’s about going down, right down into the thick of things, with your heart.

What provides the experience of “then” for me are:

Meditation

Relationships with people who value the gifts I bring and with whom I value the gifts they bring

Being of Service helping others

Making art

Dancing or moving my body

Looking at things that scare me in a straightforward, nonavoidant way

Writing

     I would love to say it IS about the product and there IS an endpoint! Here is where it is and here is how you get there! I have created a map! Just follow it and you will arrive at fantasy island! But the name kind of says it all, doesn’t it? This is not a fantasy. This is real in the trenches imperfect life, with all of its ups and downs every day throughout a nonlinear journey called your life. What provides the experience of “then” for you? I’d love to hear it!

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Many Blessings

Legs and Feet: Walking the walk, Baby steps, Taking the first step

 “A journey of a thousand miles begins with a single step.” – Lao Tzu

Did you know it takes babies first stepat least a year to take their first step? And this is a first attempt, not fully practiced walking. Most babies begin to stand briefly and take small steps while holding onto support prior to walking by themselves. This is often called “cruising.” Not all babies walk at one year though- some do at 9 months, some at 17 months. It is an individual process. Once started, the journey of learning how to walk independently continues through many, many months trial and error: two steps forward, one fall down; two steps forward, one fall down.

– resource: Baby’s Milestones: Your child’s first year of development WebMD.com

We could interpret this “first step” in all kinds of ways metaphorically. In the 12 steps, the first step is about admitting powerlessness and unmanageability- not in a disempowered way, but in admitting your current (and past) way of walking in the world is no longer working. It is about taking an honest look about where you have fallen down, “hit bottom.” It is about reflecting, as you get up, on how you can learn to walk differently. How can you walk down the sidewalk in a different way or walk a different sidewalk? There is a well-quoted poem about the recovery process that goes like this:

Autobiography in Five Short Chapters

I I walk down the street. There is a deep hole in the sidewalkimages-1 I fall in. I am lost … I am helpless. It isn’t my fault. It takes me forever to find a way out.

II I walk down the same street. There is a deep hole in the sidewalk. I pretend I don’t see it. I fall in again. I can’t believe I am in the same place but, it isn’t my fault. It still takes a long time to get out.

III I walk down the same street. There is a deep hole in the sidewalk. I see it is there. I still fall in … it’s a habit. my eyes are open I know where I am. It is my fault. I get out immediately.

IV I walk down the same street. There is a deep hole in the sidewalk. I walk around it.

V I walk down another street.

resource: Portia Nelson, There’s A Hole in My Sidewalk, 1993. As you are learning to walk down the sidewalk in your recovery, in motherhood, in life:

  • How can you allow for holes in the sidewalk?
  • How can you practice taking steps down another sidewalk?
  • How can you love and accept your legs and feet while you are taking each step?

Give yourself time to learn how to walk differently in the world in your recovery process, whether it be from an eating disorder, alcoholism/addiction, codependency, depression, or postpartum. Try to accept and appreciate your legs and feet as they are and not need to change them. Babies learning to walk do not judge themselves when they fall and they certainly do not worry about the size of their thighs. They get back up, again and again, and again, focusing on the task of learning their new skill. In recovery, this skill is to notice the judgments, not believe them, and keep walking. Here are two suggestions for how to practice walking steps in the road to recovery:

  1. Lean on Support


Ask yourself: How can I allow others to support me? How can I allow them to walk with me? Recovery is a time to let support in, not push it away. However, many people find it difficult to reach out and accept support from others. The truth is it’s much easier to walk the road of recovery with someone walking alongside you than making the trip on your own. If you are having difficulty accepting support, think about how you feel when you are given the opportunity to provide support to others. Remember, it is a gift. Resource: Life During Recovery: Questions to Ask Yourself from National Eating Disorders Association (NEDA) website, By Maggie Baumann, BA, Reprinted from Eating Disorders Recovery Today, Spring 2007 Volume 5, Number 2, (c) 2007 Gürze Books.

  1. Practice Mindful Walking:

Walk slowly and carefully walk feeling your feet connect at each point on the floor. Without controlling the breath too much, you can try pairing walking and breathing so that 1 foot touches the ground at each in and out breath. See how many steps seem natural to take during each inhalation and exhalation. Direct all attention towards the sensations of walking: you feet and lower legs. Which part touches the ground first? Pay attention to how your weight shifts from one foot to the other. What are the feelings in your knees as they bend? What is the texture of the ground (hard, soft, cracks, stones)? Differences in walking on different surfaces? From Coping Skills handout Compiled by Shannon Dorsey, Ph.D. Associate Professor and Licensed Psychologist, University of Washington, Evidence Based Treatments images

Remember the one-year-old practicing her first steps for a whole year. As a Japanese proverb states, “Fall seven times, stand up eight.”

Also, it is not only ok but encouraged to make time for pedicures and (non exercise-bulimic oriented) dancing. Your legs and feet deserve it. How are you going to take your first step today? What are you going to do to take care of your legs and feet?

Get your Butt out of the way

Many years ago, when I was in the early phase of recovery from an eating disorder, I challenged myself to buy a pair of pants embracing my butt. They were not my usual baggy style, were well-fitted, and had glitter on the butt! It was an “opposite action” to wear clothing that my internal body image critic would have never allowed. And, as all opposite action creates, it helped me develop a sense of esteem in myself by practicing an “esteem -able act.”

Many women do not like their butts, literally. Occasionally I find a woman who loves and/or accepts her butt. Jennifer Lopez is the poster child for embracing her butt as an asset.

According to Harvard medical School research, the fat found in large buttocks and hips may even protect against type 2 diabetes.

Fat found commonly around the lower areas, known as subcutaneous fat, or fat that collects under the skin, helps to improve the sensitivity of the hormone insulin. Insulin is responsible for regulating blood sugar and therefore a big bottom might offer some protection against diabetes. The research shows that…people with pear-shaped bodies, with fat deposits in the buttocks and hips, are less prone to these disorders.

Cell Metabolism, Dec. 2008, Diabetes in Control: news and Information for medical professionals, January 20, 2009, Diabetesincontrol.com

Wearing different kinds of pants (glitter or not) no longer challenges me and esteem able ac218604_10150263001270120_1161725_ots have become different in my work as a Mom and Psychologist. Now getting my “butt” out of the way has become “But I don’t have TIME to work on my book!” or “But my child won’t eat vegetables, no matter HOW I prepare them!”

Whatever your butt or but issues, see if there is a way to find an opposite action, even if it is a baby opposite action step to get your but out of the way, remembering that often what’s in the way IS the way .

PS Babies love their butts. Try to remember a (or create for the very first) time when you could love yours.

Week 2 of loving your body: Stick your neck out!

It’s week two of the Every body love your BODY project! This week we are focusing on neck and chin. Do you hate your neck and chin? Love them? Don’t think about them much? Here is a happy one with chocolate:

IMG_0814Where did the phrase “Not by the hair on my chinny chin chin” come from? And what about stick your neck out? Years ago, I used to hate my “double chin.” Now I feel neutral. I just don’t think about it much. And my neck? Well, I don’t see it, so I don’t really worry about it, other than scarf or necklace decorating 🙂

Sofia Loren, the famous Italian-French film star, is quoted as saying

“I’m a giraffe. I even walk like a giraffe with a long neck and legs. It’s a pretty dumb animal, mind you.”funny giraffe

You might be thinking, Well THAT’s not a kind thing to say to yourself! But what I hear is a self-depreciating sense of humor. And having a sense of humor about your insecurities, your neuroses, your strengths and weaknesses (if not used as a defense) can be a way to grow and be more at peace with yourself.

If giraffes don’t stick their necks out, they don’t reach the leaves they need to survive. (Except for this one, who apparently also needed to climb a tree).

This week, the invitation is to find something to love, cherish about your neck and chin. In addition, I want to invite you to affirm one way you can “stick your neck out” in your growth. Where can you take a risk? Where can you practice vulnerability in the service of something greater? This blog is my version. What is yours?

In the words of Sid Waddell,eastern_long_neck_turtle

“Behold the turtle. He makes progress only when he sticks his neck out.”

The Every Body love your Body Project (5 minutes for 8 weeks)

embodyingart_f

“It takes no time to open your heart, but when will you do it? That is what takes the time.”

After working with women recovering from body hatred for the past decade and a half, I have noticed a few pitfalls that people get stuck in during the process of learning to love (and/or accept more on this soon) their bodies. One of them is:

“I don’t have TIME.”

In eating disorder recovery, it often shows up as “OK, I’ve stopped bingeing/purging/starving/overeating(insert disordered eating behavior here), so I should love my body now. When will that happen? 1 month? 2? Because I don’t have the patience for years. I’m ready to move on and be “normal.” What I say to this is Ummmm, sorry. There is no “normal,” and if there was (if “normal” means not having an eating disorder) then many of those people don’t like their bodies either.  Leaning to love and accept yourself at a deep fundamental level (which is what body image issues are really about) takes time. Usually years. It cuts to the fundamental core of the self. (But don’t worry this project is 5 minutes PER WEEK for 8 weeks. You can do that. You can do this!)

In mommy hood, it often shows up as “I’m too busy taking care of everyone else! I don’t have time for that superficial body image stuff! I’m lucky if I get a pair of sweat pants on and a haircut once/year!” To which I would say first of all, you can’t afford to NOT have the time because your child is picking up on every single nonverbal cue you give them as to your relationship with your own body and you are passing it on. So if there’s any suffering there that you wish your child to NOT experience, you have to do your own work. And second of all, it doesn’t actually take that much time. It is more about quality rather than quantity.

The Power of Intention

This is a new project, but not a new idea. It is about the power of intention to shift your relationship with your body. The good news is It won’t require much from you except willingness. And, actually, it won’t take too much time. 5 minutes/week for 8 weeks. But let me tell you a bit about the premise. As a clinician assisting people cultivate a different relationship with their bodies and themselves, I work with willingness. I also work with assisting people identify and shift the ways they talk to themselves, including both the content and the tone.  A large part of this is actually dis-identifyig enough from the parts of yourself, particularly the often overdeveloped Superego Critical part, to find and cultivate other parts. The other part(s) being kinder, more self-advocating, non-shaming loving parts.

There is a well-know study in which experimenters were told to observe rats in a maze, but one group of experimenters were told that their rats were “bright” and another group were told that their rats were “dull.” (Rosenthal, R. & Fode, K.L.1963) They were actually all from the same group of lab rats, but guess which rats performed better? Yep. The ones that were supposedly “bright.” When looking at why, it was found that the experimenters had an intention of them doing better and encouraged these rats more. I want to invite you to bring this “experimenter bias” back to yourself: loving kindness, attention, intention.

Which brings me back to the issue of how you talk to your body. How do you speak to your body? Do you say “You should be smaller/larger/less wrinkled/not have cellulite/be less flabby/stop being so disgusting”? Then this is an opportunity for you to practice treating your body more “bright” and less “dull.” Really- if you’ve been saying unkind things to yourself for decades, what do you have to lose by trying to say something different?

The Every Body Love your Body Project

5 minutes (or less) of writing an affirmative statement toward part of your body every Wednesday (You can write yours on whatever day you would like but I will pick an affirmation winner and post the next part on Wednesday). Write your statement in the comments, and I will randomly pick a winner every week. I invite you to write this statement on a note and post it on your mirror for the week.

Each week we will look at a different part of your body and say something kind to it. That is IT. The only “rules” are:

1) It must be authentic to you.

2) It has to be kind, accepting, or neutral in tone.

3) If it is negative, it must be directed toward your body image CRITIC, not your body.

Then every week, I will pick a winner from the comments and that person will receive a free affirmation from Dr. Linda!

This week’s body part: the FACE

I’ll get us started on some examples here. Since we are starting with the face, I could say (going with the three choices above):

1) I like my little wrinkles around my eyes. They show empathy, wisdom and kindness.

2) I have nice cheekbones.ama

3) Those furrows between my eyes and on my forehead are hard-won! If I were to Botox those wrinkles, my face would lose its character. Shut the F*ck up! (That is to my body image critic, which says “Maybe you should think about getting bangs because did you know that bangs are the new Botox?”)

You may notice, when you write something kind toward your body, part(s) of you roaring in protest “WHO DO YOU THINK YOU ARE?” That is good. That means you are on the right track with shifting from treating yourself as a “dull rat” to a “bright” one 🙂 Keep going!

See you next week!

For Partners: Navigating the Land-mines of Postpartum and Eating Disorder Recovery

I just finished reading The Postpartum Husband, by Karen Kleinman.* This is hands down the most fabulous book I have seen for partners (except for the non-PC title that excludes same sex or unmarried partners) supporting women through Postpartum Depression. It is basically the Men are from Mars Women are from Venus of Postpartum Depression Recovery sourcebook. The style is direct, informative, non-shaming and concise. The chapters are 1-2 pages long- perfect for men and partners wanting bullet point versions of information that are most likely sleep-deprived and potentially in-crisis-with-a-depressed-new-mom-and-baby. Some gems that stood out for me were: YOU CANNOT FIX THIS.

And also:

What works for you may not work for her:

You’d want to be alone; she wants you there all the time

You’d get up and out and run yourself through this; she stays inside and can’t get up and go

You’d isolate yourself at work; she craves support and comfort from others

You’d turn your sadness into anger; she feels inadequate and worthless.

As a pragmatic clinician and eating disorder specialist, I am always asking the question, how does this apply to eating disorder recovery? Here are Karen Kleinman’s thoughts on supporting women in PPD recovery followed by my thoughts on supporting women in eating disorder recovery:

  • The single most important thing for you to do to help is to sit with her. Just be with her. No TV, no kids, no bills, no newspaper. Just you and her. Let her know that you are there. (DITTO)
  • This isn’t easy to do, especially with someone who seems so sad or so distant. Five minutes a day is a good place to start. (DITTO)

Here’s what you’re up against:

  • If you tell her you love her, she won’t believe you (Ditto)
  • If you tell her she’s a good mother, think you’re just saying that to make her feel better. (Substitute “good person.”)
  • If you tell her she’s beautiful, she’ll assume you’re lying. (Ditto. If you tell her “you’re not fat,” she will think you are lying or are minimizing her distress.)
  • If you tell her not to worry about anything, she’ll think you have no idea how bad she’s feeling.(Ditto)
  • If you tell her you’ll come home early to help her, she’ll feel guilty. (If you tell her you will eat with her to help her, she will feel guilty, ashamed, anxious)
  • If you tell her you have to work late, she’ll think you don’t care. (If you tell her you have to work late, she will think it is to be with someone else because you hate her company or are sick of her.)

You may (as the partner) be thinking, THEN WHAT IS THE POINT? Anything I do is fruitless. That is where I would encourage you to be aware of the cognitive distortions rampant in depression and eating disorders that you are up against: all or nothing thinking, personalizing, perfectionism, minimizing, control fallacies… However, there ARE things you can do. Here are some examples:

  • Tell her you know she feels terrible. (Ditto)
  • Tell her she will get better. (Ditto)
  • Tell her she is doing the right things (therapy, medication) to get better. (Ditto)
  • Tell her she can still be a good mother and feel terrible. (Substitute “person.”)
  • Tell her it’s ok to make mistakes she doesn’t have to do everything perfectly. (Ditto)
  • Tell her you know how hard she is working right now. (Ditto)
  • Tell her to let you know what she needs you to do to help. (Ditto)
  • Tell her you love her. (Ditto)
  • Tell her your baby will be fine. (Tell her that her eating disorder is not destroying you and that you can handle all of her feelings.)

For eating disorder recovery, I would add the following DO’s and DON’t’s:

  • Do NOT try to be “the food police” or try to be her nutritionist/dietician. DO redirect her to her nutritionist/dietician for advice on her food plan recovery.
  • Do NOT bring up emotionally difficult conversations during meals when she is already struggling. DO know that meals will most likely be uncomfortable for her and keeping conversation “light and polite” or simply giving her a kind look that acknowledges you know meals can be tough for her, but you are right here beside her. DO ask when a good time to talk about difficult things is for her and for you (ex in the morning, at night before 8pm, on the weekend).
  • Do NOT assume she is feeling or will feel better if she is eating according to her food plan, gaining/losing weight as a result of her recovery action steps. Do NOT comment on her body size, even if you think she looks “better” or “healthy.” . She is most likely feeling WORSE. DO validate that she is most likely feeling worse and know that she will cultivate tools for managing these distressing emotions without using her eating disorder behaviors as she continues her recovery (therapy, group, nutrition) work.
  • Do NOT comment on her appearance or “level of fatness,” even if she asks (ex “Do I look fat in this?”) DO instead say “How can I support you through this difficult feeling right now?,” “I trust your ability to find the right outfit that feels comfortable to you,” or “I’m not going to comment on that but love you.”
  • DO access your own support system or if you don’t have one, develop one! CODA and Al-anon are great 12 step resources for partners.

For women recovering from eating disorders/body image difficulties AND postpartum depression:

DO remind her that you love HER and that her body made a baby. Remind her that postpartum media images are NOT realistic. Remind her she is a whole person that you love, not simply a body. Remind her that you are with her as a partner and friend with all of your own age-ing postpartum imperfections.

Above all, try to hold a big picture of this time as limited and it will get better. Take very good care of yourself and put your own oxygen mask on first.

As always, this blog is not intended to diagnose or treat any mental illness or eating disorder. Please contact your therapist for individualized diagnosis and treatment. If you would like to schedule an assessment with Dr Linda, you can call 415-335-2596

Resources:

* Kelinman, Karen, MSW (2001) The Postpartum Husband: Practical Solutions for Living with Postpartum Depression

http://www.postpartumdads.org/ is a support resource for Dads run by Postpartum International.

Motherhood, Body Image, and Disordered Eating in Middle Age

I remember going to my first ObGyn visit when I was pregnant. The Doctor put “AMA” in my chart. Having worked in treatment settings for eating disorder recovery for many years, I thought she meant “Against Medical Advice,” the term clinicians use when a client is choosing to leave treatment despite their providers’ recommendations. I quickly said to my Doctor:

“I just want you to know am willing to implement any medical advice that you give me regarding my pregnancy!”

She gave me a blank stare.

I explained that I noticed she had written “AMA.”

She smiled. That means “Advanced Maternal Age.”

“Oh.” Long pause. “Oh.”

Being a mother of “advanced maternal age” is becoming more and more common in developed nations, as women work toward completing higher education, solidifying their careers, finding the right partner, and doing personal growth work prior to having children. The Center for Disease Control and Prevention reports:

Delayed childbearing in the United States is evident in the 3.6-year increase in the average age at first birth between 1970 and 2006…The dramatic increase in women having their first birth at the age of 35 years and over has played the largest role in the increased average age of first-time mothers…many other developed nations have observed increases in average age at first birth with some now averaging near 30.0 years of age. 1

What does this phenomena have to do with disordered eating and body image?

Although data regarding body image in middle aged and older women remains sparse, a study published just this past month in the International Journal of Eating Disorders suggests that body dissatisfaction and drive for thinness do not diminish with age. In a survey of 715 women just out, of which 76.5% were married with children, 4.6% met full diagnostic criteria for an Eating Disorder and 4.8% met criteria for Subthreshold Eating Disorder (SED). 2 Together, that makes roughly 10%. So that means 71 of those women with children are suffering with disordered eating.

And yet the myth persists that eating disorders primarily affect adolescents. Why?

There is a reason why the myth that eating disorders affect young women in adolescence exists. According to the National Association of Anorexia and Associated Disorders (ANAD): Over one-half of teenage girls…use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.3 Adolescence is a huge rite of passage for a woman. When a rite of passage is not celebrated, ritualized, or supported, the growth required to complete crossing the threshold of this rite of passage goes underground. Mary Pipher, author of Reviving Ophelia: Saving the Selves of Adolescent Girls (2005), writes:

“I think anorexia is a metaphor. It is a young woman’s statement that she will become what the culture asks of its women, which is that they be thin and nonthreatening…Anorexic women signal with their bodies “I will take up only a small amount of space. I won’t get in the way.” They signal, “I won’t be intimidating or threatening. (Who is afraid of a seventy-pound adult?)” 4

Similar to adolescence, both parenting and middle age are rites of passage in a woman’s life. When not honored, seen, and embraced, these can also turn into eating disorders and body image distress. Ageing women also face the cultural taboos of not taking up too much space, speaking too loudly, or being seen and valued. They face the task of loving themselves and embracing aspects of the beauty of mortality, power, and wisdom that western media culture is terrified of in women: wrinkles, thick middles, saggy boobs, gray hair. I remember reading one article on “objectification theory” in my doctoral research that linked media and female body image obsession with western culture’s fear of mortality. Female body objectification may veil unconscious existential fears. 5 Other stress factors that affect women in middle age that are similar to adolescence are hormonal changes. However, middle age women also face different stressors such as: medical scares, death of a parent or a spouse, divorce, and career challenges. 6 Margo Maine, co-author of The Body Myth: Adult Women and the Pressure to be Perfect, writes:

Women in their 30s, 40s and beyond face increasing pressure to look slender and youthful despite years of childbearing, hormonal changes at menopause and the demands of careers, parenting and caring for aging relatives…Some researchers call it the ‘Desperate Housewives effect,’ referring to the cultural influence of the hit TV series, in which improbably thin women in their 40s prance around in short shorts. 7

It is an interesting journey being “advanced maternal age.” Sometimes I look at young(er) women or young(er) mothers and I think You look so not tired. Or Wow your stomach looks so not stretched. I remember that. That feels like a long time ago. Or I envy younger moms who are more likely to have their grandparents be present for their children’s growing up. My child will already never meet one of his Grandpas. He died before my baby was born. However, there are gifts I have being “middle aged” that I couldn’t have come by earlier in my journey. I had not yet solidified my eating disorder recovery in my twenties. I had not earned a doctoral degree in Psychology in my twenties. I had lots of ideas and lots of difficulty with follow-through. I thought being earnest would pay the rent. The concept of income needing to match or be greater than outgoing expenditures was not a concept I truly understood or felt applied to me. Because I now have financial clarity, I don’t have to “deprive,” “restrict” or  “binge” or “purge” with money, like I used to do with food in my twenties. Interestingly, though I hated my (flatter) stomach in my twenties, I now love my (stretched) stomach in my early middle age. I also have much more capacity to pause and come back to difficult interactions in relationships rather than avoid, hide, or leave. I would not have been ready for marriage in my twenties. I would not have had the “distress tolerance” skills to go toward a young child and stay emotionally present through individuation-attempting tantrums. I would have been inadvertently shaming or stuffed the discomfort with food. I can tolerate it now. I would not have been a good, or frankly even good-enough, mother in my twenties. I wasn’t ready. I remember studying for the Psychologist licensure exam learning that the executive function of the brain (the part that fully understand cause and effect and is able to therefore pause impulsive actions) is not fully developed until the late twenties, or even 30. Does that mean all women should only have children after age 35? Or that only women over 35 are good (enough) mothers? Of course not. And not all women are able to. One always has the potential to become a good (enough) mother. In fact, the eating disorder recovery process mirrors the journey of becoming a good enough mother to one’s self: allowing and embracing imperfection, listening to and honoring emotions, communicating clearly, getting enough sleep, eating in a balanced way, practicing mindfulness or spirituality, connecting with support. And THAT is always possible and always a work-in-process, regardless of one’s chronological age.

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Dr. Linda Shanti McCabe is a Mom and Licensed Clinical Psychologist who works with women recovering from Eating Disorders, Body image difficulty, Depression/Anxiety, Perinatal Mood Disorders, and New Mommy “boot camp.”You can read about her work professionally at www.drlindashanti.com

Resources:

1. T.J. Mathews, T.J. and Brady E. Hamilton, “Delayed Childbearing: More Women Are Having Their
First Child Later in Life,” Center for Disease Control NCHS Data Brief, Number 21, August 2009. http://www.cdc.gov/nchs/data/databriefs/db21.htm

2. Mangweth-Matzek, Barbara, Hoek, Hans W. et al, “Prevalence of eating Disorders in Middle-Aged Women,” International Journal of Eating Disorders2014; 47:320-324.

3. National Association of Anorexia Nervosa and Associated Disorders websitehttp://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/

4. Pipher, Mary, Reviving Ophelia: Saving the Selves of Adolescent Girls (2005).

5. Grabe, Shelly, Routledge, Clay, Cook, Alison, Anderson, Christie, and Arndt, Jamie “In defense of the Body: The Effect of Salience on Female Body Objectification”, Psychology of Women Quarterly, Vol 29, 2005.

6. Harding, Anne Eating disorders: Not just for the young, CNNHealth.com, June 27, 2012. http://www.cnn.com/2012/06/26/health/mental-health/eating-disorders-not-just-for-young/

7. Barton, Adriana, “Are middle-aged women succumbing to ‘Desperate Housewives syndrome’?” The Globe and Mail, March 6, 2013.http://www.theglobeandmail.com/life/health-and-fitness/are-middle-aged-women-succumbing-to-desperate-housewives-syndrome/article578178/

8. Tiggemann M., “Body image across the adult life span: Stability and change,”Body Image 2004; 1:29-41. 9. Slevec JH, Tiggemann M., “Predictors of body dissatisfaction and disordered eating in middle-aged women,” Clinical Psychology Review 2011; 31: 515-524.

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